Loma Linda University Behavioral Medicine Center (BMC)

All Charges

Charge

Type

Setting

Price

LOSARTAN ORAL SUSPENSION COMPOUND 2.5 MG/ML [4080293]

Facility

$2.26

Service Code	NDC 9994-0802-93
Hospital Charge Code	1715238
Hospital Revenue Code	259
Min. Negotiated Rate	$1.24
Max. Negotiated Rate	$1.81
Rate for Payer: Cash Price	$1.02
Rate for Payer: Cigna of CA HMO/PPO	$1.81
Rate for Payer: Health Smart Auto/Commercial	$1.36
Rate for Payer: LLUH Dept of Risk Management WC	$1.24
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$1.70

LOSARTAN ORAL SUSPENSION COMPOUND 2.5 MG/ML [4080293]

Facility

$2.26

Service Code	NDC 9994-0802-93
Hospital Charge Code	1715238
Hospital Revenue Code	259
Min. Negotiated Rate	$1.24
Max. Negotiated Rate	$1.70
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$1.36
Rate for Payer: Aetna of CA Government/Medicare	$1.36
Rate for Payer: Cash Price	$1.02
Rate for Payer: Health Smart Auto/Commercial	$1.36
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$1.36
Rate for Payer: LLUH Dept of Risk Management WC	$1.24
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$1.70

LOXAPINE SUCCINATE 10 MG CAPSULE [4599]

Facility

$0.86

Service Code	NDC 0591-0370-01
Hospital Charge Code	1712344
Hospital Revenue Code	259
Min. Negotiated Rate	$0.47
Max. Negotiated Rate	$0.69
Rate for Payer: Cash Price	$0.39
Rate for Payer: Cigna of CA HMO/PPO	$0.69
Rate for Payer: Health Smart Auto/Commercial	$0.52
Rate for Payer: LLUH Dept of Risk Management WC	$0.47
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$0.65

LOXAPINE SUCCINATE 10 MG CAPSULE [4599]

Facility

$0.86

Service Code	NDC 0527-1395-01
Hospital Charge Code	1712344
Hospital Revenue Code	259
Min. Negotiated Rate	$0.47
Max. Negotiated Rate	$0.69
Rate for Payer: Cash Price	$0.39
Rate for Payer: Cigna of CA HMO/PPO	$0.69
Rate for Payer: Health Smart Auto/Commercial	$0.52
Rate for Payer: LLUH Dept of Risk Management WC	$0.47
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$0.65

LOXAPINE SUCCINATE 10 MG CAPSULE [4599]

Facility

$0.86

Service Code	NDC 0591-0370-01
Hospital Charge Code	1712344
Hospital Revenue Code	259
Min. Negotiated Rate	$0.47
Max. Negotiated Rate	$0.65
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$0.52
Rate for Payer: Aetna of CA Government/Medicare	$0.52
Rate for Payer: Cash Price	$0.39
Rate for Payer: Health Smart Auto/Commercial	$0.52
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$0.52
Rate for Payer: LLUH Dept of Risk Management WC	$0.47
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$0.65

LOXAPINE SUCCINATE 10 MG CAPSULE [4599]

Facility

$0.86

Service Code	NDC 0527-1395-01
Hospital Charge Code	1712344
Hospital Revenue Code	259
Min. Negotiated Rate	$0.47
Max. Negotiated Rate	$0.65
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$0.52
Rate for Payer: Aetna of CA Government/Medicare	$0.52
Rate for Payer: Cash Price	$0.39
Rate for Payer: Health Smart Auto/Commercial	$0.52
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$0.52
Rate for Payer: LLUH Dept of Risk Management WC	$0.47
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$0.65

LUBIPROSTONE 24 MCG CAPSULE [70472]

Facility

$7.42

Service Code	NDC 64764-240-60
Hospital Charge Code	1711906
Hospital Revenue Code	259
Min. Negotiated Rate	$4.08
Max. Negotiated Rate	$5.56
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$4.45
Rate for Payer: Aetna of CA Government/Medicare	$4.45
Rate for Payer: Cash Price	$3.34
Rate for Payer: Health Smart Auto/Commercial	$4.45
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$4.45
Rate for Payer: LLUH Dept of Risk Management WC	$4.08
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$5.56

LUBIPROSTONE 24 MCG CAPSULE [70472]

Facility

$7.42

Service Code	NDC 64764-240-60
Hospital Charge Code	1711906
Hospital Revenue Code	259
Min. Negotiated Rate	$4.08
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	$4.45
Rate for Payer: LLUH Dept of Risk Management WC	$4.08
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$5.56

LUBIPROSTONE 24 MCG CAPSULE [70472]

Facility

$2.12

Service Code	NDC 0480-4138-06
Hospital Charge Code	1711906
Hospital Revenue Code	259
Min. Negotiated Rate	$1.17
Max. Negotiated Rate	$1.59
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	$0.95
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 Beech St/Commercial/PHCS	$1.59

LUBIPROSTONE 24 MCG CAPSULE [70472]

Facility

$2.12

Service Code	NDC 0480-4138-06
Hospital Charge Code	1711906
Hospital Revenue Code	259
Min. Negotiated Rate	$1.17
Max. Negotiated Rate	$1.70
Rate for Payer: Cash Price	$0.95
Rate for Payer: Cigna of CA 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 Beech St/Commercial/PHCS	$1.59

LUBIPROSTONE 24 MCG CAPSULE [70472]

Facility

$5.94

Service Code	NDC 0254-3029-02
Hospital Charge Code	1711906
Hospital Revenue Code	259
Min. Negotiated Rate	$3.27
Max. Negotiated Rate	$4.46
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$3.56
Rate for Payer: Aetna of CA Government/Medicare	$3.56
Rate for Payer: Cash Price	$2.67
Rate for Payer: Health Smart Auto/Commercial	$3.56
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$3.56
Rate for Payer: LLUH Dept of Risk Management WC	$3.27
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$4.46

LUBIPROSTONE 24 MCG CAPSULE [70472]

Facility

$5.94

Service Code	NDC 0254-3029-02
Hospital Charge Code	1711906
Hospital Revenue Code	259
Min. Negotiated Rate	$3.27
Max. Negotiated Rate	$4.75
Rate for Payer: Cash Price	$2.67
Rate for Payer: Cigna of CA HMO/PPO	$4.75
Rate for Payer: Health Smart Auto/Commercial	$3.56
Rate for Payer: LLUH Dept of Risk Management WC	$3.27
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$4.46

LUBIPROSTONE 8 MCG CAPSULE [91534]

Facility

$7.42

Service Code	NDC 64764-080-60
Hospital Charge Code	1712473
Hospital Revenue Code	259
Min. Negotiated Rate	$4.08
Max. Negotiated Rate	$5.56
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$4.45
Rate for Payer: Aetna of CA Government/Medicare	$4.45
Rate for Payer: Cash Price	$3.34
Rate for Payer: Health Smart Auto/Commercial	$4.45
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$4.45
Rate for Payer: LLUH Dept of Risk Management WC	$4.08
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$5.56

LUBIPROSTONE 8 MCG CAPSULE [91534]

Facility

$7.42

Service Code	NDC 64764-080-60
Hospital Charge Code	1712473
Hospital Revenue Code	259
Min. Negotiated Rate	$4.08
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	$4.45
Rate for Payer: LLUH Dept of Risk Management WC	$4.08
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$5.56

LURASIDONE 40 MG TABLET [107668]

Facility

$56.75

Service Code	NDC 63402-304-30
Hospital Charge Code	1712502
Hospital Revenue Code	259
Min. Negotiated Rate	$31.21
Max. Negotiated Rate	$42.56
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$34.05
Rate for Payer: Aetna of CA Government/Medicare	$34.05
Rate for Payer: Cash Price	$25.54
Rate for Payer: Health Smart Auto/Commercial	$34.05
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$34.05
Rate for Payer: LLUH Dept of Risk Management WC	$31.21
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$42.56

LURASIDONE 40 MG TABLET [107668]

Facility

$5.13

Service Code	NDC 60687-758-21
Hospital Charge Code	1712502
Hospital Revenue Code	259
Min. Negotiated Rate	$2.82
Max. Negotiated Rate	$3.85
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: Cash Price	$2.31
Rate for Payer: Health Smart Auto/Commercial	$3.08
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$3.08
Rate for Payer: LLUH Dept of Risk Management WC	$2.82
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$3.85

LURASIDONE 40 MG TABLET [107668]

Facility

$5.13

Service Code	NDC 60687-758-21
Hospital Charge Code	1712502
Hospital Revenue Code	259
Min. Negotiated Rate	$2.82
Max. Negotiated Rate	$4.10
Rate for Payer: Cash Price	$2.31
Rate for Payer: Cigna of CA HMO/PPO	$4.10
Rate for Payer: Health Smart Auto/Commercial	$3.08
Rate for Payer: LLUH Dept of Risk Management WC	$2.82
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$3.85

LURASIDONE 40 MG TABLET [107668]

Facility

$5.13

Service Code	NDC 60687-758-11
Hospital Charge Code	1712502
Hospital Revenue Code	259
Min. Negotiated Rate	$2.82
Max. Negotiated Rate	$4.10
Rate for Payer: Cash Price	$2.31
Rate for Payer: Cigna of CA HMO/PPO	$4.10
Rate for Payer: Health Smart Auto/Commercial	$3.08
Rate for Payer: LLUH Dept of Risk Management WC	$2.82
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$3.85

LURASIDONE 40 MG TABLET [107668]

Facility

$5.13

Service Code	NDC 60687-758-11
Hospital Charge Code	1712502
Hospital Revenue Code	259
Min. Negotiated Rate	$2.82
Max. Negotiated Rate	$3.85
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: Cash Price	$2.31
Rate for Payer: Health Smart Auto/Commercial	$3.08
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$3.08
Rate for Payer: LLUH Dept of Risk Management WC	$2.82
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$3.85

LURASIDONE 40 MG TABLET [107668]

Facility

$2.13

Service Code	NDC 47335-684-83
Hospital Charge Code	1712502
Hospital Revenue Code	259
Min. Negotiated Rate	$1.17
Max. Negotiated Rate	$1.60
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$1.28
Rate for Payer: Aetna of CA Government/Medicare	$1.28
Rate for Payer: Cash Price	$0.96
Rate for Payer: Health Smart Auto/Commercial	$1.28
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$1.28
Rate for Payer: LLUH Dept of Risk Management WC	$1.17
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$1.60

LURASIDONE 40 MG TABLET [107668]

Facility

$56.75

Service Code	NDC 63402-304-30
Hospital Charge Code	1712502
Hospital Revenue Code	259
Min. Negotiated Rate	$31.21
Max. Negotiated Rate	$45.40
Rate for Payer: Cash Price	$25.54
Rate for Payer: Cigna of CA HMO/PPO	$45.40
Rate for Payer: Health Smart Auto/Commercial	$34.05
Rate for Payer: LLUH Dept of Risk Management WC	$31.21
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$42.56

LURASIDONE 40 MG TABLET [107668]

Facility

$2.13

Service Code	NDC 47335-684-83
Hospital Charge Code	1712502
Hospital Revenue Code	259
Min. Negotiated Rate	$1.17
Max. Negotiated Rate	$1.70
Rate for Payer: Cash Price	$0.96
Rate for Payer: Cigna of CA HMO/PPO	$1.70
Rate for Payer: Health Smart Auto/Commercial	$1.28
Rate for Payer: LLUH Dept of Risk Management WC	$1.17
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$1.60

LURBINECTEDIN 4 MG INTRAVENOUS SOLUTION [228261]

Facility

$9,396.00

Service Code	NDC 68727-712-01
Hospital Charge Code	ERX408205864
Hospital Revenue Code	636
Min. Negotiated Rate	$5,167.80
Max. Negotiated Rate	$7,516.80
Rate for Payer: Cash Price	$4,228.20
Rate for Payer: Cigna of CA HMO/PPO	$7,516.80
Rate for Payer: Health Smart Auto/Commercial	$5,637.60
Rate for Payer: LLUH Dept of Risk Management WC	$5,167.80
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$7,047.00

LURBINECTEDIN 4 MG INTRAVENOUS SOLUTION [228261]

Facility

$9,396.00

Service Code	NDC 68727-712-01
Hospital Charge Code	ERX408205864
Hospital Revenue Code	636
Min. Negotiated Rate	$5,167.80
Max. Negotiated Rate	$7,047.00
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$5,637.60
Rate for Payer: Aetna of CA Government/Medicare	$5,637.60
Rate for Payer: Cash Price	$4,228.20
Rate for Payer: Health Smart Auto/Commercial	$5,637.60
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$5,637.60
Rate for Payer: LLUH Dept of Risk Management WC	$5,167.80
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$7,047.00

LUSPATERCEPT-AAMT 25 MG SUBCUTANEOUS SOLUTION [225877]

Facility

$4,559.88

Service Code	CPT J0896
Hospital Charge Code	ERX225877
Hospital Revenue Code	636
Min. Negotiated Rate	$2,507.93
Max. Negotiated Rate	$3,647.90
Rate for Payer: Cash Price	$2,051.95
Rate for Payer: Cigna of CA HMO/PPO	$3,647.90
Rate for Payer: Health Smart Auto/Commercial	$2,735.93
Rate for Payer: LLUH Dept of Risk Management WC	$2,507.93
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$3,419.91

Know your out-of-pocket cost for care.

All Charges