Loma Linda University Behavioral Medicine Center (BMC)

All Charges

Charge

Type

Setting

Price

METHYLCELLULOSE (BULK) 1 % GEL [82599]

Facility

$0.04

Service Code	NDC 38779-30608
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

METHYLDOPA 250 MG TABLET [4982]

Facility

$0.22

Service Code	NDC 51079-200-01
Hospital Charge Code	901700029
Hospital Revenue Code	259
Min. Negotiated Rate	$0.12
Max. Negotiated Rate	$0.18
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	$0.12
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$0.18
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 Commercial	$0.17

METHYLDOPA 250 MG TABLET [4982]

Facility

$0.22

Service Code	NDC 51079-200-01
Hospital Charge Code	901700029
Hospital Revenue Code	259
Min. Negotiated Rate	$0.12
Max. Negotiated Rate	$0.18
Rate for Payer: Cash Price	$0.12
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$0.18
Rate for Payer: Health Smart Auto/Commercial	$0.13
Rate for Payer: LLUH Dept of Risk Management WC	$0.12
Rate for Payer: Multiplan Commercial	$0.17

METHYLDOPA ORAL SUSPENSION COMPOUND 50 MG/ML [4080300]

Facility

$1.54

Service Code	NDC 9994-0803-00
Hospital Charge Code	901700029
Hospital Revenue Code	259
Min. Negotiated Rate	$0.85
Max. Negotiated Rate	$1.23
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$0.92
Rate for Payer: Aetna of CA Government/Medicare	$0.92
Rate for Payer: Cash Price	$0.85
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$1.23
Rate for Payer: Health Smart Auto/Commercial	$0.92
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$0.92
Rate for Payer: LLUH Dept of Risk Management WC	$0.85
Rate for Payer: Multiplan Commercial	$1.16

METHYLDOPA ORAL SUSPENSION COMPOUND 50 MG/ML [4080300]

Facility

$1.54

Service Code	NDC 9994-0803-00
Hospital Charge Code	901700029
Hospital Revenue Code	259
Min. Negotiated Rate	$0.85
Max. Negotiated Rate	$1.23
Rate for Payer: Cash Price	$0.85
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$1.23
Rate for Payer: Health Smart Auto/Commercial	$0.92
Rate for Payer: LLUH Dept of Risk Management WC	$0.85
Rate for Payer: Multiplan Commercial	$1.16

METHYLENE BLUE (ANTIDOTE) 1 % (10 MG/ML) INTRAVENOUS SOLUTION [4985]

Facility

$25.20

Service Code	HCPCS Q9968
Hospital Charge Code	901700025
Hospital Revenue Code	636
Min. Negotiated Rate	$13.86
Max. Negotiated Rate	$20.16
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$15.12
Rate for Payer: Aetna of CA Government/Medicare	$15.12
Rate for Payer: Cash Price	$13.86
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$20.16
Rate for Payer: Health Smart Auto/Commercial	$15.12
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$15.12
Rate for Payer: LLUH Dept of Risk Management WC	$13.86
Rate for Payer: Multiplan Commercial	$18.90

METHYLENE BLUE (ANTIDOTE) 1 % (10 MG/ML) INTRAVENOUS SOLUTION [4985]

Facility

$25.20

Service Code	HCPCS Q9968
Hospital Charge Code	901700025
Hospital Revenue Code	636
Min. Negotiated Rate	$13.86
Max. Negotiated Rate	$20.16
Rate for Payer: Cash Price	$13.86
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$20.16
Rate for Payer: Health Smart Auto/Commercial	$15.12
Rate for Payer: LLUH Dept of Risk Management WC	$13.86
Rate for Payer: Multiplan Commercial	$18.90

METHYLENE BLUE (ANTIDOTE) 5 MG/ML INTRAVENOUS SOLUTION [215473]

Facility

$16.20

Service Code	HCPCS Q9968
Hospital Charge Code	901700025
Hospital Revenue Code	636
Min. Negotiated Rate	$8.91
Max. Negotiated Rate	$12.96
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$9.72
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$16.88
Rate for Payer: Aetna of CA Government/Medicare	$9.72
Rate for Payer: Aetna of CA Government/Medicare	$16.88
Rate for Payer: Cash Price	$8.91
Rate for Payer: Cash Price	$15.47
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$12.96
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$22.50
Rate for Payer: Health Smart Auto/Commercial	$9.72
Rate for Payer: Health Smart Auto/Commercial	$16.88
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$9.72
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$16.88
Rate for Payer: LLUH Dept of Risk Management WC	$15.47
Rate for Payer: LLUH Dept of Risk Management WC	$8.91
Rate for Payer: Multiplan Commercial	$12.15
Rate for Payer: Multiplan Commercial	$21.10

METHYLENE BLUE (ANTIDOTE) 5 MG/ML INTRAVENOUS SOLUTION [215473]

Facility

$16.20

Service Code	HCPCS Q9968
Hospital Charge Code	901700025
Hospital Revenue Code	636
Min. Negotiated Rate	$8.91
Max. Negotiated Rate	$12.96
Rate for Payer: Cash Price	$8.91
Rate for Payer: Cash Price	$15.47
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$12.96
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$22.50
Rate for Payer: Health Smart Auto/Commercial	$9.72
Rate for Payer: Health Smart Auto/Commercial	$16.88
Rate for Payer: LLUH Dept of Risk Management WC	$15.47
Rate for Payer: LLUH Dept of Risk Management WC	$8.91
Rate for Payer: Multiplan Commercial	$12.15
Rate for Payer: Multiplan Commercial	$21.10

METHYLERGONOVINE 0.2 MG/ML (1 ML) INJECTION SOLUTION [10571]

Facility

$37.54

Service Code	HCPCS J2210
Hospital Charge Code	901700025
Hospital Revenue Code	636
Min. Negotiated Rate	$20.65
Max. Negotiated Rate	$30.03
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$22.52
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$14.23
Rate for Payer: Aetna of CA Government/Medicare	$22.52
Rate for Payer: Aetna of CA Government/Medicare	$14.23
Rate for Payer: Cash Price	$20.64
Rate for Payer: Cash Price	$13.04
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$30.03
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$18.97
Rate for Payer: Health Smart Auto/Commercial	$14.23
Rate for Payer: Health Smart Auto/Commercial	$22.52
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$22.52
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$14.23
Rate for Payer: LLUH Dept of Risk Management WC	$13.04
Rate for Payer: LLUH Dept of Risk Management WC	$20.65
Rate for Payer: Multiplan Commercial	$28.16
Rate for Payer: Multiplan Commercial	$17.78

METHYLERGONOVINE 0.2 MG/ML (1 ML) INJECTION SOLUTION [10571]

Facility

$23.71

Service Code	HCPCS J2210
Hospital Charge Code	901700025
Hospital Revenue Code	636
Min. Negotiated Rate	$13.04
Max. Negotiated Rate	$18.97
Rate for Payer: Cash Price	$13.04
Rate for Payer: Cash Price	$20.64
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$30.03
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$18.97
Rate for Payer: Health Smart Auto/Commercial	$14.23
Rate for Payer: Health Smart Auto/Commercial	$22.52
Rate for Payer: LLUH Dept of Risk Management WC	$13.04
Rate for Payer: LLUH Dept of Risk Management WC	$20.65
Rate for Payer: Multiplan Commercial	$17.78
Rate for Payer: Multiplan Commercial	$28.16

METHYLERGONOVINE 0.2 MG TABLET [10572]

Facility

$23.83

Service Code	NDC 0093-3655-28
Hospital Charge Code	901700029
Hospital Revenue Code	259
Min. Negotiated Rate	$13.11
Max. Negotiated Rate	$19.06
Rate for Payer: Cash Price	$13.11
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$19.06
Rate for Payer: Health Smart Auto/Commercial	$14.30
Rate for Payer: LLUH Dept of Risk Management WC	$13.11
Rate for Payer: Multiplan Commercial	$17.87

METHYLERGONOVINE 0.2 MG TABLET [10572]

Facility

$23.83

Service Code	NDC 0093-3655-28
Hospital Charge Code	901700029
Hospital Revenue Code	259
Min. Negotiated Rate	$13.11
Max. Negotiated Rate	$19.06
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$14.30
Rate for Payer: Aetna of CA Government/Medicare	$14.30
Rate for Payer: Cash Price	$13.11
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$19.06
Rate for Payer: Health Smart Auto/Commercial	$14.30
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$14.30
Rate for Payer: LLUH Dept of Risk Management WC	$13.11
Rate for Payer: Multiplan Commercial	$17.87

METHYLERGONOVINE 0.2 MG TABLET [10572]

Facility

$16.83

Service Code	NDC 70010-786-12
Hospital Charge Code	901700029
Hospital Revenue Code	259
Min. Negotiated Rate	$9.26
Max. Negotiated Rate	$13.46
Rate for Payer: Cash Price	$9.26
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$13.46
Rate for Payer: Health Smart Auto/Commercial	$10.10
Rate for Payer: LLUH Dept of Risk Management WC	$9.26
Rate for Payer: Multiplan Commercial	$12.62

METHYLERGONOVINE 0.2 MG TABLET [10572]

Facility

$19.80

Service Code	NDC 69238-1605-8
Hospital Charge Code	901700029
Hospital Revenue Code	259
Min. Negotiated Rate	$10.89
Max. Negotiated Rate	$15.84
Rate for Payer: Cash Price	$10.89
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$15.84
Rate for Payer: Health Smart Auto/Commercial	$11.88
Rate for Payer: LLUH Dept of Risk Management WC	$10.89
Rate for Payer: Multiplan Commercial	$14.85

METHYLERGONOVINE 0.2 MG TABLET [10572]

Facility

$16.83

Service Code	NDC 70010-786-12
Hospital Charge Code	901700029
Hospital Revenue Code	259
Min. Negotiated Rate	$9.26
Max. Negotiated Rate	$13.46
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$10.10
Rate for Payer: Aetna of CA Government/Medicare	$10.10
Rate for Payer: Cash Price	$9.26
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$13.46
Rate for Payer: Health Smart Auto/Commercial	$10.10
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$10.10
Rate for Payer: LLUH Dept of Risk Management WC	$9.26
Rate for Payer: Multiplan Commercial	$12.62

METHYLERGONOVINE 0.2 MG TABLET [10572]

Facility

$19.80

Service Code	NDC 69238-1605-2
Hospital Charge Code	901700029
Hospital Revenue Code	259
Min. Negotiated Rate	$10.89
Max. Negotiated Rate	$15.84
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$11.88
Rate for Payer: Aetna of CA Government/Medicare	$11.88
Rate for Payer: Cash Price	$10.89
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$15.84
Rate for Payer: Health Smart Auto/Commercial	$11.88
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$11.88
Rate for Payer: LLUH Dept of Risk Management WC	$10.89
Rate for Payer: Multiplan Commercial	$14.85

METHYLERGONOVINE 0.2 MG TABLET [10572]

Facility

$19.80

Service Code	NDC 69238-1605-8
Hospital Charge Code	901700029
Hospital Revenue Code	259
Min. Negotiated Rate	$10.89
Max. Negotiated Rate	$15.84
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$11.88
Rate for Payer: Aetna of CA Government/Medicare	$11.88
Rate for Payer: Cash Price	$10.89
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$15.84
Rate for Payer: Health Smart Auto/Commercial	$11.88
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$11.88
Rate for Payer: LLUH Dept of Risk Management WC	$10.89
Rate for Payer: Multiplan Commercial	$14.85

METHYLERGONOVINE 0.2 MG TABLET [10572]

Facility

$19.80

Service Code	NDC 69238-1605-2
Hospital Charge Code	901700029
Hospital Revenue Code	259
Min. Negotiated Rate	$10.89
Max. Negotiated Rate	$15.84
Rate for Payer: Cash Price	$10.89
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$15.84
Rate for Payer: Health Smart Auto/Commercial	$11.88
Rate for Payer: LLUH Dept of Risk Management WC	$10.89
Rate for Payer: Multiplan Commercial	$14.85

METHYLNALTREXONE 12 MG/0.6 ML SUBCUTANEOUS SYRINGE [154475]

Facility

$339.86

Service Code	HCPCS J2212
Hospital Charge Code	901700025
Hospital Revenue Code	636
Min. Negotiated Rate	$186.92
Max. Negotiated Rate	$271.89
Rate for Payer: Cash Price	$186.92
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$271.89
Rate for Payer: Health Smart Auto/Commercial	$203.92
Rate for Payer: LLUH Dept of Risk Management WC	$186.92
Rate for Payer: Multiplan Commercial	$254.90

METHYLNALTREXONE 12 MG/0.6 ML SUBCUTANEOUS SYRINGE [154475]

Facility

$339.86

Service Code	HCPCS J2212
Hospital Charge Code	901700025
Hospital Revenue Code	636
Min. Negotiated Rate	$186.92
Max. Negotiated Rate	$271.89
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$203.92
Rate for Payer: Aetna of CA Government/Medicare	$203.92
Rate for Payer: Cash Price	$186.92
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$271.89
Rate for Payer: Health Smart Auto/Commercial	$203.92
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$203.92
Rate for Payer: LLUH Dept of Risk Management WC	$186.92
Rate for Payer: Multiplan Commercial	$254.90

METHYLNALTREXONE 12 MG/0.6 ML SUBCUTANEOUS WRAP [40891651]

Facility

$339.86

Service Code	HCPCS J2212
Hospital Charge Code	901700025
Hospital Revenue Code	636
Min. Negotiated Rate	$186.92
Max. Negotiated Rate	$271.89
Rate for Payer: Cash Price	$186.92
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$271.89
Rate for Payer: Health Smart Auto/Commercial	$203.92
Rate for Payer: LLUH Dept of Risk Management WC	$186.92
Rate for Payer: Multiplan Commercial	$254.90

METHYLNALTREXONE 12 MG/0.6 ML SUBCUTANEOUS WRAP [40891651]

Facility

$339.86

Service Code	HCPCS J2212
Hospital Charge Code	901700025
Hospital Revenue Code	636
Min. Negotiated Rate	$186.92
Max. Negotiated Rate	$271.89
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$203.92
Rate for Payer: Aetna of CA Government/Medicare	$203.92
Rate for Payer: Cash Price	$186.92
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$271.89
Rate for Payer: Health Smart Auto/Commercial	$203.92
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$203.92
Rate for Payer: LLUH Dept of Risk Management WC	$186.92
Rate for Payer: Multiplan Commercial	$254.90

METHYLPHENIDATE 5 MG TABLET [4988]

Facility

$2.46

Service Code	NDC 68084-805-21
Hospital Charge Code	901700029
Hospital Revenue Code	259
Min. Negotiated Rate	$1.35
Max. Negotiated Rate	$1.97
Rate for Payer: Cash Price	$1.35
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO 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 Commercial	$1.84

METHYLPHENIDATE 5 MG TABLET [4988]

Facility

$0.12

Service Code	NDC 0115-1800-01
Hospital Charge Code	901700029
Hospital Revenue Code	259
Min. Negotiated Rate	$0.07
Max. Negotiated Rate	$0.10
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$0.07
Rate for Payer: Aetna of CA Government/Medicare	$0.07
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	$0.07
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$0.07
Rate for Payer: LLUH Dept of Risk Management WC	$0.07
Rate for Payer: Multiplan Commercial	$0.09

Know your out-of-pocket cost for care.

All Charges