Loma Linda University Behavioral Medicine Center (BMC)

All Charges

Charge

Type

Setting

Price

LANREOTIDE 90 MG/0.3 ML SUBCUTANEOUS SYRINGE [87860]

Facility

$32,432.00

Service Code	CPT J1930
Hospital Charge Code	NDG87860
Hospital Revenue Code	636
Min. Negotiated Rate	$17,837.60
Max. Negotiated Rate	$25,945.60
Rate for Payer: Cash Price	$14,594.40
Rate for Payer: Cigna of CA HMO/PPO	$25,945.60
Rate for Payer: Health Smart Auto/Commercial	$19,459.20
Rate for Payer: LLUH Dept of Risk Management WC	$17,837.60
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$24,324.00

LANSOPRAZOLE 15 MG CAPSULE,DELAYED RELEASE [27691]

Facility

$3.65

Service Code	NDC 60687-111-21
Hospital Charge Code	1711714
Hospital Revenue Code	259
Min. Negotiated Rate	$2.01
Max. Negotiated Rate	$2.74
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$2.19
Rate for Payer: Aetna of CA Government/Medicare	$2.19
Rate for Payer: Cash Price	$1.64
Rate for Payer: Health Smart Auto/Commercial	$2.19
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$2.19
Rate for Payer: LLUH Dept of Risk Management WC	$2.01
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$2.74

LANSOPRAZOLE 15 MG CAPSULE,DELAYED RELEASE [27691]

Facility

$3.65

Service Code	NDC 60687-111-11
Hospital Charge Code	1711714
Hospital Revenue Code	259
Min. Negotiated Rate	$2.01
Max. Negotiated Rate	$2.74
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$2.19
Rate for Payer: Aetna of CA Government/Medicare	$2.19
Rate for Payer: Cash Price	$1.64
Rate for Payer: Health Smart Auto/Commercial	$2.19
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$2.19
Rate for Payer: LLUH Dept of Risk Management WC	$2.01
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$2.74

LANSOPRAZOLE 15 MG CAPSULE,DELAYED RELEASE [27691]

Facility

$3.65

Service Code	NDC 60687-111-21
Hospital Charge Code	1711714
Hospital Revenue Code	259
Min. Negotiated Rate	$2.01
Max. Negotiated Rate	$2.92
Rate for Payer: Cash Price	$1.64
Rate for Payer: Cigna of CA HMO/PPO	$2.92
Rate for Payer: Health Smart Auto/Commercial	$2.19
Rate for Payer: LLUH Dept of Risk Management WC	$2.01
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$2.74

LANSOPRAZOLE 15 MG CAPSULE,DELAYED RELEASE [27691]

Facility

$3.65

Service Code	NDC 60687-111-11
Hospital Charge Code	1711714
Hospital Revenue Code	259
Min. Negotiated Rate	$2.01
Max. Negotiated Rate	$2.92
Rate for Payer: Cash Price	$1.64
Rate for Payer: Cigna of CA HMO/PPO	$2.92
Rate for Payer: Health Smart Auto/Commercial	$2.19
Rate for Payer: LLUH Dept of Risk Management WC	$2.01
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$2.74

LANSOPRAZOLE 30 MG DELAYED RELEASE,DISINTEGRATING TABLET [34595]

Facility

$16.60

Service Code	NDC 64764-544-11
Hospital Charge Code	1711847
Hospital Revenue Code	259
Min. Negotiated Rate	$9.13
Max. Negotiated Rate	$13.28
Rate for Payer: Cash Price	$7.47
Rate for Payer: Cigna of CA HMO/PPO	$13.28
Rate for Payer: Health Smart Auto/Commercial	$9.96
Rate for Payer: LLUH Dept of Risk Management WC	$9.13
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$12.45

LANSOPRAZOLE 30 MG DELAYED RELEASE,DISINTEGRATING TABLET [34595]

Facility

$16.60

Service Code	NDC 64764-544-11
Hospital Charge Code	1711847
Hospital Revenue Code	259
Min. Negotiated Rate	$9.13
Max. Negotiated Rate	$12.45
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$9.96
Rate for Payer: Aetna of CA Government/Medicare	$9.96
Rate for Payer: Cash Price	$7.47
Rate for Payer: Health Smart Auto/Commercial	$9.96
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$9.96
Rate for Payer: LLUH Dept of Risk Management WC	$9.13
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$12.45

LANSOPRAZOLE ORAL SUSPENSION COMPOUND 3 MG/ML [4080290]

Facility

$0.57

Service Code	NDC 9994-0802-90
Hospital Charge Code	1715980
Hospital Revenue Code	259
Min. Negotiated Rate	$0.31
Max. Negotiated Rate	$0.46
Rate for Payer: Cash Price	$0.26
Rate for Payer: Cigna of CA HMO/PPO	$0.46
Rate for Payer: Health Smart Auto/Commercial	$0.34
Rate for Payer: LLUH Dept of Risk Management WC	$0.31
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$0.43

LANSOPRAZOLE ORAL SUSPENSION COMPOUND 3 MG/ML [4080290]

Facility

$0.57

Service Code	NDC 9994-0802-90
Hospital Charge Code	1715980
Hospital Revenue Code	259
Min. Negotiated Rate	$0.31
Max. Negotiated Rate	$0.43
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	$0.26
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 Beech St/Commercial/PHCS	$0.43

LANTHANUM 1,000 MG CHEWABLE TABLET [43548]

Facility

$6.67

Service Code	NDC 68180-821-47
Hospital Charge Code	1711937
Hospital Revenue Code	259
Min. Negotiated Rate	$3.67
Max. Negotiated Rate	$5.34
Rate for Payer: Cash Price	$3.00
Rate for Payer: Cigna of CA HMO/PPO	$5.34
Rate for Payer: Health Smart Auto/Commercial	$4.00
Rate for Payer: LLUH Dept of Risk Management WC	$3.67
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$5.00

LANTHANUM 1,000 MG CHEWABLE TABLET [43548]

Facility

$12.95

Service Code	NDC 66993-424-85
Hospital Charge Code	1711937
Hospital Revenue Code	259
Min. Negotiated Rate	$7.12
Max. Negotiated Rate	$9.71
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$7.77
Rate for Payer: Aetna of CA Government/Medicare	$7.77
Rate for Payer: Cash Price	$5.83
Rate for Payer: Health Smart Auto/Commercial	$7.77
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$7.77
Rate for Payer: LLUH Dept of Risk Management WC	$7.12
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$9.71

LANTHANUM 1,000 MG CHEWABLE TABLET [43548]

Facility

$6.67

Service Code	NDC 68180-821-47
Hospital Charge Code	1711937
Hospital Revenue Code	259
Min. Negotiated Rate	$3.67
Max. Negotiated Rate	$5.00
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$4.00
Rate for Payer: Aetna of CA Government/Medicare	$4.00
Rate for Payer: Cash Price	$3.00
Rate for Payer: Health Smart Auto/Commercial	$4.00
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$4.00
Rate for Payer: LLUH Dept of Risk Management WC	$3.67
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$5.00

LANTHANUM 1,000 MG CHEWABLE TABLET [43548]

Facility

$6.67

Service Code	NDC 68180-821-10
Hospital Charge Code	1711937
Hospital Revenue Code	259
Min. Negotiated Rate	$3.67
Max. Negotiated Rate	$5.00
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$4.00
Rate for Payer: Aetna of CA Government/Medicare	$4.00
Rate for Payer: Cash Price	$3.00
Rate for Payer: Health Smart Auto/Commercial	$4.00
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$4.00
Rate for Payer: LLUH Dept of Risk Management WC	$3.67
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$5.00

LANTHANUM 1,000 MG CHEWABLE TABLET [43548]

Facility

$6.67

Service Code	NDC 68180-821-10
Hospital Charge Code	1711937
Hospital Revenue Code	259
Min. Negotiated Rate	$3.67
Max. Negotiated Rate	$5.34
Rate for Payer: Cash Price	$3.00
Rate for Payer: Cigna of CA HMO/PPO	$5.34
Rate for Payer: Health Smart Auto/Commercial	$4.00
Rate for Payer: LLUH Dept of Risk Management WC	$3.67
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$5.00

LANTHANUM 1,000 MG CHEWABLE TABLET [43548]

Facility

$12.95

Service Code	NDC 66993-424-75
Hospital Charge Code	1711937
Hospital Revenue Code	259
Min. Negotiated Rate	$7.12
Max. Negotiated Rate	$10.36
Rate for Payer: Cash Price	$5.83
Rate for Payer: Cigna of CA HMO/PPO	$10.36
Rate for Payer: Health Smart Auto/Commercial	$7.77
Rate for Payer: LLUH Dept of Risk Management WC	$7.12
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$9.71

LANTHANUM 1,000 MG CHEWABLE TABLET [43548]

Facility

$12.95

Service Code	NDC 66993-424-75
Hospital Charge Code	1711937
Hospital Revenue Code	259
Min. Negotiated Rate	$7.12
Max. Negotiated Rate	$9.71
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$7.77
Rate for Payer: Aetna of CA Government/Medicare	$7.77
Rate for Payer: Cash Price	$5.83
Rate for Payer: Health Smart Auto/Commercial	$7.77
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$7.77
Rate for Payer: LLUH Dept of Risk Management WC	$7.12
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$9.71

LANTHANUM 1,000 MG CHEWABLE TABLET [43548]

Facility

$12.95

Service Code	NDC 66993-424-85
Hospital Charge Code	1711937
Hospital Revenue Code	259
Min. Negotiated Rate	$7.12
Max. Negotiated Rate	$10.36
Rate for Payer: Cash Price	$5.83
Rate for Payer: Cigna of CA HMO/PPO	$10.36
Rate for Payer: Health Smart Auto/Commercial	$7.77
Rate for Payer: LLUH Dept of Risk Management WC	$7.12
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$9.71

LANTHANUM 500 MG CHEWABLE TABLET [39975]

Facility

$14.41

Service Code	NDC 54092-252-45
Hospital Charge Code	1711939
Hospital Revenue Code	259
Min. Negotiated Rate	$7.93
Max. Negotiated Rate	$11.53
Rate for Payer: Cash Price	$6.48
Rate for Payer: Cigna of CA HMO/PPO	$11.53
Rate for Payer: Health Smart Auto/Commercial	$8.65
Rate for Payer: LLUH Dept of Risk Management WC	$7.93
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$10.81

LANTHANUM 500 MG CHEWABLE TABLET [39975]

Facility

$14.41

Service Code	NDC 54092-252-45
Hospital Charge Code	1711939
Hospital Revenue Code	259
Min. Negotiated Rate	$7.93
Max. Negotiated Rate	$10.81
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$8.65
Rate for Payer: Aetna of CA Government/Medicare	$8.65
Rate for Payer: Cash Price	$6.48
Rate for Payer: Health Smart Auto/Commercial	$8.65
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$8.65
Rate for Payer: LLUH Dept of Risk Management WC	$7.93
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$10.81

LARONIDASE 2.9 MG/5 ML INTRAVENOUS SOLUTION [35779]

Facility

$247.05

Service Code	CPT J1931
Hospital Charge Code	1753490
Hospital Revenue Code	636
Min. Negotiated Rate	$135.88
Max. Negotiated Rate	$197.64
Rate for Payer: Cash Price	$111.17
Rate for Payer: Cigna of CA HMO/PPO	$197.64
Rate for Payer: Health Smart Auto/Commercial	$148.23
Rate for Payer: LLUH Dept of Risk Management WC	$135.88
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$185.29

LARONIDASE 2.9 MG/5 ML INTRAVENOUS SOLUTION [35779]

Facility

$247.05

Service Code	CPT J1931
Hospital Charge Code	1753490
Hospital Revenue Code	636
Min. Negotiated Rate	$135.88
Max. Negotiated Rate	$185.29
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$148.23
Rate for Payer: Aetna of CA Government/Medicare	$148.23
Rate for Payer: Cash Price	$111.17
Rate for Payer: Health Smart Auto/Commercial	$148.23
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$148.23
Rate for Payer: LLUH Dept of Risk Management WC	$135.88
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$185.29

LATANOPROST 0.005 % EYE DROPS [18621]

Facility

$2.38

Service Code	NDC 70069-421-01
Hospital Charge Code	1740302
Hospital Revenue Code	259
Min. Negotiated Rate	$1.31
Max. Negotiated Rate	$1.78
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$1.43
Rate for Payer: Aetna of CA Government/Medicare	$1.43
Rate for Payer: Cash Price	$1.07
Rate for Payer: Health Smart Auto/Commercial	$1.43
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$1.43
Rate for Payer: LLUH Dept of Risk Management WC	$1.31
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$1.78

LATANOPROST 0.005 % EYE DROPS [18621]

Facility

$5.14

Service Code	NDC 61314-547-01
Hospital Charge Code	1740302
Hospital Revenue Code	259
Min. Negotiated Rate	$2.83
Max. Negotiated Rate	$4.11
Rate for Payer: Cash Price	$2.31
Rate for Payer: Cigna of CA HMO/PPO	$4.11
Rate for Payer: Health Smart Auto/Commercial	$3.08
Rate for Payer: LLUH Dept of Risk Management WC	$2.83
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$3.86

LATANOPROST 0.005 % EYE DROPS [18621]

Facility

$2.38

Service Code	NDC 70069-421-01
Hospital Charge Code	1740302
Hospital Revenue Code	259
Min. Negotiated Rate	$1.31
Max. Negotiated Rate	$1.90
Rate for Payer: Cash Price	$1.07
Rate for Payer: Cigna of CA HMO/PPO	$1.90
Rate for Payer: Health Smart Auto/Commercial	$1.43
Rate for Payer: LLUH Dept of Risk Management WC	$1.31
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$1.78

LATANOPROST 0.005 % EYE DROPS [18621]

Facility

$5.14

Service Code	NDC 61314-547-01
Hospital Charge Code	1740302
Hospital Revenue Code	259
Min. Negotiated Rate	$2.83
Max. Negotiated Rate	$3.86
Rate for Payer: Health Smart Auto/Commercial	$3.08
Rate for Payer: Cash Price	$2.31
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$3.08
Rate for Payer: Aetna of CA Government/Medicare	$3.08
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$3.08
Rate for Payer: LLUH Dept of Risk Management WC	$2.83
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$3.86

Know your out-of-pocket cost for care.

All Charges