Loma Linda University Behavioral Medicine Center (BMC)

All Charges

Charge

Type

Setting

Price

CITRULLINE 600 MG CAPSULE [13319]

Facility

$76.00

Service Code	NDC 53335-00689
Hospital Charge Code	1712162
Hospital Revenue Code	259
Min. Negotiated Rate	$41.80
Max. Negotiated Rate	$57.00
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$45.60
Rate for Payer: Aetna of CA Government/Medicare	$45.60
Rate for Payer: Cash Price	$34.20
Rate for Payer: Health Smart Auto/Commercial	$45.60
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$45.60
Rate for Payer: LLUH Dept of Risk Management WC	$41.80
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$57.00

CITRULLINE 600 MG CAPSULE [13319]

Facility

$76.00

Service Code	NDC 53335-00689
Hospital Charge Code	1712162
Hospital Revenue Code	259
Min. Negotiated Rate	$41.80
Max. Negotiated Rate	$60.80
Rate for Payer: Cash Price	$34.20
Rate for Payer: Cigna of CA HMO/PPO	$60.80
Rate for Payer: Health Smart Auto/Commercial	$45.60
Rate for Payer: LLUH Dept of Risk Management WC	$41.80
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$57.00

CITRULLINE POWDER. [40819153]

Facility

$6.48

Service Code	NDC 6299127531
Hospital Charge Code	NDG19153
Hospital Revenue Code	259
Min. Negotiated Rate	$3.56
Max. Negotiated Rate	$5.18
Rate for Payer: Cash Price	$2.92
Rate for Payer: Cigna of CA HMO/PPO	$5.18
Rate for Payer: Health Smart Auto/Commercial	$3.89
Rate for Payer: LLUH Dept of Risk Management WC	$3.56
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$4.86

CITRULLINE POWDER. [40819153]

Facility

$6.48

Service Code	NDC 6299127531
Hospital Charge Code	NDG19153
Hospital Revenue Code	259
Min. Negotiated Rate	$3.56
Max. Negotiated Rate	$4.86
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$3.89
Rate for Payer: Aetna of CA Government/Medicare	$3.89
Rate for Payer: Cash Price	$2.92
Rate for Payer: Health Smart Auto/Commercial	$3.89
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$3.89
Rate for Payer: LLUH Dept of Risk Management WC	$3.56
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$4.86

CLADRIBINE 10 MG/10 ML INTRAVENOUS SOLUTION [9615]

Facility

$52.20

Service Code	CPT J9065
Hospital Charge Code	1755613
Hospital Revenue Code	636
Min. Negotiated Rate	$28.71
Max. Negotiated Rate	$39.15
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$31.32
Rate for Payer: Aetna of CA Government/Medicare	$31.32
Rate for Payer: Cash Price	$23.49
Rate for Payer: Health Smart Auto/Commercial	$31.32
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$31.32
Rate for Payer: LLUH Dept of Risk Management WC	$28.71
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$39.15

CLADRIBINE 10 MG/10 ML INTRAVENOUS SOLUTION [9615]

Facility

$52.20

Service Code	CPT J9065
Hospital Charge Code	1755613
Hospital Revenue Code	636
Min. Negotiated Rate	$28.71
Max. Negotiated Rate	$41.76
Rate for Payer: Cash Price	$23.49
Rate for Payer: Cigna of CA HMO/PPO	$41.76
Rate for Payer: Health Smart Auto/Commercial	$31.32
Rate for Payer: LLUH Dept of Risk Management WC	$28.71
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$39.15

CLARITHROMYCIN 125 MG/5 ML ORAL SUSPENSION [12885]

Facility

$1.41

Service Code	NDC 0781-6022-52
Hospital Charge Code	1715982
Hospital Revenue Code	259
Min. Negotiated Rate	$0.78
Max. Negotiated Rate	$1.13
Rate for Payer: Cash Price	$0.63
Rate for Payer: Cigna of CA HMO/PPO	$1.13
Rate for Payer: Health Smart Auto/Commercial	$0.85
Rate for Payer: LLUH Dept of Risk Management WC	$0.78
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$1.06

CLARITHROMYCIN 125 MG/5 ML ORAL SUSPENSION [12885]

Facility

$1.41

Service Code	NDC 0781-6022-52
Hospital Charge Code	1715982
Hospital Revenue Code	259
Min. Negotiated Rate	$0.78
Max. Negotiated Rate	$1.06
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$0.85
Rate for Payer: Aetna of CA Government/Medicare	$0.85
Rate for Payer: Cash Price	$0.63
Rate for Payer: Health Smart Auto/Commercial	$0.85
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$0.85
Rate for Payer: LLUH Dept of Risk Management WC	$0.78
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$1.06

CLARITHROMYCIN 125 MG/5 ML ORAL SUSPENSION [12885]

Facility

$1.31

Service Code	NDC 0781-6022-46
Hospital Charge Code	NDG12285
Hospital Revenue Code	259
Min. Negotiated Rate	$0.72
Max. Negotiated Rate	$1.05
Rate for Payer: Cash Price	$0.59
Rate for Payer: Cigna of CA HMO/PPO	$1.05
Rate for Payer: Health Smart Auto/Commercial	$0.79
Rate for Payer: LLUH Dept of Risk Management WC	$0.72
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$0.98

CLARITHROMYCIN 125 MG/5 ML ORAL SUSPENSION [12885]

Facility

$1.31

Service Code	NDC 0781-6022-46
Hospital Charge Code	NDG12285
Hospital Revenue Code	259
Min. Negotiated Rate	$0.72
Max. Negotiated Rate	$0.98
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$0.79
Rate for Payer: Aetna of CA Government/Medicare	$0.79
Rate for Payer: Cash Price	$0.59
Rate for Payer: Health Smart Auto/Commercial	$0.79
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$0.79
Rate for Payer: LLUH Dept of Risk Management WC	$0.72
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$0.98

CLARITHROMYCIN 250 MG/5 ML ORAL SUSPENSION [12886]

Facility

$2.06

Service Code	NDC 0781-6023-52
Hospital Charge Code	1715955
Hospital Revenue Code	259
Min. Negotiated Rate	$1.13
Max. Negotiated Rate	$1.54
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$1.24
Rate for Payer: Aetna of CA Government/Medicare	$1.24
Rate for Payer: Cash Price	$0.93
Rate for Payer: Health Smart Auto/Commercial	$1.24
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$1.24
Rate for Payer: LLUH Dept of Risk Management WC	$1.13
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$1.54

CLARITHROMYCIN 250 MG/5 ML ORAL SUSPENSION [12886]

Facility

$2.06

Service Code	NDC 0781-6023-52
Hospital Charge Code	1715955
Hospital Revenue Code	259
Min. Negotiated Rate	$1.13
Max. Negotiated Rate	$1.65
Rate for Payer: Cash Price	$0.93
Rate for Payer: Cigna of CA HMO/PPO	$1.65
Rate for Payer: Health Smart Auto/Commercial	$1.24
Rate for Payer: LLUH Dept of Risk Management WC	$1.13
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$1.54

CLARITHROMYCIN 250 MG TABLET [9616]

Facility

$1.17

Service Code	NDC 0781-1961-60
Hospital Charge Code	1711631
Hospital Revenue Code	259
Min. Negotiated Rate	$0.64
Max. Negotiated Rate	$0.88
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$0.70
Rate for Payer: Aetna of CA Government/Medicare	$0.70
Rate for Payer: Cash Price	$0.53
Rate for Payer: Health Smart Auto/Commercial	$0.70
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$0.70
Rate for Payer: LLUH Dept of Risk Management WC	$0.64
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$0.88

CLARITHROMYCIN 250 MG TABLET [9616]

Facility

$1.17

Service Code	NDC 0781-1961-60
Hospital Charge Code	1711631
Hospital Revenue Code	259
Min. Negotiated Rate	$0.64
Max. Negotiated Rate	$0.94
Rate for Payer: Cash Price	$0.53
Rate for Payer: Cigna of CA HMO/PPO	$0.94
Rate for Payer: Health Smart Auto/Commercial	$0.70
Rate for Payer: LLUH Dept of Risk Management WC	$0.64
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$0.88

CLARITHROMYCIN 500 MG TABLET [9617]

Facility

$1.17

Service Code	NDC 0781-1962-60
Hospital Charge Code	1711531
Hospital Revenue Code	259
Min. Negotiated Rate	$0.64
Max. Negotiated Rate	$0.88
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$0.70
Rate for Payer: Aetna of CA Government/Medicare	$0.70
Rate for Payer: Cash Price	$0.53
Rate for Payer: Health Smart Auto/Commercial	$0.70
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$0.70
Rate for Payer: LLUH Dept of Risk Management WC	$0.64
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$0.88

CLARITHROMYCIN 500 MG TABLET [9617]

Facility

$1.17

Service Code	NDC 0781-1962-60
Hospital Charge Code	1711531
Hospital Revenue Code	259
Min. Negotiated Rate	$0.64
Max. Negotiated Rate	$0.94
Rate for Payer: Cash Price	$0.53
Rate for Payer: Cigna of CA HMO/PPO	$0.94
Rate for Payer: Health Smart Auto/Commercial	$0.70
Rate for Payer: LLUH Dept of Risk Management WC	$0.64
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$0.88

CLEVIDIPINE 25 MG/50 ML INTRAVENOUS EMULSION [93936]

Facility

$1.99

Service Code	CPT C9248
Hospital Charge Code	NDG93936
Hospital Revenue Code	636
Min. Negotiated Rate	$1.09
Max. Negotiated Rate	$1.59
Rate for Payer: Cash Price	$0.90
Rate for Payer: Cigna of CA HMO/PPO	$1.59
Rate for Payer: Health Smart Auto/Commercial	$1.19
Rate for Payer: LLUH Dept of Risk Management WC	$1.09
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$1.49

CLEVIDIPINE 25 MG/50 ML INTRAVENOUS EMULSION [93936]

Facility

$1.99

Service Code	CPT C9248
Hospital Charge Code	NDG93936
Hospital Revenue Code	636
Min. Negotiated Rate	$1.09
Max. Negotiated Rate	$1.49
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$1.19
Rate for Payer: Aetna of CA Government/Medicare	$1.19
Rate for Payer: Cash Price	$0.90
Rate for Payer: Health Smart Auto/Commercial	$1.19
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$1.19
Rate for Payer: LLUH Dept of Risk Management WC	$1.09
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$1.49

CLINDAMYCIN 150 MG/ML INJECTION SOLUTION [1743]

Facility

$0.73

Service Code	CPT J0736
Hospital Charge Code	1720474
Hospital Revenue Code	636
Min. Negotiated Rate	$0.40
Max. Negotiated Rate	$0.55
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$0.44
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$0.57
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$0.51
Rate for Payer: Aetna of CA Government/Medicare	$0.57
Rate for Payer: Aetna of CA Government/Medicare	$0.51
Rate for Payer: Aetna of CA Government/Medicare	$0.44
Rate for Payer: Cash Price	$0.33
Rate for Payer: Cash Price	$0.43
Rate for Payer: Cash Price	$0.38
Rate for Payer: Health Smart Auto/Commercial	$0.44
Rate for Payer: Health Smart Auto/Commercial	$0.51
Rate for Payer: Health Smart Auto/Commercial	$0.57
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$0.44
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$0.51
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$0.57
Rate for Payer: LLUH Dept of Risk Management WC	$0.40
Rate for Payer: LLUH Dept of Risk Management WC	$0.47
Rate for Payer: LLUH Dept of Risk Management WC	$0.52
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$0.55
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$0.64
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$0.71

CLINDAMYCIN 150 MG/ML INJECTION SOLUTION [1743]

Facility

$1.05

Service Code	CPT J0736
Hospital Charge Code	1721155
Hospital Revenue Code	636
Min. Negotiated Rate	$0.58
Max. Negotiated Rate	$0.79
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$0.63
Rate for Payer: Aetna of CA Government/Medicare	$0.63
Rate for Payer: Cash Price	$0.47
Rate for Payer: Health Smart Auto/Commercial	$0.63
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$0.63
Rate for Payer: LLUH Dept of Risk Management WC	$0.58
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$0.79

CLINDAMYCIN 150 MG/ML INJECTION SOLUTION [1743]

Facility

$1.27

Service Code	CPT J0736
Hospital Charge Code	1720473
Hospital Revenue Code	636
Min. Negotiated Rate	$0.70
Max. Negotiated Rate	$1.02
Rate for Payer: Cash Price	$0.57
Rate for Payer: Cigna of CA HMO/PPO	$1.02
Rate for Payer: Health Smart Auto/Commercial	$0.76
Rate for Payer: LLUH Dept of Risk Management WC	$0.70
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$0.95

CLINDAMYCIN 150 MG/ML INJECTION SOLUTION [1743]

Facility

$1.05

Service Code	CPT J0736
Hospital Charge Code	1721155
Hospital Revenue Code	636
Min. Negotiated Rate	$0.58
Max. Negotiated Rate	$0.84
Rate for Payer: Cash Price	$0.47
Rate for Payer: Cigna of CA HMO/PPO	$0.84
Rate for Payer: Health Smart Auto/Commercial	$0.63
Rate for Payer: LLUH Dept of Risk Management WC	$0.58
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$0.79

CLINDAMYCIN 150 MG/ML INJECTION SOLUTION [1743]

Facility

$0.46

Service Code	CPT J0736
Hospital Charge Code	NDG1743A
Hospital Revenue Code	636
Min. Negotiated Rate	$0.25
Max. Negotiated Rate	$0.35
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$0.28
Rate for Payer: Aetna of CA Government/Medicare	$0.28
Rate for Payer: Cash Price	$0.21
Rate for Payer: Health Smart Auto/Commercial	$0.28
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$0.28
Rate for Payer: LLUH Dept of Risk Management WC	$0.25
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$0.35

CLINDAMYCIN 150 MG/ML INJECTION SOLUTION [1743]

Facility

$0.46

Service Code	CPT J0736
Hospital Charge Code	NDG1743A
Hospital Revenue Code	636
Min. Negotiated Rate	$0.25
Max. Negotiated Rate	$0.37
Rate for Payer: Cash Price	$0.21
Rate for Payer: Cigna of CA HMO/PPO	$0.37
Rate for Payer: Health Smart Auto/Commercial	$0.28
Rate for Payer: LLUH Dept of Risk Management WC	$0.25
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$0.35

CLINDAMYCIN 150 MG/ML INJECTION SOLUTION [1743]

Facility

$0.73

Service Code	CPT J0736
Hospital Charge Code	1720474
Hospital Revenue Code	636
Min. Negotiated Rate	$0.40
Max. Negotiated Rate	$0.58
Rate for Payer: Cash Price	$0.33
Rate for Payer: Cash Price	$0.38
Rate for Payer: Cash Price	$0.43
Rate for Payer: Cigna of CA HMO/PPO	$0.58
Rate for Payer: Cigna of CA HMO/PPO	$0.76
Rate for Payer: Cigna of CA HMO/PPO	$0.68
Rate for Payer: Health Smart Auto/Commercial	$0.57
Rate for Payer: Health Smart Auto/Commercial	$0.44
Rate for Payer: Health Smart Auto/Commercial	$0.51
Rate for Payer: LLUH Dept of Risk Management WC	$0.40
Rate for Payer: LLUH Dept of Risk Management WC	$0.52
Rate for Payer: LLUH Dept of Risk Management WC	$0.47
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$0.55
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$0.71
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$0.64

Know your out-of-pocket cost for care.

All Charges