Loma Linda University Behavioral Medicine Center (BMC)

All Charges

Charge

Type

Setting

Price

IRINOTECAN 500 MG/25 ML INTRAVENOUS SOLUTION [94341]

Facility

$7.07

Service Code	CPT J9206
Hospital Charge Code	NDG94341
Hospital Revenue Code	636
Min. Negotiated Rate	$3.89
Max. Negotiated Rate	$5.30
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$4.24
Rate for Payer: Aetna of CA Government/Medicare	$4.24
Rate for Payer: Cash Price	$3.18
Rate for Payer: Health Smart Auto/Commercial	$4.24
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$4.24
Rate for Payer: LLUH Dept of Risk Management WC	$3.89
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$5.30

IRINOTECAN LIPOSOMAL 4.3 MG/ML INTRAVENOUS [211718]

Facility

$323.88

Service Code	CPT J9205
Hospital Charge Code	NDG211718
Hospital Revenue Code	636
Min. Negotiated Rate	$178.13
Max. Negotiated Rate	$242.91
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$194.33
Rate for Payer: Aetna of CA Government/Medicare	$194.33
Rate for Payer: Cash Price	$145.75
Rate for Payer: Health Smart Auto/Commercial	$194.33
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$194.33
Rate for Payer: LLUH Dept of Risk Management WC	$178.13
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$242.91

IRINOTECAN LIPOSOMAL 4.3 MG/ML INTRAVENOUS [211718]

Facility

$323.88

Service Code	CPT J9205
Hospital Charge Code	NDG211718
Hospital Revenue Code	636
Min. Negotiated Rate	$178.13
Max. Negotiated Rate	$259.10
Rate for Payer: Cash Price	$145.75
Rate for Payer: Cigna of CA HMO/PPO	$259.10
Rate for Payer: Health Smart Auto/Commercial	$194.33
Rate for Payer: LLUH Dept of Risk Management WC	$178.13
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$242.91

IRON, CARBONYL 45 MG TABLET [33267]

Facility

$0.18

Service Code	NDC 4601709660
Hospital Charge Code	1711916
Hospital Revenue Code	259
Min. Negotiated Rate	$0.10
Max. Negotiated Rate	$0.14
Rate for Payer: Cash Price	$0.08
Rate for Payer: Cigna of CA HMO/PPO	$0.14
Rate for Payer: Health Smart Auto/Commercial	$0.11
Rate for Payer: LLUH Dept of Risk Management WC	$0.10
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$0.14

IRON, CARBONYL 45 MG TABLET [33267]

Facility

$0.18

Service Code	NDC 4601709660
Hospital Charge Code	1711916
Hospital Revenue Code	259
Min. Negotiated Rate	$0.10
Max. Negotiated Rate	$0.14
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$0.11
Rate for Payer: Aetna of CA Government/Medicare	$0.11
Rate for Payer: Cash Price	$0.08
Rate for Payer: Health Smart Auto/Commercial	$0.11
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$0.11
Rate for Payer: LLUH Dept of Risk Management WC	$0.10
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$0.14

IRON DEXTRAN 50 MG/ML INJECTION SOLUTION [221652]

Facility

$20.29

Service Code	NDC 0023-6082-10
Hospital Charge Code	NDG199344
Hospital Revenue Code	636
Min. Negotiated Rate	$11.16
Max. Negotiated Rate	$16.23
Rate for Payer: Cash Price	$9.13
Rate for Payer: Cigna of CA HMO/PPO	$16.23
Rate for Payer: Health Smart Auto/Commercial	$12.17
Rate for Payer: LLUH Dept of Risk Management WC	$11.16
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$15.22

IRON DEXTRAN 50 MG/ML INJECTION SOLUTION [221652]

Facility

$20.29

Service Code	NDC 0023-6082-01
Hospital Charge Code	NDG199344
Hospital Revenue Code	636
Min. Negotiated Rate	$11.16
Max. Negotiated Rate	$15.22
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$12.17
Rate for Payer: Aetna of CA Government/Medicare	$12.17
Rate for Payer: Cash Price	$9.13
Rate for Payer: Health Smart Auto/Commercial	$12.17
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$12.17
Rate for Payer: LLUH Dept of Risk Management WC	$11.16
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$15.22

IRON DEXTRAN 50 MG/ML INJECTION SOLUTION [221652]

Facility

$20.29

Service Code	NDC 0023-6082-10
Hospital Charge Code	NDG199344
Hospital Revenue Code	636
Min. Negotiated Rate	$11.16
Max. Negotiated Rate	$15.22
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$12.17
Rate for Payer: Aetna of CA Government/Medicare	$12.17
Rate for Payer: Cash Price	$9.13
Rate for Payer: Health Smart Auto/Commercial	$12.17
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$12.17
Rate for Payer: LLUH Dept of Risk Management WC	$11.16
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$15.22

IRON DEXTRAN 50 MG/ML INJECTION SOLUTION [221652]

Facility

$20.29

Service Code	NDC 0023-6082-01
Hospital Charge Code	NDG199344
Hospital Revenue Code	636
Min. Negotiated Rate	$11.16
Max. Negotiated Rate	$16.23
Rate for Payer: Cash Price	$9.13
Rate for Payer: Cigna of CA HMO/PPO	$16.23
Rate for Payer: Health Smart Auto/Commercial	$12.17
Rate for Payer: LLUH Dept of Risk Management WC	$11.16
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$15.22

IRON SUCROSE 100 MG IRON/5 ML INTRAVENOUS SOLUTION [29132]

Facility

$8.83

Service Code	CPT J1756
Hospital Charge Code	1720948
Hospital Revenue Code	636
Min. Negotiated Rate	$4.86
Max. Negotiated Rate	$6.62
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$5.30
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$8.32
Rate for Payer: Aetna of CA Government/Medicare	$5.30
Rate for Payer: Aetna of CA Government/Medicare	$8.32
Rate for Payer: Cash Price	$6.24
Rate for Payer: Cash Price	$3.97
Rate for Payer: Health Smart Auto/Commercial	$5.30
Rate for Payer: Health Smart Auto/Commercial	$8.32
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$8.32
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$5.30
Rate for Payer: LLUH Dept of Risk Management WC	$7.62
Rate for Payer: LLUH Dept of Risk Management WC	$4.86
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$10.40
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$6.62

IRON SUCROSE 100 MG IRON/5 ML INTRAVENOUS SOLUTION [29132]

Facility

$13.86

Service Code	CPT J1756
Hospital Charge Code	1720948
Hospital Revenue Code	636
Min. Negotiated Rate	$7.62
Max. Negotiated Rate	$11.09
Rate for Payer: Cash Price	$6.24
Rate for Payer: Cash Price	$3.97
Rate for Payer: Cigna of CA HMO/PPO	$7.06
Rate for Payer: Cigna of CA HMO/PPO	$11.09
Rate for Payer: Health Smart Auto/Commercial	$5.30
Rate for Payer: Health Smart Auto/Commercial	$8.32
Rate for Payer: LLUH Dept of Risk Management WC	$4.86
Rate for Payer: LLUH Dept of Risk Management WC	$7.62
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$6.62
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$10.40

IRON SUCROSE 200 MG IRON/10 ML INTRAVENOUS SOLUTION [187493]

Facility

$13.86

Service Code	CPT J1756
Hospital Charge Code	NDG187493
Hospital Revenue Code	636
Min. Negotiated Rate	$7.62
Max. Negotiated Rate	$11.09
Rate for Payer: Cash Price	$6.24
Rate for Payer: Cash Price	$5.18
Rate for Payer: Cigna of CA HMO/PPO	$11.09
Rate for Payer: Cigna of CA HMO/PPO	$9.22
Rate for Payer: Health Smart Auto/Commercial	$6.91
Rate for Payer: Health Smart Auto/Commercial	$8.32
Rate for Payer: LLUH Dept of Risk Management WC	$7.62
Rate for Payer: LLUH Dept of Risk Management WC	$6.34
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$10.40
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$8.64

IRON SUCROSE 200 MG IRON/10 ML INTRAVENOUS SOLUTION [187493]

Facility

$11.52

Service Code	CPT J1756
Hospital Charge Code	NDG187493
Hospital Revenue Code	636
Min. Negotiated Rate	$6.34
Max. Negotiated Rate	$8.64
Rate for Payer: Cash Price	$6.24
Rate for Payer: Cash Price	$5.18
Rate for Payer: Health Smart Auto/Commercial	$6.91
Rate for Payer: Health Smart Auto/Commercial	$8.32
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$6.91
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$8.32
Rate for Payer: Aetna of CA Government/Medicare	$6.91
Rate for Payer: Aetna of CA Government/Medicare	$8.32
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$6.91
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$8.32
Rate for Payer: LLUH Dept of Risk Management WC	$6.34
Rate for Payer: LLUH Dept of Risk Management WC	$7.62
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$10.40
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$8.64

ISATUXIMAB-IRFC 20 MG/ML INTRAVENOUS SOLUTION [227445]

Facility

$180.81

Service Code	NDC 0024-0656-01
Hospital Charge Code	NDG227445A
Hospital Revenue Code	636
Min. Negotiated Rate	$99.45
Max. Negotiated Rate	$135.61
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$108.49
Rate for Payer: Aetna of CA Government/Medicare	$108.49
Rate for Payer: Cash Price	$81.36
Rate for Payer: Health Smart Auto/Commercial	$108.49
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$108.49
Rate for Payer: LLUH Dept of Risk Management WC	$99.45
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$135.61

ISATUXIMAB-IRFC 20 MG/ML INTRAVENOUS SOLUTION [227445]

Facility

$180.81

Service Code	NDC 0024-0656-01
Hospital Charge Code	NDG227445A
Hospital Revenue Code	636
Min. Negotiated Rate	$99.45
Max. Negotiated Rate	$144.65
Rate for Payer: Cash Price	$81.36
Rate for Payer: Cigna of CA HMO/PPO	$144.65
Rate for Payer: Health Smart Auto/Commercial	$108.49
Rate for Payer: LLUH Dept of Risk Management WC	$99.45
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$135.61

ISATUXIMAB-IRFC 20 MG/ML INTRAVENOUS SOLUTION [227445]

Facility

$180.81

Service Code	NDC 0024-0654-01
Hospital Charge Code	NDG227445
Hospital Revenue Code	636
Min. Negotiated Rate	$99.45
Max. Negotiated Rate	$144.65
Rate for Payer: Cash Price	$81.36
Rate for Payer: Cigna of CA HMO/PPO	$144.65
Rate for Payer: Health Smart Auto/Commercial	$108.49
Rate for Payer: LLUH Dept of Risk Management WC	$99.45
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$135.61

ISATUXIMAB-IRFC 20 MG/ML INTRAVENOUS SOLUTION [227445]

Facility

$180.81

Service Code	NDC 0024-0654-01
Hospital Charge Code	NDG227445
Hospital Revenue Code	636
Min. Negotiated Rate	$99.45
Max. Negotiated Rate	$135.61
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$108.49
Rate for Payer: Aetna of CA Government/Medicare	$108.49
Rate for Payer: Cash Price	$81.36
Rate for Payer: Health Smart Auto/Commercial	$108.49
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$108.49
Rate for Payer: LLUH Dept of Risk Management WC	$99.45
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$135.61

ISAVUCONAZONIUM SULFATE 186 MG CAPSULE [209331]

Facility

$128.43

Service Code	NDC 0469-0520-02
Hospital Charge Code	ERX209331
Hospital Revenue Code	259
Min. Negotiated Rate	$70.64
Max. Negotiated Rate	$96.32
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$77.06
Rate for Payer: Aetna of CA Government/Medicare	$77.06
Rate for Payer: Cash Price	$57.79
Rate for Payer: Health Smart Auto/Commercial	$77.06
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$77.06
Rate for Payer: LLUH Dept of Risk Management WC	$70.64
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$96.32

ISAVUCONAZONIUM SULFATE 186 MG CAPSULE [209331]

Facility

$128.43

Service Code	NDC 0469-0520-02
Hospital Charge Code	ERX209331
Hospital Revenue Code	259
Min. Negotiated Rate	$70.64
Max. Negotiated Rate	$102.74
Rate for Payer: Cash Price	$57.79
Rate for Payer: Cigna of CA HMO/PPO	$102.74
Rate for Payer: Health Smart Auto/Commercial	$77.06
Rate for Payer: LLUH Dept of Risk Management WC	$70.64
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$96.32

ISONIAZID 100 MG TABLET [4026]

Facility

$0.14

Service Code	NDC 0555-0066-02
Hospital Charge Code	1710461
Hospital Revenue Code	259
Min. Negotiated Rate	$0.08
Max. Negotiated Rate	$0.11
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	$0.06
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	$0.08
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$0.11

ISONIAZID 100 MG TABLET [4026]

Facility

$0.14

Service Code	NDC 0555-0066-02
Hospital Charge Code	1710461
Hospital Revenue Code	259
Min. Negotiated Rate	$0.08
Max. Negotiated Rate	$0.11
Rate for Payer: Cash Price	$0.06
Rate for Payer: Cigna of CA HMO/PPO	$0.11
Rate for Payer: Health Smart Auto/Commercial	$0.08
Rate for Payer: LLUH Dept of Risk Management WC	$0.08
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$0.11

ISONIAZID 300 MG TABLET [4027]

Facility

$1.24

Service Code	NDC 51079-083-01
Hospital Charge Code	1710467
Hospital Revenue Code	259
Min. Negotiated Rate	$0.68
Max. Negotiated Rate	$0.99
Rate for Payer: Cash Price	$0.56
Rate for Payer: Cigna of CA HMO/PPO	$0.99
Rate for Payer: Health Smart Auto/Commercial	$0.74
Rate for Payer: LLUH Dept of Risk Management WC	$0.68
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$0.93

ISONIAZID 300 MG TABLET [4027]

Facility

$0.30

Service Code	NDC 0555-0071-02
Hospital Charge Code	1710467
Hospital Revenue Code	259
Min. Negotiated Rate	$0.17
Max. Negotiated Rate	$0.23
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$0.18
Rate for Payer: Aetna of CA Government/Medicare	$0.18
Rate for Payer: Cash Price	$0.14
Rate for Payer: Health Smart Auto/Commercial	$0.18
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$0.18
Rate for Payer: LLUH Dept of Risk Management WC	$0.17
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$0.23

ISONIAZID 300 MG TABLET [4027]

Facility

$0.49

Service Code	NDC 0555-0071-01
Hospital Charge Code	1710467
Hospital Revenue Code	259
Min. Negotiated Rate	$0.27
Max. Negotiated Rate	$0.37
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$0.29
Rate for Payer: Aetna of CA Government/Medicare	$0.29
Rate for Payer: Cash Price	$0.22
Rate for Payer: Health Smart Auto/Commercial	$0.29
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$0.29
Rate for Payer: LLUH Dept of Risk Management WC	$0.27
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$0.37

ISONIAZID 300 MG TABLET [4027]

Facility

$0.30

Service Code	NDC 0555-0071-02
Hospital Charge Code	1710467
Hospital Revenue Code	259
Min. Negotiated Rate	$0.17
Max. Negotiated Rate	$0.24
Rate for Payer: Cash Price	$0.14
Rate for Payer: Cigna of CA HMO/PPO	$0.24
Rate for Payer: Health Smart Auto/Commercial	$0.18
Rate for Payer: LLUH Dept of Risk Management WC	$0.17
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$0.23

Know your out-of-pocket cost for care.

All Charges