Loma Linda University Behavioral Medicine Center (BMC)

All Charges

Charge

Type

Setting

Price

MORPHINE PCA CLINICIAN BOLUS [4083522]

Facility

$3.66

Service Code	NDC 63323-451-00
Min. Negotiated Rate	$2.01
Max. Negotiated Rate	$2.93
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$2.20
Rate for Payer: Aetna of CA Government/Medicare	$2.20
Rate for Payer: Cash Price	$2.01
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$2.93
Rate for Payer: Health Smart Auto/Commercial	$2.20
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$2.20
Rate for Payer: LLUH Dept of Risk Management WC	$2.01
Rate for Payer: Multiplan Commercial	$2.75

MORPHINE PCA CLINICIAN BOLUS [4083522]

Facility

$3.66

Service Code	NDC 63323-451-01
Min. Negotiated Rate	$2.01
Max. Negotiated Rate	$2.93
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$2.20
Rate for Payer: Aetna of CA Government/Medicare	$2.20
Rate for Payer: Cash Price	$2.01
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$2.93
Rate for Payer: Health Smart Auto/Commercial	$2.20
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$2.20
Rate for Payer: LLUH Dept of Risk Management WC	$2.01
Rate for Payer: Multiplan Commercial	$2.75

MORPHINE PCA CLINICIAN BOLUS [4083522]

Facility

$3.06

Service Code	NDC 9999-1922-78
Min. Negotiated Rate	$1.68
Max. Negotiated Rate	$2.45
Rate for Payer: Cash Price	$1.68
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$2.45
Rate for Payer: Health Smart Auto/Commercial	$1.84
Rate for Payer: LLUH Dept of Risk Management WC	$1.68
Rate for Payer: Multiplan Commercial	$2.29

MORPHINE PCA CLINICIAN BOLUS [4083522]

Facility

$3.06

Service Code	NDC 9999-1922-78
Min. Negotiated Rate	$1.68
Max. Negotiated Rate	$2.45
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$1.84
Rate for Payer: Aetna of CA Government/Medicare	$1.84
Rate for Payer: Cash Price	$1.68
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$2.45
Rate for Payer: Health Smart Auto/Commercial	$1.84
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$1.84
Rate for Payer: LLUH Dept of Risk Management WC	$1.68
Rate for Payer: Multiplan Commercial	$2.29

MORPHINE PCA CLINICIAN BOLUS [4083522]

Facility

$3.66

Service Code	NDC 63323-451-01
Min. Negotiated Rate	$2.01
Max. Negotiated Rate	$2.93
Rate for Payer: Cash Price	$2.01
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$2.93
Rate for Payer: Health Smart Auto/Commercial	$2.20
Rate for Payer: LLUH Dept of Risk Management WC	$2.01
Rate for Payer: Multiplan Commercial	$2.75

MORPHINE PCA CLINICIAN BOLUS [4083522]

Facility

$3.66

Service Code	NDC 63323-451-00
Min. Negotiated Rate	$2.01
Max. Negotiated Rate	$2.93
Rate for Payer: Cash Price	$2.01
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$2.93
Rate for Payer: Health Smart Auto/Commercial	$2.20
Rate for Payer: LLUH Dept of Risk Management WC	$2.01
Rate for Payer: Multiplan Commercial	$2.75

MORPHINE (PF) 10 MG/ML INJECTION SOLUTION [77009]

Facility

$13.61

Service Code	HCPCS J2270
Hospital Charge Code	901700025
Hospital Revenue Code	636
Min. Negotiated Rate	$7.49
Max. Negotiated Rate	$10.89
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$8.17
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$7.49
Rate for Payer: Aetna of CA Government/Medicare	$8.17
Rate for Payer: Aetna of CA Government/Medicare	$7.49
Rate for Payer: Cash Price	$7.49
Rate for Payer: Cash Price	$6.86
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$10.89
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$9.98
Rate for Payer: Health Smart Auto/Commercial	$7.49
Rate for Payer: Health Smart Auto/Commercial	$8.17
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$7.49
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$8.17
Rate for Payer: LLUH Dept of Risk Management WC	$7.49
Rate for Payer: LLUH Dept of Risk Management WC	$6.86
Rate for Payer: Multiplan Commercial	$10.21
Rate for Payer: Multiplan Commercial	$9.36

MORPHINE (PF) 10 MG/ML INJECTION SOLUTION [77009]

Facility

$13.61

Service Code	HCPCS J2270
Hospital Charge Code	901700025
Hospital Revenue Code	636
Min. Negotiated Rate	$7.49
Max. Negotiated Rate	$10.89
Rate for Payer: Cash Price	$7.49
Rate for Payer: Cash Price	$6.86
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$9.98
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$10.89
Rate for Payer: Health Smart Auto/Commercial	$7.49
Rate for Payer: Health Smart Auto/Commercial	$8.17
Rate for Payer: LLUH Dept of Risk Management WC	$7.49
Rate for Payer: LLUH Dept of Risk Management WC	$6.86
Rate for Payer: Multiplan Commercial	$9.36
Rate for Payer: Multiplan Commercial	$10.21

MORPHINE (PF) 1 MG/2 ML INTRAVENOUS SYRINGE [212745]

Facility

$2.62

Service Code	HCPCS J2270
Hospital Charge Code	901700025
Hospital Revenue Code	636
Min. Negotiated Rate	$1.44
Max. Negotiated Rate	$2.10
Rate for Payer: Cash Price	$1.44
Rate for Payer: Cash Price	$1.58
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$2.30
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$2.10
Rate for Payer: Health Smart Auto/Commercial	$1.57
Rate for Payer: Health Smart Auto/Commercial	$1.72
Rate for Payer: LLUH Dept of Risk Management WC	$1.44
Rate for Payer: LLUH Dept of Risk Management WC	$1.58
Rate for Payer: Multiplan Commercial	$2.15
Rate for Payer: Multiplan Commercial	$1.97

MORPHINE (PF) 1 MG/2 ML INTRAVENOUS SYRINGE [212745]

Facility

$2.62

Service Code	HCPCS J2270
Hospital Charge Code	901700025
Hospital Revenue Code	636
Min. Negotiated Rate	$1.44
Max. Negotiated Rate	$2.10
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$1.57
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$1.72
Rate for Payer: Aetna of CA Government/Medicare	$1.57
Rate for Payer: Aetna of CA Government/Medicare	$1.72
Rate for Payer: Cash Price	$1.44
Rate for Payer: Cash Price	$1.58
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$2.10
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$2.30
Rate for Payer: Health Smart Auto/Commercial	$1.57
Rate for Payer: Health Smart Auto/Commercial	$1.72
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$1.57
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$1.72
Rate for Payer: LLUH Dept of Risk Management WC	$1.58
Rate for Payer: LLUH Dept of Risk Management WC	$1.44
Rate for Payer: Multiplan Commercial	$1.97
Rate for Payer: Multiplan Commercial	$2.15

MORPHINE (PF) 1 MG/ML IN 0.9% SODIUM CHLORIDE INTRAVENOUS SOLUTION [154492]

Facility

$0.14

Service Code	HCPCS J2270
Hospital Charge Code	901700025
Hospital Revenue Code	636
Min. Negotiated Rate	$0.08
Max. Negotiated Rate	$0.11
Rate for Payer: Cash Price	$0.08
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO 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 Commercial	$0.11

MORPHINE (PF) 1 MG/ML IN 0.9% SODIUM CHLORIDE INTRAVENOUS SOLUTION [154492]

Facility

$0.14

Service Code	HCPCS J2270
Hospital Charge Code	901700025
Hospital Revenue Code	636
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	$0.08
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$0.11
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 Commercial	$0.11

MORPHINE (PF) 1 MG/ML INJECTION SOLUTION [15852]

Facility

$2.52

Service Code	HCPCS J2270
Hospital Charge Code	901700025
Hospital Revenue Code	636
Min. Negotiated Rate	$1.39
Max. Negotiated Rate	$2.02
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$1.51
Rate for Payer: Aetna of CA Government/Medicare	$1.51
Rate for Payer: Cash Price	$1.38
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$2.02
Rate for Payer: Health Smart Auto/Commercial	$1.51
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$1.51
Rate for Payer: LLUH Dept of Risk Management WC	$1.39
Rate for Payer: Multiplan Commercial	$1.89

MORPHINE (PF) 1 MG/ML INJECTION SOLUTION [15852]

Facility

$2.52

Service Code	HCPCS J2270
Hospital Charge Code	901700025
Hospital Revenue Code	636
Min. Negotiated Rate	$1.39
Max. Negotiated Rate	$2.02
Rate for Payer: Cash Price	$1.38
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$2.02
Rate for Payer: Health Smart Auto/Commercial	$1.51
Rate for Payer: LLUH Dept of Risk Management WC	$1.39
Rate for Payer: Multiplan Commercial	$1.89

MORPHINE (PF) 50 MG/50 ML(1 MG/ML) IN 0.9% SOD.CHLORIDE IV PCA SYRINGE [214839]

Facility

$0.17

Service Code	HCPCS J2270
Hospital Charge Code	901700025
Hospital Revenue Code	636
Min. Negotiated Rate	$0.09
Max. Negotiated Rate	$0.14
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$0.10
Rate for Payer: Aetna of CA Government/Medicare	$0.10
Rate for Payer: Cash Price	$0.09
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$0.14
Rate for Payer: Health Smart Auto/Commercial	$0.10
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$0.10
Rate for Payer: LLUH Dept of Risk Management WC	$0.09
Rate for Payer: Multiplan Commercial	$0.13

MORPHINE (PF) 50 MG/50 ML(1 MG/ML) IN 0.9% SOD.CHLORIDE IV PCA SYRINGE [214839]

Facility

$0.17

Service Code	HCPCS J2270
Hospital Charge Code	901700025
Hospital Revenue Code	636
Min. Negotiated Rate	$0.09
Max. Negotiated Rate	$0.14
Rate for Payer: Cash Price	$0.09
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$0.14
Rate for Payer: Health Smart Auto/Commercial	$0.10
Rate for Payer: LLUH Dept of Risk Management WC	$0.09
Rate for Payer: Multiplan Commercial	$0.13

MOXIFLOXACIN 0.5 % EYE DROPS [35699]

Facility

$4.64

Service Code	NDC 72266-158-01
Hospital Charge Code	901700029
Hospital Revenue Code	259
Min. Negotiated Rate	$2.55
Max. Negotiated Rate	$3.71
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$2.78
Rate for Payer: Aetna of CA Government/Medicare	$2.78
Rate for Payer: Cash Price	$2.55
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$3.71
Rate for Payer: Health Smart Auto/Commercial	$2.78
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$2.78
Rate for Payer: LLUH Dept of Risk Management WC	$2.55
Rate for Payer: Multiplan Commercial	$3.48

MOXIFLOXACIN 0.5 % EYE DROPS [35699]

Facility

$6.00

Service Code	NDC 68180-422-01
Hospital Charge Code	901700029
Hospital Revenue Code	259
Min. Negotiated Rate	$3.30
Max. Negotiated Rate	$4.80
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$3.60
Rate for Payer: Aetna of CA Government/Medicare	$3.60
Rate for Payer: Cash Price	$3.30
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$4.80
Rate for Payer: Health Smart Auto/Commercial	$3.60
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$3.60
Rate for Payer: LLUH Dept of Risk Management WC	$3.30
Rate for Payer: Multiplan Commercial	$4.50

MOXIFLOXACIN 0.5 % EYE DROPS [35699]

Facility

$13.39

Service Code	NDC 65862-840-03
Hospital Charge Code	901700029
Hospital Revenue Code	259
Min. Negotiated Rate	$7.36
Max. Negotiated Rate	$10.71
Rate for Payer: Cash Price	$7.36
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$10.71
Rate for Payer: Health Smart Auto/Commercial	$8.03
Rate for Payer: LLUH Dept of Risk Management WC	$7.36
Rate for Payer: Multiplan Commercial	$10.04

MOXIFLOXACIN 0.5 % EYE DROPS [35699]

Facility

$13.39

Service Code	NDC 65862-840-03
Hospital Charge Code	901700029
Hospital Revenue Code	259
Min. Negotiated Rate	$7.36
Max. Negotiated Rate	$10.71
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$8.03
Rate for Payer: Aetna of CA Government/Medicare	$8.03
Rate for Payer: Cash Price	$7.36
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$10.71
Rate for Payer: Health Smart Auto/Commercial	$8.03
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$8.03
Rate for Payer: LLUH Dept of Risk Management WC	$7.36
Rate for Payer: Multiplan Commercial	$10.04

MOXIFLOXACIN 0.5 % EYE DROPS [35699]

Facility

$6.00

Service Code	NDC 68180-422-01
Hospital Charge Code	901700029
Hospital Revenue Code	259
Min. Negotiated Rate	$3.30
Max. Negotiated Rate	$4.80
Rate for Payer: Cash Price	$3.30
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$4.80
Rate for Payer: Health Smart Auto/Commercial	$3.60
Rate for Payer: LLUH Dept of Risk Management WC	$3.30
Rate for Payer: Multiplan Commercial	$4.50

MOXIFLOXACIN 0.5 % EYE DROPS [35699]

Facility

$14.00

Service Code	NDC 0781-7135-93
Hospital Charge Code	901700029
Hospital Revenue Code	259
Min. Negotiated Rate	$7.70
Max. Negotiated Rate	$11.20
Rate for Payer: Cash Price	$7.70
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$11.20
Rate for Payer: Health Smart Auto/Commercial	$8.40
Rate for Payer: LLUH Dept of Risk Management WC	$7.70
Rate for Payer: Multiplan Commercial	$10.50

MOXIFLOXACIN 0.5 % EYE DROPS [35699]

Facility

$14.00

Service Code	NDC 0781-7135-93
Hospital Charge Code	901700029
Hospital Revenue Code	259
Min. Negotiated Rate	$7.70
Max. Negotiated Rate	$11.20
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$8.40
Rate for Payer: Aetna of CA Government/Medicare	$8.40
Rate for Payer: Cash Price	$7.70
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$11.20
Rate for Payer: Health Smart Auto/Commercial	$8.40
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$8.40
Rate for Payer: LLUH Dept of Risk Management WC	$7.70
Rate for Payer: Multiplan Commercial	$10.50

MOXIFLOXACIN 0.5 % EYE DROPS [35699]

Facility

$4.64

Service Code	NDC 72266-158-01
Hospital Charge Code	901700029
Hospital Revenue Code	259
Min. Negotiated Rate	$2.55
Max. Negotiated Rate	$3.71
Rate for Payer: Cash Price	$2.55
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$3.71
Rate for Payer: Health Smart Auto/Commercial	$2.78
Rate for Payer: LLUH Dept of Risk Management WC	$2.55
Rate for Payer: Multiplan Commercial	$3.48

MOXIFLOXACIN 400 MG/250 ML-SODIUM CHLORIDE(ISO) INTRAVENOUS PIGGYBACK [31906]

Facility

$0.24

Service Code	HCPCS J2280
Hospital Charge Code	901700025
Hospital Revenue Code	636
Min. Negotiated Rate	$0.13
Max. Negotiated Rate	$0.19
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$0.14
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$0.13
Rate for Payer: Aetna of CA Government/Medicare	$0.14
Rate for Payer: Aetna of CA Government/Medicare	$0.13
Rate for Payer: Cash Price	$0.13
Rate for Payer: Cash Price	$0.12
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$0.19
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$0.17
Rate for Payer: Health Smart Auto/Commercial	$0.13
Rate for Payer: Health Smart Auto/Commercial	$0.14
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$0.14
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: LLUH Dept of Risk Management WC	$0.13
Rate for Payer: Multiplan Commercial	$0.18
Rate for Payer: Multiplan Commercial	$0.16

Know your out-of-pocket cost for care.

All Charges