Loma Linda University Behavioral Medicine Center (BMC)

All Charges

Charge

Type

Setting

Price

LAMOTRIGINE 25 MG TABLET [13981]

Facility

$0.05

Service Code	NDC 62332-037-31
Hospital Charge Code	901700029
Hospital Revenue Code	259
Min. Negotiated Rate	$0.03
Max. Negotiated Rate	$0.04
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$0.03
Rate for Payer: Aetna of CA Government/Medicare	$0.03
Rate for Payer: Cash Price	$0.03
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$0.04
Rate for Payer: Health Smart Auto/Commercial	$0.03
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$0.03
Rate for Payer: LLUH Dept of Risk Management WC	$0.03
Rate for Payer: Multiplan Commercial	$0.04

LAMOTRIGINE 50 MG DISINTEGRATING TABLET [96940]

Facility

$6.36

Service Code	NDC 27241-184-30
Hospital Charge Code	901700029
Hospital Revenue Code	259
Min. Negotiated Rate	$3.50
Max. Negotiated Rate	$5.09
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$3.82
Rate for Payer: Aetna of CA Government/Medicare	$3.82
Rate for Payer: Cash Price	$3.50
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$5.09
Rate for Payer: Health Smart Auto/Commercial	$3.82
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$3.82
Rate for Payer: LLUH Dept of Risk Management WC	$3.50
Rate for Payer: Multiplan Commercial	$4.77

LAMOTRIGINE 50 MG DISINTEGRATING TABLET [96940]

Facility

$6.41

Service Code	NDC 43598-551-30
Hospital Charge Code	901700029
Hospital Revenue Code	259
Min. Negotiated Rate	$3.53
Max. Negotiated Rate	$5.13
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$3.85
Rate for Payer: Aetna of CA Government/Medicare	$3.85
Rate for Payer: Cash Price	$3.52
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$5.13
Rate for Payer: Health Smart Auto/Commercial	$3.85
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$3.85
Rate for Payer: LLUH Dept of Risk Management WC	$3.53
Rate for Payer: Multiplan Commercial	$4.81

LAMOTRIGINE 50 MG DISINTEGRATING TABLET [96940]

Facility

$6.41

Service Code	NDC 43598-551-30
Hospital Charge Code	901700029
Hospital Revenue Code	259
Min. Negotiated Rate	$3.53
Max. Negotiated Rate	$5.13
Rate for Payer: Cash Price	$3.52
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$5.13
Rate for Payer: Health Smart Auto/Commercial	$3.85
Rate for Payer: LLUH Dept of Risk Management WC	$3.53
Rate for Payer: Multiplan Commercial	$4.81

LAMOTRIGINE 50 MG DISINTEGRATING TABLET [96940]

Facility

$6.36

Service Code	NDC 27241-184-30
Hospital Charge Code	901700029
Hospital Revenue Code	259
Min. Negotiated Rate	$3.50
Max. Negotiated Rate	$5.09
Rate for Payer: Cash Price	$3.50
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$5.09
Rate for Payer: Health Smart Auto/Commercial	$3.82
Rate for Payer: LLUH Dept of Risk Management WC	$3.50
Rate for Payer: Multiplan Commercial	$4.77

LAMOTRIGINE 5 MG CHEWABLE DISPERSIBLE TABLET [104568]

Facility

$11.42

Service Code	NDC 0173-0526-00
Hospital Charge Code	901700029
Hospital Revenue Code	259
Min. Negotiated Rate	$6.28
Max. Negotiated Rate	$9.14
Rate for Payer: Cash Price	$6.28
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$9.14
Rate for Payer: Health Smart Auto/Commercial	$6.85
Rate for Payer: LLUH Dept of Risk Management WC	$6.28
Rate for Payer: Multiplan Commercial	$8.56

LAMOTRIGINE 5 MG CHEWABLE DISPERSIBLE TABLET [104568]

Facility

$11.42

Service Code	NDC 0173-0526-00
Hospital Charge Code	901700029
Hospital Revenue Code	259
Min. Negotiated Rate	$6.28
Max. Negotiated Rate	$9.14
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$6.85
Rate for Payer: Aetna of CA Government/Medicare	$6.85
Rate for Payer: Cash Price	$6.28
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$9.14
Rate for Payer: Health Smart Auto/Commercial	$6.85
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$6.85
Rate for Payer: LLUH Dept of Risk Management WC	$6.28
Rate for Payer: Multiplan Commercial	$8.56

LANOLIN ALCOHOLS-MINERAL OIL-W.PETROLATUM-CERESIN TOPICAL CREAM [120012]

Facility

$0.08

Service Code	NDC 7214000022
Hospital Charge Code	901700029
Hospital Revenue Code	259
Min. Negotiated Rate	$0.04
Max. Negotiated Rate	$0.06
Rate for Payer: Cash Price	$0.04
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$0.06
Rate for Payer: Health Smart Auto/Commercial	$0.05
Rate for Payer: LLUH Dept of Risk Management WC	$0.04
Rate for Payer: Multiplan Commercial	$0.06

LANOLIN ALCOHOLS-MINERAL OIL-W.PETROLATUM-CERESIN TOPICAL CREAM [120012]

Facility

$0.10

Service Code	NDC 7214003868
Hospital Charge Code	901700029
Hospital Revenue Code	259
Min. Negotiated Rate	$0.06
Max. Negotiated Rate	$0.08
Rate for Payer: Cash Price	$0.06
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$0.08
Rate for Payer: Health Smart Auto/Commercial	$0.06
Rate for Payer: LLUH Dept of Risk Management WC	$0.06
Rate for Payer: Multiplan Commercial	$0.08

LANOLIN ALCOHOLS-MINERAL OIL-W.PETROLATUM-CERESIN TOPICAL CREAM [120012]

Facility

$0.08

Service Code	NDC 7214000022
Hospital Charge Code	901700029
Hospital Revenue Code	259
Min. Negotiated Rate	$0.04
Max. Negotiated Rate	$0.06
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$0.05
Rate for Payer: Aetna of CA Government/Medicare	$0.05
Rate for Payer: Cash Price	$0.04
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$0.06
Rate for Payer: Health Smart Auto/Commercial	$0.05
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$0.05
Rate for Payer: LLUH Dept of Risk Management WC	$0.04
Rate for Payer: Multiplan Commercial	$0.06

LANOLIN ALCOHOLS-MINERAL OIL-W.PETROLATUM-CERESIN TOPICAL CREAM [120012]

Facility

$0.10

Service Code	NDC 7214003868
Hospital Charge Code	901700029
Hospital Revenue Code	259
Min. Negotiated Rate	$0.06
Max. Negotiated Rate	$0.08
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$0.06
Rate for Payer: Aetna of CA Government/Medicare	$0.06
Rate for Payer: Cash Price	$0.06
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$0.08
Rate for Payer: Health Smart Auto/Commercial	$0.06
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$0.06
Rate for Payer: LLUH Dept of Risk Management WC	$0.06
Rate for Payer: Multiplan Commercial	$0.08

LANOLIN-MINERAL OIL LOTION [2787]

Facility

$0.04

Service Code	NDC 7214011019
Hospital Charge Code	901700029
Hospital Revenue Code	259
Min. Negotiated Rate	$0.02
Max. Negotiated Rate	$0.03
Rate for Payer: Cash Price	$0.02
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$0.03
Rate for Payer: Health Smart Auto/Commercial	$0.02
Rate for Payer: LLUH Dept of Risk Management WC	$0.02
Rate for Payer: Multiplan Commercial	$0.03

LANOLIN-MINERAL OIL LOTION [2787]

Facility

$0.04

Service Code	NDC 7214011019
Hospital Charge Code	901700029
Hospital Revenue Code	259
Min. Negotiated Rate	$0.02
Max. Negotiated Rate	$0.03
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$0.02
Rate for Payer: Aetna of CA Government/Medicare	$0.02
Rate for Payer: Cash Price	$0.02
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$0.03
Rate for Payer: Health Smart Auto/Commercial	$0.02
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$0.02
Rate for Payer: LLUH Dept of Risk Management WC	$0.02
Rate for Payer: Multiplan Commercial	$0.03

LANSOPRAZOLE 15 MG CAPSULE,DELAYED RELEASE [27691]

Facility

$3.65

Service Code	NDC 60687-111-21
Hospital Charge Code	901700029
Hospital Revenue Code	259
Min. Negotiated Rate	$2.01
Max. Negotiated Rate	$2.92
Rate for Payer: Cash Price	$2.01
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$2.92
Rate for Payer: Health Smart Auto/Commercial	$2.19
Rate for Payer: LLUH Dept of Risk Management WC	$2.01
Rate for Payer: Multiplan Commercial	$2.74

LANSOPRAZOLE 15 MG CAPSULE,DELAYED RELEASE [27691]

Facility

$3.65

Service Code	NDC 60687-111-11
Hospital Charge Code	901700029
Hospital Revenue Code	259
Min. Negotiated Rate	$2.01
Max. Negotiated Rate	$2.92
Rate for Payer: Cash Price	$2.01
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$2.92
Rate for Payer: Health Smart Auto/Commercial	$2.19
Rate for Payer: LLUH Dept of Risk Management WC	$2.01
Rate for Payer: Multiplan Commercial	$2.74

LANSOPRAZOLE 15 MG CAPSULE,DELAYED RELEASE [27691]

Facility

$3.65

Service Code	NDC 60687-111-21
Hospital Charge Code	901700029
Hospital Revenue Code	259
Min. Negotiated Rate	$2.01
Max. Negotiated Rate	$2.92
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$2.19
Rate for Payer: Aetna of CA Government/Medicare	$2.19
Rate for Payer: Cash Price	$2.01
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$2.92
Rate for Payer: Health Smart Auto/Commercial	$2.19
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$2.19
Rate for Payer: LLUH Dept of Risk Management WC	$2.01
Rate for Payer: Multiplan Commercial	$2.74

LANSOPRAZOLE 15 MG CAPSULE,DELAYED RELEASE [27691]

Facility

$3.65

Service Code	NDC 60687-111-11
Hospital Charge Code	901700029
Hospital Revenue Code	259
Min. Negotiated Rate	$2.01
Max. Negotiated Rate	$2.92
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$2.19
Rate for Payer: Aetna of CA Government/Medicare	$2.19
Rate for Payer: Cash Price	$2.01
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$2.92
Rate for Payer: Health Smart Auto/Commercial	$2.19
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$2.19
Rate for Payer: LLUH Dept of Risk Management WC	$2.01
Rate for Payer: Multiplan Commercial	$2.74

LANSOPRAZOLE 30 MG DELAYED RELEASE,DISINTEGRATING TABLET [34595]

Facility

$16.60

Service Code	NDC 64764-544-11
Hospital Charge Code	901700029
Hospital Revenue Code	259
Min. Negotiated Rate	$9.13
Max. Negotiated Rate	$13.28
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$9.96
Rate for Payer: Aetna of CA Government/Medicare	$9.96
Rate for Payer: Cash Price	$9.13
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$13.28
Rate for Payer: Health Smart Auto/Commercial	$9.96
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$9.96
Rate for Payer: LLUH Dept of Risk Management WC	$9.13
Rate for Payer: Multiplan Commercial	$12.45

LANSOPRAZOLE 30 MG DELAYED RELEASE,DISINTEGRATING TABLET [34595]

Facility

$16.60

Service Code	NDC 64764-544-11
Hospital Charge Code	901700029
Hospital Revenue Code	259
Min. Negotiated Rate	$9.13
Max. Negotiated Rate	$13.28
Rate for Payer: Cash Price	$9.13
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$13.28
Rate for Payer: Health Smart Auto/Commercial	$9.96
Rate for Payer: LLUH Dept of Risk Management WC	$9.13
Rate for Payer: Multiplan Commercial	$12.45

LANSOPRAZOLE ORAL SUSPENSION COMPOUND 3 MG/ML [4080290]

Facility

$0.57

Service Code	NDC 9994-0802-90
Hospital Charge Code	901700029
Hospital Revenue Code	259
Min. Negotiated Rate	$0.31
Max. Negotiated Rate	$0.46
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	$0.31
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$0.46
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 Commercial	$0.43

LANSOPRAZOLE ORAL SUSPENSION COMPOUND 3 MG/ML [4080290]

Facility

$0.57

Service Code	NDC 9994-0802-90
Hospital Charge Code	901700029
Hospital Revenue Code	259
Min. Negotiated Rate	$0.31
Max. Negotiated Rate	$0.46
Rate for Payer: Cash Price	$0.31
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO 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 Commercial	$0.43

LANTHANUM 1,000 MG CHEWABLE TABLET [43548]

Facility

$12.95

Service Code	NDC 66993-424-85
Hospital Charge Code	901700025
Hospital Revenue Code	636
Min. Negotiated Rate	$7.12
Max. Negotiated Rate	$10.36
Rate for Payer: Cash Price	$7.12
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$10.36
Rate for Payer: Health Smart Auto/Commercial	$7.77
Rate for Payer: LLUH Dept of Risk Management WC	$7.12
Rate for Payer: Multiplan Commercial	$9.71

LANTHANUM 1,000 MG CHEWABLE TABLET [43548]

Facility

$12.95

Service Code	NDC 66993-424-75
Hospital Charge Code	901700025
Hospital Revenue Code	636
Min. Negotiated Rate	$7.12
Max. Negotiated Rate	$10.36
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$7.77
Rate for Payer: Aetna of CA Government/Medicare	$7.77
Rate for Payer: Cash Price	$7.12
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$10.36
Rate for Payer: Health Smart Auto/Commercial	$7.77
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$7.77
Rate for Payer: LLUH Dept of Risk Management WC	$7.12
Rate for Payer: Multiplan Commercial	$9.71

LANTHANUM 1,000 MG CHEWABLE TABLET [43548]

Facility

$6.67

Service Code	NDC 68180-821-10
Hospital Charge Code	901700025
Hospital Revenue Code	636
Min. Negotiated Rate	$3.67
Max. Negotiated Rate	$5.34
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$4.00
Rate for Payer: Aetna of CA Government/Medicare	$4.00
Rate for Payer: Cash Price	$3.67
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$5.34
Rate for Payer: Health Smart Auto/Commercial	$4.00
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$4.00
Rate for Payer: LLUH Dept of Risk Management WC	$3.67
Rate for Payer: Multiplan Commercial	$5.00

LANTHANUM 1,000 MG CHEWABLE TABLET [43548]

Facility

$6.67

Service Code	NDC 68180-821-10
Hospital Charge Code	901700025
Hospital Revenue Code	636
Min. Negotiated Rate	$3.67
Max. Negotiated Rate	$5.34
Rate for Payer: Cash Price	$3.67
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$5.34
Rate for Payer: Health Smart Auto/Commercial	$4.00
Rate for Payer: LLUH Dept of Risk Management WC	$3.67
Rate for Payer: Multiplan Commercial	$5.00

Know your out-of-pocket cost for care.

All Charges