Loma Linda University Behavioral Medicine Center (BMC)

All Charges

Charge

Type

Setting

Price

NEOSTIGMINE METHYLSULFATE 1 MG/ML INJECTION SOLUTION. [4085490]

Facility

$3.02

Service Code	CPT J2710
Hospital Charge Code	NDG120692
Hospital Revenue Code	636
Min. Negotiated Rate	$1.66
Max. Negotiated Rate	$2.42
Rate for Payer: Cash Price	$1.36
Rate for Payer: Cigna of CA HMO/PPO	$2.42
Rate for Payer: Health Smart Auto/Commercial	$1.81
Rate for Payer: LLUH Dept of Risk Management WC	$1.66
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$2.26

NEOSTIGMINE METHYLSULFATE 5 MG/5 ML (1 MG/ML) INTRAVENOUS SYRINGE [120692]

Facility

$3.02

Service Code	CPT J2710
Hospital Charge Code	NDG120692
Hospital Revenue Code	636
Min. Negotiated Rate	$1.66
Max. Negotiated Rate	$2.26
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$1.81
Rate for Payer: Aetna of CA Government/Medicare	$1.81
Rate for Payer: Cash Price	$1.36
Rate for Payer: Health Smart Auto/Commercial	$1.81
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$1.81
Rate for Payer: LLUH Dept of Risk Management WC	$1.66
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$2.26

NEOSTIGMINE METHYLSULFATE 5 MG/5 ML (1 MG/ML) INTRAVENOUS SYRINGE [120692]

Facility

$3.02

Service Code	CPT J2710
Hospital Charge Code	NDG120692
Hospital Revenue Code	636
Min. Negotiated Rate	$1.66
Max. Negotiated Rate	$2.42
Rate for Payer: Cash Price	$1.36
Rate for Payer: Cigna of CA HMO/PPO	$2.42
Rate for Payer: Health Smart Auto/Commercial	$1.81
Rate for Payer: LLUH Dept of Risk Management WC	$1.66
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$2.26

NEPAFENAC 0.1 % EYE DROPS,SUSPENSION [42486]

Facility

$125.38

Service Code	NDC 0065-0002-03
Hospital Charge Code	1740380
Hospital Revenue Code	259
Min. Negotiated Rate	$68.96
Max. Negotiated Rate	$100.30
Rate for Payer: Cash Price	$56.42
Rate for Payer: Cigna of CA HMO/PPO	$100.30
Rate for Payer: Health Smart Auto/Commercial	$75.23
Rate for Payer: LLUH Dept of Risk Management WC	$68.96
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$94.04

NEPAFENAC 0.1 % EYE DROPS,SUSPENSION [42486]

Facility

$125.38

Service Code	NDC 0065-0002-03
Hospital Charge Code	1740380
Hospital Revenue Code	259
Min. Negotiated Rate	$68.96
Max. Negotiated Rate	$94.04
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$75.23
Rate for Payer: Aetna of CA Government/Medicare	$75.23
Rate for Payer: Cash Price	$56.42
Rate for Payer: Health Smart Auto/Commercial	$75.23
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$75.23
Rate for Payer: LLUH Dept of Risk Management WC	$68.96
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$94.04

NEPAFENAC 0.3 % EYE DROPS,SUSPENSION [199693]

Facility

$144.84

Service Code	NDC 0078-0743-03
Hospital Charge Code	NDG199693B
Hospital Revenue Code	259
Min. Negotiated Rate	$79.66
Max. Negotiated Rate	$108.63
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$86.90
Rate for Payer: Aetna of CA Government/Medicare	$86.90
Rate for Payer: Cash Price	$65.18
Rate for Payer: Health Smart Auto/Commercial	$86.90
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$86.90
Rate for Payer: LLUH Dept of Risk Management WC	$79.66
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$108.63

NEPAFENAC 0.3 % EYE DROPS,SUSPENSION [199693]

Facility

$144.84

Service Code	NDC 0078-0743-03
Hospital Charge Code	NDG199693B
Hospital Revenue Code	259
Min. Negotiated Rate	$79.66
Max. Negotiated Rate	$115.87
Rate for Payer: Cash Price	$65.18
Rate for Payer: Cigna of CA HMO/PPO	$115.87
Rate for Payer: Health Smart Auto/Commercial	$86.90
Rate for Payer: LLUH Dept of Risk Management WC	$79.66
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$108.63

NEVIRAPINE 200 MG TABLET [17403]

Facility

$0.20

Service Code	NDC 0378-4050-91
Hospital Charge Code	1711732
Hospital Revenue Code	259
Min. Negotiated Rate	$0.11
Max. Negotiated Rate	$0.16
Rate for Payer: Cash Price	$0.09
Rate for Payer: Cigna of CA HMO/PPO	$0.16
Rate for Payer: Health Smart Auto/Commercial	$0.12
Rate for Payer: LLUH Dept of Risk Management WC	$0.11
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$0.15

NEVIRAPINE 200 MG TABLET [17403]

Facility

$0.20

Service Code	NDC 0378-4050-91
Hospital Charge Code	1711732
Hospital Revenue Code	259
Min. Negotiated Rate	$0.11
Max. Negotiated Rate	$0.15
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$0.12
Rate for Payer: Aetna of CA Government/Medicare	$0.12
Rate for Payer: Cash Price	$0.09
Rate for Payer: Health Smart Auto/Commercial	$0.12
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$0.12
Rate for Payer: LLUH Dept of Risk Management WC	$0.11
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$0.15

NIACIN 100 MG TABLET [5539]

Facility

$0.02

Service Code	NDC 8068105700
Hospital Charge Code	1710130
Hospital Revenue Code	259
Min. Negotiated Rate	$0.01
Max. Negotiated Rate	$0.02
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$0.01
Rate for Payer: Aetna of CA Government/Medicare	$0.01
Rate for Payer: Cash Price	$0.01
Rate for Payer: Health Smart Auto/Commercial	$0.01
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$0.01
Rate for Payer: LLUH Dept of Risk Management WC	$0.01
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$0.02

NIACIN 100 MG TABLET [5539]

Facility

$0.02

Service Code	NDC 8068105700
Hospital Charge Code	1710130
Hospital Revenue Code	259
Min. Negotiated Rate	$0.01
Max. Negotiated Rate	$0.02
Rate for Payer: Cash Price	$0.01
Rate for Payer: Cigna of CA HMO/PPO	$0.02
Rate for Payer: Health Smart Auto/Commercial	$0.01
Rate for Payer: LLUH Dept of Risk Management WC	$0.01
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$0.02

NIACIN 500 MG TABLET [5542]

Facility

$0.06

Service Code	NDC 7985420983
Hospital Charge Code	1710108
Hospital Revenue Code	259
Min. Negotiated Rate	$0.03
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	$0.03
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$0.05

NIACIN 500 MG TABLET [5542]

Facility

$0.06

Service Code	NDC 7985420983
Hospital Charge Code	1710108
Hospital Revenue Code	259
Min. Negotiated Rate	$0.03
Max. Negotiated Rate	$0.05
Rate for Payer: Cash Price	$0.03
Rate for Payer: Cigna of CA HMO/PPO	$0.05
Rate for Payer: Health Smart Auto/Commercial	$0.04
Rate for Payer: LLUH Dept of Risk Management WC	$0.03
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$0.05

NIACIN 500 MG TABLET [5542]

Facility

$0.03

Service Code	NDC 904227260
Hospital Charge Code	1710108
Hospital Revenue Code	259
Min. Negotiated Rate	$0.02
Max. Negotiated Rate	$0.02
Rate for Payer: Cash Price	$0.01
Rate for Payer: Cigna of CA HMO/PPO	$0.02
Rate for Payer: Health Smart Auto/Commercial	$0.02
Rate for Payer: LLUH Dept of Risk Management WC	$0.02
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$0.02

NIACIN 500 MG TABLET [5542]

Facility

$0.03

Service Code	NDC 904227260
Hospital Charge Code	1710108
Hospital Revenue Code	259
Min. Negotiated Rate	$0.02
Max. Negotiated Rate	$0.02
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$0.02
Rate for Payer: Aetna of CA Government/Medicare	$0.02
Rate for Payer: Cash Price	$0.01
Rate for Payer: Health Smart Auto/Commercial	$0.02
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$0.02
Rate for Payer: LLUH Dept of Risk Management WC	$0.02
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$0.02

NIACINAMIDE 500 MG TABLET [5548]

Facility

$0.03

Service Code	NDC 8068101900
Hospital Charge Code	1710144
Hospital Revenue Code	259
Min. Negotiated Rate	$0.02
Max. Negotiated Rate	$0.02
Rate for Payer: Cash Price	$0.01
Rate for Payer: Cigna of CA HMO/PPO	$0.02
Rate for Payer: Health Smart Auto/Commercial	$0.02
Rate for Payer: LLUH Dept of Risk Management WC	$0.02
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$0.02

NIACINAMIDE 500 MG TABLET [5548]

Facility

$0.03

Service Code	NDC 8068101900
Hospital Charge Code	1710144
Hospital Revenue Code	259
Min. Negotiated Rate	$0.02
Max. Negotiated Rate	$0.02
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$0.02
Rate for Payer: Aetna of CA Government/Medicare	$0.02
Rate for Payer: Cash Price	$0.01
Rate for Payer: Health Smart Auto/Commercial	$0.02
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$0.02
Rate for Payer: LLUH Dept of Risk Management WC	$0.02
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$0.02

NIACIN ER 500 MG TABLET,EXTENDED RELEASE 24 HR [27181]

Facility

$0.43

Service Code	NDC 65162-321-09
Hospital Charge Code	1710973
Hospital Revenue Code	259
Min. Negotiated Rate	$0.24
Max. Negotiated Rate	$0.34
Rate for Payer: Cash Price	$0.19
Rate for Payer: Cigna of CA HMO/PPO	$0.34
Rate for Payer: Health Smart Auto/Commercial	$0.26
Rate for Payer: LLUH Dept of Risk Management WC	$0.24
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$0.32

NIACIN ER 500 MG TABLET,EXTENDED RELEASE 24 HR [27181]

Facility

$0.43

Service Code	NDC 65162-321-09
Hospital Charge Code	1710973
Hospital Revenue Code	259
Min. Negotiated Rate	$0.24
Max. Negotiated Rate	$0.32
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$0.26
Rate for Payer: Aetna of CA Government/Medicare	$0.26
Rate for Payer: Cash Price	$0.19
Rate for Payer: Health Smart Auto/Commercial	$0.26
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$0.26
Rate for Payer: LLUH Dept of Risk Management WC	$0.24
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$0.32

NIACIN ER 500 MG TABLET,EXTENDED RELEASE 24 HR [27181]

Facility

$0.48

Service Code	NDC 47335-539-81
Hospital Charge Code	1710973
Hospital Revenue Code	259
Min. Negotiated Rate	$0.26
Max. Negotiated Rate	$0.36
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$0.29
Rate for Payer: Aetna of CA Government/Medicare	$0.29
Rate for Payer: Cash Price	$0.22
Rate for Payer: Health Smart Auto/Commercial	$0.29
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$0.29
Rate for Payer: LLUH Dept of Risk Management WC	$0.26
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$0.36

NIACIN ER 500 MG TABLET,EXTENDED RELEASE 24 HR [27181]

Facility

$0.48

Service Code	NDC 47335-539-81
Hospital Charge Code	1710973
Hospital Revenue Code	259
Min. Negotiated Rate	$0.26
Max. Negotiated Rate	$0.38
Rate for Payer: Cash Price	$0.22
Rate for Payer: Cigna of CA HMO/PPO	$0.38
Rate for Payer: Health Smart Auto/Commercial	$0.29
Rate for Payer: LLUH Dept of Risk Management WC	$0.26
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$0.36

NICARDIPINE 25 MG/10 ML INTRAVENOUS SOLUTION [12370]

Facility

$3.06

Service Code	NDC 0143-9689-01
Hospital Charge Code	1757061
Hospital Revenue Code	250
Min. Negotiated Rate	$1.68
Max. Negotiated Rate	$2.45
Rate for Payer: Cash Price	$1.38
Rate for Payer: Cigna of CA HMO/PPO	$2.45
Rate for Payer: Health Smart Auto/Commercial	$1.84
Rate for Payer: LLUH Dept of Risk Management WC	$1.68
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$2.30

NICARDIPINE 25 MG/10 ML INTRAVENOUS SOLUTION [12370]

Facility

$3.06

Service Code	NDC 0143-9689-10
Hospital Charge Code	1757061
Hospital Revenue Code	250
Min. Negotiated Rate	$1.68
Max. Negotiated Rate	$2.30
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$1.84
Rate for Payer: Aetna of CA Government/Medicare	$1.84
Rate for Payer: Cash Price	$1.38
Rate for Payer: Health Smart Auto/Commercial	$1.84
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$1.84
Rate for Payer: LLUH Dept of Risk Management WC	$1.68
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$2.30

NICARDIPINE 25 MG/10 ML INTRAVENOUS SOLUTION [12370]

Facility

$2.55

Service Code	NDC 55150-183-10
Hospital Charge Code	1757061
Hospital Revenue Code	250
Min. Negotiated Rate	$1.40
Max. Negotiated Rate	$1.91
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$1.53
Rate for Payer: Aetna of CA Government/Medicare	$1.53
Rate for Payer: Cash Price	$1.15
Rate for Payer: Health Smart Auto/Commercial	$1.53
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$1.53
Rate for Payer: LLUH Dept of Risk Management WC	$1.40
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$1.91

NICARDIPINE 25 MG/10 ML INTRAVENOUS SOLUTION [12370]

Facility

$2.55

Service Code	NDC 55150-183-01
Hospital Charge Code	1757061
Hospital Revenue Code	250
Min. Negotiated Rate	$1.40
Max. Negotiated Rate	$1.91
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$1.53
Rate for Payer: Aetna of CA Government/Medicare	$1.53
Rate for Payer: Cash Price	$1.15
Rate for Payer: Health Smart Auto/Commercial	$1.53
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$1.53
Rate for Payer: LLUH Dept of Risk Management WC	$1.40
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$1.91

Know your out-of-pocket cost for care.

All Charges