Loma Linda University Behavioral Medicine Center (BMC)

All Charges

Charge

Type

Setting

Price

NALOXONE ORAL SOLUTION (IV FORM) 0.4 MG/ML [4080435]

Facility

$10.45

Service Code	NDC 9994-0804-35
Hospital Charge Code	1715254
Hospital Revenue Code	259
Min. Negotiated Rate	$5.75
Max. Negotiated Rate	$7.84
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$6.27
Rate for Payer: Aetna of CA Government/Medicare	$6.27
Rate for Payer: Cash Price	$4.70
Rate for Payer: Health Smart Auto/Commercial	$6.27
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$6.27
Rate for Payer: LLUH Dept of Risk Management WC	$5.75
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$7.84

NALTREXONE 50 MG TABLET [10685]

Facility

$2.40

Service Code	NDC 47335-326-83
Hospital Charge Code	1711834
Hospital Revenue Code	259
Min. Negotiated Rate	$1.32
Max. Negotiated Rate	$1.80
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$1.44
Rate for Payer: Aetna of CA Government/Medicare	$1.44
Rate for Payer: Cash Price	$1.08
Rate for Payer: Health Smart Auto/Commercial	$1.44
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$1.44
Rate for Payer: LLUH Dept of Risk Management WC	$1.32
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$1.80

NALTREXONE 50 MG TABLET [10685]

Facility

$1.04

Service Code	NDC 51224-206-30
Hospital Charge Code	1711834
Hospital Revenue Code	259
Min. Negotiated Rate	$0.57
Max. Negotiated Rate	$0.78
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$0.62
Rate for Payer: Aetna of CA Government/Medicare	$0.62
Rate for Payer: Cash Price	$0.47
Rate for Payer: Health Smart Auto/Commercial	$0.62
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$0.62
Rate for Payer: LLUH Dept of Risk Management WC	$0.57
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$0.78

NALTREXONE 50 MG TABLET [10685]

Facility

$2.40

Service Code	NDC 47335-326-83
Hospital Charge Code	1711834
Hospital Revenue Code	259
Min. Negotiated Rate	$1.32
Max. Negotiated Rate	$1.92
Rate for Payer: Cash Price	$1.08
Rate for Payer: Cigna of CA HMO/PPO	$1.92
Rate for Payer: Health Smart Auto/Commercial	$1.44
Rate for Payer: LLUH Dept of Risk Management WC	$1.32
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$1.80

NALTREXONE 50 MG TABLET [10685]

Facility

$1.80

Service Code	NDC 0406-1170-03
Hospital Charge Code	1711834
Hospital Revenue Code	259
Min. Negotiated Rate	$0.99
Max. Negotiated Rate	$1.35
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$1.08
Rate for Payer: Aetna of CA Government/Medicare	$1.08
Rate for Payer: Cash Price	$0.81
Rate for Payer: Health Smart Auto/Commercial	$1.08
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$1.08
Rate for Payer: LLUH Dept of Risk Management WC	$0.99
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$1.35

NALTREXONE 50 MG TABLET [10685]

Facility

$1.04

Service Code	NDC 51224-206-30
Hospital Charge Code	1711834
Hospital Revenue Code	259
Min. Negotiated Rate	$0.57
Max. Negotiated Rate	$0.83
Rate for Payer: Cash Price	$0.47
Rate for Payer: Cigna of CA HMO/PPO	$0.83
Rate for Payer: Health Smart Auto/Commercial	$0.62
Rate for Payer: LLUH Dept of Risk Management WC	$0.57
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$0.78

NALTREXONE 50 MG TABLET [10685]

Facility

$1.80

Service Code	NDC 0406-1170-03
Hospital Charge Code	1711834
Hospital Revenue Code	259
Min. Negotiated Rate	$0.99
Max. Negotiated Rate	$1.44
Rate for Payer: Cash Price	$0.81
Rate for Payer: Cigna of CA HMO/PPO	$1.44
Rate for Payer: Health Smart Auto/Commercial	$1.08
Rate for Payer: LLUH Dept of Risk Management WC	$0.99
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$1.35

NAPHAZOLINE 0.025 %-PHENIRAMINE 0.3 % EYE DROPS [5384]

Facility

$0.63

Service Code	NDC 0065-0085-15
Hospital Charge Code	1740213
Hospital Revenue Code	259
Min. Negotiated Rate	$0.35
Max. Negotiated Rate	$0.47
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$0.38
Rate for Payer: Aetna of CA Government/Medicare	$0.38
Rate for Payer: Cash Price	$0.28
Rate for Payer: Health Smart Auto/Commercial	$0.38
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$0.38
Rate for Payer: LLUH Dept of Risk Management WC	$0.35
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$0.47

NAPHAZOLINE 0.025 %-PHENIRAMINE 0.3 % EYE DROPS [5384]

Facility

$0.63

Service Code	NDC 0065-0085-15
Hospital Charge Code	1740213
Hospital Revenue Code	259
Min. Negotiated Rate	$0.35
Max. Negotiated Rate	$0.50
Rate for Payer: Cash Price	$0.28
Rate for Payer: Cigna of CA HMO/PPO	$0.50
Rate for Payer: Health Smart Auto/Commercial	$0.38
Rate for Payer: LLUH Dept of Risk Management WC	$0.35
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$0.47

NAPROXEN 250 MG TABLET [5391]

Facility

$0.31

Service Code	NDC 50268-594-15
Hospital Charge Code	1711235
Hospital Revenue Code	259
Min. Negotiated Rate	$0.17
Max. Negotiated Rate	$0.23
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$0.19
Rate for Payer: Aetna of CA Government/Medicare	$0.19
Rate for Payer: Cash Price	$0.14
Rate for Payer: Health Smart Auto/Commercial	$0.19
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$0.19
Rate for Payer: LLUH Dept of Risk Management WC	$0.17
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$0.23

NAPROXEN 250 MG TABLET [5391]

Facility

$0.10

Service Code	NDC 68462-188-01
Hospital Charge Code	1711235
Hospital Revenue Code	259
Min. Negotiated Rate	$0.06
Max. Negotiated Rate	$0.08
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$0.06
Rate for Payer: Aetna of CA Government/Medicare	$0.06
Rate for Payer: Cash Price	$0.05
Rate for Payer: Health Smart Auto/Commercial	$0.06
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$0.06
Rate for Payer: LLUH Dept of Risk Management WC	$0.06
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$0.08

NAPROXEN 250 MG TABLET [5391]

Facility

$0.31

Service Code	NDC 50268-594-15
Hospital Charge Code	1711235
Hospital Revenue Code	259
Min. Negotiated Rate	$0.17
Max. Negotiated Rate	$0.25
Rate for Payer: Cash Price	$0.14
Rate for Payer: Cigna of CA HMO/PPO	$0.25
Rate for Payer: Health Smart Auto/Commercial	$0.19
Rate for Payer: LLUH Dept of Risk Management WC	$0.17
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$0.23

NAPROXEN 250 MG TABLET [5391]

Facility

$0.10

Service Code	NDC 68462-188-01
Hospital Charge Code	1711235
Hospital Revenue Code	259
Min. Negotiated Rate	$0.06
Max. Negotiated Rate	$0.08
Rate for Payer: Cash Price	$0.05
Rate for Payer: Cigna of CA HMO/PPO	$0.08
Rate for Payer: Health Smart Auto/Commercial	$0.06
Rate for Payer: LLUH Dept of Risk Management WC	$0.06
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$0.08

NAPROXEN 250 MG TABLET [5391]

Facility

$0.31

Service Code	NDC 50268-594-11
Hospital Charge Code	1711235
Hospital Revenue Code	259
Min. Negotiated Rate	$0.17
Max. Negotiated Rate	$0.25
Rate for Payer: Cash Price	$0.14
Rate for Payer: Cigna of CA HMO/PPO	$0.25
Rate for Payer: Health Smart Auto/Commercial	$0.19
Rate for Payer: LLUH Dept of Risk Management WC	$0.17
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$0.23

NAPROXEN 250 MG TABLET [5391]

Facility

$0.31

Service Code	NDC 50268-594-11
Hospital Charge Code	1711235
Hospital Revenue Code	259
Min. Negotiated Rate	$0.17
Max. Negotiated Rate	$0.23
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$0.19
Rate for Payer: Aetna of CA Government/Medicare	$0.19
Rate for Payer: Cash Price	$0.14
Rate for Payer: Health Smart Auto/Commercial	$0.19
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$0.19
Rate for Payer: LLUH Dept of Risk Management WC	$0.17
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$0.23

NAPROXEN 375 MG TABLET [5392]

Facility

$0.12

Service Code	NDC 68462-189-01
Hospital Charge Code	1711242
Hospital Revenue Code	259
Min. Negotiated Rate	$0.07
Max. Negotiated Rate	$0.10
Rate for Payer: Cash Price	$0.05
Rate for Payer: Cigna of CA HMO/PPO	$0.10
Rate for Payer: Health Smart Auto/Commercial	$0.07
Rate for Payer: LLUH Dept of Risk Management WC	$0.07
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$0.09

NAPROXEN 375 MG TABLET [5392]

Facility

$0.12

Service Code	NDC 68462-189-01
Hospital Charge Code	1711242
Hospital Revenue Code	259
Min. Negotiated Rate	$0.07
Max. Negotiated Rate	$0.09
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	$0.07
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$0.09

NAPROXEN 500 MG TABLET [5393]

Facility

$0.15

Service Code	NDC 65162-190-10
Hospital Charge Code	1711246
Hospital Revenue Code	259
Min. Negotiated Rate	$0.08
Max. Negotiated Rate	$0.11
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$0.09
Rate for Payer: Aetna of CA Government/Medicare	$0.09
Rate for Payer: Cash Price	$0.07
Rate for Payer: Health Smart Auto/Commercial	$0.09
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$0.09
Rate for Payer: LLUH Dept of Risk Management WC	$0.08
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$0.11

NAPROXEN 500 MG TABLET [5393]

Facility

$0.14

Service Code	NDC 68462-190-01
Hospital Charge Code	1711246
Hospital Revenue Code	259
Min. Negotiated Rate	$0.08
Max. Negotiated Rate	$0.11
Rate for Payer: Cash Price	$0.06
Rate for Payer: Cigna of CA HMO/PPO	$0.11
Rate for Payer: Health Smart Auto/Commercial	$0.08
Rate for Payer: LLUH Dept of Risk Management WC	$0.08
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$0.11

NAPROXEN 500 MG TABLET [5393]

Facility

$0.15

Service Code	NDC 65162-190-10
Hospital Charge Code	1711246
Hospital Revenue Code	259
Min. Negotiated Rate	$0.08
Max. Negotiated Rate	$0.12
Rate for Payer: Cash Price	$0.07
Rate for Payer: Cigna of CA HMO/PPO	$0.12
Rate for Payer: Health Smart Auto/Commercial	$0.09
Rate for Payer: LLUH Dept of Risk Management WC	$0.08
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$0.11

NAPROXEN 500 MG TABLET [5393]

Facility

$0.14

Service Code	NDC 68462-190-01
Hospital Charge Code	1711246
Hospital Revenue Code	259
Min. Negotiated Rate	$0.08
Max. Negotiated Rate	$0.11
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$0.08
Rate for Payer: Aetna of CA Government/Medicare	$0.08
Rate for Payer: Cash Price	$0.06
Rate for Payer: Health Smart Auto/Commercial	$0.08
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$0.08
Rate for Payer: LLUH Dept of Risk Management WC	$0.08
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$0.11

NATALIZUMAB 300 MG/15 ML INTRAVENOUS SOLUTION [40120]

Facility

$656.75

Service Code	CPT J2323
Hospital Charge Code	1720955
Hospital Revenue Code	636
Min. Negotiated Rate	$361.21
Max. Negotiated Rate	$525.40
Rate for Payer: Cash Price	$295.54
Rate for Payer: Cigna of CA HMO/PPO	$525.40
Rate for Payer: Health Smart Auto/Commercial	$394.05
Rate for Payer: LLUH Dept of Risk Management WC	$361.21
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$492.56

NATALIZUMAB 300 MG/15 ML INTRAVENOUS SOLUTION [40120]

Facility

$656.75

Service Code	CPT J2323
Hospital Charge Code	1720955
Hospital Revenue Code	636
Min. Negotiated Rate	$361.21
Max. Negotiated Rate	$492.56
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$394.05
Rate for Payer: Aetna of CA Government/Medicare	$394.05
Rate for Payer: Cash Price	$295.54
Rate for Payer: Health Smart Auto/Commercial	$394.05
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$394.05
Rate for Payer: LLUH Dept of Risk Management WC	$361.21
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$492.56

NATAMYCIN 5 % EYE DROPS,SUSPENSION [10692]

Facility

$37.89

Service Code	NDC 71776-005-15
Hospital Charge Code	1740103
Hospital Revenue Code	259
Min. Negotiated Rate	$20.84
Max. Negotiated Rate	$28.42
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$22.73
Rate for Payer: Aetna of CA Government/Medicare	$22.73
Rate for Payer: Cash Price	$17.05
Rate for Payer: Health Smart Auto/Commercial	$22.73
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$22.73
Rate for Payer: LLUH Dept of Risk Management WC	$20.84
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$28.42

NATAMYCIN 5 % EYE DROPS,SUSPENSION [10692]

Facility

$37.89

Service Code	NDC 0065-0645-15
Hospital Charge Code	1740103
Hospital Revenue Code	259
Min. Negotiated Rate	$20.84
Max. Negotiated Rate	$28.42
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$22.73
Rate for Payer: Aetna of CA Government/Medicare	$22.73
Rate for Payer: Cash Price	$17.05
Rate for Payer: Health Smart Auto/Commercial	$22.73
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$22.73
Rate for Payer: LLUH Dept of Risk Management WC	$20.84
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$28.42

Know your out-of-pocket cost for care.

All Charges