Loma Linda University Behavioral Medicine Center (BMC)

All Charges

Charge

Type

Setting

Price

MEPERIDINE 50 MG/ML INJECTION SOLUTION [110376]

Facility

$4.13

Service Code	CPT J2175
Hospital Charge Code	NDG110376
Hospital Revenue Code	636
Min. Negotiated Rate	$2.27
Max. Negotiated Rate	$3.10
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$2.48
Rate for Payer: Aetna of CA Government/Medicare	$2.48
Rate for Payer: Cash Price	$1.86
Rate for Payer: Health Smart Auto/Commercial	$2.48
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$2.48
Rate for Payer: LLUH Dept of Risk Management WC	$2.27
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$3.10

MEPERIDINE 50 MG/ML INJECTION SOLUTION [110376]

Facility

$4.13

Service Code	CPT J2175
Hospital Charge Code	NDG110376
Hospital Revenue Code	636
Min. Negotiated Rate	$2.27
Max. Negotiated Rate	$3.30
Rate for Payer: Cash Price	$1.86
Rate for Payer: Cigna of CA HMO/PPO	$3.30
Rate for Payer: Health Smart Auto/Commercial	$2.48
Rate for Payer: LLUH Dept of Risk Management WC	$2.27
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$3.10

MEPERIDINE (PF) 100 MG/2 ML INJECTION SOLUTION [108100]

Facility

$2.78

Service Code	NDC 0409-1255-12
Hospital Charge Code	NDG108100
Hospital Revenue Code	636
Min. Negotiated Rate	$1.53
Max. Negotiated Rate	$2.08
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$1.67
Rate for Payer: Aetna of CA Government/Medicare	$1.67
Rate for Payer: Cash Price	$1.25
Rate for Payer: Health Smart Auto/Commercial	$1.67
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$1.67
Rate for Payer: LLUH Dept of Risk Management WC	$1.53
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$2.08

MEPERIDINE (PF) 100 MG/2 ML INJECTION SOLUTION [108100]

Facility

$2.78

Service Code	NDC 0409-1255-02
Hospital Charge Code	NDG108100
Hospital Revenue Code	636
Min. Negotiated Rate	$1.53
Max. Negotiated Rate	$2.22
Rate for Payer: Cash Price	$1.25
Rate for Payer: Cigna of CA HMO/PPO	$2.22
Rate for Payer: Health Smart Auto/Commercial	$1.67
Rate for Payer: LLUH Dept of Risk Management WC	$1.53
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$2.08

MEPERIDINE (PF) 100 MG/2 ML INJECTION SOLUTION [108100]

Facility

$2.78

Service Code	NDC 0409-1255-12
Hospital Charge Code	NDG108100
Hospital Revenue Code	636
Min. Negotiated Rate	$1.53
Max. Negotiated Rate	$2.22
Rate for Payer: Cash Price	$1.25
Rate for Payer: Cigna of CA HMO/PPO	$2.22
Rate for Payer: Health Smart Auto/Commercial	$1.67
Rate for Payer: LLUH Dept of Risk Management WC	$1.53
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$2.08

MEPERIDINE (PF) 100 MG/2 ML INJECTION SOLUTION [108100]

Facility

$2.78

Service Code	NDC 0409-1255-02
Hospital Charge Code	NDG108100
Hospital Revenue Code	636
Min. Negotiated Rate	$1.53
Max. Negotiated Rate	$2.08
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$1.67
Rate for Payer: Aetna of CA Government/Medicare	$1.67
Rate for Payer: Cash Price	$1.25
Rate for Payer: Health Smart Auto/Commercial	$1.67
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$1.67
Rate for Payer: LLUH Dept of Risk Management WC	$1.53
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$2.08

MEPERIDINE (PF) 25 MG/ML INJECTION SOLUTION [117787]

Facility

$3.04

Service Code	CPT J2175
Hospital Charge Code	NDG117787
Hospital Revenue Code	636
Min. Negotiated Rate	$1.67
Max. Negotiated Rate	$2.28
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$1.82
Rate for Payer: Aetna of CA Government/Medicare	$1.82
Rate for Payer: Cash Price	$1.37
Rate for Payer: Health Smart Auto/Commercial	$1.82
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$1.82
Rate for Payer: LLUH Dept of Risk Management WC	$1.67
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$2.28

MEPERIDINE (PF) 25 MG/ML INJECTION SOLUTION [117787]

Facility

$3.04

Service Code	CPT J2175
Hospital Charge Code	NDG117787
Hospital Revenue Code	636
Min. Negotiated Rate	$1.67
Max. Negotiated Rate	$2.43
Rate for Payer: Cash Price	$1.37
Rate for Payer: Cigna of CA HMO/PPO	$2.43
Rate for Payer: Health Smart Auto/Commercial	$1.82
Rate for Payer: LLUH Dept of Risk Management WC	$1.67
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$2.28

MEPERIDINE (PF) 50 MG/ML INJECTION SOLUTION [4904]

Facility

$3.17

Service Code	CPT J2175
Hospital Charge Code	1737004
Hospital Revenue Code	636
Min. Negotiated Rate	$1.74
Max. Negotiated Rate	$2.38
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$1.90
Rate for Payer: Aetna of CA Government/Medicare	$1.90
Rate for Payer: Cash Price	$1.43
Rate for Payer: Health Smart Auto/Commercial	$1.90
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$1.90
Rate for Payer: LLUH Dept of Risk Management WC	$1.74
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$2.38

MEPERIDINE (PF) 50 MG/ML INJECTION SOLUTION [4904]

Facility

$3.17

Service Code	CPT J2175
Hospital Charge Code	1737004
Hospital Revenue Code	636
Min. Negotiated Rate	$1.74
Max. Negotiated Rate	$2.54
Rate for Payer: Cash Price	$1.43
Rate for Payer: Cigna of CA HMO/PPO	$2.54
Rate for Payer: Health Smart Auto/Commercial	$1.90
Rate for Payer: LLUH Dept of Risk Management WC	$1.74
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$2.38

MEPIVACAINE (PF) 15 MG/ML (1.5 %) INJECTION SOLUTION [10529]

Facility

$0.47

Service Code	CPT J0670
Hospital Charge Code	1720267
Hospital Revenue Code	636
Min. Negotiated Rate	$0.26
Max. Negotiated Rate	$0.38
Rate for Payer: Cash Price	$0.21
Rate for Payer: Cigna of CA HMO/PPO	$0.38
Rate for Payer: Health Smart Auto/Commercial	$0.28
Rate for Payer: LLUH Dept of Risk Management WC	$0.26
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$0.35

MEPIVACAINE (PF) 15 MG/ML (1.5 %) INJECTION SOLUTION [10529]

Facility

$0.47

Service Code	CPT J0670
Hospital Charge Code	1720267
Hospital Revenue Code	636
Min. Negotiated Rate	$0.26
Max. Negotiated Rate	$0.35
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$0.28
Rate for Payer: Aetna of CA Government/Medicare	$0.28
Rate for Payer: Cash Price	$0.21
Rate for Payer: Health Smart Auto/Commercial	$0.28
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$0.28
Rate for Payer: LLUH Dept of Risk Management WC	$0.26
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$0.35

MEPIVACAINE (PF) 20 MG/ML (2 %) INJECTION SOLUTION [105638]

Facility

$0.57

Service Code	CPT J0670
Hospital Charge Code	1720276
Hospital Revenue Code	636
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

MEPIVACAINE (PF) 20 MG/ML (2 %) INJECTION SOLUTION [105638]

Facility

$0.57

Service Code	CPT J0670
Hospital Charge Code	1720276
Hospital Revenue Code	636
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

MEPIVACAINE (PF) 30 MG/ML (3 %) INJECTION SOLUTION [4081086]

Facility

$0.57

Service Code	CPT J0670
Hospital Charge Code	NDC4081086
Hospital Revenue Code	636
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

MEPIVACAINE (PF) 30 MG/ML (3 %) INJECTION SOLUTION [4081086]

Facility

$0.57

Service Code	CPT J0670
Hospital Charge Code	NDC4081086
Hospital Revenue Code	636
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

MEPOLIZUMAB 100 MG SUBCUTANEOUS SOLUTION [211796]

Facility

$4,033.58

Service Code	CPT J2182
Hospital Charge Code	ERX211796
Hospital Revenue Code	636
Min. Negotiated Rate	$2,218.47
Max. Negotiated Rate	$3,025.18
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$2,420.15
Rate for Payer: Aetna of CA Government/Medicare	$2,420.15
Rate for Payer: Cash Price	$1,815.11
Rate for Payer: Health Smart Auto/Commercial	$2,420.15
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$2,420.15
Rate for Payer: LLUH Dept of Risk Management WC	$2,218.47
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$3,025.18

MEPOLIZUMAB 100 MG SUBCUTANEOUS SOLUTION [211796]

Facility

$4,033.58

Service Code	CPT J2182
Hospital Charge Code	ERX211796
Hospital Revenue Code	636
Min. Negotiated Rate	$2,218.47
Max. Negotiated Rate	$3,226.86
Rate for Payer: Cash Price	$1,815.11
Rate for Payer: Cigna of CA HMO/PPO	$3,226.86
Rate for Payer: Health Smart Auto/Commercial	$2,420.15
Rate for Payer: LLUH Dept of Risk Management WC	$2,218.47
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$3,025.18

MERCAPTOPURINE 20 MG/ML ORAL SUSPENSION [206120]

Facility

$17.20

Service Code	CPT S0108
Hospital Charge Code	NDG206120
Hospital Revenue Code	636
Min. Negotiated Rate	$9.46
Max. Negotiated Rate	$13.76
Rate for Payer: Cash Price	$7.74
Rate for Payer: Cigna of CA HMO/PPO	$13.76
Rate for Payer: Health Smart Auto/Commercial	$10.32
Rate for Payer: LLUH Dept of Risk Management WC	$9.46
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$12.90

MERCAPTOPURINE 20 MG/ML ORAL SUSPENSION [206120]

Facility

$17.20

Service Code	CPT S0108
Hospital Charge Code	NDG206120
Hospital Revenue Code	636
Min. Negotiated Rate	$9.46
Max. Negotiated Rate	$12.90
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$10.32
Rate for Payer: Aetna of CA Government/Medicare	$10.32
Rate for Payer: Cash Price	$7.74
Rate for Payer: Health Smart Auto/Commercial	$10.32
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$10.32
Rate for Payer: LLUH Dept of Risk Management WC	$9.46
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$12.90

MERCAPTOPURINE 25 MG 1/2 TAB [192268]

Facility

$2.00

Service Code	CPT S0108
Hospital Charge Code	1712421
Hospital Revenue Code	636
Min. Negotiated Rate	$1.10
Max. Negotiated Rate	$1.50
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$1.20
Rate for Payer: Aetna of CA Government/Medicare	$1.20
Rate for Payer: Cash Price	$0.90
Rate for Payer: Health Smart Auto/Commercial	$1.20
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$1.20
Rate for Payer: LLUH Dept of Risk Management WC	$1.10
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$1.50

MERCAPTOPURINE 25 MG 1/2 TAB [192268]

Facility

$2.00

Service Code	CPT S0108
Hospital Charge Code	1712421
Hospital Revenue Code	636
Min. Negotiated Rate	$1.10
Max. Negotiated Rate	$1.60
Rate for Payer: Cash Price	$0.90
Rate for Payer: Cigna of CA HMO/PPO	$1.60
Rate for Payer: Health Smart Auto/Commercial	$1.20
Rate for Payer: LLUH Dept of Risk Management WC	$1.10
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$1.50

MERCAPTOPURINE 50 MG TABLET [10531]

Facility

$3.80

Service Code	CPT S0108
Hospital Charge Code	1711074
Hospital Revenue Code	259
Min. Negotiated Rate	$2.09
Max. Negotiated Rate	$2.85
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$2.28
Rate for Payer: Aetna of CA Government/Medicare	$2.28
Rate for Payer: Cash Price	$1.71
Rate for Payer: Health Smart Auto/Commercial	$2.28
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$2.28
Rate for Payer: LLUH Dept of Risk Management WC	$2.09
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$2.85

MERCAPTOPURINE 50 MG TABLET [10531]

Facility

$3.80

Service Code	CPT S0108
Hospital Charge Code	1711074
Hospital Revenue Code	259
Min. Negotiated Rate	$2.09
Max. Negotiated Rate	$3.04
Rate for Payer: Cash Price	$1.71
Rate for Payer: Cigna of CA HMO/PPO	$3.04
Rate for Payer: Health Smart Auto/Commercial	$2.28
Rate for Payer: LLUH Dept of Risk Management WC	$2.09
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$2.85

MEROPENEM 1 GRAM INTRAVENOUS SOLUTION [17380]

Facility

$22.01

Service Code	CPT J2185
Hospital Charge Code	ERX17380
Hospital Revenue Code	636
Min. Negotiated Rate	$12.11
Max. Negotiated Rate	$17.61
Rate for Payer: Cash Price	$9.90
Rate for Payer: Cash Price	$16.20
Rate for Payer: Cash Price	$11.18
Rate for Payer: Cash Price	$3.11
Rate for Payer: Cash Price	$10.80
Rate for Payer: Cigna of CA HMO/PPO	$17.61
Rate for Payer: Cigna of CA HMO/PPO	$5.52
Rate for Payer: Cigna of CA HMO/PPO	$19.88
Rate for Payer: Cigna of CA HMO/PPO	$28.80
Rate for Payer: Cigna of CA HMO/PPO	$19.20
Rate for Payer: Health Smart Auto/Commercial	$21.60
Rate for Payer: Health Smart Auto/Commercial	$14.91
Rate for Payer: Health Smart Auto/Commercial	$13.21
Rate for Payer: Health Smart Auto/Commercial	$14.40
Rate for Payer: Health Smart Auto/Commercial	$4.14
Rate for Payer: LLUH Dept of Risk Management WC	$13.20
Rate for Payer: LLUH Dept of Risk Management WC	$19.80
Rate for Payer: LLUH Dept of Risk Management WC	$12.11
Rate for Payer: LLUH Dept of Risk Management WC	$13.67
Rate for Payer: LLUH Dept of Risk Management WC	$3.80
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$18.64
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$18.00
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$27.00
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$5.18
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$16.51

Know your out-of-pocket cost for care.

All Charges