Loma Linda University Behavioral Medicine Center (BMC)

All Charges

Charge

Type

Setting

Price

FENTANYL (PF) 500 MCG/50 ML (10 MCG/ML) IN 0.9 % NACL IV PCA SYRINGE [121190]

Facility

$0.32

Service Code	CPT J3010
Hospital Charge Code	NDG408121190
Hospital Revenue Code	636
Min. Negotiated Rate	$0.18
Max. Negotiated Rate	$0.26
Rate for Payer: Cash Price	$0.14
Rate for Payer: Cigna of CA HMO/PPO	$0.26
Rate for Payer: Health Smart Auto/Commercial	$0.19
Rate for Payer: LLUH Dept of Risk Management WC	$0.18
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$0.24

FENTANYL (PF) 50 MCG/ML INJECTION SOLUTION [3037]

Facility

$1.27

Service Code	CPT J3010
Hospital Charge Code	1737024
Hospital Revenue Code	636
Min. Negotiated Rate	$0.70
Max. Negotiated Rate	$0.95
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$0.76
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$0.55
Rate for Payer: Aetna of CA Government/Medicare	$0.55
Rate for Payer: Aetna of CA Government/Medicare	$0.76
Rate for Payer: Cash Price	$0.57
Rate for Payer: Cash Price	$0.41
Rate for Payer: Health Smart Auto/Commercial	$0.55
Rate for Payer: Health Smart Auto/Commercial	$0.76
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$0.76
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$0.55
Rate for Payer: LLUH Dept of Risk Management WC	$0.51
Rate for Payer: LLUH Dept of Risk Management WC	$0.70
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$0.69
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$0.95

FENTANYL (PF) 50 MCG/ML INJECTION SOLUTION [3037]

Facility

$0.92

Service Code	CPT J3010
Hospital Charge Code	1737024
Hospital Revenue Code	636
Min. Negotiated Rate	$0.51
Max. Negotiated Rate	$0.74
Rate for Payer: Cash Price	$0.41
Rate for Payer: Cash Price	$0.57
Rate for Payer: Cigna of CA HMO/PPO	$1.02
Rate for Payer: Cigna of CA HMO/PPO	$0.74
Rate for Payer: Health Smart Auto/Commercial	$0.76
Rate for Payer: Health Smart Auto/Commercial	$0.55
Rate for Payer: LLUH Dept of Risk Management WC	$0.70
Rate for Payer: LLUH Dept of Risk Management WC	$0.51
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$0.95
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$0.69

FENTANYL (PF) 50 MCG/ML INJECTION SOLUTION [3037]

Facility

$0.60

Service Code	CPT J3010
Hospital Charge Code	NDG3037
Hospital Revenue Code	636
Min. Negotiated Rate	$0.33
Max. Negotiated Rate	$0.48
Rate for Payer: Cash Price	$0.27
Rate for Payer: Cash Price	$0.23
Rate for Payer: Cigna of CA HMO/PPO	$0.48
Rate for Payer: Cigna of CA HMO/PPO	$0.42
Rate for Payer: Health Smart Auto/Commercial	$0.31
Rate for Payer: Health Smart Auto/Commercial	$0.36
Rate for Payer: LLUH Dept of Risk Management WC	$0.33
Rate for Payer: LLUH Dept of Risk Management WC	$0.29
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$0.39
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$0.45

FENTANYL (PF) 50 MCG/ML INJECTION SOLUTION [3037]

Facility

$0.55

Service Code	CPT J3010
Hospital Charge Code	1737025
Hospital Revenue Code	636
Min. Negotiated Rate	$0.30
Max. Negotiated Rate	$0.44
Rate for Payer: Cash Price	$0.25
Rate for Payer: Cash Price	$0.27
Rate for Payer: Cigna of CA HMO/PPO	$0.44
Rate for Payer: Cigna of CA HMO/PPO	$0.48
Rate for Payer: Health Smart Auto/Commercial	$0.33
Rate for Payer: Health Smart Auto/Commercial	$0.36
Rate for Payer: LLUH Dept of Risk Management WC	$0.33
Rate for Payer: LLUH Dept of Risk Management WC	$0.30
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$0.41
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$0.45

FENTANYL (PF) 50 MCG/ML INJECTION SOLUTION [3037]

Facility

$0.47

Service Code	CPT J3010
Hospital Charge Code	1737027
Hospital Revenue Code	636
Min. Negotiated Rate	$0.26
Max. Negotiated Rate	$0.38
Rate for Payer: Cash Price	$0.21
Rate for Payer: Cigna of CA HMO/PPO	$0.38
Rate for Payer: Health Smart Auto/Commercial	$0.28
Rate for Payer: LLUH Dept of Risk Management WC	$0.26
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$0.35

FENTANYL (PF) 50 MCG/ML INJECTION SOLUTION [3037]

Facility

$0.52

Service Code	CPT J3010
Hospital Charge Code	NDG3037
Hospital Revenue Code	636
Min. Negotiated Rate	$0.29
Max. Negotiated Rate	$0.39
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$0.31
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$0.36
Rate for Payer: Aetna of CA Government/Medicare	$0.31
Rate for Payer: Aetna of CA Government/Medicare	$0.36
Rate for Payer: Cash Price	$0.23
Rate for Payer: Cash Price	$0.27
Rate for Payer: Health Smart Auto/Commercial	$0.36
Rate for Payer: Health Smart Auto/Commercial	$0.31
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$0.36
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$0.31
Rate for Payer: LLUH Dept of Risk Management WC	$0.33
Rate for Payer: LLUH Dept of Risk Management WC	$0.29
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$0.45
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$0.39

FENTANYL (PF) 50 MCG/ML INJECTION SOLUTION [3037]

Facility

$0.55

Service Code	CPT J3010
Hospital Charge Code	1737025
Hospital Revenue Code	636
Min. Negotiated Rate	$0.30
Max. Negotiated Rate	$0.41
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$0.33
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$0.36
Rate for Payer: Aetna of CA Government/Medicare	$0.36
Rate for Payer: Aetna of CA Government/Medicare	$0.33
Rate for Payer: Cash Price	$0.25
Rate for Payer: Cash Price	$0.27
Rate for Payer: Health Smart Auto/Commercial	$0.33
Rate for Payer: Health Smart Auto/Commercial	$0.36
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$0.36
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$0.33
Rate for Payer: LLUH Dept of Risk Management WC	$0.33
Rate for Payer: LLUH Dept of Risk Management WC	$0.30
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$0.41
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$0.45

FENTANYL (PF) 50 MCG/ML INJECTION SOLUTION [3037]

Facility

$0.47

Service Code	CPT J3010
Hospital Charge Code	1737027
Hospital Revenue Code	636
Min. Negotiated Rate	$0.26
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	$0.26
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$0.35

FENTANYL (PF) 50 MCG/ML INJECTION SYRINGE [114243]

Facility

$2.65

Service Code	CPT J3010
Hospital Charge Code	NDG3037B
Hospital Revenue Code	636
Min. Negotiated Rate	$1.46
Max. Negotiated Rate	$1.99
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$1.59
Rate for Payer: Aetna of CA Government/Medicare	$1.59
Rate for Payer: Cash Price	$1.19
Rate for Payer: Health Smart Auto/Commercial	$1.59
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$1.59
Rate for Payer: LLUH Dept of Risk Management WC	$1.46
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$1.99

FENTANYL (PF) 50 MCG/ML INJECTION SYRINGE [114243]

Facility

$2.65

Service Code	CPT J3010
Hospital Charge Code	NDG3037B
Hospital Revenue Code	636
Min. Negotiated Rate	$1.46
Max. Negotiated Rate	$2.12
Rate for Payer: Cash Price	$1.19
Rate for Payer: Cigna of CA HMO/PPO	$2.12
Rate for Payer: Health Smart Auto/Commercial	$1.59
Rate for Payer: LLUH Dept of Risk Management WC	$1.46
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$1.99

FENTANYL ROPIVACAINE (3200) 2 MCG/ML 0.15% 250 ML EPIDURAL [4080615]

Facility

$0.85

Service Code	CPT J3010
Hospital Charge Code	1737088
Hospital Revenue Code	636
Min. Negotiated Rate	$0.47
Max. Negotiated Rate	$0.64
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$0.51
Rate for Payer: Aetna of CA Government/Medicare	$0.51
Rate for Payer: Cash Price	$0.38
Rate for Payer: Health Smart Auto/Commercial	$0.51
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$0.51
Rate for Payer: LLUH Dept of Risk Management WC	$0.47
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$0.64

FENTANYL ROPIVACAINE (3200) 2 MCG/ML 0.15% 250 ML EPIDURAL [4080615]

Facility

$0.85

Service Code	CPT J3010
Hospital Charge Code	1737088
Hospital Revenue Code	636
Min. Negotiated Rate	$0.47
Max. Negotiated Rate	$0.68
Rate for Payer: Cash Price	$0.38
Rate for Payer: Cigna of CA HMO/PPO	$0.68
Rate for Payer: Health Smart Auto/Commercial	$0.51
Rate for Payer: LLUH Dept of Risk Management WC	$0.47
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$0.64

FENTANYL-ROPIVACAINE-NACL (PF) 2.5 MCG/ML-0.15% EPIDURAL [4081421]

Facility

$1.27

Service Code	CPT J3010
Hospital Charge Code	ERX4081421
Hospital Revenue Code	636
Min. Negotiated Rate	$0.70
Max. Negotiated Rate	$0.95
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$0.76
Rate for Payer: Aetna of CA Government/Medicare	$0.76
Rate for Payer: Cash Price	$0.57
Rate for Payer: Health Smart Auto/Commercial	$0.76
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$0.76
Rate for Payer: LLUH Dept of Risk Management WC	$0.70
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$0.95

FENTANYL-ROPIVACAINE-NACL (PF) 2.5 MCG/ML-0.15% EPIDURAL [4081421]

Facility

$1.27

Service Code	CPT J3010
Hospital Charge Code	ERX4081421
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

FERRIC CARBOXYMALTOSE 50 MG IRON/ML INTRAVENOUS SOLUTION [203170]

Facility

$107.81

Service Code	CPT J1439
Hospital Charge Code	NDG203170
Hospital Revenue Code	636
Min. Negotiated Rate	$59.30
Max. Negotiated Rate	$86.25
Rate for Payer: Cash Price	$48.51
Rate for Payer: Cigna of CA HMO/PPO	$86.25
Rate for Payer: Health Smart Auto/Commercial	$64.69
Rate for Payer: LLUH Dept of Risk Management WC	$59.30
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$80.86

FERRIC CARBOXYMALTOSE 50 MG IRON/ML INTRAVENOUS SOLUTION [203170]

Facility

$107.81

Service Code	CPT J1439
Hospital Charge Code	NDG203170
Hospital Revenue Code	636
Min. Negotiated Rate	$59.30
Max. Negotiated Rate	$80.86
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$64.69
Rate for Payer: Aetna of CA Government/Medicare	$64.69
Rate for Payer: Cash Price	$48.51
Rate for Payer: Health Smart Auto/Commercial	$64.69
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$64.69
Rate for Payer: LLUH Dept of Risk Management WC	$59.30
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$80.86

FERRIC SUBSULFATE 0.2 GRAM TO 0.22 GRAM/ML TOPICAL SOLN AND APPLICATOR [201459]

Facility

$1.82

Service Code	NDC 10481-0112-8
Hospital Charge Code	NDG201459
Hospital Revenue Code	259
Min. Negotiated Rate	$1.00
Max. Negotiated Rate	$1.36
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$1.09
Rate for Payer: Aetna of CA Government/Medicare	$1.09
Rate for Payer: Cash Price	$0.82
Rate for Payer: Health Smart Auto/Commercial	$1.09
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$1.09
Rate for Payer: LLUH Dept of Risk Management WC	$1.00
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$1.36

FERRIC SUBSULFATE 0.2 GRAM TO 0.22 GRAM/ML TOPICAL SOLN AND APPLICATOR [201459]

Facility

$1.82

Service Code	NDC 10481-0112-8
Hospital Charge Code	NDG201459
Hospital Revenue Code	259
Min. Negotiated Rate	$1.00
Max. Negotiated Rate	$1.46
Rate for Payer: Cash Price	$0.82
Rate for Payer: Cigna of CA HMO/PPO	$1.46
Rate for Payer: Health Smart Auto/Commercial	$1.09
Rate for Payer: LLUH Dept of Risk Management WC	$1.00
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$1.36

FERRIC SUBSULFATE 259 MG/G TOPICAL SOLUTION [28357]

Facility

$2.46

Service Code	NDC 59365-6065-1
Hospital Charge Code	NDG28357
Hospital Revenue Code	636
Min. Negotiated Rate	$1.35
Max. Negotiated Rate	$1.84
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$1.48
Rate for Payer: Aetna of CA Government/Medicare	$1.48
Rate for Payer: Cash Price	$1.11
Rate for Payer: Health Smart Auto/Commercial	$1.48
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$1.48
Rate for Payer: LLUH Dept of Risk Management WC	$1.35
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$1.84

FERRIC SUBSULFATE 259 MG/G TOPICAL SOLUTION [28357]

Facility

$2.46

Service Code	NDC 59365-6065-0
Hospital Charge Code	NDG28357
Hospital Revenue Code	636
Min. Negotiated Rate	$1.35
Max. Negotiated Rate	$1.84
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$1.48
Rate for Payer: Aetna of CA Government/Medicare	$1.48
Rate for Payer: Cash Price	$1.11
Rate for Payer: Health Smart Auto/Commercial	$1.48
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$1.48
Rate for Payer: LLUH Dept of Risk Management WC	$1.35
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$1.84

FERRIC SUBSULFATE 259 MG/G TOPICAL SOLUTION [28357]

Facility

$2.46

Service Code	NDC 59365-6065-1
Hospital Charge Code	NDG28357
Hospital Revenue Code	636
Min. Negotiated Rate	$1.35
Max. Negotiated Rate	$1.97
Rate for Payer: Cash Price	$1.11
Rate for Payer: Cigna of CA HMO/PPO	$1.97
Rate for Payer: Health Smart Auto/Commercial	$1.48
Rate for Payer: LLUH Dept of Risk Management WC	$1.35
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$1.84

FERRIC SUBSULFATE 259 MG/G TOPICAL SOLUTION [28357]

Facility

$2.46

Service Code	NDC 59365-6065-0
Hospital Charge Code	NDG28357
Hospital Revenue Code	636
Min. Negotiated Rate	$1.35
Max. Negotiated Rate	$1.97
Rate for Payer: Cash Price	$1.11
Rate for Payer: Cigna of CA HMO/PPO	$1.97
Rate for Payer: Health Smart Auto/Commercial	$1.48
Rate for Payer: LLUH Dept of Risk Management WC	$1.35
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$1.84

FERROUS FUMARATE 324 MG (106 MG IRON) TABLET [3063]

Facility

$0.35

Service Code	NDC 6025818201
Hospital Charge Code	1712565
Hospital Revenue Code	259
Min. Negotiated Rate	$0.19
Max. Negotiated Rate	$0.26
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$0.21
Rate for Payer: Aetna of CA Government/Medicare	$0.21
Rate for Payer: Cash Price	$0.16
Rate for Payer: Health Smart Auto/Commercial	$0.21
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$0.21
Rate for Payer: LLUH Dept of Risk Management WC	$0.19
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$0.26

FERROUS FUMARATE 324 MG (106 MG IRON) TABLET [3063]

Facility

$0.35

Service Code	NDC 6025818201
Hospital Charge Code	1712565
Hospital Revenue Code	259
Min. Negotiated Rate	$0.19
Max. Negotiated Rate	$0.28
Rate for Payer: Cash Price	$0.16
Rate for Payer: Cigna of CA HMO/PPO	$0.28
Rate for Payer: Health Smart Auto/Commercial	$0.21
Rate for Payer: LLUH Dept of Risk Management WC	$0.19
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$0.26

Know your out-of-pocket cost for care.

All Charges