Loma Linda University Behavioral Medicine Center (BMC)

All Charges

Charge

Type

Setting

Price

ERDAFITINIB 3 MG TABLET [224623]

Facility

$403.73

Service Code	NDC 59676-030-56
Hospital Revenue Code	636
Min. Negotiated Rate	$222.05
Max. Negotiated Rate	$302.80
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$242.24
Rate for Payer: Aetna of CA Government/Medicare	$242.24
Rate for Payer: Cash Price	$181.68
Rate for Payer: Health Smart Auto/Commercial	$242.24
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$242.24
Rate for Payer: LLUH Dept of Risk Management WC	$222.05
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$302.80

ERDAFITINIB 3 MG TABLET [224623]

Facility

$403.73

Service Code	NDC 59676-030-56
Hospital Revenue Code	636
Min. Negotiated Rate	$222.05
Max. Negotiated Rate	$322.98
Rate for Payer: Cash Price	$181.68
Rate for Payer: Cigna of CA HMO/PPO	$322.98
Rate for Payer: Health Smart Auto/Commercial	$242.24
Rate for Payer: LLUH Dept of Risk Management WC	$222.05
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$302.80

ERDAFITINIB 4 MG TABLET [224624]

Facility

$538.30

Service Code	NDC 59676-040-28
Hospital Revenue Code	636
Min. Negotiated Rate	$296.06
Max. Negotiated Rate	$403.72
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$322.98
Rate for Payer: Aetna of CA Government/Medicare	$322.98
Rate for Payer: Cash Price	$242.24
Rate for Payer: Health Smart Auto/Commercial	$322.98
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$322.98
Rate for Payer: LLUH Dept of Risk Management WC	$296.06
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$403.72

ERDAFITINIB 4 MG TABLET [224624]

Facility

$538.30

Service Code	NDC 59676-040-28
Hospital Revenue Code	636
Min. Negotiated Rate	$296.06
Max. Negotiated Rate	$430.64
Rate for Payer: Cash Price	$242.24
Rate for Payer: Cigna of CA HMO/PPO	$430.64
Rate for Payer: Health Smart Auto/Commercial	$322.98
Rate for Payer: LLUH Dept of Risk Management WC	$296.06
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$403.72

ERDAFITINIB 5 MG TABLET [224625]

Facility

$672.88

Service Code	NDC 59676-050-28
Hospital Revenue Code	636
Min. Negotiated Rate	$370.08
Max. Negotiated Rate	$504.66
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$403.73
Rate for Payer: Aetna of CA Government/Medicare	$403.73
Rate for Payer: Cash Price	$302.80
Rate for Payer: Health Smart Auto/Commercial	$403.73
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$403.73
Rate for Payer: LLUH Dept of Risk Management WC	$370.08
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$504.66

ERDAFITINIB 5 MG TABLET [224625]

Facility

$672.88

Service Code	NDC 59676-050-28
Hospital Revenue Code	636
Min. Negotiated Rate	$370.08
Max. Negotiated Rate	$538.30
Rate for Payer: Cash Price	$302.80
Rate for Payer: Cigna of CA HMO/PPO	$538.30
Rate for Payer: Health Smart Auto/Commercial	$403.73
Rate for Payer: LLUH Dept of Risk Management WC	$370.08
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$504.66

ERENUMAB-AOOE 70 MG/ML SUBCUTANEOUS AUTO-INJECTOR [221765]

Facility

$885.43

Service Code	CPT J3590
Hospital Revenue Code	636
Min. Negotiated Rate	$486.99
Max. Negotiated Rate	$708.34
Rate for Payer: Health Smart Auto/Commercial	$531.26
Rate for Payer: Cash Price	$398.44
Rate for Payer: Cigna of CA HMO/PPO	$708.34
Rate for Payer: LLUH Dept of Risk Management WC	$486.99
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$664.07

ERENUMAB-AOOE 70 MG/ML SUBCUTANEOUS AUTO-INJECTOR [221765]

Facility

$885.43

Service Code	CPT J3590
Hospital Revenue Code	636
Min. Negotiated Rate	$486.99
Max. Negotiated Rate	$664.07
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$531.26
Rate for Payer: Aetna of CA Government/Medicare	$531.26
Rate for Payer: Cash Price	$398.44
Rate for Payer: Health Smart Auto/Commercial	$531.26
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$531.26
Rate for Payer: LLUH Dept of Risk Management WC	$486.99
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$664.07

ERGOCALCIFEROL (VITAMIN D2) 1,250 MCG (50,000 UNIT) CAPSULE [2863]

Facility

$0.44

Service Code	NDC 69452-151-20
Hospital Charge Code	1710033
Hospital Revenue Code	259
Min. Negotiated Rate	$0.24
Max. Negotiated Rate	$0.35
Rate for Payer: Cash Price	$0.20
Rate for Payer: Cigna of CA HMO/PPO	$0.35
Rate for Payer: Health Smart Auto/Commercial	$0.26
Rate for Payer: LLUH Dept of Risk Management WC	$0.24
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$0.33

ERGOCALCIFEROL (VITAMIN D2) 1,250 MCG (50,000 UNIT) CAPSULE [2863]

Facility

$0.44

Service Code	NDC 69452-151-20
Hospital Charge Code	1710033
Hospital Revenue Code	259
Min. Negotiated Rate	$0.24
Max. Negotiated Rate	$0.33
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$0.26
Rate for Payer: Aetna of CA Government/Medicare	$0.26
Rate for Payer: Cash Price	$0.20
Rate for Payer: Health Smart Auto/Commercial	$0.26
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$0.26
Rate for Payer: LLUH Dept of Risk Management WC	$0.24
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$0.33

ERGOCALCIFEROL (VITAMIN D2) 200 MCG/ML (8,000 UNIT/ML) ORAL DROPS [9943]

Facility

$1.66

Service Code	NDC 3932835760
Hospital Charge Code	NDG9943
Hospital Revenue Code	259
Min. Negotiated Rate	$0.91
Max. Negotiated Rate	$1.24
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$1.00
Rate for Payer: Aetna of CA Government/Medicare	$1.00
Rate for Payer: Cash Price	$0.75
Rate for Payer: Health Smart Auto/Commercial	$1.00
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$1.00
Rate for Payer: LLUH Dept of Risk Management WC	$0.91
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$1.24

ERGOCALCIFEROL (VITAMIN D2) 200 MCG/ML (8,000 UNIT/ML) ORAL DROPS [9943]

Facility

$1.66

Service Code	NDC 3932835760
Hospital Charge Code	NDG9943
Hospital Revenue Code	259
Min. Negotiated Rate	$0.91
Max. Negotiated Rate	$1.33
Rate for Payer: Cash Price	$0.75
Rate for Payer: Cigna of CA HMO/PPO	$1.33
Rate for Payer: Health Smart Auto/Commercial	$1.00
Rate for Payer: LLUH Dept of Risk Management WC	$0.91
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$1.24

ERGOTAMINE 1 MG-CAFFEINE 100 MG TABLET [9949]

Facility

$14.82

Service Code	NDC 0781-5405-01
Hospital Charge Code	1712008
Hospital Revenue Code	259
Min. Negotiated Rate	$8.15
Max. Negotiated Rate	$11.12
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$8.89
Rate for Payer: Aetna of CA Government/Medicare	$8.89
Rate for Payer: Cash Price	$6.67
Rate for Payer: Health Smart Auto/Commercial	$8.89
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$8.89
Rate for Payer: LLUH Dept of Risk Management WC	$8.15
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$11.12

ERGOTAMINE 1 MG-CAFFEINE 100 MG TABLET [9949]

Facility

$14.82

Service Code	NDC 0781-5405-01
Hospital Charge Code	1712008
Hospital Revenue Code	259
Min. Negotiated Rate	$8.15
Max. Negotiated Rate	$11.86
Rate for Payer: Cash Price	$6.67
Rate for Payer: Cigna of CA HMO/PPO	$11.86
Rate for Payer: Health Smart Auto/Commercial	$8.89
Rate for Payer: LLUH Dept of Risk Management WC	$8.15
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$11.12

ERIBULIN 1 MG/2 ML (0.5 MG/ML) INTRAVENOUS SOLUTION [106773]

Facility

$820.80

Service Code	CPT J9179
Hospital Charge Code	1755763
Hospital Revenue Code	636
Min. Negotiated Rate	$451.44
Max. Negotiated Rate	$656.64
Rate for Payer: Cash Price	$369.36
Rate for Payer: Cigna of CA HMO/PPO	$656.64
Rate for Payer: Health Smart Auto/Commercial	$492.48
Rate for Payer: LLUH Dept of Risk Management WC	$451.44
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$615.60

ERIBULIN 1 MG/2 ML (0.5 MG/ML) INTRAVENOUS SOLUTION [106773]

Facility

$820.80

Service Code	CPT J9179
Hospital Charge Code	1755763
Hospital Revenue Code	636
Min. Negotiated Rate	$451.44
Max. Negotiated Rate	$615.60
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$492.48
Rate for Payer: Aetna of CA Government/Medicare	$492.48
Rate for Payer: Cash Price	$369.36
Rate for Payer: Health Smart Auto/Commercial	$492.48
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$492.48
Rate for Payer: LLUH Dept of Risk Management WC	$451.44
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$615.60

ERTAPENEM 1 GRAM INJECTION (IM) [4083192201]

Facility

$140.48

Service Code	CPT J1335
Hospital Revenue Code	636
Min. Negotiated Rate	$77.26
Max. Negotiated Rate	$112.38
Rate for Payer: Cash Price	$63.22
Rate for Payer: Cash Price	$25.65
Rate for Payer: Cash Price	$54.00
Rate for Payer: Cash Price	$74.95
Rate for Payer: Cash Price	$69.48
Rate for Payer: Cigna of CA HMO/PPO	$133.25
Rate for Payer: Cigna of CA HMO/PPO	$45.60
Rate for Payer: Cigna of CA HMO/PPO	$123.51
Rate for Payer: Cigna of CA HMO/PPO	$112.38
Rate for Payer: Cigna of CA HMO/PPO	$96.00
Rate for Payer: Health Smart Auto/Commercial	$92.63
Rate for Payer: Health Smart Auto/Commercial	$99.94
Rate for Payer: Health Smart Auto/Commercial	$84.29
Rate for Payer: Health Smart Auto/Commercial	$72.00
Rate for Payer: Health Smart Auto/Commercial	$34.20
Rate for Payer: LLUH Dept of Risk Management WC	$66.00
Rate for Payer: LLUH Dept of Risk Management WC	$91.61
Rate for Payer: LLUH Dept of Risk Management WC	$84.91
Rate for Payer: LLUH Dept of Risk Management WC	$77.26
Rate for Payer: LLUH Dept of Risk Management WC	$31.35
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$115.79
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$90.00
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$124.92
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$105.36
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$42.75

ERTAPENEM 1 GRAM INJECTION (IM) [4083192201]

Facility

$57.00

Service Code	CPT J1335
Hospital Revenue Code	636
Min. Negotiated Rate	$31.35
Max. Negotiated Rate	$42.75
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$34.20
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$72.00
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$99.94
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$84.29
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$92.63
Rate for Payer: Aetna of CA Government/Medicare	$92.63
Rate for Payer: Aetna of CA Government/Medicare	$99.94
Rate for Payer: Aetna of CA Government/Medicare	$84.29
Rate for Payer: Aetna of CA Government/Medicare	$72.00
Rate for Payer: Aetna of CA Government/Medicare	$34.20
Rate for Payer: Cash Price	$69.48
Rate for Payer: Cash Price	$74.95
Rate for Payer: Cash Price	$54.00
Rate for Payer: Cash Price	$63.22
Rate for Payer: Cash Price	$25.65
Rate for Payer: Health Smart Auto/Commercial	$72.00
Rate for Payer: Health Smart Auto/Commercial	$99.94
Rate for Payer: Health Smart Auto/Commercial	$84.29
Rate for Payer: Health Smart Auto/Commercial	$34.20
Rate for Payer: Health Smart Auto/Commercial	$92.63
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$84.29
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$92.63
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$72.00
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$34.20
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$99.94
Rate for Payer: LLUH Dept of Risk Management WC	$77.26
Rate for Payer: LLUH Dept of Risk Management WC	$31.35
Rate for Payer: LLUH Dept of Risk Management WC	$66.00
Rate for Payer: LLUH Dept of Risk Management WC	$91.61
Rate for Payer: LLUH Dept of Risk Management WC	$84.91
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$105.36
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$90.00
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$42.75
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$124.92
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$115.79

ERTAPENEM 1 GRAM SOLUTION FOR INJECTION [31922]

Facility

$96.00

Service Code	CPT J1335
Hospital Charge Code	1755709
Hospital Revenue Code	636
Min. Negotiated Rate	$52.80
Max. Negotiated Rate	$76.80
Rate for Payer: Cigna of CA HMO/PPO	$112.38
Rate for Payer: Cigna of CA HMO/PPO	$76.80
Rate for Payer: Health Smart Auto/Commercial	$57.60
Rate for Payer: Health Smart Auto/Commercial	$84.29
Rate for Payer: Cash Price	$43.20
Rate for Payer: Cash Price	$63.22
Rate for Payer: LLUH Dept of Risk Management WC	$77.26
Rate for Payer: LLUH Dept of Risk Management WC	$52.80
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$72.00
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$105.36

ERTAPENEM 1 GRAM SOLUTION FOR INJECTION [31922]

Facility

$140.48

Service Code	CPT J1335
Hospital Charge Code	1755709
Hospital Revenue Code	636
Min. Negotiated Rate	$77.26
Max. Negotiated Rate	$105.36
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$84.29
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$57.60
Rate for Payer: Aetna of CA Government/Medicare	$57.60
Rate for Payer: Aetna of CA Government/Medicare	$84.29
Rate for Payer: Cash Price	$43.20
Rate for Payer: Cash Price	$63.22
Rate for Payer: Health Smart Auto/Commercial	$57.60
Rate for Payer: Health Smart Auto/Commercial	$84.29
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$57.60
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$84.29
Rate for Payer: LLUH Dept of Risk Management WC	$52.80
Rate for Payer: LLUH Dept of Risk Management WC	$77.26
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$105.36
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$72.00

ERYTHROMYCIN 250 MG TABLET [2889]

Facility

$11.28

Service Code	NDC 52536-103-03
Hospital Charge Code	1710431
Hospital Revenue Code	259
Min. Negotiated Rate	$6.20
Max. Negotiated Rate	$8.46
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$6.77
Rate for Payer: Aetna of CA Government/Medicare	$6.77
Rate for Payer: Cash Price	$5.08
Rate for Payer: Health Smart Auto/Commercial	$6.77
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$6.77
Rate for Payer: LLUH Dept of Risk Management WC	$6.20
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$8.46

ERYTHROMYCIN 250 MG TABLET [2889]

Facility

$6.75

Service Code	NDC 75834-242-30
Hospital Charge Code	1710431
Hospital Revenue Code	259
Min. Negotiated Rate	$3.71
Max. Negotiated Rate	$5.40
Rate for Payer: Cash Price	$3.04
Rate for Payer: Cigna of CA HMO/PPO	$5.40
Rate for Payer: Health Smart Auto/Commercial	$4.05
Rate for Payer: LLUH Dept of Risk Management WC	$3.71
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$5.06

ERYTHROMYCIN 250 MG TABLET [2889]

Facility

$12.70

Service Code	NDC 69238-1484-3
Hospital Charge Code	1710431
Hospital Revenue Code	259
Min. Negotiated Rate	$6.98
Max. Negotiated Rate	$9.52
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$7.62
Rate for Payer: Aetna of CA Government/Medicare	$7.62
Rate for Payer: Cash Price	$5.72
Rate for Payer: Health Smart Auto/Commercial	$7.62
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$7.62
Rate for Payer: LLUH Dept of Risk Management WC	$6.98
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$9.52

ERYTHROMYCIN 250 MG TABLET [2889]

Facility

$6.75

Service Code	NDC 75834-242-30
Hospital Charge Code	1710431
Hospital Revenue Code	259
Min. Negotiated Rate	$3.71
Max. Negotiated Rate	$5.06
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$4.05
Rate for Payer: Aetna of CA Government/Medicare	$4.05
Rate for Payer: Cash Price	$3.04
Rate for Payer: Health Smart Auto/Commercial	$4.05
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$4.05
Rate for Payer: LLUH Dept of Risk Management WC	$3.71
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$5.06

ERYTHROMYCIN 250 MG TABLET [2889]

Facility

$11.28

Service Code	NDC 52536-103-13
Hospital Charge Code	1710431
Hospital Revenue Code	259
Min. Negotiated Rate	$6.20
Max. Negotiated Rate	$9.02
Rate for Payer: Cash Price	$5.08
Rate for Payer: Cigna of CA HMO/PPO	$9.02
Rate for Payer: Health Smart Auto/Commercial	$6.77
Rate for Payer: LLUH Dept of Risk Management WC	$6.20
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$8.46

Know your out-of-pocket cost for care.

All Charges