Loma Linda University Behavioral Medicine Center (BMC)

All Charges

Charge

Type

Setting

Price

CELECOXIB 100 MG CAPSULE [24500]

Facility

$0.36

Service Code	NDC 62332-141-31
Hospital Charge Code	1710870
Hospital Revenue Code	259
Min. Negotiated Rate	$0.20
Max. Negotiated Rate	$0.27
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$0.22
Rate for Payer: Aetna of CA Government/Medicare	$0.22
Rate for Payer: Cash Price	$0.16
Rate for Payer: Health Smart Auto/Commercial	$0.22
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$0.22
Rate for Payer: LLUH Dept of Risk Management WC	$0.20
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$0.27

CELECOXIB 100 MG CAPSULE [24500]

Facility

$0.18

Service Code	NDC 33342-156-11
Hospital Charge Code	1710870
Hospital Revenue Code	259
Min. Negotiated Rate	$0.10
Max. Negotiated Rate	$0.14
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$0.11
Rate for Payer: Aetna of CA Government/Medicare	$0.11
Rate for Payer: Cash Price	$0.08
Rate for Payer: Health Smart Auto/Commercial	$0.11
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$0.11
Rate for Payer: LLUH Dept of Risk Management WC	$0.10
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$0.14

CELECOXIB 100 MG CAPSULE [24500]

Facility

$11.44

Service Code	NDC 0025-1520-34
Hospital Charge Code	1710870
Hospital Revenue Code	259
Min. Negotiated Rate	$6.29
Max. Negotiated Rate	$9.15
Rate for Payer: Cash Price	$5.15
Rate for Payer: Cigna of CA HMO/PPO	$9.15
Rate for Payer: Health Smart Auto/Commercial	$6.86
Rate for Payer: LLUH Dept of Risk Management WC	$6.29
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$8.58

CELECOXIB 100 MG CAPSULE [24500]

Facility

$1.74

Service Code	NDC 60687-436-11
Hospital Charge Code	1710870
Hospital Revenue Code	259
Min. Negotiated Rate	$0.96
Max. Negotiated Rate	$1.39
Rate for Payer: Cash Price	$0.78
Rate for Payer: Cigna of CA HMO/PPO	$1.39
Rate for Payer: Health Smart Auto/Commercial	$1.04
Rate for Payer: LLUH Dept of Risk Management WC	$0.96
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$1.30

CELECOXIB 100 MG CAPSULE [24500]

Facility

$1.74

Service Code	NDC 60687-436-11
Hospital Charge Code	1710870
Hospital Revenue Code	259
Min. Negotiated Rate	$0.96
Max. Negotiated Rate	$1.30
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$1.04
Rate for Payer: Aetna of CA Government/Medicare	$1.04
Rate for Payer: Cash Price	$0.78
Rate for Payer: Health Smart Auto/Commercial	$1.04
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$1.04
Rate for Payer: LLUH Dept of Risk Management WC	$0.96
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$1.30

CELECOXIB 100 MG CAPSULE [24500]

Facility

$1.45

Service Code	NDC 0904-6502-61
Hospital Charge Code	1710870
Hospital Revenue Code	259
Min. Negotiated Rate	$0.80
Max. Negotiated Rate	$1.16
Rate for Payer: Cash Price	$0.65
Rate for Payer: Cigna of CA HMO/PPO	$1.16
Rate for Payer: Health Smart Auto/Commercial	$0.87
Rate for Payer: LLUH Dept of Risk Management WC	$0.80
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$1.09

CELECOXIB 100 MG CAPSULE [24500]

Facility

$0.36

Service Code	NDC 62332-141-31
Hospital Charge Code	1710870
Hospital Revenue Code	259
Min. Negotiated Rate	$0.20
Max. Negotiated Rate	$0.29
Rate for Payer: Cash Price	$0.16
Rate for Payer: Cigna of CA HMO/PPO	$0.29
Rate for Payer: Health Smart Auto/Commercial	$0.22
Rate for Payer: LLUH Dept of Risk Management WC	$0.20
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$0.27

CELECOXIB 200 MG CAPSULE [24501]

Facility

$6.04

Service Code	NDC 51079-215-01
Hospital Charge Code	1710871
Hospital Revenue Code	259
Min. Negotiated Rate	$3.32
Max. Negotiated Rate	$4.83
Rate for Payer: Cash Price	$2.72
Rate for Payer: Cigna of CA HMO/PPO	$4.83
Rate for Payer: Health Smart Auto/Commercial	$3.62
Rate for Payer: LLUH Dept of Risk Management WC	$3.32
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$4.53

CELECOXIB 200 MG CAPSULE [24501]

Facility

$0.12

Service Code	NDC 72241-024-05
Hospital Charge Code	1710871
Hospital Revenue Code	259
Min. Negotiated Rate	$0.07
Max. Negotiated Rate	$0.09
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$0.07
Rate for Payer: Aetna of CA Government/Medicare	$0.07
Rate for Payer: Cash Price	$0.05
Rate for Payer: Health Smart Auto/Commercial	$0.07
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$0.07
Rate for Payer: LLUH Dept of Risk Management WC	$0.07
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$0.09

CELECOXIB 200 MG CAPSULE [24501]

Facility

$1.23

Service Code	NDC 59762-1517-1
Hospital Charge Code	1710871
Hospital Revenue Code	259
Min. Negotiated Rate	$0.68
Max. Negotiated Rate	$0.98
Rate for Payer: Cash Price	$0.55
Rate for Payer: Cigna of CA HMO/PPO	$0.98
Rate for Payer: Health Smart Auto/Commercial	$0.74
Rate for Payer: LLUH Dept of Risk Management WC	$0.68
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$0.92

CELECOXIB 200 MG CAPSULE [24501]

Facility

$6.04

Service Code	NDC 51079-215-01
Hospital Charge Code	1710871
Hospital Revenue Code	259
Min. Negotiated Rate	$3.32
Max. Negotiated Rate	$4.53
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$3.62
Rate for Payer: Aetna of CA Government/Medicare	$3.62
Rate for Payer: Cash Price	$2.72
Rate for Payer: Health Smart Auto/Commercial	$3.62
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$3.62
Rate for Payer: LLUH Dept of Risk Management WC	$3.32
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$4.53

CELECOXIB 200 MG CAPSULE [24501]

Facility

$0.72

Service Code	NDC 62332-142-31
Hospital Charge Code	1710871
Hospital Revenue Code	259
Min. Negotiated Rate	$0.40
Max. Negotiated Rate	$0.58
Rate for Payer: Cash Price	$0.32
Rate for Payer: Cigna of CA HMO/PPO	$0.58
Rate for Payer: Health Smart Auto/Commercial	$0.43
Rate for Payer: LLUH Dept of Risk Management WC	$0.40
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$0.54

CELECOXIB 200 MG CAPSULE [24501]

Facility

$18.76

Service Code	NDC 0025-1525-34
Hospital Charge Code	1710871
Hospital Revenue Code	259
Min. Negotiated Rate	$10.32
Max. Negotiated Rate	$15.01
Rate for Payer: Cash Price	$8.44
Rate for Payer: Cigna of CA HMO/PPO	$15.01
Rate for Payer: Health Smart Auto/Commercial	$11.26
Rate for Payer: LLUH Dept of Risk Management WC	$10.32
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$14.07

CELECOXIB 200 MG CAPSULE [24501]

Facility

$6.04

Service Code	NDC 51079-215-20
Hospital Charge Code	1710871
Hospital Revenue Code	259
Min. Negotiated Rate	$3.32
Max. Negotiated Rate	$4.83
Rate for Payer: Cash Price	$2.72
Rate for Payer: Cigna of CA HMO/PPO	$4.83
Rate for Payer: Health Smart Auto/Commercial	$3.62
Rate for Payer: LLUH Dept of Risk Management WC	$3.32
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$4.53

CELECOXIB 200 MG CAPSULE [24501]

Facility

$6.04

Service Code	NDC 51079-215-20
Hospital Charge Code	1710871
Hospital Revenue Code	259
Min. Negotiated Rate	$3.32
Max. Negotiated Rate	$4.53
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$3.62
Rate for Payer: Aetna of CA Government/Medicare	$3.62
Rate for Payer: Cash Price	$2.72
Rate for Payer: Health Smart Auto/Commercial	$3.62
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$3.62
Rate for Payer: LLUH Dept of Risk Management WC	$3.32
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$4.53

CELECOXIB 200 MG CAPSULE [24501]

Facility

$18.76

Service Code	NDC 0025-1525-34
Hospital Charge Code	1710871
Hospital Revenue Code	259
Min. Negotiated Rate	$10.32
Max. Negotiated Rate	$14.07
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$11.26
Rate for Payer: Aetna of CA Government/Medicare	$11.26
Rate for Payer: Cash Price	$8.44
Rate for Payer: Health Smart Auto/Commercial	$11.26
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$11.26
Rate for Payer: LLUH Dept of Risk Management WC	$10.32
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$14.07

CELECOXIB 200 MG CAPSULE [24501]

Facility

$0.72

Service Code	NDC 62332-142-31
Hospital Charge Code	1710871
Hospital Revenue Code	259
Min. Negotiated Rate	$0.40
Max. Negotiated Rate	$0.54
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$0.43
Rate for Payer: Aetna of CA Government/Medicare	$0.43
Rate for Payer: Cash Price	$0.32
Rate for Payer: Health Smart Auto/Commercial	$0.43
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$0.43
Rate for Payer: LLUH Dept of Risk Management WC	$0.40
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$0.54

CELECOXIB 200 MG CAPSULE [24501]

Facility

$2.43

Service Code	NDC 60687-447-11
Hospital Charge Code	1710871
Hospital Revenue Code	259
Min. Negotiated Rate	$1.34
Max. Negotiated Rate	$1.82
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$1.46
Rate for Payer: Aetna of CA Government/Medicare	$1.46
Rate for Payer: Cash Price	$1.09
Rate for Payer: Health Smart Auto/Commercial	$1.46
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$1.46
Rate for Payer: LLUH Dept of Risk Management WC	$1.34
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$1.82

CELECOXIB 200 MG CAPSULE [24501]

Facility

$0.12

Service Code	NDC 72241-024-05
Hospital Charge Code	1710871
Hospital Revenue Code	259
Min. Negotiated Rate	$0.07
Max. Negotiated Rate	$0.10
Rate for Payer: Cash Price	$0.05
Rate for Payer: Cigna of CA HMO/PPO	$0.10
Rate for Payer: Health Smart Auto/Commercial	$0.07
Rate for Payer: LLUH Dept of Risk Management WC	$0.07
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$0.09

CELECOXIB 200 MG CAPSULE [24501]

Facility

$1.23

Service Code	NDC 59762-1517-1
Hospital Charge Code	1710871
Hospital Revenue Code	259
Min. Negotiated Rate	$0.68
Max. Negotiated Rate	$0.92
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$0.74
Rate for Payer: Aetna of CA Government/Medicare	$0.74
Rate for Payer: Cash Price	$0.55
Rate for Payer: Health Smart Auto/Commercial	$0.74
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$0.74
Rate for Payer: LLUH Dept of Risk Management WC	$0.68
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$0.92

CELECOXIB 200 MG CAPSULE [24501]

Facility

$2.43

Service Code	NDC 60687-447-11
Hospital Charge Code	1710871
Hospital Revenue Code	259
Min. Negotiated Rate	$1.34
Max. Negotiated Rate	$1.94
Rate for Payer: Cash Price	$1.09
Rate for Payer: Cigna of CA HMO/PPO	$1.94
Rate for Payer: Health Smart Auto/Commercial	$1.46
Rate for Payer: LLUH Dept of Risk Management WC	$1.34
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$1.82

CEMIPLIMAB-RWLC 50 MG/ML INTRAVENOUS SOLUTION [222941]

Facility

$1,680.32

Service Code	CPT J9119
Hospital Charge Code	NDG222941
Hospital Revenue Code	636
Min. Negotiated Rate	$924.18
Max. Negotiated Rate	$1,260.24
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$1,008.19
Rate for Payer: Aetna of CA Government/Medicare	$1,008.19
Rate for Payer: Cash Price	$756.14
Rate for Payer: Health Smart Auto/Commercial	$1,008.19
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$1,008.19
Rate for Payer: LLUH Dept of Risk Management WC	$924.18
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$1,260.24

CEMIPLIMAB-RWLC 50 MG/ML INTRAVENOUS SOLUTION [222941]

Facility

$1,680.32

Service Code	CPT J9119
Hospital Charge Code	NDG222941
Hospital Revenue Code	636
Min. Negotiated Rate	$924.18
Max. Negotiated Rate	$1,344.26
Rate for Payer: Cash Price	$756.14
Rate for Payer: Cigna of CA HMO/PPO	$1,344.26
Rate for Payer: Health Smart Auto/Commercial	$1,008.19
Rate for Payer: LLUH Dept of Risk Management WC	$924.18
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$1,260.24

CEPHALEXIN 125 MG/5 ML ORAL SUSPENSION [9501]

Facility

$0.23

Service Code	NDC 68180-440-01
Hospital Charge Code	1715596
Hospital Revenue Code	259
Min. Negotiated Rate	$0.13
Max. Negotiated Rate	$0.18
Rate for Payer: Cash Price	$0.10
Rate for Payer: Cigna of CA HMO/PPO	$0.18
Rate for Payer: Health Smart Auto/Commercial	$0.14
Rate for Payer: LLUH Dept of Risk Management WC	$0.13
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$0.17

CEPHALEXIN 125 MG/5 ML ORAL SUSPENSION [9501]

Facility

$0.10

Service Code	NDC 67877-544-68
Hospital Charge Code	NDG9501B
Hospital Revenue Code	259
Min. Negotiated Rate	$0.06
Max. Negotiated Rate	$0.08
Rate for Payer: Cash Price	$0.05
Rate for Payer: Cigna of CA HMO/PPO	$0.08
Rate for Payer: Health Smart Auto/Commercial	$0.06
Rate for Payer: LLUH Dept of Risk Management WC	$0.06
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$0.08

Know your out-of-pocket cost for care.

All Charges