Loma Linda University Behavioral Medicine Center (BMC)

All Charges

Charge

Type

Setting

Price

BENDAMUSTINE 25 MG/ML INTRAVENOUS SOLUTION [212360]

Facility

$742.14

Service Code	NDC 63459-348-04
Hospital Charge Code	NDG212360
Hospital Revenue Code	636
Min. Negotiated Rate	$408.18
Max. Negotiated Rate	$593.71
Rate for Payer: Cash Price	$333.96
Rate for Payer: Cigna of CA HMO/PPO	$593.71
Rate for Payer: Health Smart Auto/Commercial	$445.28
Rate for Payer: LLUH Dept of Risk Management WC	$408.18
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$556.60

BENDAMUSTINE 25 MG/ML INTRAVENOUS SOLUTION [212360]

Facility

$742.14

Service Code	NDC 63459-348-04
Hospital Charge Code	NDG212360
Hospital Revenue Code	636
Min. Negotiated Rate	$408.18
Max. Negotiated Rate	$556.60
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$445.28
Rate for Payer: Aetna of CA Government/Medicare	$445.28
Rate for Payer: Cash Price	$333.96
Rate for Payer: Health Smart Auto/Commercial	$445.28
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$445.28
Rate for Payer: LLUH Dept of Risk Management WC	$408.18
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$556.60

BENZNIDAZOLE 100 MG TABLET [220221]

Facility

$3.60

Service Code	NDC 0642-7464-10
Hospital Charge Code	ERX220221
Hospital Revenue Code	259
Min. Negotiated Rate	$1.98
Max. Negotiated Rate	$2.88
Rate for Payer: Cash Price	$1.62
Rate for Payer: Cigna of CA HMO/PPO	$2.88
Rate for Payer: Health Smart Auto/Commercial	$2.16
Rate for Payer: LLUH Dept of Risk Management WC	$1.98
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$2.70

BENZNIDAZOLE 100 MG TABLET [220221]

Facility

$3.60

Service Code	NDC 0642-7464-10
Hospital Charge Code	ERX220221
Hospital Revenue Code	259
Min. Negotiated Rate	$1.98
Max. Negotiated Rate	$2.70
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$2.16
Rate for Payer: Aetna of CA Government/Medicare	$2.16
Rate for Payer: Cash Price	$1.62
Rate for Payer: Health Smart Auto/Commercial	$2.16
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$2.16
Rate for Payer: LLUH Dept of Risk Management WC	$1.98
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$2.70

BENZOCAINE 10 % MUCOSAL GEL [19690]

Facility

$0.53

Service Code	NDC 0573-0218-25
Hospital Charge Code	NDG19690
Hospital Revenue Code	259
Min. Negotiated Rate	$0.29
Max. Negotiated Rate	$0.40
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$0.32
Rate for Payer: Aetna of CA Government/Medicare	$0.32
Rate for Payer: Cash Price	$0.24
Rate for Payer: Health Smart Auto/Commercial	$0.32
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$0.32
Rate for Payer: LLUH Dept of Risk Management WC	$0.29
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$0.40

BENZOCAINE 10 % MUCOSAL GEL [19690]

Facility

$0.53

Service Code	NDC 0573-0218-25
Hospital Charge Code	NDG19690
Hospital Revenue Code	259
Min. Negotiated Rate	$0.29
Max. Negotiated Rate	$0.42
Rate for Payer: Cash Price	$0.24
Rate for Payer: Cigna of CA HMO/PPO	$0.42
Rate for Payer: Health Smart Auto/Commercial	$0.32
Rate for Payer: LLUH Dept of Risk Management WC	$0.29
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$0.40

BENZOCAINE 10 % MUCOSAL GEL [19690]

Facility

$0.51

Service Code	NDC 9999-0222-40
Hospital Charge Code	1743205
Hospital Revenue Code	259
Min. Negotiated Rate	$0.28
Max. Negotiated Rate	$0.38
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$0.31
Rate for Payer: Aetna of CA Government/Medicare	$0.31
Rate for Payer: Cash Price	$0.23
Rate for Payer: Health Smart Auto/Commercial	$0.31
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$0.31
Rate for Payer: LLUH Dept of Risk Management WC	$0.28
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$0.38

BENZOCAINE 10 % MUCOSAL GEL [19690]

Facility

$0.51

Service Code	NDC 9999-0222-40
Hospital Charge Code	1743205
Hospital Revenue Code	259
Min. Negotiated Rate	$0.28
Max. Negotiated Rate	$0.41
Rate for Payer: Cash Price	$0.23
Rate for Payer: Cigna of CA HMO/PPO	$0.41
Rate for Payer: Health Smart Auto/Commercial	$0.31
Rate for Payer: LLUH Dept of Risk Management WC	$0.28
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$0.38

BENZOCAINE 15 MG-MENTHOL 10 MG LOZENGES [196289]

Facility

$0.19

Service Code	NDC 7811201746
Hospital Charge Code	ERX196289
Hospital Revenue Code	259
Min. Negotiated Rate	$0.10
Max. Negotiated Rate	$0.15
Rate for Payer: Cash Price	$0.09
Rate for Payer: Cigna of CA HMO/PPO	$0.15
Rate for Payer: Health Smart Auto/Commercial	$0.11
Rate for Payer: LLUH Dept of Risk Management WC	$0.10
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$0.14

BENZOCAINE 15 MG-MENTHOL 10 MG LOZENGES [196289]

Facility

$0.19

Service Code	NDC 7811201746
Hospital Charge Code	ERX196289
Hospital Revenue Code	259
Min. Negotiated Rate	$0.10
Max. Negotiated Rate	$0.14
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$0.11
Rate for Payer: Aetna of CA Government/Medicare	$0.11
Rate for Payer: Cash Price	$0.09
Rate for Payer: Health Smart Auto/Commercial	$0.11
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$0.11
Rate for Payer: LLUH Dept of Risk Management WC	$0.10
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$0.14

BENZOCAINE 15 MG-MENTHOL 2.6 MG LOZENGES [188175]

Facility

$0.18

Service Code	NDC 63824-732-16
Hospital Charge Code	ERX188175
Hospital Revenue Code	259
Min. Negotiated Rate	$0.10
Max. Negotiated Rate	$0.14
Rate for Payer: Cash Price	$0.08
Rate for Payer: Cigna of CA HMO/PPO	$0.14
Rate for Payer: Health Smart Auto/Commercial	$0.11
Rate for Payer: LLUH Dept of Risk Management WC	$0.10
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$0.14

BENZOCAINE 15 MG-MENTHOL 2.6 MG LOZENGES [188175]

Facility

$0.18

Service Code	NDC 63824-732-16
Hospital Charge Code	ERX188175
Hospital Revenue Code	259
Min. Negotiated Rate	$0.10
Max. Negotiated Rate	$0.14
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$0.11
Rate for Payer: Aetna of CA Government/Medicare	$0.11
Rate for Payer: Cash Price	$0.08
Rate for Payer: Health Smart Auto/Commercial	$0.11
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$0.11
Rate for Payer: LLUH Dept of Risk Management WC	$0.10
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$0.14

BENZOCAINE 15 MG-MENTHOL 3.6 MG LOZENGES [188174]

Facility

$0.11

Service Code	NDC 63824-724-82
Hospital Charge Code	ERX188174
Hospital Revenue Code	259
Min. Negotiated Rate	$0.06
Max. Negotiated Rate	$0.09
Rate for Payer: Cash Price	$0.05
Rate for Payer: Cigna of CA HMO/PPO	$0.09
Rate for Payer: Health Smart Auto/Commercial	$0.07
Rate for Payer: LLUH Dept of Risk Management WC	$0.06
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$0.08

BENZOCAINE 15 MG-MENTHOL 3.6 MG LOZENGES [188174]

Facility

$0.11

Service Code	NDC 63824-724-82
Hospital Charge Code	ERX188174
Hospital Revenue Code	259
Min. Negotiated Rate	$0.06
Max. Negotiated Rate	$0.08
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$0.07
Rate for Payer: Aetna of CA Government/Medicare	$0.07
Rate for Payer: Cash Price	$0.05
Rate for Payer: Health Smart Auto/Commercial	$0.07
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$0.07
Rate for Payer: LLUH Dept of Risk Management WC	$0.06
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$0.08

BENZOCAINE 15 MG-MENTHOL LOZENGE. [408188174]

Facility

$0.18

Service Code	NDC 63824-732-16
Hospital Charge Code	1740206
Hospital Revenue Code	259
Min. Negotiated Rate	$0.10
Max. Negotiated Rate	$0.14
Rate for Payer: Cash Price	$0.08
Rate for Payer: Cigna of CA HMO/PPO	$0.14
Rate for Payer: Health Smart Auto/Commercial	$0.11
Rate for Payer: LLUH Dept of Risk Management WC	$0.10
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$0.14

BENZOCAINE 15 MG-MENTHOL LOZENGE. [408188174]

Facility

$0.18

Service Code	NDC 63824-732-16
Hospital Charge Code	1740206
Hospital Revenue Code	259
Min. Negotiated Rate	$0.10
Max. Negotiated Rate	$0.14
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$0.11
Rate for Payer: Aetna of CA Government/Medicare	$0.11
Rate for Payer: Cash Price	$0.08
Rate for Payer: Health Smart Auto/Commercial	$0.11
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$0.11
Rate for Payer: LLUH Dept of Risk Management WC	$0.10
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$0.14

BENZOCAINE 20 %-MENTHOL 0.1 %-ZINC CHLORIDE 0.15 % MUCOSAL GEL [226683]

Facility

$0.91

Service Code	NDC 9992-2668-70
Hospital Charge Code	NDG226683
Hospital Revenue Code	259
Min. Negotiated Rate	$0.50
Max. Negotiated Rate	$0.73
Rate for Payer: Cash Price	$0.41
Rate for Payer: Cigna of CA HMO/PPO	$0.73
Rate for Payer: Health Smart Auto/Commercial	$0.55
Rate for Payer: LLUH Dept of Risk Management WC	$0.50
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$0.68

BENZOCAINE 20 %-MENTHOL 0.1 %-ZINC CHLORIDE 0.15 % MUCOSAL GEL [226683]

Facility

$0.91

Service Code	NDC 9992-2668-70
Hospital Charge Code	NDG226683
Hospital Revenue Code	259
Min. Negotiated Rate	$0.50
Max. Negotiated Rate	$0.68
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$0.55
Rate for Payer: Aetna of CA Government/Medicare	$0.55
Rate for Payer: Cash Price	$0.41
Rate for Payer: Health Smart Auto/Commercial	$0.55
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$0.55
Rate for Payer: LLUH Dept of Risk Management WC	$0.50
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$0.68

BENZOCAINE 20 %-MENTHOL 0.1 %-ZINC CHLORIDE 0.15 % MUCOSAL GEL [226683]

Facility

$0.91

Service Code	NDC 1031031840
Hospital Charge Code	NDG226683
Hospital Revenue Code	259
Min. Negotiated Rate	$0.50
Max. Negotiated Rate	$0.73
Rate for Payer: Cash Price	$0.41
Rate for Payer: Cigna of CA HMO/PPO	$0.73
Rate for Payer: Health Smart Auto/Commercial	$0.55
Rate for Payer: LLUH Dept of Risk Management WC	$0.50
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$0.68

BENZOCAINE 20 %-MENTHOL 0.1 %-ZINC CHLORIDE 0.15 % MUCOSAL GEL [226683]

Facility

$0.91

Service Code	NDC 1031031840
Hospital Charge Code	NDG226683
Hospital Revenue Code	259
Min. Negotiated Rate	$0.50
Max. Negotiated Rate	$0.68
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$0.55
Rate for Payer: Aetna of CA Government/Medicare	$0.55
Rate for Payer: Cash Price	$0.41
Rate for Payer: Health Smart Auto/Commercial	$0.55
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$0.55
Rate for Payer: LLUH Dept of Risk Management WC	$0.50
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$0.68

BENZOCAINE 20 %-MENTHOL 0.26 %-ZINC CHLORIDE 0.15 % MUCOSAL GEL [232469]

Facility

$0.61

Service Code	NDC 1031028313
Hospital Charge Code	NDG232469
Hospital Revenue Code	259
Min. Negotiated Rate	$0.34
Max. Negotiated Rate	$0.46
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$0.37
Rate for Payer: Aetna of CA Government/Medicare	$0.37
Rate for Payer: Cash Price	$0.27
Rate for Payer: Health Smart Auto/Commercial	$0.37
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$0.37
Rate for Payer: LLUH Dept of Risk Management WC	$0.34
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$0.46

BENZOCAINE 20 %-MENTHOL 0.26 %-ZINC CHLORIDE 0.15 % MUCOSAL GEL [232469]

Facility

$0.61

Service Code	NDC 1031028313
Hospital Charge Code	NDG232469
Hospital Revenue Code	259
Min. Negotiated Rate	$0.34
Max. Negotiated Rate	$0.49
Rate for Payer: Cigna of CA HMO/PPO	$0.49
Rate for Payer: Health Smart Auto/Commercial	$0.37
Rate for Payer: Cash Price	$0.27
Rate for Payer: LLUH Dept of Risk Management WC	$0.34
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$0.46

BENZOCAINE 20 %-MENTHOL 0.5 % TOPICAL AEROSOL [28048]

Facility

$0.07

Service Code	NDC 16864-680-01
Hospital Charge Code	NDG28048
Hospital Revenue Code	259
Min. Negotiated Rate	$0.04
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: 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	$0.04
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$0.05

BENZOCAINE 20 %-MENTHOL 0.5 % TOPICAL AEROSOL [28048]

Facility

$0.07

Service Code	NDC 16864-680-01
Hospital Charge Code	NDG28048
Hospital Revenue Code	259
Min. Negotiated Rate	$0.04
Max. Negotiated Rate	$0.06
Rate for Payer: Cash Price	$0.03
Rate for Payer: Cigna of CA HMO/PPO	$0.06
Rate for Payer: Health Smart Auto/Commercial	$0.04
Rate for Payer: LLUH Dept of Risk Management WC	$0.04
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$0.05

BENZOCAINE 20 % MUCOSAL AEROSOL SPRAY [19696]

Facility

$0.62

Service Code	NDC 0283-0679-02
Hospital Charge Code	1743446
Hospital Revenue Code	259
Min. Negotiated Rate	$0.34
Max. Negotiated Rate	$0.47
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$0.37
Rate for Payer: Aetna of CA Government/Medicare	$0.37
Rate for Payer: Cash Price	$0.28
Rate for Payer: Health Smart Auto/Commercial	$0.37
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$0.37
Rate for Payer: LLUH Dept of Risk Management WC	$0.34
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$0.47

Know your out-of-pocket cost for care.

All Charges