Loma Linda University Behavioral Medicine Center (BMC)

All Charges

Charge

Type

Setting

Price

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	$30.31
Rate for Payer: Cash Price	$17.05
Rate for Payer: Cigna of CA HMO/PPO	$30.31
Rate for Payer: Health Smart Auto/Commercial	$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

NATEGLINIDE 120 MG TABLET [29438]

Facility

$2.39

Service Code	NDC 68084-459-21
Hospital Charge Code	1711806
Hospital Revenue Code	259
Min. Negotiated Rate	$1.31
Max. Negotiated Rate	$1.91
Rate for Payer: Cash Price	$1.08
Rate for Payer: Cigna of CA HMO/PPO	$1.91
Rate for Payer: Health Smart Auto/Commercial	$1.43
Rate for Payer: LLUH Dept of Risk Management WC	$1.31
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$1.79

NATEGLINIDE 120 MG TABLET [29438]

Facility

$2.39

Service Code	NDC 68084-459-11
Hospital Charge Code	1711806
Hospital Revenue Code	259
Min. Negotiated Rate	$1.31
Max. Negotiated Rate	$1.91
Rate for Payer: Cash Price	$1.08
Rate for Payer: Cigna of CA HMO/PPO	$1.91
Rate for Payer: Health Smart Auto/Commercial	$1.43
Rate for Payer: LLUH Dept of Risk Management WC	$1.31
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$1.79

NATEGLINIDE 120 MG TABLET [29438]

Facility

$2.39

Service Code	NDC 68084-459-11
Hospital Charge Code	1711806
Hospital Revenue Code	259
Min. Negotiated Rate	$1.31
Max. Negotiated Rate	$1.79
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$1.43
Rate for Payer: Aetna of CA Government/Medicare	$1.43
Rate for Payer: Cash Price	$1.08
Rate for Payer: Health Smart Auto/Commercial	$1.43
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$1.43
Rate for Payer: LLUH Dept of Risk Management WC	$1.31
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$1.79

NATEGLINIDE 120 MG TABLET [29438]

Facility

$2.39

Service Code	NDC 68084-459-21
Hospital Charge Code	1711806
Hospital Revenue Code	259
Min. Negotiated Rate	$1.31
Max. Negotiated Rate	$1.79
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$1.43
Rate for Payer: Aetna of CA Government/Medicare	$1.43
Rate for Payer: Cash Price	$1.08
Rate for Payer: Health Smart Auto/Commercial	$1.43
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$1.43
Rate for Payer: LLUH Dept of Risk Management WC	$1.31
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$1.79

NATEGLINIDE 60 MG TABLET [29437]

Facility

$2.27

Service Code	NDC 68084-458-11
Hospital Charge Code	1711805
Hospital Revenue Code	259
Min. Negotiated Rate	$1.25
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	$1.25
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$1.70

NATEGLINIDE 60 MG TABLET [29437]

Facility

$2.27

Service Code	NDC 68084-458-11
Hospital Charge Code	1711805
Hospital Revenue Code	259
Min. Negotiated Rate	$1.25
Max. Negotiated Rate	$1.82
Rate for Payer: Cash Price	$1.02
Rate for Payer: Cigna of CA HMO/PPO	$1.82
Rate for Payer: Health Smart Auto/Commercial	$1.36
Rate for Payer: LLUH Dept of Risk Management WC	$1.25
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$1.70

NAXITAMAB-GQGK 4 MG/ML INTRAVENOUS SOLUTION [229812]

Facility

$2,770.88

Service Code	CPT J9348
Hospital Charge Code	NDG229812
Hospital Revenue Code	636
Min. Negotiated Rate	$1,523.98
Max. Negotiated Rate	$2,216.70
Rate for Payer: Cash Price	$1,246.90
Rate for Payer: Cigna of CA HMO/PPO	$2,216.70
Rate for Payer: Health Smart Auto/Commercial	$1,662.53
Rate for Payer: LLUH Dept of Risk Management WC	$1,523.98
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$2,078.16

NAXITAMAB-GQGK 4 MG/ML INTRAVENOUS SOLUTION [229812]

Facility

$2,770.88

Service Code	CPT J9348
Hospital Charge Code	NDG229812
Hospital Revenue Code	636
Min. Negotiated Rate	$1,523.98
Max. Negotiated Rate	$2,078.16
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$1,662.53
Rate for Payer: Aetna of CA Government/Medicare	$1,662.53
Rate for Payer: Cash Price	$1,246.90
Rate for Payer: Health Smart Auto/Commercial	$1,662.53
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$1,662.53
Rate for Payer: LLUH Dept of Risk Management WC	$1,523.98
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$2,078.16

NEBIVOLOL 10 MG TABLET [89286]

Facility

$0.56

Service Code	NDC 67877-391-30
Hospital Charge Code	1712399
Hospital Revenue Code	259
Min. Negotiated Rate	$0.31
Max. Negotiated Rate	$0.42
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	$0.25
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	$0.42

NEBIVOLOL 10 MG TABLET [89286]

Facility

$0.28

Service Code	NDC 43547-526-03
Hospital Charge Code	1712399
Hospital Revenue Code	259
Min. Negotiated Rate	$0.15
Max. Negotiated Rate	$0.22
Rate for Payer: Cash Price	$0.13
Rate for Payer: Cigna of CA HMO/PPO	$0.22
Rate for Payer: Health Smart Auto/Commercial	$0.17
Rate for Payer: LLUH Dept of Risk Management WC	$0.15
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$0.21

NEBIVOLOL 10 MG TABLET [89286]

Facility

$0.56

Service Code	NDC 67877-391-30
Hospital Charge Code	1712399
Hospital Revenue Code	259
Min. Negotiated Rate	$0.31
Max. Negotiated Rate	$0.45
Rate for Payer: Cash Price	$0.25
Rate for Payer: Cigna of CA HMO/PPO	$0.45
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	$0.42

NEBIVOLOL 10 MG TABLET [89286]

Facility

$0.28

Service Code	NDC 43547-526-03
Hospital Charge Code	1712399
Hospital Revenue Code	259
Min. Negotiated Rate	$0.15
Max. Negotiated Rate	$0.21
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$0.17
Rate for Payer: Aetna of CA Government/Medicare	$0.17
Rate for Payer: Cash Price	$0.13
Rate for Payer: Health Smart Auto/Commercial	$0.17
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$0.17
Rate for Payer: LLUH Dept of Risk Management WC	$0.15
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$0.21

NEBIVOLOL 5 MG TABLET [89284]

Facility

$3.38

Service Code	NDC 62559-276-30
Hospital Charge Code	1712386
Hospital Revenue Code	259
Min. Negotiated Rate	$1.86
Max. Negotiated Rate	$2.54
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$2.03
Rate for Payer: Aetna of CA Government/Medicare	$2.03
Rate for Payer: Cash Price	$1.52
Rate for Payer: Health Smart Auto/Commercial	$2.03
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$2.03
Rate for Payer: LLUH Dept of Risk Management WC	$1.86
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$2.54

NEBIVOLOL 5 MG TABLET [89284]

Facility

$6.96

Service Code	NDC 0456-1405-30
Hospital Charge Code	1712386
Hospital Revenue Code	259
Min. Negotiated Rate	$3.83
Max. Negotiated Rate	$5.22
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$4.18
Rate for Payer: Aetna of CA Government/Medicare	$4.18
Rate for Payer: Cash Price	$3.13
Rate for Payer: Health Smart Auto/Commercial	$4.18
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$4.18
Rate for Payer: LLUH Dept of Risk Management WC	$3.83
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$5.22

NEBIVOLOL 5 MG TABLET [89284]

Facility

$6.96

Service Code	NDC 0456-1405-30
Hospital Charge Code	1712386
Hospital Revenue Code	259
Min. Negotiated Rate	$3.83
Max. Negotiated Rate	$5.57
Rate for Payer: Cash Price	$3.13
Rate for Payer: Cigna of CA HMO/PPO	$5.57
Rate for Payer: Health Smart Auto/Commercial	$4.18
Rate for Payer: LLUH Dept of Risk Management WC	$3.83
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$5.22

NEBIVOLOL 5 MG TABLET [89284]

Facility

$0.28

Service Code	NDC 43547-525-03
Hospital Charge Code	1712386
Hospital Revenue Code	259
Min. Negotiated Rate	$0.15
Max. Negotiated Rate	$0.21
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$0.17
Rate for Payer: Aetna of CA Government/Medicare	$0.17
Rate for Payer: Cash Price	$0.13
Rate for Payer: Health Smart Auto/Commercial	$0.17
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$0.17
Rate for Payer: LLUH Dept of Risk Management WC	$0.15
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$0.21

NEBIVOLOL 5 MG TABLET [89284]

Facility

$0.56

Service Code	NDC 67877-392-30
Hospital Charge Code	1712386
Hospital Revenue Code	259
Min. Negotiated Rate	$0.31
Max. Negotiated Rate	$0.45
Rate for Payer: Cash Price	$0.25
Rate for Payer: Cigna of CA HMO/PPO	$0.45
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	$0.42

NEBIVOLOL 5 MG TABLET [89284]

Facility

$3.38

Service Code	NDC 62559-276-30
Hospital Charge Code	1712386
Hospital Revenue Code	259
Min. Negotiated Rate	$1.86
Max. Negotiated Rate	$2.70
Rate for Payer: Cash Price	$1.52
Rate for Payer: Cigna of CA HMO/PPO	$2.70
Rate for Payer: Health Smart Auto/Commercial	$2.03
Rate for Payer: LLUH Dept of Risk Management WC	$1.86
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$2.54

NEBIVOLOL 5 MG TABLET [89284]

Facility

$0.56

Service Code	NDC 67877-392-30
Hospital Charge Code	1712386
Hospital Revenue Code	259
Min. Negotiated Rate	$0.31
Max. Negotiated Rate	$0.42
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	$0.25
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	$0.42

NEBIVOLOL 5 MG TABLET [89284]

Facility

$0.28

Service Code	NDC 43547-525-03
Hospital Charge Code	1712386
Hospital Revenue Code	259
Min. Negotiated Rate	$0.15
Max. Negotiated Rate	$0.22
Rate for Payer: Cash Price	$0.13
Rate for Payer: Cigna of CA HMO/PPO	$0.22
Rate for Payer: Health Smart Auto/Commercial	$0.17
Rate for Payer: LLUH Dept of Risk Management WC	$0.15
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$0.21

NELARABINE 250 MG/50 ML INTRAVENOUS SOLUTION [70267]

Facility

$15.86

Service Code	CPT J9261
Hospital Charge Code	1755714
Hospital Revenue Code	636
Min. Negotiated Rate	$8.72
Max. Negotiated Rate	$11.90
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$9.52
Rate for Payer: Aetna of CA Government/Medicare	$9.52
Rate for Payer: Cash Price	$7.14
Rate for Payer: Health Smart Auto/Commercial	$9.52
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$9.52
Rate for Payer: LLUH Dept of Risk Management WC	$8.72
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$11.90

NELARABINE 250 MG/50 ML INTRAVENOUS SOLUTION [70267]

Facility

$15.86

Service Code	CPT J9261
Hospital Charge Code	1755714
Hospital Revenue Code	636
Min. Negotiated Rate	$8.72
Max. Negotiated Rate	$12.69
Rate for Payer: Cash Price	$7.14
Rate for Payer: Cigna of CA HMO/PPO	$12.69
Rate for Payer: Health Smart Auto/Commercial	$9.52
Rate for Payer: LLUH Dept of Risk Management WC	$8.72
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$11.90

NELFINAVIR 250 MG TABLET [20032]

Facility

$4.86

Service Code	NDC 63010-010-30
Hospital Charge Code	1712238
Hospital Revenue Code	259
Min. Negotiated Rate	$2.67
Max. Negotiated Rate	$3.89
Rate for Payer: Cash Price	$2.19
Rate for Payer: Cigna of CA HMO/PPO	$3.89
Rate for Payer: Health Smart Auto/Commercial	$2.92
Rate for Payer: LLUH Dept of Risk Management WC	$2.67
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$3.64

Know your out-of-pocket cost for care.

All Charges