Loma Linda University Behavioral Medicine Center (BMC)

All Charges

Charge

Type

Setting

Price

ABACAVIR 20 MG/ML ORAL SOLUTION [24439]

Facility

$0.63

Service Code	NDC 31722-562-24
Hospital Charge Code	NDG24439
Hospital Revenue Code	259
Min. Negotiated Rate	$0.35
Max. Negotiated Rate	$0.50
Rate for Payer: Cash Price	$0.28
Rate for Payer: Cigna of CA HMO/PPO	$0.50
Rate for Payer: Health Smart Auto/Commercial	$0.38
Rate for Payer: LLUH Dept of Risk Management WC	$0.35
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$0.47

ABACAVIR 20 MG/ML ORAL SOLUTION [24439]

Facility

$0.63

Service Code	NDC 31722-562-24
Hospital Charge Code	NDG24439
Hospital Revenue Code	259
Min. Negotiated Rate	$0.35
Max. Negotiated Rate	$0.47
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$0.38
Rate for Payer: Aetna of CA Government/Medicare	$0.38
Rate for Payer: Cash Price	$0.28
Rate for Payer: Health Smart Auto/Commercial	$0.38
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$0.38
Rate for Payer: LLUH Dept of Risk Management WC	$0.35
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$0.47

ABACAVIR 300 MG TABLET [24438]

Facility

$3.00

Service Code	NDC 31722-557-60
Hospital Charge Code	1710876
Hospital Revenue Code	259
Min. Negotiated Rate	$1.65
Max. Negotiated Rate	$2.25
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$1.80
Rate for Payer: Aetna of CA Government/Medicare	$1.80
Rate for Payer: Cash Price	$1.35
Rate for Payer: Health Smart Auto/Commercial	$1.80
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$1.80
Rate for Payer: LLUH Dept of Risk Management WC	$1.65
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$2.25

ABACAVIR 300 MG TABLET [24438]

Facility

$3.00

Service Code	NDC 31722-557-60
Hospital Charge Code	1710876
Hospital Revenue Code	259
Min. Negotiated Rate	$1.65
Max. Negotiated Rate	$2.40
Rate for Payer: Cash Price	$1.35
Rate for Payer: Cigna of CA HMO/PPO	$2.40
Rate for Payer: Health Smart Auto/Commercial	$1.80
Rate for Payer: LLUH Dept of Risk Management WC	$1.65
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$2.25

ABACAVIR 300 MG TABLET [24438]

Facility

$10.59

Service Code	NDC 68084-021-11
Hospital Charge Code	1710876
Hospital Revenue Code	259
Min. Negotiated Rate	$5.82
Max. Negotiated Rate	$8.47
Rate for Payer: Cash Price	$4.77
Rate for Payer: Cigna of CA HMO/PPO	$8.47
Rate for Payer: Health Smart Auto/Commercial	$6.35
Rate for Payer: LLUH Dept of Risk Management WC	$5.82
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$7.94

ABACAVIR 300 MG TABLET [24438]

Facility

$10.59

Service Code	NDC 68084-021-11
Hospital Charge Code	1710876
Hospital Revenue Code	259
Min. Negotiated Rate	$5.82
Max. Negotiated Rate	$7.94
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$6.35
Rate for Payer: Aetna of CA Government/Medicare	$6.35
Rate for Payer: Cash Price	$4.77
Rate for Payer: Health Smart Auto/Commercial	$6.35
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$6.35
Rate for Payer: LLUH Dept of Risk Management WC	$5.82
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$7.94

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

Facility

$141.50

Service Code	NDC 49702-231-13
Hospital Charge Code	ERX207101
Hospital Revenue Code	259
Min. Negotiated Rate	$77.82
Max. Negotiated Rate	$106.12
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$84.90
Rate for Payer: Aetna of CA Government/Medicare	$84.90
Rate for Payer: Cash Price	$63.68
Rate for Payer: Health Smart Auto/Commercial	$84.90
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$84.90
Rate for Payer: LLUH Dept of Risk Management WC	$77.82
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$106.12

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

Facility

$141.50

Service Code	NDC 49702-231-13
Hospital Charge Code	ERX207101
Hospital Revenue Code	259
Min. Negotiated Rate	$77.82
Max. Negotiated Rate	$113.20
Rate for Payer: Cash Price	$63.68
Rate for Payer: Cigna of CA HMO/PPO	$113.20
Rate for Payer: Health Smart Auto/Commercial	$84.90
Rate for Payer: LLUH Dept of Risk Management WC	$77.82
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$106.12

ABACAVIR 600 MG-LAMIVUDINE 300 MG TABLET [39301]

Facility

$4.00

Service Code	NDC 69097-362-02
Hospital Charge Code	1711932
Hospital Revenue Code	259
Min. Negotiated Rate	$2.20
Max. Negotiated Rate	$3.20
Rate for Payer: Cash Price	$1.80
Rate for Payer: Cigna of CA HMO/PPO	$3.20
Rate for Payer: Health Smart Auto/Commercial	$2.40
Rate for Payer: LLUH Dept of Risk Management WC	$2.20
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$3.00

ABACAVIR 600 MG-LAMIVUDINE 300 MG TABLET [39301]

Facility

$4.00

Service Code	NDC 69097-362-02
Hospital Charge Code	1711932
Hospital Revenue Code	259
Min. Negotiated Rate	$2.20
Max. Negotiated Rate	$3.00
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$2.40
Rate for Payer: Aetna of CA Government/Medicare	$2.40
Rate for Payer: Cash Price	$1.80
Rate for Payer: Health Smart Auto/Commercial	$2.40
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$2.40
Rate for Payer: LLUH Dept of Risk Management WC	$2.20
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$3.00

ABATACEPT (WITH MALTOSE) 250 MG INTRAVENOUS SOLUTION [70287]

Facility

$1,655.88

Service Code	CPT J0129
Hospital Charge Code	1720952
Hospital Revenue Code	636
Min. Negotiated Rate	$910.73
Max. Negotiated Rate	$1,324.70
Rate for Payer: Cash Price	$745.15
Rate for Payer: Cigna of CA HMO/PPO	$1,324.70
Rate for Payer: Health Smart Auto/Commercial	$993.53
Rate for Payer: LLUH Dept of Risk Management WC	$910.73
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$1,241.91

ABATACEPT (WITH MALTOSE) 250 MG INTRAVENOUS SOLUTION [70287]

Facility

$1,655.88

Service Code	CPT J0129
Hospital Charge Code	1720952
Hospital Revenue Code	636
Min. Negotiated Rate	$910.73
Max. Negotiated Rate	$1,241.91
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$993.53
Rate for Payer: Aetna of CA Government/Medicare	$993.53
Rate for Payer: Cash Price	$745.15
Rate for Payer: Health Smart Auto/Commercial	$993.53
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$993.53
Rate for Payer: LLUH Dept of Risk Management WC	$910.73
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$1,241.91

ABEMACICLIB 100 MG TABLET [219901]

Facility

$311.44

Service Code	NDC 0002-4815-54
Hospital Charge Code	ERX219901
Hospital Revenue Code	259
Min. Negotiated Rate	$171.29
Max. Negotiated Rate	$233.58
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$186.86
Rate for Payer: Aetna of CA Government/Medicare	$186.86
Rate for Payer: Cash Price	$140.15
Rate for Payer: Health Smart Auto/Commercial	$186.86
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$186.86
Rate for Payer: LLUH Dept of Risk Management WC	$171.29
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$233.58

ABEMACICLIB 100 MG TABLET [219901]

Facility

$311.44

Service Code	NDC 0002-4815-54
Hospital Charge Code	ERX219901
Hospital Revenue Code	259
Min. Negotiated Rate	$171.29
Max. Negotiated Rate	$249.15
Rate for Payer: Cash Price	$140.15
Rate for Payer: Cigna of CA HMO/PPO	$249.15
Rate for Payer: Health Smart Auto/Commercial	$186.86
Rate for Payer: LLUH Dept of Risk Management WC	$171.29
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$233.58

ABEMACICLIB 150 MG TABLET [219900]

Facility

$311.44

Service Code	NDC 0002-5337-54
Hospital Charge Code	ERX219900
Hospital Revenue Code	259
Min. Negotiated Rate	$171.29
Max. Negotiated Rate	$233.58
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$186.86
Rate for Payer: Aetna of CA Government/Medicare	$186.86
Rate for Payer: Cash Price	$140.15
Rate for Payer: Health Smart Auto/Commercial	$186.86
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$186.86
Rate for Payer: LLUH Dept of Risk Management WC	$171.29
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$233.58

ABEMACICLIB 150 MG TABLET [219900]

Facility

$311.44

Service Code	NDC 0002-5337-54
Hospital Charge Code	ERX219900
Hospital Revenue Code	259
Min. Negotiated Rate	$171.29
Max. Negotiated Rate	$249.15
Rate for Payer: Cash Price	$140.15
Rate for Payer: Cigna of CA HMO/PPO	$249.15
Rate for Payer: Health Smart Auto/Commercial	$186.86
Rate for Payer: LLUH Dept of Risk Management WC	$171.29
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$233.58

ABEMACICLIB 200 MG TABLET [219899]

Facility

$311.44

Service Code	NDC 0002-6216-54
Hospital Charge Code	ERX219899
Hospital Revenue Code	259
Min. Negotiated Rate	$171.29
Max. Negotiated Rate	$233.58
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$186.86
Rate for Payer: Aetna of CA Government/Medicare	$186.86
Rate for Payer: Cash Price	$140.15
Rate for Payer: Health Smart Auto/Commercial	$186.86
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$186.86
Rate for Payer: LLUH Dept of Risk Management WC	$171.29
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$233.58

ABEMACICLIB 200 MG TABLET [219899]

Facility

$311.44

Service Code	NDC 0002-6216-54
Hospital Charge Code	ERX219899
Hospital Revenue Code	259
Min. Negotiated Rate	$171.29
Max. Negotiated Rate	$249.15
Rate for Payer: Cash Price	$140.15
Rate for Payer: Cigna of CA HMO/PPO	$249.15
Rate for Payer: Health Smart Auto/Commercial	$186.86
Rate for Payer: LLUH Dept of Risk Management WC	$171.29
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$233.58

ABEMACICLIB 50 MG TABLET [219902]

Facility

$311.44

Service Code	NDC 0002-4483-54
Hospital Charge Code	ERX219902
Hospital Revenue Code	259
Min. Negotiated Rate	$171.29
Max. Negotiated Rate	$233.58
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$186.86
Rate for Payer: Aetna of CA Government/Medicare	$186.86
Rate for Payer: Cash Price	$140.15
Rate for Payer: Health Smart Auto/Commercial	$186.86
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$186.86
Rate for Payer: LLUH Dept of Risk Management WC	$171.29
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$233.58

ABEMACICLIB 50 MG TABLET [219902]

Facility

$311.44

Service Code	NDC 0002-4483-54
Hospital Charge Code	ERX219902
Hospital Revenue Code	259
Min. Negotiated Rate	$171.29
Max. Negotiated Rate	$249.15
Rate for Payer: Cash Price	$140.15
Rate for Payer: Cigna of CA HMO/PPO	$249.15
Rate for Payer: Health Smart Auto/Commercial	$186.86
Rate for Payer: LLUH Dept of Risk Management WC	$171.29
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$233.58

ABIRATERONE 250 MG TABLET [109776]

Facility

$108.87

Service Code	NDC 57894-150-12
Hospital Charge Code	1712538
Hospital Revenue Code	259
Min. Negotiated Rate	$59.88
Max. Negotiated Rate	$81.65
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$65.32
Rate for Payer: Aetna of CA Government/Medicare	$65.32
Rate for Payer: Cash Price	$48.99
Rate for Payer: Health Smart Auto/Commercial	$65.32
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$65.32
Rate for Payer: LLUH Dept of Risk Management WC	$59.88
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$81.65

ABIRATERONE 250 MG TABLET [109776]

Facility

$108.87

Service Code	NDC 57894-150-12
Hospital Charge Code	1712538
Hospital Revenue Code	259
Min. Negotiated Rate	$59.88
Max. Negotiated Rate	$87.10
Rate for Payer: Cash Price	$48.99
Rate for Payer: Cigna of CA HMO/PPO	$87.10
Rate for Payer: Health Smart Auto/Commercial	$65.32
Rate for Payer: LLUH Dept of Risk Management WC	$59.88
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$81.65

ABOBOTULINUMTOXINA 300 UNIT INTRAMUSCULAR SOLUTION [106761]

Facility

$618.60

Service Code	CPT J0586
Hospital Charge Code	ERX106761
Hospital Revenue Code	636
Min. Negotiated Rate	$340.23
Max. Negotiated Rate	$463.95
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$371.16
Rate for Payer: Aetna of CA Government/Medicare	$371.16
Rate for Payer: Cash Price	$278.37
Rate for Payer: Health Smart Auto/Commercial	$371.16
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$371.16
Rate for Payer: LLUH Dept of Risk Management WC	$340.23
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$463.95

ABOBOTULINUMTOXINA 300 UNIT INTRAMUSCULAR SOLUTION [106761]

Facility

$618.60

Service Code	CPT J0586
Hospital Charge Code	ERX106761
Hospital Revenue Code	636
Min. Negotiated Rate	$340.23
Max. Negotiated Rate	$494.88
Rate for Payer: Cash Price	$278.37
Rate for Payer: Cigna of CA HMO/PPO	$494.88
Rate for Payer: Health Smart Auto/Commercial	$371.16
Rate for Payer: LLUH Dept of Risk Management WC	$340.23
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$463.95

ABOBOTULINUMTOXINA 500 UNIT INTRAMUSCULAR SOLUTION [99465]

Facility

$1,030.80

Service Code	CPT J0586
Hospital Charge Code	ERX99465
Hospital Revenue Code	636
Min. Negotiated Rate	$566.94
Max. Negotiated Rate	$824.64
Rate for Payer: Cash Price	$463.86
Rate for Payer: Cigna of CA HMO/PPO	$824.64
Rate for Payer: Health Smart Auto/Commercial	$618.48
Rate for Payer: LLUH Dept of Risk Management WC	$566.94
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$773.10

Know your out-of-pocket cost for care.

All Charges