Loma Linda University Behavioral Medicine Center (BMC)

All Charges

Charge

Type

Setting

Price

DOXAZOSIN 4 MG TABLET [9896]

Facility

$1.03

Service Code	NDC 68084-862-95
Hospital Charge Code	1712422
Hospital Revenue Code	259
Min. Negotiated Rate	$0.57
Max. Negotiated Rate	$0.77
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$0.62
Rate for Payer: Aetna of CA Government/Medicare	$0.62
Rate for Payer: Cash Price	$0.46
Rate for Payer: Health Smart Auto/Commercial	$0.62
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$0.62
Rate for Payer: LLUH Dept of Risk Management WC	$0.57
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$0.77

DOXEPIN 10 MG CAPSULE [2608]

Facility

$0.64

Service Code	NDC 51079-436-20
Hospital Charge Code	1711025
Hospital Revenue Code	259
Min. Negotiated Rate	$0.35
Max. Negotiated Rate	$0.48
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	$0.29
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	$0.48

DOXEPIN 10 MG CAPSULE [2608]

Facility

$0.64

Service Code	NDC 51079-436-01
Hospital Charge Code	1711025
Hospital Revenue Code	259
Min. Negotiated Rate	$0.35
Max. Negotiated Rate	$0.51
Rate for Payer: Cash Price	$0.29
Rate for Payer: Cigna of CA HMO/PPO	$0.51
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	$0.48

DOXEPIN 10 MG CAPSULE [2608]

Facility

$0.64

Service Code	NDC 51079-436-01
Hospital Charge Code	1711025
Hospital Revenue Code	259
Min. Negotiated Rate	$0.35
Max. Negotiated Rate	$0.48
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	$0.29
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	$0.48

DOXEPIN 10 MG CAPSULE [2608]

Facility

$0.56

Service Code	NDC 49884-217-01
Hospital Charge Code	1711025
Hospital Revenue Code	259
Min. Negotiated Rate	$0.31
Max. Negotiated Rate	$0.45
Rate for Payer: Cash Price	$0.25
Rate for Payer: Cigna of CA HMO/PPO	$0.45
Rate for Payer: Health Smart Auto/Commercial	$0.34
Rate for Payer: LLUH Dept of Risk Management WC	$0.31
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$0.42

DOXEPIN 10 MG CAPSULE [2608]

Facility

$0.64

Service Code	NDC 51079-436-20
Hospital Charge Code	1711025
Hospital Revenue Code	259
Min. Negotiated Rate	$0.35
Max. Negotiated Rate	$0.51
Rate for Payer: Cash Price	$0.29
Rate for Payer: Cigna of CA HMO/PPO	$0.51
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	$0.48

DOXEPIN 10 MG CAPSULE [2608]

Facility

$0.56

Service Code	NDC 49884-217-01
Hospital Charge Code	1711025
Hospital Revenue Code	259
Min. Negotiated Rate	$0.31
Max. Negotiated Rate	$0.42
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$0.34
Rate for Payer: Aetna of CA Government/Medicare	$0.34
Rate for Payer: Cash Price	$0.25
Rate for Payer: Health Smart Auto/Commercial	$0.34
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$0.34
Rate for Payer: LLUH Dept of Risk Management WC	$0.31
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$0.42

DOXEPIN 10 MG/ML ORAL CONCENTRATE [2614]

Facility

$0.57

Service Code	NDC 54838-512-40
Hospital Charge Code	NDG2614
Hospital Revenue Code	250
Min. Negotiated Rate	$0.31
Max. Negotiated Rate	$0.43
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$0.34
Rate for Payer: Aetna of CA Government/Medicare	$0.34
Rate for Payer: Cash Price	$0.26
Rate for Payer: Health Smart Auto/Commercial	$0.34
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$0.34
Rate for Payer: LLUH Dept of Risk Management WC	$0.31
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$0.43

DOXEPIN 10 MG/ML ORAL CONCENTRATE [2614]

Facility

$0.57

Service Code	NDC 54838-512-40
Hospital Charge Code	NDG2614
Hospital Revenue Code	250
Min. Negotiated Rate	$0.31
Max. Negotiated Rate	$0.46
Rate for Payer: Cash Price	$0.26
Rate for Payer: Cigna of CA HMO/PPO	$0.46
Rate for Payer: Health Smart Auto/Commercial	$0.34
Rate for Payer: LLUH Dept of Risk Management WC	$0.31
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$0.43

DOXEPIN 25 MG CAPSULE [2611]

Facility

$0.26

Service Code	NDC 69238-1170-9
Hospital Charge Code	1711039
Hospital Revenue Code	259
Min. Negotiated Rate	$0.14
Max. Negotiated Rate	$0.21
Rate for Payer: Cash Price	$0.12
Rate for Payer: Cigna of CA HMO/PPO	$0.21
Rate for Payer: Health Smart Auto/Commercial	$0.16
Rate for Payer: LLUH Dept of Risk Management WC	$0.14
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$0.20

DOXEPIN 25 MG CAPSULE [2611]

Facility

$0.26

Service Code	NDC 69238-1170-9
Hospital Charge Code	1711039
Hospital Revenue Code	259
Min. Negotiated Rate	$0.14
Max. Negotiated Rate	$0.20
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$0.16
Rate for Payer: Aetna of CA Government/Medicare	$0.16
Rate for Payer: Cash Price	$0.12
Rate for Payer: Health Smart Auto/Commercial	$0.16
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$0.16
Rate for Payer: LLUH Dept of Risk Management WC	$0.14
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$0.20

DOXEPIN 25 MG CAPSULE [2611]

Facility

$0.36

Service Code	NDC 27241-168-01
Hospital Charge Code	1711039
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

DOXEPIN 25 MG CAPSULE [2611]

Facility

$0.36

Service Code	NDC 27241-168-01
Hospital Charge Code	1711039
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

DOXEPIN 25 MG CAPSULE [2611]

Facility

$0.84

Service Code	NDC 51079-437-20
Hospital Charge Code	1711039
Hospital Revenue Code	259
Min. Negotiated Rate	$0.46
Max. Negotiated Rate	$0.63
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$0.50
Rate for Payer: Aetna of CA Government/Medicare	$0.50
Rate for Payer: Cash Price	$0.38
Rate for Payer: Health Smart Auto/Commercial	$0.50
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$0.50
Rate for Payer: LLUH Dept of Risk Management WC	$0.46
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$0.63

DOXEPIN 25 MG CAPSULE [2611]

Facility

$0.84

Service Code	NDC 51079-437-01
Hospital Charge Code	1711039
Hospital Revenue Code	259
Min. Negotiated Rate	$0.46
Max. Negotiated Rate	$0.63
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$0.50
Rate for Payer: Aetna of CA Government/Medicare	$0.50
Rate for Payer: Cash Price	$0.38
Rate for Payer: Health Smart Auto/Commercial	$0.50
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$0.50
Rate for Payer: LLUH Dept of Risk Management WC	$0.46
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$0.63

DOXEPIN 25 MG CAPSULE [2611]

Facility

$0.84

Service Code	NDC 51079-437-01
Hospital Charge Code	1711039
Hospital Revenue Code	259
Min. Negotiated Rate	$0.46
Max. Negotiated Rate	$0.67
Rate for Payer: Cash Price	$0.38
Rate for Payer: Cigna of CA HMO/PPO	$0.67
Rate for Payer: Health Smart Auto/Commercial	$0.50
Rate for Payer: LLUH Dept of Risk Management WC	$0.46
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$0.63

DOXEPIN 25 MG CAPSULE [2611]

Facility

$0.84

Service Code	NDC 51079-437-20
Hospital Charge Code	1711039
Hospital Revenue Code	259
Min. Negotiated Rate	$0.46
Max. Negotiated Rate	$0.67
Rate for Payer: Cash Price	$0.38
Rate for Payer: Cigna of CA HMO/PPO	$0.67
Rate for Payer: Health Smart Auto/Commercial	$0.50
Rate for Payer: LLUH Dept of Risk Management WC	$0.46
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$0.63

DOXORUBICIN 10 MG/5 ML INTRAVENOUS SOLUTION [120047]

Facility

$2.44

Service Code	CPT J9000
Hospital Charge Code	1755130
Hospital Revenue Code	636
Min. Negotiated Rate	$1.34
Max. Negotiated Rate	$1.95
Rate for Payer: Cash Price	$1.10
Rate for Payer: Cigna of CA HMO/PPO	$1.95
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	$1.83

DOXORUBICIN 10 MG/5 ML INTRAVENOUS SOLUTION [120047]

Facility

$2.44

Service Code	CPT J9000
Hospital Charge Code	1755130
Hospital Revenue Code	636
Min. Negotiated Rate	$1.34
Max. Negotiated Rate	$1.83
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	$1.10
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	$1.83

DOXORUBICIN 20 MG/10 ML INTRAVENOUS SOLUTION [120048]

Facility

$3.12

Service Code	CPT J9000
Hospital Charge Code	NDG120048
Hospital Revenue Code	636
Min. Negotiated Rate	$1.72
Max. Negotiated Rate	$2.34
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$1.87
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$1.15
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: Aetna of CA Government/Medicare	$1.87
Rate for Payer: Aetna of CA Government/Medicare	$1.15
Rate for Payer: Cash Price	$1.10
Rate for Payer: Cash Price	$0.86
Rate for Payer: Cash Price	$1.40
Rate for Payer: Health Smart Auto/Commercial	$1.87
Rate for Payer: Health Smart Auto/Commercial	$1.46
Rate for Payer: Health Smart Auto/Commercial	$1.15
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$1.15
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$1.87
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$1.46
Rate for Payer: LLUH Dept of Risk Management WC	$1.72
Rate for Payer: LLUH Dept of Risk Management WC	$1.06
Rate for Payer: LLUH Dept of Risk Management WC	$1.34
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$1.44
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$1.83
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$2.34

DOXORUBICIN 20 MG/10 ML INTRAVENOUS SOLUTION [120048]

Facility

$3.12

Service Code	CPT J9000
Hospital Charge Code	NDG120048
Hospital Revenue Code	636
Min. Negotiated Rate	$1.72
Max. Negotiated Rate	$2.50
Rate for Payer: Cash Price	$1.40
Rate for Payer: Cash Price	$0.86
Rate for Payer: Cash Price	$1.10
Rate for Payer: Cigna of CA HMO/PPO	$1.54
Rate for Payer: Cigna of CA HMO/PPO	$1.95
Rate for Payer: Cigna of CA HMO/PPO	$2.50
Rate for Payer: Health Smart Auto/Commercial	$1.46
Rate for Payer: Health Smart Auto/Commercial	$1.87
Rate for Payer: Health Smart Auto/Commercial	$1.15
Rate for Payer: LLUH Dept of Risk Management WC	$1.06
Rate for Payer: LLUH Dept of Risk Management WC	$1.34
Rate for Payer: LLUH Dept of Risk Management WC	$1.72
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$1.83
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$1.44
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$2.34

DOXORUBICIN 2 MG/ML INTRAVENOUS SOLUTION (100 ML) [2616]

Facility

$1.44

Service Code	CPT J9000
Hospital Charge Code	1755747
Hospital Revenue Code	636
Min. Negotiated Rate	$0.79
Max. Negotiated Rate	$1.08
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$0.86
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$1.03
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$0.47
Rate for Payer: Aetna of CA Government/Medicare	$1.03
Rate for Payer: Aetna of CA Government/Medicare	$0.47
Rate for Payer: Aetna of CA Government/Medicare	$0.86
Rate for Payer: Cash Price	$0.35
Rate for Payer: Cash Price	$0.65
Rate for Payer: Cash Price	$0.77
Rate for Payer: Health Smart Auto/Commercial	$0.47
Rate for Payer: Health Smart Auto/Commercial	$1.03
Rate for Payer: Health Smart Auto/Commercial	$0.86
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$0.86
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$1.03
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$0.47
Rate for Payer: LLUH Dept of Risk Management WC	$0.43
Rate for Payer: LLUH Dept of Risk Management WC	$0.79
Rate for Payer: LLUH Dept of Risk Management WC	$0.94
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$1.08
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$0.59
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$1.28

DOXORUBICIN 2 MG/ML INTRAVENOUS SOLUTION (100 ML) [2616]

Facility

$1.44

Service Code	CPT J9000
Hospital Charge Code	1755747
Hospital Revenue Code	636
Min. Negotiated Rate	$0.79
Max. Negotiated Rate	$1.15
Rate for Payer: Cash Price	$0.65
Rate for Payer: Cash Price	$0.35
Rate for Payer: Cash Price	$0.77
Rate for Payer: Cigna of CA HMO/PPO	$1.15
Rate for Payer: Cigna of CA HMO/PPO	$0.62
Rate for Payer: Cigna of CA HMO/PPO	$1.37
Rate for Payer: Health Smart Auto/Commercial	$1.03
Rate for Payer: Health Smart Auto/Commercial	$0.86
Rate for Payer: Health Smart Auto/Commercial	$0.47
Rate for Payer: LLUH Dept of Risk Management WC	$0.43
Rate for Payer: LLUH Dept of Risk Management WC	$0.79
Rate for Payer: LLUH Dept of Risk Management WC	$0.94
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$0.59
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$1.28
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$1.08

DOXORUBICIN 50 MG/25 ML INTRAVENOUS SOLUTION [120046]

Facility

$1.44

Service Code	CPT J9000
Hospital Charge Code	1755775
Hospital Revenue Code	636
Min. Negotiated Rate	$0.79
Max. Negotiated Rate	$1.08
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$0.86
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$1.03
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$1.01
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$0.71
Rate for Payer: Aetna of CA Government/Medicare	$1.01
Rate for Payer: Aetna of CA Government/Medicare	$0.71
Rate for Payer: Aetna of CA Government/Medicare	$0.86
Rate for Payer: Aetna of CA Government/Medicare	$1.03
Rate for Payer: Cash Price	$0.53
Rate for Payer: Cash Price	$0.76
Rate for Payer: Cash Price	$0.65
Rate for Payer: Cash Price	$0.77
Rate for Payer: Health Smart Auto/Commercial	$1.03
Rate for Payer: Health Smart Auto/Commercial	$0.71
Rate for Payer: Health Smart Auto/Commercial	$1.01
Rate for Payer: Health Smart Auto/Commercial	$0.86
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$0.86
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$1.01
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$1.03
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$0.71
Rate for Payer: LLUH Dept of Risk Management WC	$0.92
Rate for Payer: LLUH Dept of Risk Management WC	$0.94
Rate for Payer: LLUH Dept of Risk Management WC	$0.65
Rate for Payer: LLUH Dept of Risk Management WC	$0.79
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$1.26
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$0.89
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$1.28
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$1.08

DOXORUBICIN 50 MG/25 ML INTRAVENOUS SOLUTION [120046]

Facility

$1.68

Service Code	CPT J9000
Hospital Charge Code	1755775
Hospital Revenue Code	636
Min. Negotiated Rate	$0.92
Max. Negotiated Rate	$1.34
Rate for Payer: Cash Price	$0.76
Rate for Payer: Cash Price	$0.53
Rate for Payer: Cash Price	$0.65
Rate for Payer: Cash Price	$0.77
Rate for Payer: Cigna of CA HMO/PPO	$1.15
Rate for Payer: Cigna of CA HMO/PPO	$1.37
Rate for Payer: Cigna of CA HMO/PPO	$1.34
Rate for Payer: Cigna of CA HMO/PPO	$0.94
Rate for Payer: Health Smart Auto/Commercial	$0.71
Rate for Payer: Health Smart Auto/Commercial	$0.86
Rate for Payer: Health Smart Auto/Commercial	$1.01
Rate for Payer: Health Smart Auto/Commercial	$1.03
Rate for Payer: LLUH Dept of Risk Management WC	$0.92
Rate for Payer: LLUH Dept of Risk Management WC	$0.65
Rate for Payer: LLUH Dept of Risk Management WC	$0.94
Rate for Payer: LLUH Dept of Risk Management WC	$0.79
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$1.26
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$0.89
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$1.28
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$1.08

Know your out-of-pocket cost for care.

All Charges