Loma Linda University Behavioral Medicine Center (BMC)

All Charges

Charge

Type

Setting

Price

METHACHOLINE 0 MG TO 48 MG/3 ML (0 MG TO 16 MG/ML) NEBULIZATION SOLN [228989]

Facility

$9.00

Service Code	NDC 69374-542-06
Hospital Charge Code	901700029
Hospital Revenue Code	259
Min. Negotiated Rate	$4.95
Max. Negotiated Rate	$7.20
Rate for Payer: Cash Price	$4.95
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$7.20
Rate for Payer: Health Smart Auto/Commercial	$5.40
Rate for Payer: LLUH Dept of Risk Management WC	$4.95
Rate for Payer: Multiplan Commercial	$6.75

METHACHOLINE 0 MG TO 48 MG/3 ML (0 MG TO 16 MG/ML) NEBULIZATION SOLN [228989]

Facility

$9.00

Service Code	NDC 64281-110-05
Hospital Charge Code	901700029
Hospital Revenue Code	259
Min. Negotiated Rate	$4.95
Max. Negotiated Rate	$7.20
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$5.40
Rate for Payer: Aetna of CA Government/Medicare	$5.40
Rate for Payer: Cash Price	$4.95
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$7.20
Rate for Payer: Health Smart Auto/Commercial	$5.40
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$5.40
Rate for Payer: LLUH Dept of Risk Management WC	$4.95
Rate for Payer: Multiplan Commercial	$6.75

METHACHOLINE 0 MG TO 48 MG/3 ML (0 MG TO 16 MG/ML) NEBULIZATION SOLN [228989]

Facility

$9.00

Service Code	NDC 64281-110-06
Hospital Charge Code	901700029
Hospital Revenue Code	259
Min. Negotiated Rate	$4.95
Max. Negotiated Rate	$7.20
Rate for Payer: Cash Price	$4.95
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$7.20
Rate for Payer: Health Smart Auto/Commercial	$5.40
Rate for Payer: LLUH Dept of Risk Management WC	$4.95
Rate for Payer: Multiplan Commercial	$6.75

METHACHOLINE 0 MG TO 48 MG/3 ML (0 MG TO 16 MG/ML) NEBULIZATION SOLN [228989]

Facility

$9.00

Service Code	NDC 64281-110-05
Hospital Charge Code	901700029
Hospital Revenue Code	259
Min. Negotiated Rate	$4.95
Max. Negotiated Rate	$7.20
Rate for Payer: Cash Price	$4.95
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$7.20
Rate for Payer: Health Smart Auto/Commercial	$5.40
Rate for Payer: LLUH Dept of Risk Management WC	$4.95
Rate for Payer: Multiplan Commercial	$6.75

METHACHOLINE CHLORIDE 0.1875 MG/3 ML (0.0625 MG/ML) NEBULIZATION SOLN [229020]

Facility

$9.00

Service Code	NDC 64281-112-00
Min. Negotiated Rate	$4.95
Max. Negotiated Rate	$7.20
Rate for Payer: Cash Price	$4.95
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$7.20
Rate for Payer: Health Smart Auto/Commercial	$5.40
Rate for Payer: LLUH Dept of Risk Management WC	$4.95
Rate for Payer: Multiplan Commercial	$6.75

METHACHOLINE CHLORIDE 0.1875 MG/3 ML (0.0625 MG/ML) NEBULIZATION SOLN [229020]

Facility

$9.00

Service Code	NDC 64281-112-00
Min. Negotiated Rate	$4.95
Max. Negotiated Rate	$7.20
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$5.40
Rate for Payer: Aetna of CA Government/Medicare	$5.40
Rate for Payer: Cash Price	$4.95
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$7.20
Rate for Payer: Health Smart Auto/Commercial	$5.40
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$5.40
Rate for Payer: LLUH Dept of Risk Management WC	$4.95
Rate for Payer: Multiplan Commercial	$6.75

METHACHOLINE CHLORIDE 0.75 MG/3 ML (0.25 MG/ML) NEBULIZATION SOLUTION [229021]

Facility

$9.00

Service Code	NDC 64281-113-00
Min. Negotiated Rate	$4.95
Max. Negotiated Rate	$7.20
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$5.40
Rate for Payer: Aetna of CA Government/Medicare	$5.40
Rate for Payer: Cash Price	$4.95
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$7.20
Rate for Payer: Health Smart Auto/Commercial	$5.40
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$5.40
Rate for Payer: LLUH Dept of Risk Management WC	$4.95
Rate for Payer: Multiplan Commercial	$6.75

METHACHOLINE CHLORIDE 0.75 MG/3 ML (0.25 MG/ML) NEBULIZATION SOLUTION [229021]

Facility

$9.00

Service Code	NDC 64281-113-00
Min. Negotiated Rate	$4.95
Max. Negotiated Rate	$7.20
Rate for Payer: Cash Price	$4.95
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$7.20
Rate for Payer: Health Smart Auto/Commercial	$5.40
Rate for Payer: LLUH Dept of Risk Management WC	$4.95
Rate for Payer: Multiplan Commercial	$6.75

METHACHOLINE CHLORIDE 0 MG/3 ML (0 MG/ML) NEBULIZATION SOLUTION [229082]

Facility

$9.00

Service Code	NDC 64281-111-00
Min. Negotiated Rate	$4.95
Max. Negotiated Rate	$7.20
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$5.40
Rate for Payer: Aetna of CA Government/Medicare	$5.40
Rate for Payer: Cash Price	$4.95
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$7.20
Rate for Payer: Health Smart Auto/Commercial	$5.40
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$5.40
Rate for Payer: LLUH Dept of Risk Management WC	$4.95
Rate for Payer: Multiplan Commercial	$6.75

METHACHOLINE CHLORIDE 0 MG/3 ML (0 MG/ML) NEBULIZATION SOLUTION [229082]

Facility

$9.00

Service Code	NDC 64281-111-00
Min. Negotiated Rate	$4.95
Max. Negotiated Rate	$7.20
Rate for Payer: Cash Price	$4.95
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$7.20
Rate for Payer: Health Smart Auto/Commercial	$5.40
Rate for Payer: LLUH Dept of Risk Management WC	$4.95
Rate for Payer: Multiplan Commercial	$6.75

METHACHOLINE CHLORIDE 100 MG SOLUTION FOR INHALATION [27032]

Facility

$109.20

Service Code	HCPCS J7674
Hospital Charge Code	901700025
Hospital Revenue Code	636
Min. Negotiated Rate	$60.06
Max. Negotiated Rate	$87.36
Rate for Payer: Cash Price	$60.06
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$87.36
Rate for Payer: Health Smart Auto/Commercial	$65.52
Rate for Payer: LLUH Dept of Risk Management WC	$60.06
Rate for Payer: Multiplan Commercial	$81.90

METHACHOLINE CHLORIDE 100 MG SOLUTION FOR INHALATION [27032]

Facility

$109.20

Service Code	HCPCS J7674
Hospital Charge Code	901700025
Hospital Revenue Code	636
Min. Negotiated Rate	$60.06
Max. Negotiated Rate	$87.36
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$65.52
Rate for Payer: Aetna of CA Government/Medicare	$65.52
Rate for Payer: Cash Price	$60.06
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$87.36
Rate for Payer: Health Smart Auto/Commercial	$65.52
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$65.52
Rate for Payer: LLUH Dept of Risk Management WC	$60.06
Rate for Payer: Multiplan Commercial	$81.90

METHACHOLINE CHLORIDE 12 MG/3 ML (4 MG/ML) NEBULIZATION SOLUTION [229017]

Facility

$9.00

Service Code	NDC 64281-115-00
Min. Negotiated Rate	$4.95
Max. Negotiated Rate	$7.20
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$5.40
Rate for Payer: Aetna of CA Government/Medicare	$5.40
Rate for Payer: Cash Price	$4.95
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$7.20
Rate for Payer: Health Smart Auto/Commercial	$5.40
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$5.40
Rate for Payer: LLUH Dept of Risk Management WC	$4.95
Rate for Payer: Multiplan Commercial	$6.75

METHACHOLINE CHLORIDE 12 MG/3 ML (4 MG/ML) NEBULIZATION SOLUTION [229017]

Facility

$9.00

Service Code	NDC 64281-115-00
Min. Negotiated Rate	$4.95
Max. Negotiated Rate	$7.20
Rate for Payer: Cash Price	$4.95
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$7.20
Rate for Payer: Health Smart Auto/Commercial	$5.40
Rate for Payer: LLUH Dept of Risk Management WC	$4.95
Rate for Payer: Multiplan Commercial	$6.75

METHACHOLINE CHLORIDE 3 MG/3 ML (1 MG/ML) NEBULIZATION SOLUTION [229016]

Facility

$9.00

Service Code	NDC 64281-114-00
Min. Negotiated Rate	$4.95
Max. Negotiated Rate	$7.20
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$5.40
Rate for Payer: Aetna of CA Government/Medicare	$5.40
Rate for Payer: Cash Price	$4.95
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$7.20
Rate for Payer: Health Smart Auto/Commercial	$5.40
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$5.40
Rate for Payer: LLUH Dept of Risk Management WC	$4.95
Rate for Payer: Multiplan Commercial	$6.75

METHACHOLINE CHLORIDE 3 MG/3 ML (1 MG/ML) NEBULIZATION SOLUTION [229016]

Facility

$9.00

Service Code	NDC 64281-114-00
Min. Negotiated Rate	$4.95
Max. Negotiated Rate	$7.20
Rate for Payer: Cash Price	$4.95
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$7.20
Rate for Payer: Health Smart Auto/Commercial	$5.40
Rate for Payer: LLUH Dept of Risk Management WC	$4.95
Rate for Payer: Multiplan Commercial	$6.75

METHACHOLINE CHLORIDE 48 MG/3 ML (16 MG/ML) NEBULIZATION SOLUTION [229018]

Facility

$9.00

Service Code	NDC 64281-116-00
Min. Negotiated Rate	$4.95
Max. Negotiated Rate	$7.20
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$5.40
Rate for Payer: Aetna of CA Government/Medicare	$5.40
Rate for Payer: Cash Price	$4.95
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$7.20
Rate for Payer: Health Smart Auto/Commercial	$5.40
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$5.40
Rate for Payer: LLUH Dept of Risk Management WC	$4.95
Rate for Payer: Multiplan Commercial	$6.75

METHACHOLINE CHLORIDE 48 MG/3 ML (16 MG/ML) NEBULIZATION SOLUTION [229018]

Facility

$9.00

Service Code	NDC 64281-116-00
Min. Negotiated Rate	$4.95
Max. Negotiated Rate	$7.20
Rate for Payer: Cash Price	$4.95
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$7.20
Rate for Payer: Health Smart Auto/Commercial	$5.40
Rate for Payer: LLUH Dept of Risk Management WC	$4.95
Rate for Payer: Multiplan Commercial	$6.75

METHADONE 10 MG/5 ML ORAL SOLUTION [4951]

Facility

$0.13

Service Code	HCPCS S0109
Hospital Charge Code	901700032
Hospital Revenue Code	636
Min. Negotiated Rate	$0.07
Max. Negotiated Rate	$0.10
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$0.08
Rate for Payer: Aetna of CA Government/Medicare	$0.08
Rate for Payer: Cash Price	$0.07
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$0.10
Rate for Payer: Health Smart Auto/Commercial	$0.08
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$0.08
Rate for Payer: LLUH Dept of Risk Management WC	$0.07
Rate for Payer: Multiplan Commercial	$0.10

METHADONE 10 MG/5 ML ORAL SOLUTION [4951]

Facility

$0.13

Service Code	HCPCS S0109
Hospital Charge Code	901700032
Hospital Revenue Code	636
Min. Negotiated Rate	$0.07
Max. Negotiated Rate	$0.10
Rate for Payer: Cash Price	$0.07
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$0.10
Rate for Payer: Health Smart Auto/Commercial	$0.08
Rate for Payer: LLUH Dept of Risk Management WC	$0.07
Rate for Payer: Multiplan Commercial	$0.10

METHADONE 10 MG/ML INJECTION. [4081195]

Facility

$28.19

Service Code	HCPCS J1230
Hospital Charge Code	901700025
Hospital Revenue Code	636
Min. Negotiated Rate	$15.50
Max. Negotiated Rate	$22.55
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$16.91
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$12.96
Rate for Payer: Aetna of CA Government/Medicare	$12.96
Rate for Payer: Aetna of CA Government/Medicare	$16.91
Rate for Payer: Cash Price	$11.88
Rate for Payer: Cash Price	$15.50
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$22.55
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$17.28
Rate for Payer: Health Smart Auto/Commercial	$16.91
Rate for Payer: Health Smart Auto/Commercial	$12.96
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$12.96
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$16.91
Rate for Payer: LLUH Dept of Risk Management WC	$11.88
Rate for Payer: LLUH Dept of Risk Management WC	$15.50
Rate for Payer: Multiplan Commercial	$21.14
Rate for Payer: Multiplan Commercial	$16.20

METHADONE 10 MG/ML INJECTION. [4081195]

Facility

$21.60

Service Code	HCPCS J1230
Hospital Charge Code	901700025
Hospital Revenue Code	636
Min. Negotiated Rate	$11.88
Max. Negotiated Rate	$17.28
Rate for Payer: Cash Price	$11.88
Rate for Payer: Cash Price	$15.50
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$22.55
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$17.28
Rate for Payer: Health Smart Auto/Commercial	$12.96
Rate for Payer: Health Smart Auto/Commercial	$16.91
Rate for Payer: LLUH Dept of Risk Management WC	$11.88
Rate for Payer: LLUH Dept of Risk Management WC	$15.50
Rate for Payer: Multiplan Commercial	$16.20
Rate for Payer: Multiplan Commercial	$21.14

METHADONE 10 MG/ML INJECTION SOLUTION [10546]

Facility

$28.19

Service Code	HCPCS J1230
Hospital Charge Code	901700025
Hospital Revenue Code	636
Min. Negotiated Rate	$15.50
Max. Negotiated Rate	$22.55
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$16.91
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$14.76
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$15.39
Rate for Payer: Aetna of CA Government/Medicare	$14.76
Rate for Payer: Aetna of CA Government/Medicare	$16.91
Rate for Payer: Aetna of CA Government/Medicare	$15.39
Rate for Payer: Cash Price	$13.53
Rate for Payer: Cash Price	$15.50
Rate for Payer: Cash Price	$14.11
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$22.55
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$19.68
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$20.52
Rate for Payer: Health Smart Auto/Commercial	$14.76
Rate for Payer: Health Smart Auto/Commercial	$15.39
Rate for Payer: Health Smart Auto/Commercial	$16.91
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$15.39
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$14.76
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$16.91
Rate for Payer: LLUH Dept of Risk Management WC	$14.11
Rate for Payer: LLUH Dept of Risk Management WC	$13.53
Rate for Payer: LLUH Dept of Risk Management WC	$15.50
Rate for Payer: Multiplan Commercial	$18.45
Rate for Payer: Multiplan Commercial	$19.24
Rate for Payer: Multiplan Commercial	$21.14

METHADONE 10 MG/ML INJECTION SOLUTION [10546]

Facility

$28.19

Service Code	HCPCS J1230
Hospital Charge Code	901700025
Hospital Revenue Code	636
Min. Negotiated Rate	$15.50
Max. Negotiated Rate	$22.55
Rate for Payer: Cash Price	$15.50
Rate for Payer: Cash Price	$13.53
Rate for Payer: Cash Price	$14.11
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$20.52
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$22.55
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$19.68
Rate for Payer: Health Smart Auto/Commercial	$14.76
Rate for Payer: Health Smart Auto/Commercial	$15.39
Rate for Payer: Health Smart Auto/Commercial	$16.91
Rate for Payer: LLUH Dept of Risk Management WC	$15.50
Rate for Payer: LLUH Dept of Risk Management WC	$13.53
Rate for Payer: LLUH Dept of Risk Management WC	$14.11
Rate for Payer: Multiplan Commercial	$18.45
Rate for Payer: Multiplan Commercial	$19.24
Rate for Payer: Multiplan Commercial	$21.14

METHADONE 10 MG/ML INTRAVENOUS SYRINGE [153564]

Facility

$21.60

Service Code	HCPCS J1230
Hospital Charge Code	901700025
Hospital Revenue Code	636
Min. Negotiated Rate	$11.88
Max. Negotiated Rate	$17.28
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$12.96
Rate for Payer: Aetna of CA Government/Medicare	$12.96
Rate for Payer: Cash Price	$11.88
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$17.28
Rate for Payer: Health Smart Auto/Commercial	$12.96
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$12.96
Rate for Payer: LLUH Dept of Risk Management WC	$11.88
Rate for Payer: Multiplan Commercial	$16.20

Know your out-of-pocket cost for care.

All Charges