Loma Linda University Behavioral Medicine Center (BMC)

All Charges

Charge

Type

Setting

Price

ESLICARBAZEPINE 600 MG TABLET [204961]

Facility

$47.95

Service Code	NDC 63402-206-60
Hospital Charge Code	ERX204961
Hospital Revenue Code	259
Min. Negotiated Rate	$26.37
Max. Negotiated Rate	$35.96
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$28.77
Rate for Payer: Aetna of CA Government/Medicare	$28.77
Rate for Payer: Cash Price	$21.58
Rate for Payer: Health Smart Auto/Commercial	$28.77
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$28.77
Rate for Payer: LLUH Dept of Risk Management WC	$26.37
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$35.96

ESLICARBAZEPINE 600 MG TABLET [204961]

Facility

$47.95

Service Code	NDC 63402-206-60
Hospital Charge Code	ERX204961
Hospital Revenue Code	259
Min. Negotiated Rate	$26.37
Max. Negotiated Rate	$38.36
Rate for Payer: Cash Price	$21.58
Rate for Payer: Cigna of CA HMO/PPO	$38.36
Rate for Payer: Health Smart Auto/Commercial	$28.77
Rate for Payer: LLUH Dept of Risk Management WC	$26.37
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$35.96

ESLICARBAZEPINE 800 MG TABLET [204959]

Facility

$47.95

Service Code	NDC 63402-208-30
Hospital Charge Code	ERX204959
Hospital Revenue Code	259
Min. Negotiated Rate	$26.37
Max. Negotiated Rate	$35.96
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$28.77
Rate for Payer: Aetna of CA Government/Medicare	$28.77
Rate for Payer: Cash Price	$21.58
Rate for Payer: Health Smart Auto/Commercial	$28.77
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$28.77
Rate for Payer: LLUH Dept of Risk Management WC	$26.37
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$35.96

ESLICARBAZEPINE 800 MG TABLET [204959]

Facility

$47.95

Service Code	NDC 63402-208-30
Hospital Charge Code	ERX204959
Hospital Revenue Code	259
Min. Negotiated Rate	$26.37
Max. Negotiated Rate	$38.36
Rate for Payer: Cash Price	$21.58
Rate for Payer: Cigna of CA HMO/PPO	$38.36
Rate for Payer: Health Smart Auto/Commercial	$28.77
Rate for Payer: LLUH Dept of Risk Management WC	$26.37
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$35.96

ESMOLOL 100 MG/10 ML (10 MG/ML) INTRAVENOUS SOLUTION [9957]

Facility

$0.53

Service Code	CPT J1805
Hospital Charge Code	1720612
Hospital Revenue Code	636
Min. Negotiated Rate	$0.29
Max. Negotiated Rate	$0.42
Rate for Payer: Cash Price	$0.24
Rate for Payer: Cash Price	$0.38
Rate for Payer: Cigna of CA HMO/PPO	$0.67
Rate for Payer: Cigna of CA HMO/PPO	$0.42
Rate for Payer: Health Smart Auto/Commercial	$0.32
Rate for Payer: Health Smart Auto/Commercial	$0.50
Rate for Payer: LLUH Dept of Risk Management WC	$0.46
Rate for Payer: LLUH Dept of Risk Management WC	$0.29
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$0.63
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$0.40

ESMOLOL 100 MG/10 ML (10 MG/ML) INTRAVENOUS SOLUTION [9957]

Facility

$0.53

Service Code	CPT J1805
Hospital Charge Code	1720612
Hospital Revenue Code	636
Min. Negotiated Rate	$0.29
Max. Negotiated Rate	$0.40
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$0.32
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$0.50
Rate for Payer: Aetna of CA Government/Medicare	$0.32
Rate for Payer: Aetna of CA Government/Medicare	$0.50
Rate for Payer: Cash Price	$0.24
Rate for Payer: Cash Price	$0.38
Rate for Payer: Health Smart Auto/Commercial	$0.50
Rate for Payer: Health Smart Auto/Commercial	$0.32
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$0.50
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$0.32
Rate for Payer: LLUH Dept of Risk Management WC	$0.46
Rate for Payer: LLUH Dept of Risk Management WC	$0.29
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$0.63
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$0.40

ESMOLOL 2,000 MG/100 ML (20 MG/ML) IN SODIUM CHLORIDE (ISO-OSMOTIC) IV [35639]

Facility

$1.92

Service Code	CPT J1805
Hospital Charge Code	1759130
Hospital Revenue Code	636
Min. Negotiated Rate	$1.06
Max. Negotiated Rate	$1.44
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$1.15
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$3.63
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$1.08
Rate for Payer: Aetna of CA Government/Medicare	$1.15
Rate for Payer: Aetna of CA Government/Medicare	$3.63
Rate for Payer: Aetna of CA Government/Medicare	$1.08
Rate for Payer: Cash Price	$0.86
Rate for Payer: Cash Price	$0.81
Rate for Payer: Cash Price	$2.72
Rate for Payer: Health Smart Auto/Commercial	$1.08
Rate for Payer: Health Smart Auto/Commercial	$3.63
Rate for Payer: Health Smart Auto/Commercial	$1.15
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$3.63
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$1.08
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$1.15
Rate for Payer: LLUH Dept of Risk Management WC	$3.33
Rate for Payer: LLUH Dept of Risk Management WC	$1.06
Rate for Payer: LLUH Dept of Risk Management WC	$0.99
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$1.35
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$4.54
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$1.44

ESMOLOL 2,000 MG/100 ML (20 MG/ML) IN SODIUM CHLORIDE (ISO-OSMOTIC) IV [35639]

Facility

$1.80

Service Code	CPT J1805
Hospital Charge Code	1759130
Hospital Revenue Code	636
Min. Negotiated Rate	$0.99
Max. Negotiated Rate	$1.44
Rate for Payer: Cash Price	$0.81
Rate for Payer: Cash Price	$0.86
Rate for Payer: Cash Price	$2.72
Rate for Payer: Cigna of CA HMO/PPO	$1.54
Rate for Payer: Cigna of CA HMO/PPO	$4.84
Rate for Payer: Cigna of CA HMO/PPO	$1.44
Rate for Payer: Health Smart Auto/Commercial	$1.15
Rate for Payer: Health Smart Auto/Commercial	$1.08
Rate for Payer: Health Smart Auto/Commercial	$3.63
Rate for Payer: LLUH Dept of Risk Management WC	$3.33
Rate for Payer: LLUH Dept of Risk Management WC	$1.06
Rate for Payer: LLUH Dept of Risk Management WC	$0.99
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$1.35
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$1.44
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$4.54

ESMOLOL 2,000 MG/100 ML (20 MG/ML) IN STERILE WATER INTRAVENOUS SOLN [221109]

Facility

$1.55

Service Code	CPT J1806
Hospital Charge Code	NDG221109
Hospital Revenue Code	636
Min. Negotiated Rate	$0.85
Max. Negotiated Rate	$1.16
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$0.93
Rate for Payer: Aetna of CA Government/Medicare	$0.93
Rate for Payer: Cash Price	$0.70
Rate for Payer: Health Smart Auto/Commercial	$0.93
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$0.93
Rate for Payer: LLUH Dept of Risk Management WC	$0.85
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$1.16

ESMOLOL 2,000 MG/100 ML (20 MG/ML) IN STERILE WATER INTRAVENOUS SOLN [221109]

Facility

$1.55

Service Code	CPT J1806
Hospital Charge Code	NDG221109
Hospital Revenue Code	636
Min. Negotiated Rate	$0.85
Max. Negotiated Rate	$1.24
Rate for Payer: Cash Price	$0.70
Rate for Payer: Cigna of CA HMO/PPO	$1.24
Rate for Payer: Health Smart Auto/Commercial	$0.93
Rate for Payer: LLUH Dept of Risk Management WC	$0.85
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$1.16

ESMOLOL 2,500 MG/250 ML (10 MG/ML) IN SODIUM CHLORIDE (ISO-OSMOTIC) IV [29805]

Facility

$2.25

Service Code	CPT J1805
Hospital Charge Code	1759131
Hospital Revenue Code	636
Min. Negotiated Rate	$1.24
Max. Negotiated Rate	$1.80
Rate for Payer: Cash Price	$1.01
Rate for Payer: Cash Price	$0.70
Rate for Payer: Cash Price	$0.36
Rate for Payer: Cigna of CA HMO/PPO	$0.63
Rate for Payer: Cigna of CA HMO/PPO	$1.80
Rate for Payer: Cigna of CA HMO/PPO	$1.24
Rate for Payer: Health Smart Auto/Commercial	$1.35
Rate for Payer: Health Smart Auto/Commercial	$0.93
Rate for Payer: Health Smart Auto/Commercial	$0.47
Rate for Payer: LLUH Dept of Risk Management WC	$1.24
Rate for Payer: LLUH Dept of Risk Management WC	$0.43
Rate for Payer: LLUH Dept of Risk Management WC	$0.85
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$1.69
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$0.59
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$1.16

ESMOLOL 2,500 MG/250 ML (10 MG/ML) IN SODIUM CHLORIDE (ISO-OSMOTIC) IV [29805]

Facility

$2.25

Service Code	CPT J1805
Hospital Charge Code	1759131
Hospital Revenue Code	636
Min. Negotiated Rate	$1.24
Max. Negotiated Rate	$1.69
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$1.35
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$0.47
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$0.93
Rate for Payer: Aetna of CA Government/Medicare	$1.35
Rate for Payer: Aetna of CA Government/Medicare	$0.93
Rate for Payer: Aetna of CA Government/Medicare	$0.47
Rate for Payer: Cash Price	$1.01
Rate for Payer: Cash Price	$0.36
Rate for Payer: Cash Price	$0.70
Rate for Payer: Health Smart Auto/Commercial	$1.35
Rate for Payer: Health Smart Auto/Commercial	$0.47
Rate for Payer: Health Smart Auto/Commercial	$0.93
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$0.93
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$0.47
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$1.35
Rate for Payer: LLUH Dept of Risk Management WC	$0.85
Rate for Payer: LLUH Dept of Risk Management WC	$1.24
Rate for Payer: LLUH Dept of Risk Management WC	$0.43
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$1.16
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$0.59
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$1.69

ESOMEPRAZOLE MAGNESIUM 20 MG CAPSULE,DELAYED RELEASE [29745]

Facility

$11.01

Service Code	NDC 0186-5020-54
Hospital Charge Code	1711865
Hospital Revenue Code	259
Min. Negotiated Rate	$6.06
Max. Negotiated Rate	$8.26
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$6.61
Rate for Payer: Aetna of CA Government/Medicare	$6.61
Rate for Payer: Cash Price	$4.95
Rate for Payer: Health Smart Auto/Commercial	$6.61
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$6.61
Rate for Payer: LLUH Dept of Risk Management WC	$6.06
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$8.26

ESOMEPRAZOLE MAGNESIUM 20 MG CAPSULE,DELAYED RELEASE [29745]

Facility

$11.01

Service Code	NDC 0186-5020-54
Hospital Charge Code	1711865
Hospital Revenue Code	259
Min. Negotiated Rate	$6.06
Max. Negotiated Rate	$8.81
Rate for Payer: Cash Price	$4.95
Rate for Payer: Cigna of CA HMO/PPO	$8.81
Rate for Payer: Health Smart Auto/Commercial	$6.61
Rate for Payer: LLUH Dept of Risk Management WC	$6.06
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$8.26

ESOMEPRAZOLE MAGNESIUM 40 MG CAPSULE,DELAYED RELEASE [29746]

Facility

$11.01

Service Code	NDC 0186-5040-54
Hospital Charge Code	1711866
Hospital Revenue Code	259
Min. Negotiated Rate	$6.06
Max. Negotiated Rate	$8.26
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$6.61
Rate for Payer: Aetna of CA Government/Medicare	$6.61
Rate for Payer: Cash Price	$4.95
Rate for Payer: Health Smart Auto/Commercial	$6.61
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$6.61
Rate for Payer: LLUH Dept of Risk Management WC	$6.06
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$8.26

ESOMEPRAZOLE MAGNESIUM 40 MG CAPSULE,DELAYED RELEASE [29746]

Facility

$11.01

Service Code	NDC 0186-5040-54
Hospital Charge Code	1711866
Hospital Revenue Code	259
Min. Negotiated Rate	$6.06
Max. Negotiated Rate	$8.81
Rate for Payer: Cash Price	$4.95
Rate for Payer: Cigna of CA HMO/PPO	$8.81
Rate for Payer: Health Smart Auto/Commercial	$6.61
Rate for Payer: LLUH Dept of Risk Management WC	$6.06
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$8.26

ESOMEPRAZOLE MAGNESIUM DR 10 MG GRANULES DELAYED RELEASE FOR SUSP [91031]

Facility

$11.49

Service Code	NDC 0186-4010-01
Hospital Charge Code	ERX91031
Hospital Revenue Code	259
Min. Negotiated Rate	$6.32
Max. Negotiated Rate	$9.19
Rate for Payer: Health Smart Auto/Commercial	$6.89
Rate for Payer: Cash Price	$5.17
Rate for Payer: Cigna of CA HMO/PPO	$9.19
Rate for Payer: LLUH Dept of Risk Management WC	$6.32
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$8.62

ESOMEPRAZOLE MAGNESIUM DR 10 MG GRANULES DELAYED RELEASE FOR SUSP [91031]

Facility

$11.49

Service Code	NDC 0186-4010-01
Hospital Charge Code	ERX91031
Hospital Revenue Code	259
Min. Negotiated Rate	$6.32
Max. Negotiated Rate	$8.62
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$6.89
Rate for Payer: Aetna of CA Government/Medicare	$6.89
Rate for Payer: Cash Price	$5.17
Rate for Payer: Health Smart Auto/Commercial	$6.89
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$6.89
Rate for Payer: LLUH Dept of Risk Management WC	$6.32
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$8.62

ESOMEPRAZOLE SODIUM 40 MG INTRAVENOUS SOLUTION [41174]

Facility

$53.58

Service Code	CPT C9113
Hospital Charge Code	1722037
Hospital Revenue Code	636
Min. Negotiated Rate	$29.47
Max. Negotiated Rate	$42.86
Rate for Payer: Cash Price	$24.11
Rate for Payer: Cigna of CA HMO/PPO	$42.86
Rate for Payer: Health Smart Auto/Commercial	$32.15
Rate for Payer: LLUH Dept of Risk Management WC	$29.47
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$40.18

ESOMEPRAZOLE SODIUM 40 MG INTRAVENOUS SOLUTION [41174]

Facility

$53.58

Service Code	CPT C9113
Hospital Charge Code	1722037
Hospital Revenue Code	636
Min. Negotiated Rate	$29.47
Max. Negotiated Rate	$40.18
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$32.15
Rate for Payer: Aetna of CA Government/Medicare	$32.15
Rate for Payer: Cash Price	$24.11
Rate for Payer: Health Smart Auto/Commercial	$32.15
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$32.15
Rate for Payer: LLUH Dept of Risk Management WC	$29.47
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$40.18

ESTERIFIED ESTROGENS 1.25 MG TABLET [9965]

Facility

$4.41

Service Code	NDC 61570-074-01
Hospital Charge Code	1712371
Hospital Revenue Code	259
Min. Negotiated Rate	$2.43
Max. Negotiated Rate	$3.53
Rate for Payer: Cash Price	$1.98
Rate for Payer: Cigna of CA HMO/PPO	$3.53
Rate for Payer: Health Smart Auto/Commercial	$2.65
Rate for Payer: LLUH Dept of Risk Management WC	$2.43
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$3.31

ESTERIFIED ESTROGENS 1.25 MG TABLET [9965]

Facility

$4.41

Service Code	NDC 61570-074-01
Hospital Charge Code	1712371
Hospital Revenue Code	259
Min. Negotiated Rate	$2.43
Max. Negotiated Rate	$3.31
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$2.65
Rate for Payer: Aetna of CA Government/Medicare	$2.65
Rate for Payer: Cash Price	$1.98
Rate for Payer: Health Smart Auto/Commercial	$2.65
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$2.65
Rate for Payer: LLUH Dept of Risk Management WC	$2.43
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$3.31

ESTRADIOL 0.01% (0.1 MG/GRAM) VAGINAL CREAM [9969]

Facility

$3.07

Service Code	NDC 0093-3541-43
Hospital Charge Code	1743763
Hospital Revenue Code	259
Min. Negotiated Rate	$1.69
Max. Negotiated Rate	$2.46
Rate for Payer: Cash Price	$1.38
Rate for Payer: Cigna of CA HMO/PPO	$2.46
Rate for Payer: Health Smart Auto/Commercial	$1.84
Rate for Payer: LLUH Dept of Risk Management WC	$1.69
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$2.30

ESTRADIOL 0.01% (0.1 MG/GRAM) VAGINAL CREAM [9969]

Facility

$9.74

Service Code	NDC 0430-3754-14
Hospital Charge Code	1743763
Hospital Revenue Code	259
Min. Negotiated Rate	$5.36
Max. Negotiated Rate	$7.79
Rate for Payer: Cash Price	$4.38
Rate for Payer: Cigna of CA HMO/PPO	$7.79
Rate for Payer: Health Smart Auto/Commercial	$5.84
Rate for Payer: LLUH Dept of Risk Management WC	$5.36
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$7.30

ESTRADIOL 0.01% (0.1 MG/GRAM) VAGINAL CREAM [9969]

Facility

$3.07

Service Code	NDC 0093-3541-43
Hospital Charge Code	1743763
Hospital Revenue Code	259
Min. Negotiated Rate	$1.69
Max. Negotiated Rate	$2.30
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$1.84
Rate for Payer: Aetna of CA Government/Medicare	$1.84
Rate for Payer: Cash Price	$1.38
Rate for Payer: Health Smart Auto/Commercial	$1.84
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$1.84
Rate for Payer: LLUH Dept of Risk Management WC	$1.69
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$2.30

Know your out-of-pocket cost for care.

All Charges