Loma Linda University Behavioral Medicine Center (BMC)

All Charges

Charge

Type

Setting

Price

NEBIVOLOL 10 MG TABLET [89286]

Facility

$4.20

Service Code	NDC 60687-652-11
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

NEBIVOLOL 10 MG TABLET [89286]

Facility

$0.28

Service Code	NDC 43547-526-03
Hospital Charge Code	901700029
Hospital Revenue Code	259
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

NEBIVOLOL 10 MG TABLET [89286]

Facility

$4.20

Service Code	NDC 60687-652-11
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

NEBIVOLOL 10 MG TABLET [89286]

Facility

$0.28

Service Code	NDC 43547-526-03
Hospital Charge Code	901700029
Hospital Revenue Code	259
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

NEBIVOLOL 5 MG TABLET [89284]

Facility

$0.28

Service Code	NDC 43547-525-03
Hospital Charge Code	901700029
Hospital Revenue Code	259
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

NEBIVOLOL 5 MG TABLET [89284]

Facility

$0.56

Service Code	NDC 67877-392-30
Hospital Charge Code	901700029
Hospital Revenue Code	259
Min. Negotiated Rate	$0.31
Max. Negotiated Rate	$0.45
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$0.34
Rate for Payer: Aetna of CA Government/Medicare	$0.34
Rate for Payer: Cash Price	$0.31
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$0.45
Rate for Payer: Health Smart Auto/Commercial	$0.34
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$0.34
Rate for Payer: LLUH Dept of Risk Management WC	$0.31
Rate for Payer: Multiplan Commercial	$0.42

NEBIVOLOL 5 MG TABLET [89284]

Facility

$0.56

Service Code	NDC 67877-392-30
Hospital Charge Code	901700029
Hospital Revenue Code	259
Min. Negotiated Rate	$0.31
Max. Negotiated Rate	$0.45
Rate for Payer: Cash Price	$0.31
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$0.45
Rate for Payer: Health Smart Auto/Commercial	$0.34
Rate for Payer: LLUH Dept of Risk Management WC	$0.31
Rate for Payer: Multiplan Commercial	$0.42

NEBIVOLOL 5 MG TABLET [89284]

Facility

$0.28

Service Code	NDC 43547-525-03
Hospital Charge Code	901700029
Hospital Revenue Code	259
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

NEBIVOLOL 5 MG TABLET [89284]

Facility

$3.38

Service Code	NDC 62559-276-30
Hospital Charge Code	901700029
Hospital Revenue Code	259
Min. Negotiated Rate	$1.86
Max. Negotiated Rate	$2.70
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$2.03
Rate for Payer: Aetna of CA Government/Medicare	$2.03
Rate for Payer: Cash Price	$1.86
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$2.70
Rate for Payer: Health Smart Auto/Commercial	$2.03
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$2.03
Rate for Payer: LLUH Dept of Risk Management WC	$1.86
Rate for Payer: Multiplan Commercial	$2.54

NEBIVOLOL 5 MG TABLET [89284]

Facility

$3.38

Service Code	NDC 62559-276-30
Hospital Charge Code	901700029
Hospital Revenue Code	259
Min. Negotiated Rate	$1.86
Max. Negotiated Rate	$2.70
Rate for Payer: Cash Price	$1.86
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$2.70
Rate for Payer: Health Smart Auto/Commercial	$2.03
Rate for Payer: LLUH Dept of Risk Management WC	$1.86
Rate for Payer: Multiplan Commercial	$2.54

NELARABINE 250 MG/50 ML INTRAVENOUS SOLUTION [70267]

Facility

$15.86

Service Code	HCPCS J9261
Hospital Charge Code	901700025
Hospital Revenue Code	636
Min. Negotiated Rate	$8.72
Max. Negotiated Rate	$12.69
Rate for Payer: Cash Price	$8.73
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$12.69
Rate for Payer: Health Smart Auto/Commercial	$9.52
Rate for Payer: LLUH Dept of Risk Management WC	$8.72
Rate for Payer: Multiplan Commercial	$11.89

NELARABINE 250 MG/50 ML INTRAVENOUS SOLUTION [70267]

Facility

$15.86

Service Code	HCPCS J9261
Hospital Charge Code	901700025
Hospital Revenue Code	636
Min. Negotiated Rate	$8.72
Max. Negotiated Rate	$12.69
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$9.52
Rate for Payer: Aetna of CA Government/Medicare	$9.52
Rate for Payer: Cash Price	$8.73
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$12.69
Rate for Payer: Health Smart Auto/Commercial	$9.52
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$9.52
Rate for Payer: LLUH Dept of Risk Management WC	$8.72
Rate for Payer: Multiplan Commercial	$11.89

NELFINAVIR 250 MG TABLET [20032]

Facility

$4.86

Service Code	NDC 63010-010-30
Hospital Charge Code	901700029
Hospital Revenue Code	259
Min. Negotiated Rate	$2.67
Max. Negotiated Rate	$3.89
Rate for Payer: Cash Price	$2.67
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$3.89
Rate for Payer: Health Smart Auto/Commercial	$2.92
Rate for Payer: LLUH Dept of Risk Management WC	$2.67
Rate for Payer: Multiplan Commercial	$3.65

NELFINAVIR 250 MG TABLET [20032]

Facility

$4.86

Service Code	NDC 63010-010-30
Hospital Charge Code	901700029
Hospital Revenue Code	259
Min. Negotiated Rate	$2.67
Max. Negotiated Rate	$3.89
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$2.92
Rate for Payer: Aetna of CA Government/Medicare	$2.92
Rate for Payer: Cash Price	$2.67
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$3.89
Rate for Payer: Health Smart Auto/Commercial	$2.92
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$2.92
Rate for Payer: LLUH Dept of Risk Management WC	$2.67
Rate for Payer: Multiplan Commercial	$3.65

NEOMY-BACIT-POLYMYX-PRAMOXINE 3.5 MG-500 UNIT-10,000 UNIT/G TOP OINT [21070]

Facility

$0.15

Service Code	NDC 0713-0622-31
Hospital Charge Code	901700029
Hospital Revenue Code	259
Min. Negotiated Rate	$0.08
Max. Negotiated Rate	$0.12
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$0.09
Rate for Payer: Aetna of CA Government/Medicare	$0.09
Rate for Payer: Cash Price	$0.08
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$0.12
Rate for Payer: Health Smart Auto/Commercial	$0.09
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$0.09
Rate for Payer: LLUH Dept of Risk Management WC	$0.08
Rate for Payer: Multiplan Commercial	$0.11

NEOMY-BACIT-POLYMYX-PRAMOXINE 3.5 MG-500 UNIT-10,000 UNIT/G TOP OINT [21070]

Facility

$0.15

Service Code	NDC 0713-0622-31
Hospital Charge Code	901700029
Hospital Revenue Code	259
Min. Negotiated Rate	$0.08
Max. Negotiated Rate	$0.12
Rate for Payer: Cash Price	$0.08
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$0.12
Rate for Payer: Health Smart Auto/Commercial	$0.09
Rate for Payer: LLUH Dept of Risk Management WC	$0.08
Rate for Payer: Multiplan Commercial	$0.11

NEOMYCIN 1.75 MG-POLYMYXIN 10,000 UNIT-GRAMICIDIN 0.025MG/ML EYE DROPS [5474]

Facility

$6.13

Service Code	NDC 24208-790-62
Hospital Charge Code	901700029
Hospital Revenue Code	259
Min. Negotiated Rate	$3.37
Max. Negotiated Rate	$4.90
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$3.68
Rate for Payer: Aetna of CA Government/Medicare	$3.68
Rate for Payer: Cash Price	$3.37
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$4.90
Rate for Payer: Health Smart Auto/Commercial	$3.68
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$3.68
Rate for Payer: LLUH Dept of Risk Management WC	$3.37
Rate for Payer: Multiplan Commercial	$4.60

NEOMYCIN 1.75 MG-POLYMYXIN 10,000 UNIT-GRAMICIDIN 0.025MG/ML EYE DROPS [5474]

Facility

$6.13

Service Code	NDC 24208-790-62
Hospital Charge Code	901700029
Hospital Revenue Code	259
Min. Negotiated Rate	$3.37
Max. Negotiated Rate	$4.90
Rate for Payer: Cash Price	$3.37
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$4.90
Rate for Payer: Health Smart Auto/Commercial	$3.68
Rate for Payer: LLUH Dept of Risk Management WC	$3.37
Rate for Payer: Multiplan Commercial	$4.60

NEOMYCIN 3.5 MG/G-POLYMYXIN B 10,000 UNIT/G-DEXAMETH 0.1 % EYE OINT [106249]

Facility

$6.17

Service Code	NDC 61314-631-36
Hospital Charge Code	901700029
Hospital Revenue Code	259
Min. Negotiated Rate	$3.39
Max. Negotiated Rate	$4.94
Rate for Payer: Cash Price	$3.39
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$4.94
Rate for Payer: Health Smart Auto/Commercial	$3.70
Rate for Payer: LLUH Dept of Risk Management WC	$3.39
Rate for Payer: Multiplan Commercial	$4.63

NEOMYCIN 3.5 MG/G-POLYMYXIN B 10,000 UNIT/G-DEXAMETH 0.1 % EYE OINT [106249]

Facility

$5.45

Service Code	NDC 24208-795-35
Hospital Charge Code	901700029
Hospital Revenue Code	259
Min. Negotiated Rate	$3.00
Max. Negotiated Rate	$4.36
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$3.27
Rate for Payer: Aetna of CA Government/Medicare	$3.27
Rate for Payer: Cash Price	$3.00
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$4.36
Rate for Payer: Health Smart Auto/Commercial	$3.27
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$3.27
Rate for Payer: LLUH Dept of Risk Management WC	$3.00
Rate for Payer: Multiplan Commercial	$4.09

NEOMYCIN 3.5 MG/G-POLYMYXIN B 10,000 UNIT/G-DEXAMETH 0.1 % EYE OINT [106249]

Facility

$5.45

Service Code	NDC 24208-795-35
Hospital Charge Code	901700029
Hospital Revenue Code	259
Min. Negotiated Rate	$3.00
Max. Negotiated Rate	$4.36
Rate for Payer: Cash Price	$3.00
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$4.36
Rate for Payer: Health Smart Auto/Commercial	$3.27
Rate for Payer: LLUH Dept of Risk Management WC	$3.00
Rate for Payer: Multiplan Commercial	$4.09

NEOMYCIN 3.5 MG/G-POLYMYXIN B 10,000 UNIT/G-DEXAMETH 0.1 % EYE OINT [106249]

Facility

$6.17

Service Code	NDC 61314-631-36
Hospital Charge Code	901700029
Hospital Revenue Code	259
Min. Negotiated Rate	$3.39
Max. Negotiated Rate	$4.94
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$3.70
Rate for Payer: Aetna of CA Government/Medicare	$3.70
Rate for Payer: Cash Price	$3.39
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$4.94
Rate for Payer: Health Smart Auto/Commercial	$3.70
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$3.70
Rate for Payer: LLUH Dept of Risk Management WC	$3.39
Rate for Payer: Multiplan Commercial	$4.63

NEOMYCIN 3.5 MG-POLYMYXIN 10,000 UNIT-HYDROCORT 10 MG/ML EYE DROP,SUSP [35126]

Facility

$23.95

Service Code	NDC 61314-641-75
Hospital Charge Code	901700029
Hospital Revenue Code	259
Min. Negotiated Rate	$13.17
Max. Negotiated Rate	$19.16
Rate for Payer: Cash Price	$13.17
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$19.16
Rate for Payer: Health Smart Auto/Commercial	$14.37
Rate for Payer: LLUH Dept of Risk Management WC	$13.17
Rate for Payer: Multiplan Commercial	$17.96

NEOMYCIN 3.5 MG-POLYMYXIN 10,000 UNIT-HYDROCORT 10 MG/ML EYE DROP,SUSP [35126]

Facility

$23.95

Service Code	NDC 61314-641-75
Hospital Charge Code	901700029
Hospital Revenue Code	259
Min. Negotiated Rate	$13.17
Max. Negotiated Rate	$19.16
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$14.37
Rate for Payer: Aetna of CA Government/Medicare	$14.37
Rate for Payer: Cash Price	$13.17
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$19.16
Rate for Payer: Health Smart Auto/Commercial	$14.37
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$14.37
Rate for Payer: LLUH Dept of Risk Management WC	$13.17
Rate for Payer: Multiplan Commercial	$17.96

NEOMYCIN 40 MG-POLYMYXIN B 200,000 UNIT/ML GU IRRIGATION SOLUTION [70678]

Facility

$13.11

Service Code	NDC 39822-1201-1
Hospital Charge Code	901700004
Hospital Revenue Code	250
Min. Negotiated Rate	$7.21
Max. Negotiated Rate	$10.49
Rate for Payer: Cash Price	$7.21
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$10.49
Rate for Payer: Health Smart Auto/Commercial	$7.87
Rate for Payer: LLUH Dept of Risk Management WC	$7.21
Rate for Payer: Multiplan Commercial	$9.83

Know your out-of-pocket cost for care.

All Charges