Loma Linda University Behavioral Medicine Center (BMC)

All Charges

Charge

Type

Setting

Price

NEOMYCIN-POLYMYXIN-HYDROCORT 3.5 MG/ML-10,000 UNIT/ML-1 % EAR SOLUTION [34814]

Facility

$10.07

Service Code	NDC 24208-631-10
Hospital Charge Code	901700029
Hospital Revenue Code	259
Min. Negotiated Rate	$5.54
Max. Negotiated Rate	$8.06
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$6.04
Rate for Payer: Aetna of CA Government/Medicare	$6.04
Rate for Payer: Cash Price	$5.54
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$8.06
Rate for Payer: Health Smart Auto/Commercial	$6.04
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$6.04
Rate for Payer: LLUH Dept of Risk Management WC	$5.54
Rate for Payer: Multiplan Commercial	$7.55

NEOMYCIN-POLYMYXIN-HYDROCORT 3.5 MG/ML-10,000 UNIT/ML-1 % EAR SOLUTION [34814]

Facility

$10.07

Service Code	NDC 24208-631-10
Hospital Charge Code	901700029
Hospital Revenue Code	259
Min. Negotiated Rate	$5.54
Max. Negotiated Rate	$8.06
Rate for Payer: Cash Price	$5.54
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$8.06
Rate for Payer: Health Smart Auto/Commercial	$6.04
Rate for Payer: LLUH Dept of Risk Management WC	$5.54
Rate for Payer: Multiplan Commercial	$7.55

NEOSTIGMINE 5 MG/5 ML IN STERILE WATER INJECTION SYRINGE [215593]

Facility

$3.61

Service Code	HCPCS J2710
Hospital Charge Code	901700025
Hospital Revenue Code	636
Min. Negotiated Rate	$1.99
Max. Negotiated Rate	$2.89
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$2.17
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$2.06
Rate for Payer: Aetna of CA Government/Medicare	$2.06
Rate for Payer: Aetna of CA Government/Medicare	$2.17
Rate for Payer: Cash Price	$1.89
Rate for Payer: Cash Price	$1.99
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$2.89
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$2.74
Rate for Payer: Health Smart Auto/Commercial	$2.17
Rate for Payer: Health Smart Auto/Commercial	$2.06
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$2.06
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$2.17
Rate for Payer: LLUH Dept of Risk Management WC	$1.89
Rate for Payer: LLUH Dept of Risk Management WC	$1.99
Rate for Payer: Multiplan Commercial	$2.71
Rate for Payer: Multiplan Commercial	$2.57

NEOSTIGMINE 5 MG/5 ML IN STERILE WATER INJECTION SYRINGE [215593]

Facility

$3.43

Service Code	HCPCS J2710
Hospital Charge Code	901700025
Hospital Revenue Code	636
Min. Negotiated Rate	$1.89
Max. Negotiated Rate	$2.74
Rate for Payer: Cash Price	$1.89
Rate for Payer: Cash Price	$1.99
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$2.89
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$2.74
Rate for Payer: Health Smart Auto/Commercial	$2.06
Rate for Payer: Health Smart Auto/Commercial	$2.17
Rate for Payer: LLUH Dept of Risk Management WC	$1.89
Rate for Payer: LLUH Dept of Risk Management WC	$1.99
Rate for Payer: Multiplan Commercial	$2.57
Rate for Payer: Multiplan Commercial	$2.71

NEOSTIGMINE METHYLSULFATE 1 MG/ML INJECTION SOLUTION. [4085490]

Facility

$3.43

Service Code	HCPCS J2710
Hospital Charge Code	901700025
Hospital Revenue Code	636
Min. Negotiated Rate	$1.89
Max. Negotiated Rate	$2.74
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$2.06
Rate for Payer: Aetna of CA Government/Medicare	$2.06
Rate for Payer: Cash Price	$1.89
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$2.74
Rate for Payer: Health Smart Auto/Commercial	$2.06
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$2.06
Rate for Payer: LLUH Dept of Risk Management WC	$1.89
Rate for Payer: Multiplan Commercial	$2.57

NEOSTIGMINE METHYLSULFATE 1 MG/ML INJECTION SOLUTION. [4085490]

Facility

$3.43

Service Code	HCPCS J2710
Hospital Charge Code	901700025
Hospital Revenue Code	636
Min. Negotiated Rate	$1.89
Max. Negotiated Rate	$2.74
Rate for Payer: Cash Price	$1.89
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$2.74
Rate for Payer: Health Smart Auto/Commercial	$2.06
Rate for Payer: LLUH Dept of Risk Management WC	$1.89
Rate for Payer: Multiplan Commercial	$2.57

NEVIRAPINE 200 MG TABLET [17403]

Facility

$0.20

Service Code	NDC 0378-4050-91
Hospital Charge Code	901700029
Hospital Revenue Code	259
Min. Negotiated Rate	$0.11
Max. Negotiated Rate	$0.16
Rate for Payer: Cash Price	$0.11
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$0.16
Rate for Payer: Health Smart Auto/Commercial	$0.12
Rate for Payer: LLUH Dept of Risk Management WC	$0.11
Rate for Payer: Multiplan Commercial	$0.15

NEVIRAPINE 200 MG TABLET [17403]

Facility

$0.20

Service Code	NDC 0378-4050-91
Hospital Charge Code	901700029
Hospital Revenue Code	259
Min. Negotiated Rate	$0.11
Max. Negotiated Rate	$0.16
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$0.12
Rate for Payer: Aetna of CA Government/Medicare	$0.12
Rate for Payer: Cash Price	$0.11
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$0.16
Rate for Payer: Health Smart Auto/Commercial	$0.12
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$0.12
Rate for Payer: LLUH Dept of Risk Management WC	$0.11
Rate for Payer: Multiplan Commercial	$0.15

NIACIN 100 MG TABLET [5539]

Facility

$0.02

Service Code	NDC 8068105700
Hospital Charge Code	901700029
Hospital Revenue Code	259
Min. Negotiated Rate	$0.01
Max. Negotiated Rate	$0.02
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$0.01
Rate for Payer: Aetna of CA Government/Medicare	$0.01
Rate for Payer: Cash Price	$0.01
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$0.02
Rate for Payer: Health Smart Auto/Commercial	$0.01
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$0.01
Rate for Payer: LLUH Dept of Risk Management WC	$0.01
Rate for Payer: Multiplan Commercial	$0.02

NIACIN 100 MG TABLET [5539]

Facility

$0.02

Service Code	NDC 8068105700
Hospital Charge Code	901700029
Hospital Revenue Code	259
Min. Negotiated Rate	$0.01
Max. Negotiated Rate	$0.02
Rate for Payer: Cash Price	$0.01
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$0.02
Rate for Payer: Health Smart Auto/Commercial	$0.01
Rate for Payer: LLUH Dept of Risk Management WC	$0.01
Rate for Payer: Multiplan Commercial	$0.02

NIACIN 500 MG TABLET [5542]

Facility

$0.06

Service Code	NDC 7985420983
Hospital Charge Code	901700029
Hospital Revenue Code	259
Min. Negotiated Rate	$0.03
Max. Negotiated Rate	$0.05
Rate for Payer: Cash Price	$0.03
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$0.05
Rate for Payer: Health Smart Auto/Commercial	$0.04
Rate for Payer: LLUH Dept of Risk Management WC	$0.03
Rate for Payer: Multiplan Commercial	$0.05

NIACIN 500 MG TABLET [5542]

Facility

$0.06

Service Code	NDC 7985420983
Hospital Charge Code	901700029
Hospital Revenue Code	259
Min. Negotiated Rate	$0.03
Max. Negotiated Rate	$0.05
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$0.04
Rate for Payer: Aetna of CA Government/Medicare	$0.04
Rate for Payer: Cash Price	$0.03
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$0.05
Rate for Payer: Health Smart Auto/Commercial	$0.04
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$0.04
Rate for Payer: LLUH Dept of Risk Management WC	$0.03
Rate for Payer: Multiplan Commercial	$0.05

NIACIN 500 MG TABLET [5542]

Facility

$0.03

Service Code	NDC 0904227260
Hospital Charge Code	901700029
Hospital Revenue Code	259
Min. Negotiated Rate	$0.02
Max. Negotiated Rate	$0.02
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	$0.02
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	$0.02

NIACIN 500 MG TABLET [5542]

Facility

$0.03

Service Code	NDC 0904227260
Hospital Charge Code	901700029
Hospital Revenue Code	259
Min. Negotiated Rate	$0.02
Max. Negotiated Rate	$0.02
Rate for Payer: Cash Price	$0.02
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$0.02
Rate for Payer: Health Smart Auto/Commercial	$0.02
Rate for Payer: LLUH Dept of Risk Management WC	$0.02
Rate for Payer: Multiplan Commercial	$0.02

NIACINAMIDE 500 MG TABLET [5548]

Facility

$0.03

Service Code	NDC 8068101900
Hospital Charge Code	901700029
Hospital Revenue Code	259
Min. Negotiated Rate	$0.02
Max. Negotiated Rate	$0.02
Rate for Payer: Cash Price	$0.02
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$0.02
Rate for Payer: Health Smart Auto/Commercial	$0.02
Rate for Payer: LLUH Dept of Risk Management WC	$0.02
Rate for Payer: Multiplan Commercial	$0.02

NIACINAMIDE 500 MG TABLET [5548]

Facility

$0.03

Service Code	NDC 8068101900
Hospital Charge Code	901700029
Hospital Revenue Code	259
Min. Negotiated Rate	$0.02
Max. Negotiated Rate	$0.02
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	$0.02
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	$0.02

NIACIN ER 500 MG TABLET,EXTENDED RELEASE 24 HR [27181]

Facility

$0.48

Service Code	NDC 47335-539-81
Hospital Charge Code	901700029
Hospital Revenue Code	259
Min. Negotiated Rate	$0.26
Max. Negotiated Rate	$0.38
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	$0.26
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$0.38
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	$0.26
Rate for Payer: Multiplan Commercial	$0.36

NIACIN ER 500 MG TABLET,EXTENDED RELEASE 24 HR [27181]

Facility

$0.48

Service Code	NDC 47335-539-81
Hospital Charge Code	901700029
Hospital Revenue Code	259
Min. Negotiated Rate	$0.26
Max. Negotiated Rate	$0.38
Rate for Payer: Cash Price	$0.26
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$0.38
Rate for Payer: Health Smart Auto/Commercial	$0.29
Rate for Payer: LLUH Dept of Risk Management WC	$0.26
Rate for Payer: Multiplan Commercial	$0.36

NIACIN ER 500 MG TABLET,EXTENDED RELEASE 24 HR [27181]

Facility

$0.43

Service Code	NDC 65162-321-09
Hospital Charge Code	901700029
Hospital Revenue Code	259
Min. Negotiated Rate	$0.24
Max. Negotiated Rate	$0.34
Rate for Payer: Cash Price	$0.23
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$0.34
Rate for Payer: Health Smart Auto/Commercial	$0.26
Rate for Payer: LLUH Dept of Risk Management WC	$0.24
Rate for Payer: Multiplan Commercial	$0.32

NIACIN ER 500 MG TABLET,EXTENDED RELEASE 24 HR [27181]

Facility

$0.43

Service Code	NDC 65162-321-09
Hospital Charge Code	901700029
Hospital Revenue Code	259
Min. Negotiated Rate	$0.24
Max. Negotiated Rate	$0.34
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$0.26
Rate for Payer: Aetna of CA Government/Medicare	$0.26
Rate for Payer: Cash Price	$0.23
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$0.34
Rate for Payer: Health Smart Auto/Commercial	$0.26
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$0.26
Rate for Payer: LLUH Dept of Risk Management WC	$0.24
Rate for Payer: Multiplan Commercial	$0.32

NICARDIPINE 25 MG/10 ML INTRAVENOUS SOLUTION [12370]

Facility

$2.42

Service Code	HCPCS J2404
Hospital Charge Code	901700025
Hospital Revenue Code	636
Min. Negotiated Rate	$1.33
Max. Negotiated Rate	$1.94
Rate for Payer: Cash Price	$1.33
Rate for Payer: Cash Price	$0.92
Rate for Payer: Cash Price	$1.68
Rate for Payer: Cash Price	$1.40
Rate for Payer: Cash Price	$1.30
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$1.89
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$1.34
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$1.94
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$2.04
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$2.45
Rate for Payer: Health Smart Auto/Commercial	$1.01
Rate for Payer: Health Smart Auto/Commercial	$1.42
Rate for Payer: Health Smart Auto/Commercial	$1.84
Rate for Payer: Health Smart Auto/Commercial	$1.53
Rate for Payer: Health Smart Auto/Commercial	$1.45
Rate for Payer: LLUH Dept of Risk Management WC	$0.92
Rate for Payer: LLUH Dept of Risk Management WC	$1.33
Rate for Payer: LLUH Dept of Risk Management WC	$1.68
Rate for Payer: LLUH Dept of Risk Management WC	$1.30
Rate for Payer: LLUH Dept of Risk Management WC	$1.40
Rate for Payer: Multiplan Commercial	$1.77
Rate for Payer: Multiplan Commercial	$1.81
Rate for Payer: Multiplan Commercial	$1.91
Rate for Payer: Multiplan Commercial	$2.29
Rate for Payer: Multiplan Commercial	$1.26

NICARDIPINE 25 MG/10 ML INTRAVENOUS SOLUTION [12370]

Facility

$1.68

Service Code	HCPCS J2404
Hospital Charge Code	901700025
Hospital Revenue Code	636
Min. Negotiated Rate	$0.92
Max. Negotiated Rate	$1.34
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$1.01
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$1.84
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$1.53
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$1.45
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$1.42
Rate for Payer: Aetna of CA Government/Medicare	$1.42
Rate for Payer: Aetna of CA Government/Medicare	$1.53
Rate for Payer: Aetna of CA Government/Medicare	$1.84
Rate for Payer: Aetna of CA Government/Medicare	$1.45
Rate for Payer: Aetna of CA Government/Medicare	$1.01
Rate for Payer: Cash Price	$1.30
Rate for Payer: Cash Price	$1.68
Rate for Payer: Cash Price	$0.92
Rate for Payer: Cash Price	$1.40
Rate for Payer: Cash Price	$1.33
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$1.94
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$2.45
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$1.34
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$1.89
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$2.04
Rate for Payer: Health Smart Auto/Commercial	$1.45
Rate for Payer: Health Smart Auto/Commercial	$1.01
Rate for Payer: Health Smart Auto/Commercial	$1.42
Rate for Payer: Health Smart Auto/Commercial	$1.53
Rate for Payer: Health Smart Auto/Commercial	$1.84
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$1.45
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$1.53
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$1.42
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$1.01
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$1.84
Rate for Payer: LLUH Dept of Risk Management WC	$1.33
Rate for Payer: LLUH Dept of Risk Management WC	$0.92
Rate for Payer: LLUH Dept of Risk Management WC	$1.30
Rate for Payer: LLUH Dept of Risk Management WC	$1.68
Rate for Payer: LLUH Dept of Risk Management WC	$1.40
Rate for Payer: Multiplan Commercial	$2.29
Rate for Payer: Multiplan Commercial	$1.91
Rate for Payer: Multiplan Commercial	$1.26
Rate for Payer: Multiplan Commercial	$1.81
Rate for Payer: Multiplan Commercial	$1.77

NICOTINE 14 MG/24 HR DAILY TRANSDERMAL PATCH [27862]

Facility

$2.12

Service Code	NDC 46122-352-74
Hospital Charge Code	901700029
Hospital Revenue Code	259
Min. Negotiated Rate	$1.17
Max. Negotiated Rate	$1.70
Rate for Payer: Cash Price	$1.16
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$1.70
Rate for Payer: Health Smart Auto/Commercial	$1.27
Rate for Payer: LLUH Dept of Risk Management WC	$1.17
Rate for Payer: Multiplan Commercial	$1.59

NICOTINE 14 MG/24 HR DAILY TRANSDERMAL PATCH [27862]

Facility

$2.12

Service Code	NDC 46122-352-74
Hospital Charge Code	901700029
Hospital Revenue Code	259
Min. Negotiated Rate	$1.17
Max. Negotiated Rate	$1.70
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$1.27
Rate for Payer: Aetna of CA Government/Medicare	$1.27
Rate for Payer: Cash Price	$1.16
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$1.70
Rate for Payer: Health Smart Auto/Commercial	$1.27
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$1.27
Rate for Payer: LLUH Dept of Risk Management WC	$1.17
Rate for Payer: Multiplan Commercial	$1.59

NICOTINE 14 MG/24 HR DAILY TRANSDERMAL PATCH [27862]

Facility

$2.12

Service Code	NDC 8770142789
Hospital Charge Code	901700029
Hospital Revenue Code	259
Min. Negotiated Rate	$1.17
Max. Negotiated Rate	$1.70
Rate for Payer: Cash Price	$1.16
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$1.70
Rate for Payer: Health Smart Auto/Commercial	$1.27
Rate for Payer: LLUH Dept of Risk Management WC	$1.17
Rate for Payer: Multiplan Commercial	$1.59

Know your out-of-pocket cost for care.

All Charges