Loma Linda University Behavioral Medicine Center (BMC)

All Charges

Charge

Type

Setting

Price

LIDOCAINE (PF) 5 MG/ML (0.5 %) INJECTION SOLUTION [105635]

Facility

$0.10

Service Code	HCPCS J2003
Hospital Charge Code	901700025
Hospital Revenue Code	636
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

LIDOCAINE (PF) 8 MG/ML (0.8 %) IN 5 % DEXTROSE INTRAVENOUS SOLUTION [14869]

Facility

$0.04

Service Code	HCPCS J2002
Hospital Charge Code	901700025
Hospital Revenue Code	636
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

LIDOCAINE (PF) 8 MG/ML (0.8 %) IN 5 % DEXTROSE INTRAVENOUS SOLUTION [14869]

Facility

$0.04

Service Code	HCPCS J2002
Hospital Charge Code	901700025
Hospital Revenue Code	636
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

LIDOCAINE (PF) 8 MG/ML (0.8 %) IN 5 % DEXTROSE INTRAVENOUS SOLUTION - FOR PAIN (LLU) [408148692]

Facility

$0.04

Service Code	HCPCS J2002
Hospital Charge Code	901700025
Hospital Revenue Code	636
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

LIDOCAINE (PF) 8 MG/ML (0.8 %) IN 5 % DEXTROSE INTRAVENOUS SOLUTION - FOR PAIN (LLU) [408148692]

Facility

$0.04

Service Code	HCPCS J2002
Hospital Charge Code	901700025
Hospital Revenue Code	636
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

LIDOCAINE (PF) 8 MG/ML (0.8 %) IN 5 % DEXTROSE IV PEDS [4081321]

Facility

$0.04

Service Code	HCPCS J2002
Hospital Charge Code	901700025
Hospital Revenue Code	636
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

LIDOCAINE (PF) 8 MG/ML (0.8 %) IN 5 % DEXTROSE IV PEDS [4081321]

Facility

$0.04

Service Code	HCPCS J2002
Hospital Charge Code	901700025
Hospital Revenue Code	636
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

LIDOCAINE-PRILOCAINE 2.5 %-2.5 % TOPICAL CREAM [10434]

Facility

$0.60

Service Code	NDC 0168-0357-30
Hospital Charge Code	901700029
Hospital Revenue Code	259
Min. Negotiated Rate	$0.33
Max. Negotiated Rate	$0.48
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: Cash Price	$0.33
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$0.48
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: LLUH Dept of Risk Management WC	$0.33
Rate for Payer: Multiplan Commercial	$0.45

LIDOCAINE-PRILOCAINE 2.5 %-2.5 % TOPICAL CREAM [10434]

Facility

$0.60

Service Code	NDC 0168-0357-30
Hospital Charge Code	901700029
Hospital Revenue Code	259
Min. Negotiated Rate	$0.33
Max. Negotiated Rate	$0.48
Rate for Payer: Cash Price	$0.33
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$0.48
Rate for Payer: Health Smart Auto/Commercial	$0.36
Rate for Payer: LLUH Dept of Risk Management WC	$0.33
Rate for Payer: Multiplan Commercial	$0.45

LINACLOTIDE 145 MCG CAPSULE [199379]

Facility

$22.72

Service Code	NDC 0456-1201-30
Hospital Charge Code	901700029
Hospital Revenue Code	259
Min. Negotiated Rate	$12.50
Max. Negotiated Rate	$18.18
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$13.63
Rate for Payer: Aetna of CA Government/Medicare	$13.63
Rate for Payer: Cash Price	$12.50
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$18.18
Rate for Payer: Health Smart Auto/Commercial	$13.63
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$13.63
Rate for Payer: LLUH Dept of Risk Management WC	$12.50
Rate for Payer: Multiplan Commercial	$17.04

LINACLOTIDE 145 MCG CAPSULE [199379]

Facility

$22.72

Service Code	NDC 0456-1201-30
Hospital Charge Code	901700029
Hospital Revenue Code	259
Min. Negotiated Rate	$12.50
Max. Negotiated Rate	$18.18
Rate for Payer: Cash Price	$12.50
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$18.18
Rate for Payer: Health Smart Auto/Commercial	$13.63
Rate for Payer: LLUH Dept of Risk Management WC	$12.50
Rate for Payer: Multiplan Commercial	$17.04

LINEZOLID 100 MG/5 ML ORAL SUSPENSION [28225]

Facility

$2.69

Service Code	NDC 60687-754-05
Hospital Charge Code	901700029
Hospital Revenue Code	259
Min. Negotiated Rate	$1.48
Max. Negotiated Rate	$2.15
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$1.61
Rate for Payer: Aetna of CA Government/Medicare	$1.61
Rate for Payer: Cash Price	$1.48
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$2.15
Rate for Payer: Health Smart Auto/Commercial	$1.61
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$1.61
Rate for Payer: LLUH Dept of Risk Management WC	$1.48
Rate for Payer: Multiplan Commercial	$2.02

LINEZOLID 100 MG/5 ML ORAL SUSPENSION [28225]

Facility

$4.42

Service Code	NDC 31722-865-25
Hospital Charge Code	901700029
Hospital Revenue Code	259
Min. Negotiated Rate	$2.43
Max. Negotiated Rate	$3.54
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	$2.43
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$3.54
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 Commercial	$3.31

LINEZOLID 100 MG/5 ML ORAL SUSPENSION [28225]

Facility

$5.37

Service Code	NDC 0054-0319-50
Hospital Charge Code	901700029
Hospital Revenue Code	259
Min. Negotiated Rate	$2.95
Max. Negotiated Rate	$4.30
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$3.22
Rate for Payer: Aetna of CA Government/Medicare	$3.22
Rate for Payer: Cash Price	$2.96
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$4.30
Rate for Payer: Health Smart Auto/Commercial	$3.22
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$3.22
Rate for Payer: LLUH Dept of Risk Management WC	$2.95
Rate for Payer: Multiplan Commercial	$4.03

LINEZOLID 100 MG/5 ML ORAL SUSPENSION [28225]

Facility

$4.42

Service Code	NDC 31722-865-25
Hospital Charge Code	901700029
Hospital Revenue Code	259
Min. Negotiated Rate	$2.43
Max. Negotiated Rate	$3.54
Rate for Payer: Cash Price	$2.43
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$3.54
Rate for Payer: Health Smart Auto/Commercial	$2.65
Rate for Payer: LLUH Dept of Risk Management WC	$2.43
Rate for Payer: Multiplan Commercial	$3.31

LINEZOLID 100 MG/5 ML ORAL SUSPENSION [28225]

Facility

$5.37

Service Code	NDC 0054-0319-50
Hospital Charge Code	901700029
Hospital Revenue Code	259
Min. Negotiated Rate	$2.95
Max. Negotiated Rate	$4.30
Rate for Payer: Cash Price	$2.96
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$4.30
Rate for Payer: Health Smart Auto/Commercial	$3.22
Rate for Payer: LLUH Dept of Risk Management WC	$2.95
Rate for Payer: Multiplan Commercial	$4.03

LINEZOLID 100 MG/5 ML ORAL SUSPENSION [28225]

Facility

$2.69

Service Code	NDC 60687-754-05
Hospital Charge Code	901700029
Hospital Revenue Code	259
Min. Negotiated Rate	$1.48
Max. Negotiated Rate	$2.15
Rate for Payer: Cash Price	$1.48
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$2.15
Rate for Payer: Health Smart Auto/Commercial	$1.61
Rate for Payer: LLUH Dept of Risk Management WC	$1.48
Rate for Payer: Multiplan Commercial	$2.02

LINEZOLID 600 MG/300 ML IN 0.9 % SODIUM CHLORIDE INTRAVENOUS PIGGYBACK [210366]

Facility

$0.28

Service Code	HCPCS J2021
Hospital Charge Code	901700025
Hospital Revenue Code	636
Min. Negotiated Rate	$0.15
Max. Negotiated Rate	$0.22
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$0.17
Rate for Payer: Aetna of CA Government/Medicare	$0.17
Rate for Payer: Cash Price	$0.15
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$0.22
Rate for Payer: Health Smart Auto/Commercial	$0.17
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$0.17
Rate for Payer: LLUH Dept of Risk Management WC	$0.15
Rate for Payer: Multiplan Commercial	$0.21

LINEZOLID 600 MG/300 ML IN 0.9 % SODIUM CHLORIDE INTRAVENOUS PIGGYBACK [210366]

Facility

$0.28

Service Code	HCPCS J2021
Hospital Charge Code	901700025
Hospital Revenue Code	636
Min. Negotiated Rate	$0.15
Max. Negotiated Rate	$0.22
Rate for Payer: Cash Price	$0.15
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$0.22
Rate for Payer: Health Smart Auto/Commercial	$0.17
Rate for Payer: LLUH Dept of Risk Management WC	$0.15
Rate for Payer: Multiplan Commercial	$0.21

LINEZOLID 600 MG TABLET [28224]

Facility

$7.05

Service Code	NDC 31722-749-20
Hospital Charge Code	901700029
Hospital Revenue Code	259
Min. Negotiated Rate	$3.88
Max. Negotiated Rate	$5.64
Rate for Payer: Cash Price	$3.88
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$5.64
Rate for Payer: Health Smart Auto/Commercial	$4.23
Rate for Payer: LLUH Dept of Risk Management WC	$3.88
Rate for Payer: Multiplan Commercial	$5.29

LINEZOLID 600 MG TABLET [28224]

Facility

$4.20

Service Code	NDC 67877-419-84
Hospital Charge Code	901700029
Hospital Revenue Code	259
Min. Negotiated Rate	$2.31
Max. Negotiated Rate	$3.36
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$2.52
Rate for Payer: Aetna of CA Government/Medicare	$2.52
Rate for Payer: Cash Price	$2.31
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$3.36
Rate for Payer: Health Smart Auto/Commercial	$2.52
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$2.52
Rate for Payer: LLUH Dept of Risk Management WC	$2.31
Rate for Payer: Multiplan Commercial	$3.15

LINEZOLID 600 MG TABLET [28224]

Facility

$7.40

Service Code	NDC 60687-309-11
Hospital Charge Code	901700029
Hospital Revenue Code	259
Min. Negotiated Rate	$4.07
Max. Negotiated Rate	$5.92
Rate for Payer: Cash Price	$4.07
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$5.92
Rate for Payer: Health Smart Auto/Commercial	$4.44
Rate for Payer: LLUH Dept of Risk Management WC	$4.07
Rate for Payer: Multiplan Commercial	$5.55

LINEZOLID 600 MG TABLET [28224]

Facility

$7.43

Service Code	NDC 0904-6553-04
Hospital Charge Code	901700029
Hospital Revenue Code	259
Min. Negotiated Rate	$4.09
Max. Negotiated Rate	$5.94
Rate for Payer: Cash Price	$4.09
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$5.94
Rate for Payer: Health Smart Auto/Commercial	$4.46
Rate for Payer: LLUH Dept of Risk Management WC	$4.09
Rate for Payer: Multiplan Commercial	$5.57

LINEZOLID 600 MG TABLET [28224]

Facility

$7.43

Service Code	NDC 0904-6553-04
Hospital Charge Code	901700029
Hospital Revenue Code	259
Min. Negotiated Rate	$4.09
Max. Negotiated Rate	$5.94
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$4.46
Rate for Payer: Aetna of CA Government/Medicare	$4.46
Rate for Payer: Cash Price	$4.09
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$5.94
Rate for Payer: Health Smart Auto/Commercial	$4.46
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$4.46
Rate for Payer: LLUH Dept of Risk Management WC	$4.09
Rate for Payer: Multiplan Commercial	$5.57

LINEZOLID 600 MG TABLET [28224]

Facility

$4.20

Service Code	NDC 67877-419-84
Hospital Charge Code	901700029
Hospital Revenue Code	259
Min. Negotiated Rate	$2.31
Max. Negotiated Rate	$3.36
Rate for Payer: Cash Price	$2.31
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$3.36
Rate for Payer: Health Smart Auto/Commercial	$2.52
Rate for Payer: LLUH Dept of Risk Management WC	$2.31
Rate for Payer: Multiplan Commercial	$3.15

Know your out-of-pocket cost for care.

All Charges