Loma Linda University Behavioral Medicine Center (BMC)

All Charges

Charge

Type

Setting

Price

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

MEROPENEM 500 MG INTRAVENOUS SOLUTION [17379]

Facility

$11.00

Service Code	CPT J2185
Hospital Charge Code	1753510
Hospital Revenue Code	636
Min. Negotiated Rate	$6.05
Max. Negotiated Rate	$8.80
Rate for Payer: Cash Price	$4.95
Rate for Payer: Cash Price	$5.56
Rate for Payer: Cash Price	$5.40
Rate for Payer: Cigna of CA HMO/PPO	$8.80
Rate for Payer: Cigna of CA HMO/PPO	$9.89
Rate for Payer: Cigna of CA HMO/PPO	$9.60
Rate for Payer: Health Smart Auto/Commercial	$6.60
Rate for Payer: Health Smart Auto/Commercial	$7.20
Rate for Payer: Health Smart Auto/Commercial	$7.42
Rate for Payer: LLUH Dept of Risk Management WC	$6.05
Rate for Payer: LLUH Dept of Risk Management WC	$6.60
Rate for Payer: LLUH Dept of Risk Management WC	$6.80
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$9.27
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$9.00
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$8.25

MEROPENEM 500 MG INTRAVENOUS SOLUTION [17379]

Facility

$12.00

Service Code	CPT J2185
Hospital Charge Code	1753510
Hospital Revenue Code	636
Min. Negotiated Rate	$6.60
Max. Negotiated Rate	$9.00
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$7.20
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$6.60
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$7.42
Rate for Payer: Aetna of CA Government/Medicare	$6.60
Rate for Payer: Aetna of CA Government/Medicare	$7.20
Rate for Payer: Aetna of CA Government/Medicare	$7.42
Rate for Payer: Cash Price	$4.95
Rate for Payer: Cash Price	$5.56
Rate for Payer: Cash Price	$5.40
Rate for Payer: Health Smart Auto/Commercial	$7.42
Rate for Payer: Health Smart Auto/Commercial	$6.60
Rate for Payer: Health Smart Auto/Commercial	$7.20
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$7.20
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$7.42
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$6.60
Rate for Payer: LLUH Dept of Risk Management WC	$6.05
Rate for Payer: LLUH Dept of Risk Management WC	$6.80
Rate for Payer: LLUH Dept of Risk Management WC	$6.60
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$9.27
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$9.00
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$8.25

MEROPENEM-VABORBACTAM 2 GRAM INTRAVENOUS SOLUTION [219863]

Facility

$259.20

Service Code	CPT J2186
Hospital Charge Code	ERX219863
Hospital Revenue Code	636
Min. Negotiated Rate	$142.56
Max. Negotiated Rate	$194.40
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$155.52
Rate for Payer: Aetna of CA Government/Medicare	$155.52
Rate for Payer: Cash Price	$116.64
Rate for Payer: Health Smart Auto/Commercial	$155.52
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$155.52
Rate for Payer: LLUH Dept of Risk Management WC	$142.56
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$194.40

MEROPENEM-VABORBACTAM 2 GRAM INTRAVENOUS SOLUTION [219863]

Facility

$259.20

Service Code	CPT J2186
Hospital Charge Code	ERX219863
Hospital Revenue Code	636
Min. Negotiated Rate	$142.56
Max. Negotiated Rate	$207.36
Rate for Payer: Cash Price	$116.64
Rate for Payer: Cigna of CA HMO/PPO	$207.36
Rate for Payer: Health Smart Auto/Commercial	$155.52
Rate for Payer: LLUH Dept of Risk Management WC	$142.56
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$194.40

MESALAMINE 1,000 MG RECTAL SUPPOSITORY [40369]

Facility

$7.02

Service Code	NDC 70710-1302-6
Hospital Charge Code	1748087
Hospital Revenue Code	259
Min. Negotiated Rate	$3.86
Max. Negotiated Rate	$5.26
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$4.21
Rate for Payer: Aetna of CA Government/Medicare	$4.21
Rate for Payer: Cash Price	$3.16
Rate for Payer: Health Smart Auto/Commercial	$4.21
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$4.21
Rate for Payer: LLUH Dept of Risk Management WC	$3.86
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$5.26

MESALAMINE 1,000 MG RECTAL SUPPOSITORY [40369]

Facility

$7.02

Service Code	NDC 70710-1302-7
Hospital Charge Code	1748087
Hospital Revenue Code	259
Min. Negotiated Rate	$3.86
Max. Negotiated Rate	$5.26
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$4.21
Rate for Payer: Aetna of CA Government/Medicare	$4.21
Rate for Payer: Cash Price	$3.16
Rate for Payer: Health Smart Auto/Commercial	$4.21
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$4.21
Rate for Payer: LLUH Dept of Risk Management WC	$3.86
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$5.26

MESALAMINE 1,000 MG RECTAL SUPPOSITORY [40369]

Facility

$19.10

Service Code	NDC 0378-9230-93
Hospital Charge Code	1748087
Hospital Revenue Code	259
Min. Negotiated Rate	$10.50
Max. Negotiated Rate	$15.28
Rate for Payer: Cash Price	$8.60
Rate for Payer: Cigna of CA HMO/PPO	$15.28
Rate for Payer: Health Smart Auto/Commercial	$11.46
Rate for Payer: LLUH Dept of Risk Management WC	$10.50
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$14.32

MESALAMINE 1,000 MG RECTAL SUPPOSITORY [40369]

Facility

$19.10

Service Code	NDC 0378-9230-93
Hospital Charge Code	1748087
Hospital Revenue Code	259
Min. Negotiated Rate	$10.50
Max. Negotiated Rate	$14.32
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$11.46
Rate for Payer: Aetna of CA Government/Medicare	$11.46
Rate for Payer: Cash Price	$8.60
Rate for Payer: Health Smart Auto/Commercial	$11.46
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$11.46
Rate for Payer: LLUH Dept of Risk Management WC	$10.50
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$14.32

MESALAMINE 1,000 MG RECTAL SUPPOSITORY [40369]

Facility

$7.02

Service Code	NDC 70710-1302-7
Hospital Charge Code	1748087
Hospital Revenue Code	259
Min. Negotiated Rate	$3.86
Max. Negotiated Rate	$5.62
Rate for Payer: Cash Price	$3.16
Rate for Payer: Cigna of CA HMO/PPO	$5.62
Rate for Payer: Health Smart Auto/Commercial	$4.21
Rate for Payer: LLUH Dept of Risk Management WC	$3.86
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$5.26

MESALAMINE 1,000 MG RECTAL SUPPOSITORY [40369]

Facility

$7.02

Service Code	NDC 70710-1302-6
Hospital Charge Code	1748087
Hospital Revenue Code	259
Min. Negotiated Rate	$3.86
Max. Negotiated Rate	$5.62
Rate for Payer: Cash Price	$3.16
Rate for Payer: Cigna of CA HMO/PPO	$5.62
Rate for Payer: Health Smart Auto/Commercial	$4.21
Rate for Payer: LLUH Dept of Risk Management WC	$3.86
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$5.26

MESALAMINE 1,000 MG RECTAL SUPPOSITORY [40369]

Facility

$6.77

Service Code	NDC 59762-0118-3
Hospital Charge Code	1748087
Hospital Revenue Code	259
Min. Negotiated Rate	$3.72
Max. Negotiated Rate	$5.08
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$4.06
Rate for Payer: Aetna of CA Government/Medicare	$4.06
Rate for Payer: Cash Price	$3.05
Rate for Payer: Health Smart Auto/Commercial	$4.06
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$4.06
Rate for Payer: LLUH Dept of Risk Management WC	$3.72
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$5.08

MESALAMINE 1,000 MG RECTAL SUPPOSITORY [40369]

Facility

$6.77

Service Code	NDC 59762-0118-3
Hospital Charge Code	1748087
Hospital Revenue Code	259
Min. Negotiated Rate	$3.72
Max. Negotiated Rate	$5.42
Rate for Payer: Cash Price	$3.05
Rate for Payer: Cigna of CA HMO/PPO	$5.42
Rate for Payer: Health Smart Auto/Commercial	$4.06
Rate for Payer: LLUH Dept of Risk Management WC	$3.72
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$5.08

MESALAMINE 1.2 GRAM TABLET,DELAYED RELEASE [78310]

Facility

$11.23

Service Code	NDC 54092-476-12
Hospital Charge Code	1712343
Hospital Revenue Code	259
Min. Negotiated Rate	$6.18
Max. Negotiated Rate	$8.98
Rate for Payer: Cash Price	$5.05
Rate for Payer: Cigna of CA HMO/PPO	$8.98
Rate for Payer: Health Smart Auto/Commercial	$6.74
Rate for Payer: LLUH Dept of Risk Management WC	$6.18
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$8.42

MESALAMINE 1.2 GRAM TABLET,DELAYED RELEASE [78310]

Facility

$12.48

Service Code	NDC 60687-397-95
Hospital Charge Code	1712343
Hospital Revenue Code	259
Min. Negotiated Rate	$6.86
Max. Negotiated Rate	$9.98
Rate for Payer: Cash Price	$5.62
Rate for Payer: Cigna of CA HMO/PPO	$9.98
Rate for Payer: Health Smart Auto/Commercial	$7.49
Rate for Payer: LLUH Dept of Risk Management WC	$6.86
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$9.36

MESALAMINE 1.2 GRAM TABLET,DELAYED RELEASE [78310]

Facility

$2.67

Service Code	NDC 0378-7401-78
Hospital Charge Code	1712343
Hospital Revenue Code	259
Min. Negotiated Rate	$1.47
Max. Negotiated Rate	$2.00
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$1.60
Rate for Payer: Aetna of CA Government/Medicare	$1.60
Rate for Payer: Cash Price	$1.20
Rate for Payer: Health Smart Auto/Commercial	$1.60
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$1.60
Rate for Payer: LLUH Dept of Risk Management WC	$1.47
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$2.00

MESALAMINE 1.2 GRAM TABLET,DELAYED RELEASE [78310]

Facility

$2.67

Service Code	NDC 0378-7401-78
Hospital Charge Code	1712343
Hospital Revenue Code	259
Min. Negotiated Rate	$1.47
Max. Negotiated Rate	$2.14
Rate for Payer: Cash Price	$1.20
Rate for Payer: Cigna of CA HMO/PPO	$2.14
Rate for Payer: Health Smart Auto/Commercial	$1.60
Rate for Payer: LLUH Dept of Risk Management WC	$1.47
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$2.00

MESALAMINE 1.2 GRAM TABLET,DELAYED RELEASE [78310]

Facility

$12.48

Service Code	NDC 60687-397-25
Hospital Charge Code	1712343
Hospital Revenue Code	259
Min. Negotiated Rate	$6.86
Max. Negotiated Rate	$9.36
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$7.49
Rate for Payer: Aetna of CA Government/Medicare	$7.49
Rate for Payer: Cash Price	$5.62
Rate for Payer: Health Smart Auto/Commercial	$7.49
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$7.49
Rate for Payer: LLUH Dept of Risk Management WC	$6.86
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$9.36

MESALAMINE 1.2 GRAM TABLET,DELAYED RELEASE [78310]

Facility

$12.48

Service Code	NDC 60687-397-95
Hospital Charge Code	1712343
Hospital Revenue Code	259
Min. Negotiated Rate	$6.86
Max. Negotiated Rate	$9.36
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$7.49
Rate for Payer: Aetna of CA Government/Medicare	$7.49
Rate for Payer: Cash Price	$5.62
Rate for Payer: Health Smart Auto/Commercial	$7.49
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$7.49
Rate for Payer: LLUH Dept of Risk Management WC	$6.86
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$9.36

MESALAMINE 1.2 GRAM TABLET,DELAYED RELEASE [78310]

Facility

$5.34

Service Code	NDC 63304-175-13
Hospital Charge Code	1712343
Hospital Revenue Code	259
Min. Negotiated Rate	$2.94
Max. Negotiated Rate	$4.00
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$3.20
Rate for Payer: Aetna of CA Government/Medicare	$3.20
Rate for Payer: Cash Price	$2.40
Rate for Payer: Health Smart Auto/Commercial	$3.20
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$3.20
Rate for Payer: LLUH Dept of Risk Management WC	$2.94
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$4.00

MESALAMINE 1.2 GRAM TABLET,DELAYED RELEASE [78310]

Facility

$5.34

Service Code	NDC 63304-175-13
Hospital Charge Code	1712343
Hospital Revenue Code	259
Min. Negotiated Rate	$2.94
Max. Negotiated Rate	$4.27
Rate for Payer: Cash Price	$2.40
Rate for Payer: Cigna of CA HMO/PPO	$4.27
Rate for Payer: Health Smart Auto/Commercial	$3.20
Rate for Payer: LLUH Dept of Risk Management WC	$2.94
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$4.00

MESALAMINE 1.2 GRAM TABLET,DELAYED RELEASE [78310]

Facility

$11.23

Service Code	NDC 54092-476-12
Hospital Charge Code	1712343
Hospital Revenue Code	259
Min. Negotiated Rate	$6.18
Max. Negotiated Rate	$8.42
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$6.74
Rate for Payer: Aetna of CA Government/Medicare	$6.74
Rate for Payer: Cash Price	$5.05
Rate for Payer: Health Smart Auto/Commercial	$6.74
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$6.74
Rate for Payer: LLUH Dept of Risk Management WC	$6.18
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$8.42

MESALAMINE 1.2 GRAM TABLET,DELAYED RELEASE [78310]

Facility

$12.48

Service Code	NDC 60687-397-25
Hospital Charge Code	1712343
Hospital Revenue Code	259
Min. Negotiated Rate	$6.86
Max. Negotiated Rate	$9.98
Rate for Payer: Cash Price	$5.62
Rate for Payer: Cigna of CA HMO/PPO	$9.98
Rate for Payer: Health Smart Auto/Commercial	$7.49
Rate for Payer: LLUH Dept of Risk Management WC	$6.86
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$9.36

MESALAMINE 400 MG CAPSULE (WITH DELAYED RELEASE TABLETS INSIDE) [214804]

Facility

$4.66

Service Code	NDC 0023-5853-18
Hospital Charge Code	ERX214804
Hospital Revenue Code	259
Min. Negotiated Rate	$2.56
Max. Negotiated Rate	$3.73
Rate for Payer: Cash Price	$2.10
Rate for Payer: Cigna of CA HMO/PPO	$3.73
Rate for Payer: Health Smart Auto/Commercial	$2.80
Rate for Payer: LLUH Dept of Risk Management WC	$2.56
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$3.50

MESALAMINE 400 MG CAPSULE (WITH DELAYED RELEASE TABLETS INSIDE) [214804]

Facility

$4.66

Service Code	NDC 0023-5853-18
Hospital Charge Code	ERX214804
Hospital Revenue Code	259
Min. Negotiated Rate	$2.56
Max. Negotiated Rate	$3.50
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$2.80
Rate for Payer: Aetna of CA Government/Medicare	$2.80
Rate for Payer: Cash Price	$2.10
Rate for Payer: Health Smart Auto/Commercial	$2.80
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$2.80
Rate for Payer: LLUH Dept of Risk Management WC	$2.56
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$3.50

Know your out-of-pocket cost for care.

All Charges