Loma Linda University Behavioral Medicine Center (BMC)

All Charges

Charge

Type

Setting

Price

LIDOCAINE (PF) 8 MG/ML (0.8 %) IN 5 % DEXTROSE IV BOLUS [40814869]

Facility

$0.04

Service Code	CPT J2001
Hospital Charge Code	1771168
Hospital Revenue Code	636
Min. Negotiated Rate	$0.02
Max. Negotiated Rate	$0.03
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: 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 Beech St/Commercial/PHCS	$0.03

LIDOCAINE (PF) 8 MG/ML (0.8 %) IN 5 % DEXTROSE IV PEDS [4081321]

Facility

$0.04

Service Code	CPT J2001
Hospital Charge Code	1771168
Hospital Revenue Code	636
Min. Negotiated Rate	$0.02
Max. Negotiated Rate	$0.03
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: 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 Beech St/Commercial/PHCS	$0.03

LIDOCAINE (PF) 8 MG/ML (0.8 %) IN 5 % DEXTROSE IV PEDS [4081321]

Facility

$0.04

Service Code	CPT J2001
Hospital Charge Code	1771168
Hospital Revenue Code	636
Min. Negotiated Rate	$0.02
Max. Negotiated Rate	$0.03
Rate for Payer: Cash Price	$0.02
Rate for Payer: Cigna of CA HMO/PPO	$0.03
Rate for Payer: Health Smart Auto/Commercial	$0.02
Rate for Payer: LLUH Dept of Risk Management WC	$0.02
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$0.03

LIDOCAINE-PRILOCAINE 2.5 %-2.5 % TOPICAL CREAM [10434]

Facility

$1.98

Service Code	NDC 0168-0357-05
Hospital Charge Code	NDG10434B
Hospital Revenue Code	259
Min. Negotiated Rate	$1.09
Max. Negotiated Rate	$1.58
Rate for Payer: Cash Price	$0.89
Rate for Payer: Cigna of CA HMO/PPO	$1.58
Rate for Payer: Health Smart Auto/Commercial	$1.19
Rate for Payer: LLUH Dept of Risk Management WC	$1.09
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$1.48

LIDOCAINE-PRILOCAINE 2.5 %-2.5 % TOPICAL CREAM [10434]

Facility

$1.98

Service Code	NDC 0168-0357-05
Hospital Charge Code	NDG10434B
Hospital Revenue Code	259
Min. Negotiated Rate	$1.09
Max. Negotiated Rate	$1.48
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$1.19
Rate for Payer: Aetna of CA Government/Medicare	$1.19
Rate for Payer: Cash Price	$0.89
Rate for Payer: Health Smart Auto/Commercial	$1.19
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$1.19
Rate for Payer: LLUH Dept of Risk Management WC	$1.09
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$1.48

LIDOCAINE-PRILOCAINE 2.5 %-2.5 % TOPICAL CREAM [10434]

Facility

$1.70

Service Code	NDC 0591-2070-30
Hospital Charge Code	NDG10434
Hospital Revenue Code	259
Min. Negotiated Rate	$0.94
Max. Negotiated Rate	$1.36
Rate for Payer: Cash Price	$0.77
Rate for Payer: Cigna of CA HMO/PPO	$1.36
Rate for Payer: Health Smart Auto/Commercial	$1.02
Rate for Payer: LLUH Dept of Risk Management WC	$0.94
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$1.28

LIDOCAINE-PRILOCAINE 2.5 %-2.5 % TOPICAL CREAM [10434]

Facility

$1.70

Service Code	NDC 0591-2070-30
Hospital Charge Code	NDG10434
Hospital Revenue Code	259
Min. Negotiated Rate	$0.94
Max. Negotiated Rate	$1.28
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$1.02
Rate for Payer: Aetna of CA Government/Medicare	$1.02
Rate for Payer: Cash Price	$0.77
Rate for Payer: Health Smart Auto/Commercial	$1.02
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$1.02
Rate for Payer: LLUH Dept of Risk Management WC	$0.94
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$1.28

LINACLOTIDE 145 MCG CAPSULE [199379]

Facility

$20.61

Service Code	NDC 0456-1201-30
Hospital Charge Code	ERX199379
Hospital Revenue Code	259
Min. Negotiated Rate	$11.34
Max. Negotiated Rate	$16.49
Rate for Payer: Cash Price	$9.27
Rate for Payer: Cigna of CA HMO/PPO	$16.49
Rate for Payer: Health Smart Auto/Commercial	$12.37
Rate for Payer: LLUH Dept of Risk Management WC	$11.34
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$15.46

LINACLOTIDE 145 MCG CAPSULE [199379]

Facility

$20.61

Service Code	NDC 0456-1201-30
Hospital Charge Code	ERX199379
Hospital Revenue Code	259
Min. Negotiated Rate	$11.34
Max. Negotiated Rate	$15.46
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$12.37
Rate for Payer: Aetna of CA Government/Medicare	$12.37
Rate for Payer: Cash Price	$9.27
Rate for Payer: Health Smart Auto/Commercial	$12.37
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$12.37
Rate for Payer: LLUH Dept of Risk Management WC	$11.34
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$15.46

LINEZOLID 100 MG/5 ML ORAL SUSPENSION [28225]

Facility

$5.46

Service Code	NDC 0009-5136-01
Hospital Charge Code	1715979
Hospital Revenue Code	259
Min. Negotiated Rate	$3.00
Max. Negotiated Rate	$4.37
Rate for Payer: Cash Price	$2.46
Rate for Payer: Cigna of CA HMO/PPO	$4.37
Rate for Payer: Health Smart Auto/Commercial	$3.28
Rate for Payer: LLUH Dept of Risk Management WC	$3.00
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$4.10

LINEZOLID 100 MG/5 ML ORAL SUSPENSION [28225]

Facility

$5.46

Service Code	NDC 0009-5136-01
Hospital Charge Code	1715979
Hospital Revenue Code	259
Min. Negotiated Rate	$3.00
Max. Negotiated Rate	$4.10
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$3.28
Rate for Payer: Aetna of CA Government/Medicare	$3.28
Rate for Payer: Cash Price	$2.46
Rate for Payer: Health Smart Auto/Commercial	$3.28
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$3.28
Rate for Payer: LLUH Dept of Risk Management WC	$3.00
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$4.10

LINEZOLID 100 MG/5 ML ORAL SUSPENSION [28225]

Facility

$5.25

Service Code	NDC 59762-1308-1
Hospital Charge Code	1715979
Hospital Revenue Code	259
Min. Negotiated Rate	$2.89
Max. Negotiated Rate	$4.20
Rate for Payer: Cash Price	$2.36
Rate for Payer: Cigna of CA HMO/PPO	$4.20
Rate for Payer: Health Smart Auto/Commercial	$3.15
Rate for Payer: LLUH Dept of Risk Management WC	$2.89
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$3.94

LINEZOLID 100 MG/5 ML ORAL SUSPENSION [28225]

Facility

$5.25

Service Code	NDC 59762-1308-1
Hospital Charge Code	1715979
Hospital Revenue Code	259
Min. Negotiated Rate	$2.89
Max. Negotiated Rate	$3.94
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$3.15
Rate for Payer: Aetna of CA Government/Medicare	$3.15
Rate for Payer: Cash Price	$2.36
Rate for Payer: Health Smart Auto/Commercial	$3.15
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$3.15
Rate for Payer: LLUH Dept of Risk Management WC	$2.89
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$3.94

LINEZOLID 600 MG/300 ML IN 0.9 % SODIUM CHLORIDE INTRAVENOUS PIGGYBACK [210366]

Facility

$0.25

Service Code	CPT J2021
Hospital Charge Code	NDG210366
Hospital Revenue Code	636
Min. Negotiated Rate	$0.14
Max. Negotiated Rate	$0.20
Rate for Payer: Cash Price	$0.11
Rate for Payer: Cigna of CA HMO/PPO	$0.20
Rate for Payer: Health Smart Auto/Commercial	$0.15
Rate for Payer: LLUH Dept of Risk Management WC	$0.14
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$0.19

LINEZOLID 600 MG/300 ML IN 0.9 % SODIUM CHLORIDE INTRAVENOUS PIGGYBACK [210366]

Facility

$0.25

Service Code	CPT J2021
Hospital Charge Code	NDG210366
Hospital Revenue Code	636
Min. Negotiated Rate	$0.14
Max. Negotiated Rate	$0.19
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$0.15
Rate for Payer: Aetna of CA Government/Medicare	$0.15
Rate for Payer: Cash Price	$0.11
Rate for Payer: Health Smart Auto/Commercial	$0.15
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$0.15
Rate for Payer: LLUH Dept of Risk Management WC	$0.14
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$0.19

LINEZOLID 600 MG TABLET [28224]

Facility

$7.40

Service Code	NDC 60687-309-11
Hospital Charge Code	1712242
Hospital Revenue Code	259
Min. Negotiated Rate	$4.07
Max. Negotiated Rate	$5.55
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$4.44
Rate for Payer: Aetna of CA Government/Medicare	$4.44
Rate for Payer: Cash Price	$3.33
Rate for Payer: Health Smart Auto/Commercial	$4.44
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$4.44
Rate for Payer: LLUH Dept of Risk Management WC	$4.07
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$5.55

LINEZOLID 600 MG TABLET [28224]

Facility

$4.20

Service Code	NDC 67877-419-84
Hospital Charge Code	1712242
Hospital Revenue Code	259
Min. Negotiated Rate	$2.31
Max. Negotiated Rate	$3.36
Rate for Payer: Cash Price	$1.89
Rate for Payer: Cigna of CA 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 Beech St/Commercial/PHCS	$3.15

LINEZOLID 600 MG TABLET [28224]

Facility

$7.40

Service Code	NDC 60687-309-21
Hospital Charge Code	1712242
Hospital Revenue Code	259
Min. Negotiated Rate	$4.07
Max. Negotiated Rate	$5.55
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$4.44
Rate for Payer: Aetna of CA Government/Medicare	$4.44
Rate for Payer: Cash Price	$3.33
Rate for Payer: Health Smart Auto/Commercial	$4.44
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$4.44
Rate for Payer: LLUH Dept of Risk Management WC	$4.07
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$5.55

LINEZOLID 600 MG TABLET [28224]

Facility

$7.43

Service Code	NDC 0904-6553-04
Hospital Charge Code	1712242
Hospital Revenue Code	259
Min. Negotiated Rate	$4.09
Max. Negotiated Rate	$5.57
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$4.46
Rate for Payer: Aetna of CA Government/Medicare	$4.46
Rate for Payer: Cash Price	$3.34
Rate for Payer: Health Smart Auto/Commercial	$4.46
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$4.46
Rate for Payer: LLUH Dept of Risk Management WC	$4.09
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$5.57

LINEZOLID 600 MG TABLET [28224]

Facility

$7.40

Service Code	NDC 60687-309-11
Hospital Charge Code	1712242
Hospital Revenue Code	259
Min. Negotiated Rate	$4.07
Max. Negotiated Rate	$5.92
Rate for Payer: Cash Price	$3.33
Rate for Payer: Cigna of CA HMO/PPO	$5.92
Rate for Payer: Health Smart Auto/Commercial	$4.44
Rate for Payer: LLUH Dept of Risk Management WC	$4.07
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$5.55

LINEZOLID 600 MG TABLET [28224]

Facility

$4.20

Service Code	NDC 67877-419-33
Hospital Charge Code	1712242
Hospital Revenue Code	259
Min. Negotiated Rate	$2.31
Max. Negotiated Rate	$3.36
Rate for Payer: Cash Price	$1.89
Rate for Payer: Cigna of CA 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 Beech St/Commercial/PHCS	$3.15

LINEZOLID 600 MG TABLET [28224]

Facility

$4.20

Service Code	NDC 67877-419-33
Hospital Charge Code	1712242
Hospital Revenue Code	259
Min. Negotiated Rate	$2.31
Max. Negotiated Rate	$3.15
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	$1.89
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 Beech St/Commercial/PHCS	$3.15

LINEZOLID 600 MG TABLET [28224]

Facility

$7.43

Service Code	NDC 0904-6553-04
Hospital Charge Code	1712242
Hospital Revenue Code	259
Min. Negotiated Rate	$4.09
Max. Negotiated Rate	$5.94
Rate for Payer: Cash Price	$3.34
Rate for Payer: Cigna of CA HMO/PPO	$5.94
Rate for Payer: Health Smart Auto/Commercial	$4.46
Rate for Payer: LLUH Dept of Risk Management WC	$4.09
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$5.57

LINEZOLID 600 MG TABLET [28224]

Facility

$4.20

Service Code	NDC 67877-419-84
Hospital Charge Code	1712242
Hospital Revenue Code	259
Min. Negotiated Rate	$2.31
Max. Negotiated Rate	$3.15
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	$1.89
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 Beech St/Commercial/PHCS	$3.15

LINEZOLID 600 MG TABLET [28224]

Facility

$7.40

Service Code	NDC 60687-309-21
Hospital Charge Code	1712242
Hospital Revenue Code	259
Min. Negotiated Rate	$4.07
Max. Negotiated Rate	$5.92
Rate for Payer: Cash Price	$3.33
Rate for Payer: Cigna of CA HMO/PPO	$5.92
Rate for Payer: Health Smart Auto/Commercial	$4.44
Rate for Payer: LLUH Dept of Risk Management WC	$4.07
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$5.55

Know your out-of-pocket cost for care.

All Charges