Loma Linda University Behavioral Medicine Center (BMC)

All Charges

Charge

Type

Setting

Price

GEMCITABINE 200 MG/5.26 ML (38 MG/ML) INTRAVENOUS SOLUTION [191077]

Facility

$1.76

Service Code	CPT J9201
Hospital Charge Code	NDG191077
Hospital Revenue Code	636
Min. Negotiated Rate	$0.97
Max. Negotiated Rate	$1.41
Rate for Payer: Cash Price	$0.51
Rate for Payer: Cigna of CA HMO/PPO	$1.41
Rate for Payer: Cigna of CA HMO/PPO	$0.91
Rate for Payer: Health Smart Auto/Commercial	$1.06
Rate for Payer: Health Smart Auto/Commercial	$0.68
Rate for Payer: Cash Price	$0.79
Rate for Payer: LLUH Dept of Risk Management WC	$0.97
Rate for Payer: LLUH Dept of Risk Management WC	$0.63
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$1.32
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$0.86

GEMCITABINE 200 MG/5.26 ML (38 MG/ML) INTRAVENOUS SOLUTION [191077]

Facility

$1.14

Service Code	CPT J9201
Hospital Charge Code	NDG191077
Hospital Revenue Code	636
Min. Negotiated Rate	$0.63
Max. Negotiated Rate	$0.86
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$0.68
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$1.06
Rate for Payer: Aetna of CA Government/Medicare	$0.68
Rate for Payer: Aetna of CA Government/Medicare	$1.06
Rate for Payer: Cash Price	$0.79
Rate for Payer: Cash Price	$0.51
Rate for Payer: Health Smart Auto/Commercial	$1.06
Rate for Payer: Health Smart Auto/Commercial	$0.68
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$1.06
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$0.68
Rate for Payer: LLUH Dept of Risk Management WC	$0.97
Rate for Payer: LLUH Dept of Risk Management WC	$0.63
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$1.32
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$0.86

GEMCITABINE 200 MG INTRAVENOUS SOLUTION [17121]

Facility

$12.19

Service Code	CPT J9201
Hospital Charge Code	1755759
Hospital Revenue Code	636
Min. Negotiated Rate	$6.70
Max. Negotiated Rate	$9.14
Rate for Payer: Cash Price	$6.51
Rate for Payer: Cash Price	$4.96
Rate for Payer: Cash Price	$6.48
Rate for Payer: Cash Price	$8.10
Rate for Payer: Cash Price	$5.49
Rate for Payer: Health Smart Auto/Commercial	$6.62
Rate for Payer: Health Smart Auto/Commercial	$10.80
Rate for Payer: Health Smart Auto/Commercial	$8.64
Rate for Payer: Health Smart Auto/Commercial	$8.68
Rate for Payer: Health Smart Auto/Commercial	$7.31
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$7.31
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$6.62
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$10.80
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$8.68
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$8.64
Rate for Payer: Aetna of CA Government/Medicare	$8.64
Rate for Payer: Aetna of CA Government/Medicare	$8.68
Rate for Payer: Aetna of CA Government/Medicare	$10.80
Rate for Payer: Aetna of CA Government/Medicare	$7.31
Rate for Payer: Aetna of CA Government/Medicare	$6.62
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$6.62
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$10.80
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$8.68
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$8.64
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$7.31
Rate for Payer: LLUH Dept of Risk Management WC	$9.90
Rate for Payer: LLUH Dept of Risk Management WC	$7.95
Rate for Payer: LLUH Dept of Risk Management WC	$6.07
Rate for Payer: LLUH Dept of Risk Management WC	$6.70
Rate for Payer: LLUH Dept of Risk Management WC	$7.92
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$8.27
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$10.80
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$13.50
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$10.84
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$9.14

GEMCITABINE 200 MG INTRAVENOUS SOLUTION [17121]

Facility

$18.00

Service Code	CPT J9201
Hospital Charge Code	1755759
Hospital Revenue Code	636
Min. Negotiated Rate	$9.90
Max. Negotiated Rate	$14.40
Rate for Payer: Cash Price	$8.10
Rate for Payer: Cash Price	$6.51
Rate for Payer: Cash Price	$4.96
Rate for Payer: Cash Price	$6.48
Rate for Payer: Cash Price	$5.49
Rate for Payer: Cigna of CA HMO/PPO	$11.52
Rate for Payer: Cigna of CA HMO/PPO	$14.40
Rate for Payer: Cigna of CA HMO/PPO	$11.57
Rate for Payer: Cigna of CA HMO/PPO	$8.82
Rate for Payer: Cigna of CA HMO/PPO	$9.75
Rate for Payer: Health Smart Auto/Commercial	$6.62
Rate for Payer: Health Smart Auto/Commercial	$10.80
Rate for Payer: Health Smart Auto/Commercial	$7.31
Rate for Payer: Health Smart Auto/Commercial	$8.68
Rate for Payer: Health Smart Auto/Commercial	$8.64
Rate for Payer: LLUH Dept of Risk Management WC	$9.90
Rate for Payer: LLUH Dept of Risk Management WC	$6.07
Rate for Payer: LLUH Dept of Risk Management WC	$7.95
Rate for Payer: LLUH Dept of Risk Management WC	$6.70
Rate for Payer: LLUH Dept of Risk Management WC	$7.92
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$9.14
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$8.27
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$10.84
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$10.80
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$13.50

GEMCITABINE 2 GRAM/52.6 ML (38 MG/ML) INTRAVENOUS SOLUTION [191076]

Facility

$1.76

Service Code	CPT J9201
Hospital Charge Code	NDG191076
Hospital Revenue Code	636
Min. Negotiated Rate	$0.97
Max. Negotiated Rate	$1.41
Rate for Payer: Cash Price	$0.79
Rate for Payer: Cigna of CA HMO/PPO	$1.41
Rate for Payer: Health Smart Auto/Commercial	$1.06
Rate for Payer: LLUH Dept of Risk Management WC	$0.97
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$1.32

GEMCITABINE 2 GRAM/52.6 ML (38 MG/ML) INTRAVENOUS SOLUTION [191076]

Facility

$1.76

Service Code	CPT J9201
Hospital Charge Code	NDG191076
Hospital Revenue Code	636
Min. Negotiated Rate	$0.97
Max. Negotiated Rate	$1.32
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$1.06
Rate for Payer: Aetna of CA Government/Medicare	$1.06
Rate for Payer: Cash Price	$0.79
Rate for Payer: Health Smart Auto/Commercial	$1.06
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$1.06
Rate for Payer: LLUH Dept of Risk Management WC	$0.97
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$1.32

GEMCITABINE 2 GRAM INTRAVENOUS SOLUTION [105417]

Facility

$136.18

Service Code	CPT J9201
Hospital Charge Code	ERX105417
Hospital Revenue Code	636
Min. Negotiated Rate	$74.90
Max. Negotiated Rate	$108.94
Rate for Payer: Cash Price	$61.28
Rate for Payer: Cigna of CA HMO/PPO	$108.94
Rate for Payer: Health Smart Auto/Commercial	$81.71
Rate for Payer: LLUH Dept of Risk Management WC	$74.90
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$102.14

GEMCITABINE 2 GRAM INTRAVENOUS SOLUTION [105417]

Facility

$136.18

Service Code	CPT J9201
Hospital Charge Code	ERX105417
Hospital Revenue Code	636
Min. Negotiated Rate	$74.90
Max. Negotiated Rate	$102.14
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$81.71
Rate for Payer: Aetna of CA Government/Medicare	$81.71
Rate for Payer: Cash Price	$61.28
Rate for Payer: Health Smart Auto/Commercial	$81.71
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$81.71
Rate for Payer: LLUH Dept of Risk Management WC	$74.90
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$102.14

GEMFIBROZIL 600 MG TABLET [3378]

Facility

$0.21

Service Code	NDC 69097-821-03
Hospital Charge Code	1711318
Hospital Revenue Code	259
Min. Negotiated Rate	$0.12
Max. Negotiated Rate	$0.17
Rate for Payer: Cash Price	$0.09
Rate for Payer: Cigna of CA HMO/PPO	$0.17
Rate for Payer: Health Smart Auto/Commercial	$0.13
Rate for Payer: LLUH Dept of Risk Management WC	$0.12
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$0.16

GEMFIBROZIL 600 MG TABLET [3378]

Facility

$0.31

Service Code	NDC 60687-224-11
Hospital Charge Code	1711318
Hospital Revenue Code	259
Min. Negotiated Rate	$0.17
Max. Negotiated Rate	$0.23
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$0.19
Rate for Payer: Aetna of CA Government/Medicare	$0.19
Rate for Payer: Cash Price	$0.14
Rate for Payer: Health Smart Auto/Commercial	$0.19
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$0.19
Rate for Payer: LLUH Dept of Risk Management WC	$0.17
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$0.23

GEMFIBROZIL 600 MG TABLET [3378]

Facility

$0.21

Service Code	NDC 65862-624-60
Hospital Charge Code	1711318
Hospital Revenue Code	259
Min. Negotiated Rate	$0.12
Max. Negotiated Rate	$0.16
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$0.13
Rate for Payer: Aetna of CA Government/Medicare	$0.13
Rate for Payer: Cash Price	$0.09
Rate for Payer: Health Smart Auto/Commercial	$0.13
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$0.13
Rate for Payer: LLUH Dept of Risk Management WC	$0.12
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$0.16

GEMFIBROZIL 600 MG TABLET [3378]

Facility

$0.21

Service Code	NDC 65862-624-60
Hospital Charge Code	1711318
Hospital Revenue Code	259
Min. Negotiated Rate	$0.12
Max. Negotiated Rate	$0.17
Rate for Payer: Cash Price	$0.09
Rate for Payer: Cigna of CA HMO/PPO	$0.17
Rate for Payer: Health Smart Auto/Commercial	$0.13
Rate for Payer: LLUH Dept of Risk Management WC	$0.12
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$0.16

GEMFIBROZIL 600 MG TABLET [3378]

Facility

$0.31

Service Code	NDC 60687-224-01
Hospital Charge Code	1711318
Hospital Revenue Code	259
Min. Negotiated Rate	$0.17
Max. Negotiated Rate	$0.23
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$0.19
Rate for Payer: Aetna of CA Government/Medicare	$0.19
Rate for Payer: Cash Price	$0.14
Rate for Payer: Health Smart Auto/Commercial	$0.19
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$0.19
Rate for Payer: LLUH Dept of Risk Management WC	$0.17
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$0.23

GEMFIBROZIL 600 MG TABLET [3378]

Facility

$0.31

Service Code	NDC 60687-224-11
Hospital Charge Code	1711318
Hospital Revenue Code	259
Min. Negotiated Rate	$0.17
Max. Negotiated Rate	$0.25
Rate for Payer: Cash Price	$0.14
Rate for Payer: Cigna of CA HMO/PPO	$0.25
Rate for Payer: Health Smart Auto/Commercial	$0.19
Rate for Payer: LLUH Dept of Risk Management WC	$0.17
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$0.23

GEMFIBROZIL 600 MG TABLET [3378]

Facility

$0.21

Service Code	NDC 69097-821-03
Hospital Charge Code	1711318
Hospital Revenue Code	259
Min. Negotiated Rate	$0.12
Max. Negotiated Rate	$0.16
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$0.13
Rate for Payer: Aetna of CA Government/Medicare	$0.13
Rate for Payer: Cash Price	$0.09
Rate for Payer: Health Smart Auto/Commercial	$0.13
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$0.13
Rate for Payer: LLUH Dept of Risk Management WC	$0.12
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$0.16

GEMFIBROZIL 600 MG TABLET [3378]

Facility

$0.31

Service Code	NDC 60687-224-01
Hospital Charge Code	1711318
Hospital Revenue Code	259
Min. Negotiated Rate	$0.17
Max. Negotiated Rate	$0.25
Rate for Payer: Cash Price	$0.14
Rate for Payer: Cigna of CA HMO/PPO	$0.25
Rate for Payer: Health Smart Auto/Commercial	$0.19
Rate for Payer: LLUH Dept of Risk Management WC	$0.17
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$0.23

GEMTUZUMAB OZOGAMICIN 4.5 MG (1 MG/ML INITIAL CONCENTRATION) IV SOLN [219685]

Facility

$11,527.46

Service Code	CPT J9203
Hospital Charge Code	1755680
Hospital Revenue Code	636
Min. Negotiated Rate	$6,340.10
Max. Negotiated Rate	$8,645.60
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$6,916.48
Rate for Payer: Aetna of CA Government/Medicare	$6,916.48
Rate for Payer: Cash Price	$5,187.36
Rate for Payer: Health Smart Auto/Commercial	$6,916.48
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$6,916.48
Rate for Payer: LLUH Dept of Risk Management WC	$6,340.10
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$8,645.60

GEMTUZUMAB OZOGAMICIN 4.5 MG (1 MG/ML INITIAL CONCENTRATION) IV SOLN [219685]

Facility

$11,527.46

Service Code	CPT J9203
Hospital Charge Code	1755680
Hospital Revenue Code	636
Min. Negotiated Rate	$6,340.10
Max. Negotiated Rate	$9,221.97
Rate for Payer: Cash Price	$5,187.36
Rate for Payer: Cigna of CA HMO/PPO	$9,221.97
Rate for Payer: Health Smart Auto/Commercial	$6,916.48
Rate for Payer: LLUH Dept of Risk Management WC	$6,340.10
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$8,645.60

GENTAMICIN 0.1 % TOPICAL CREAM [3423]

Facility

$3.16

Service Code	NDC 45802-056-35
Hospital Charge Code	1743212
Hospital Revenue Code	259
Min. Negotiated Rate	$1.74
Max. Negotiated Rate	$2.37
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$1.90
Rate for Payer: Aetna of CA Government/Medicare	$1.90
Rate for Payer: Cash Price	$1.42
Rate for Payer: Health Smart Auto/Commercial	$1.90
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$1.90
Rate for Payer: LLUH Dept of Risk Management WC	$1.74
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$2.37

GENTAMICIN 0.1 % TOPICAL CREAM [3423]

Facility

$3.16

Service Code	NDC 0713-0683-15
Hospital Charge Code	1743212
Hospital Revenue Code	259
Min. Negotiated Rate	$1.74
Max. Negotiated Rate	$2.53
Rate for Payer: Cash Price	$1.42
Rate for Payer: Cigna of CA HMO/PPO	$2.53
Rate for Payer: Health Smart Auto/Commercial	$1.90
Rate for Payer: LLUH Dept of Risk Management WC	$1.74
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$2.37

GENTAMICIN 0.1 % TOPICAL CREAM [3423]

Facility

$3.16

Service Code	NDC 0713-0683-15
Hospital Charge Code	1743212
Hospital Revenue Code	259
Min. Negotiated Rate	$1.74
Max. Negotiated Rate	$2.37
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$1.90
Rate for Payer: Aetna of CA Government/Medicare	$1.90
Rate for Payer: Cash Price	$1.42
Rate for Payer: Health Smart Auto/Commercial	$1.90
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$1.90
Rate for Payer: LLUH Dept of Risk Management WC	$1.74
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$2.37

GENTAMICIN 0.1 % TOPICAL CREAM [3423]

Facility

$3.16

Service Code	NDC 0713-0683-31
Hospital Charge Code	NDG3423
Hospital Revenue Code	259
Min. Negotiated Rate	$1.74
Max. Negotiated Rate	$2.53
Rate for Payer: Cash Price	$1.42
Rate for Payer: Cigna of CA HMO/PPO	$2.53
Rate for Payer: Health Smart Auto/Commercial	$1.90
Rate for Payer: LLUH Dept of Risk Management WC	$1.74
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$2.37

GENTAMICIN 0.1 % TOPICAL CREAM [3423]

Facility

$3.16

Service Code	NDC 0713-0683-31
Hospital Charge Code	NDG3423
Hospital Revenue Code	259
Min. Negotiated Rate	$1.74
Max. Negotiated Rate	$2.37
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$1.90
Rate for Payer: Aetna of CA Government/Medicare	$1.90
Rate for Payer: Cash Price	$1.42
Rate for Payer: Health Smart Auto/Commercial	$1.90
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$1.90
Rate for Payer: LLUH Dept of Risk Management WC	$1.74
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$2.37

GENTAMICIN 0.1 % TOPICAL CREAM [3423]

Facility

$3.16

Service Code	NDC 45802-056-35
Hospital Charge Code	1743212
Hospital Revenue Code	259
Min. Negotiated Rate	$1.74
Max. Negotiated Rate	$2.53
Rate for Payer: Cash Price	$1.42
Rate for Payer: Cigna of CA HMO/PPO	$2.53
Rate for Payer: Health Smart Auto/Commercial	$1.90
Rate for Payer: LLUH Dept of Risk Management WC	$1.74
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$2.37

GENTAMICIN 0.1 % TOPICAL OINTMENT [3424]

Facility

$2.80

Service Code	NDC 52565-090-30
Hospital Charge Code	NDG3424
Hospital Revenue Code	259
Min. Negotiated Rate	$1.54
Max. Negotiated Rate	$2.10
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$1.68
Rate for Payer: Aetna of CA Government/Medicare	$1.68
Rate for Payer: Cash Price	$1.26
Rate for Payer: Health Smart Auto/Commercial	$1.68
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$1.68
Rate for Payer: LLUH Dept of Risk Management WC	$1.54
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$2.10

Know your out-of-pocket cost for care.

All Charges