Loma Linda University Behavioral Medicine Center (BMC)

All Charges

Charge

Type

Setting

Price

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

$3.06

Service Code	NDC 0143-9689-10
Hospital Charge Code	1757061
Hospital Revenue Code	250
Min. Negotiated Rate	$1.68
Max. Negotiated Rate	$2.45
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

$2.55

Service Code	NDC 55150-183-01
Hospital Charge Code	1757061
Hospital Revenue Code	250
Min. Negotiated Rate	$1.40
Max. Negotiated Rate	$2.04
Rate for Payer: Cash Price	$1.15
Rate for Payer: Cigna of CA HMO/PPO	$2.04
Rate for Payer: Health Smart Auto/Commercial	$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

$3.06

Service Code	NDC 0143-9689-01
Hospital Charge Code	1757061
Hospital Revenue Code	250
Min. Negotiated Rate	$1.68
Max. Negotiated Rate	$2.30
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

NICOTINE 14 MG/24 HR DAILY TRANSDERMAL PATCH [27862]

Facility

$2.12

Service Code	NDC 46122-352-74
Hospital Charge Code	1743655
Hospital Revenue Code	259
Min. Negotiated Rate	$1.17
Max. Negotiated Rate	$1.70
Rate for Payer: Cash Price	$0.95
Rate for Payer: Cigna of CA HMO/PPO	$1.70
Rate for Payer: Health Smart Auto/Commercial	$1.27
Rate for Payer: LLUH Dept of Risk Management WC	$1.17
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$1.59

NICOTINE 14 MG/24 HR DAILY TRANSDERMAL PATCH [27862]

Facility

$2.12

Service Code	NDC 8770142789
Hospital Charge Code	1743655
Hospital Revenue Code	259
Min. Negotiated Rate	$1.17
Max. Negotiated Rate	$1.70
Rate for Payer: Cash Price	$0.95
Rate for Payer: Cigna of CA HMO/PPO	$1.70
Rate for Payer: Health Smart Auto/Commercial	$1.27
Rate for Payer: LLUH Dept of Risk Management WC	$1.17
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$1.59

NICOTINE 14 MG/24 HR DAILY TRANSDERMAL PATCH [27862]

Facility

$2.12

Service Code	NDC 8770142789
Hospital Charge Code	1743655
Hospital Revenue Code	259
Min. Negotiated Rate	$1.17
Max. Negotiated Rate	$1.59
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$1.27
Rate for Payer: Aetna of CA Government/Medicare	$1.27
Rate for Payer: Cash Price	$0.95
Rate for Payer: Health Smart Auto/Commercial	$1.27
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$1.27
Rate for Payer: LLUH Dept of Risk Management WC	$1.17
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$1.59

NICOTINE 14 MG/24 HR DAILY TRANSDERMAL PATCH [27862]

Facility

$2.12

Service Code	NDC 46122-352-74
Hospital Charge Code	1743655
Hospital Revenue Code	259
Min. Negotiated Rate	$1.17
Max. Negotiated Rate	$1.59
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$1.27
Rate for Payer: Aetna of CA Government/Medicare	$1.27
Rate for Payer: Cash Price	$0.95
Rate for Payer: Health Smart Auto/Commercial	$1.27
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$1.27
Rate for Payer: LLUH Dept of Risk Management WC	$1.17
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$1.59

NICOTINE 21 MG/24 HR DAILY TRANSDERMAL PATCH [27863]

Facility

$2.12

Service Code	NDC 46122-353-74
Hospital Charge Code	1743656
Hospital Revenue Code	259
Min. Negotiated Rate	$1.17
Max. Negotiated Rate	$1.59
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$1.27
Rate for Payer: Aetna of CA Government/Medicare	$1.27
Rate for Payer: Cash Price	$0.95
Rate for Payer: Health Smart Auto/Commercial	$1.27
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$1.27
Rate for Payer: LLUH Dept of Risk Management WC	$1.17
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$1.59

NICOTINE 21 MG/24 HR DAILY TRANSDERMAL PATCH [27863]

Facility

$2.12

Service Code	NDC 46122-353-74
Hospital Charge Code	1743656
Hospital Revenue Code	259
Min. Negotiated Rate	$1.17
Max. Negotiated Rate	$1.70
Rate for Payer: Cash Price	$0.95
Rate for Payer: Cigna of CA HMO/PPO	$1.70
Rate for Payer: Health Smart Auto/Commercial	$1.27
Rate for Payer: LLUH Dept of Risk Management WC	$1.17
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$1.59

NICOTINE 21 MG/24 HR DAILY TRANSDERMAL PATCH [27863]

Facility

$2.12

Service Code	NDC 8770142790
Hospital Charge Code	1743656
Hospital Revenue Code	259
Min. Negotiated Rate	$1.17
Max. Negotiated Rate	$1.70
Rate for Payer: Cash Price	$0.95
Rate for Payer: Cigna of CA HMO/PPO	$1.70
Rate for Payer: Health Smart Auto/Commercial	$1.27
Rate for Payer: LLUH Dept of Risk Management WC	$1.17
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$1.59

NICOTINE 21 MG/24 HR DAILY TRANSDERMAL PATCH [27863]

Facility

$2.12

Service Code	NDC 8770142790
Hospital Charge Code	1743656
Hospital Revenue Code	259
Min. Negotiated Rate	$1.17
Max. Negotiated Rate	$1.59
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$1.27
Rate for Payer: Aetna of CA Government/Medicare	$1.27
Rate for Payer: Cash Price	$0.95
Rate for Payer: Health Smart Auto/Commercial	$1.27
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$1.27
Rate for Payer: LLUH Dept of Risk Management WC	$1.17
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$1.59

NICOTINE 7 MG/24 HR DAILY TRANSDERMAL PATCH [27860]

Facility

$2.13

Service Code	NDC 43598-446-74
Hospital Charge Code	1743654
Hospital Revenue Code	259
Min. Negotiated Rate	$1.17
Max. Negotiated Rate	$1.70
Rate for Payer: Cash Price	$0.96
Rate for Payer: Cigna of CA HMO/PPO	$1.70
Rate for Payer: Health Smart Auto/Commercial	$1.28
Rate for Payer: LLUH Dept of Risk Management WC	$1.17
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$1.60

NICOTINE 7 MG/24 HR DAILY TRANSDERMAL PATCH [27860]

Facility

$2.06

Service Code	NDC 43598-446-71
Hospital Charge Code	1743654
Hospital Revenue Code	259
Min. Negotiated Rate	$1.13
Max. Negotiated Rate	$1.65
Rate for Payer: Cash Price	$0.93
Rate for Payer: Cigna of CA HMO/PPO	$1.65
Rate for Payer: Health Smart Auto/Commercial	$1.24
Rate for Payer: LLUH Dept of Risk Management WC	$1.13
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$1.54

NICOTINE 7 MG/24 HR DAILY TRANSDERMAL PATCH [27860]

Facility

$2.06

Service Code	NDC 43598-446-71
Hospital Charge Code	1743654
Hospital Revenue Code	259
Min. Negotiated Rate	$1.13
Max. Negotiated Rate	$1.54
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$1.24
Rate for Payer: Aetna of CA Government/Medicare	$1.24
Rate for Payer: Cash Price	$0.93
Rate for Payer: Health Smart Auto/Commercial	$1.24
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$1.24
Rate for Payer: LLUH Dept of Risk Management WC	$1.13
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$1.54

NICOTINE 7 MG/24 HR DAILY TRANSDERMAL PATCH [27860]

Facility

$3.00

Service Code	NDC 0363-0196-02
Hospital Charge Code	1743654
Hospital Revenue Code	259
Min. Negotiated Rate	$1.65
Max. Negotiated Rate	$2.40
Rate for Payer: Cash Price	$1.35
Rate for Payer: Cigna of CA HMO/PPO	$2.40
Rate for Payer: Health Smart Auto/Commercial	$1.80
Rate for Payer: LLUH Dept of Risk Management WC	$1.65
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$2.25

NICOTINE 7 MG/24 HR DAILY TRANSDERMAL PATCH [27860]

Facility

$2.06

Service Code	NDC 0536-1106-88
Hospital Charge Code	1743654
Hospital Revenue Code	259
Min. Negotiated Rate	$1.13
Max. Negotiated Rate	$1.65
Rate for Payer: Cash Price	$0.93
Rate for Payer: Cigna of CA HMO/PPO	$1.65
Rate for Payer: Health Smart Auto/Commercial	$1.24
Rate for Payer: LLUH Dept of Risk Management WC	$1.13
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$1.54

NICOTINE 7 MG/24 HR DAILY TRANSDERMAL PATCH [27860]

Facility

$2.13

Service Code	NDC 43598-446-74
Hospital Charge Code	1743654
Hospital Revenue Code	259
Min. Negotiated Rate	$1.17
Max. Negotiated Rate	$1.60
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$1.28
Rate for Payer: Aetna of CA Government/Medicare	$1.28
Rate for Payer: Cash Price	$0.96
Rate for Payer: Health Smart Auto/Commercial	$1.28
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$1.28
Rate for Payer: LLUH Dept of Risk Management WC	$1.17
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$1.60

NICOTINE 7 MG/24 HR DAILY TRANSDERMAL PATCH [27860]

Facility

$2.06

Service Code	NDC 0536-5894-33
Hospital Charge Code	1743654
Hospital Revenue Code	259
Min. Negotiated Rate	$1.13
Max. Negotiated Rate	$1.65
Rate for Payer: Cash Price	$0.93
Rate for Payer: Cigna of CA HMO/PPO	$1.65
Rate for Payer: Health Smart Auto/Commercial	$1.24
Rate for Payer: LLUH Dept of Risk Management WC	$1.13
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$1.54

NICOTINE 7 MG/24 HR DAILY TRANSDERMAL PATCH [27860]

Facility

$3.00

Service Code	NDC 0363-0196-02
Hospital Charge Code	1743654
Hospital Revenue Code	259
Min. Negotiated Rate	$1.65
Max. Negotiated Rate	$2.25
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$1.80
Rate for Payer: Aetna of CA Government/Medicare	$1.80
Rate for Payer: Cash Price	$1.35
Rate for Payer: Health Smart Auto/Commercial	$1.80
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$1.80
Rate for Payer: LLUH Dept of Risk Management WC	$1.65
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$2.25

NICOTINE 7 MG/24 HR DAILY TRANSDERMAL PATCH [27860]

Facility

$2.06

Service Code	NDC 0536-5894-88
Hospital Charge Code	1743654
Hospital Revenue Code	259
Min. Negotiated Rate	$1.13
Max. Negotiated Rate	$1.54
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$1.24
Rate for Payer: Aetna of CA Government/Medicare	$1.24
Rate for Payer: Cash Price	$0.93
Rate for Payer: Health Smart Auto/Commercial	$1.24
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$1.24
Rate for Payer: LLUH Dept of Risk Management WC	$1.13
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$1.54

NICOTINE 7 MG/24 HR DAILY TRANSDERMAL PATCH [27860]

Facility

$2.13

Service Code	NDC 4898500155
Hospital Charge Code	1743654
Hospital Revenue Code	259
Min. Negotiated Rate	$1.17
Max. Negotiated Rate	$1.70
Rate for Payer: Cash Price	$0.96
Rate for Payer: Cigna of CA HMO/PPO	$1.70
Rate for Payer: Health Smart Auto/Commercial	$1.28
Rate for Payer: LLUH Dept of Risk Management WC	$1.17
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$1.60

NICOTINE 7 MG/24 HR DAILY TRANSDERMAL PATCH [27860]

Facility

$2.06

Service Code	NDC 0536-1106-88
Hospital Charge Code	1743654
Hospital Revenue Code	259
Min. Negotiated Rate	$1.13
Max. Negotiated Rate	$1.54
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$1.24
Rate for Payer: Aetna of CA Government/Medicare	$1.24
Rate for Payer: Cash Price	$0.93
Rate for Payer: Health Smart Auto/Commercial	$1.24
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$1.24
Rate for Payer: LLUH Dept of Risk Management WC	$1.13
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$1.54

NICOTINE 7 MG/24 HR DAILY TRANSDERMAL PATCH [27860]

Facility

$2.13

Service Code	NDC 4898500155
Hospital Charge Code	1743654
Hospital Revenue Code	259
Min. Negotiated Rate	$1.17
Max. Negotiated Rate	$1.60
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$1.28
Rate for Payer: Aetna of CA Government/Medicare	$1.28
Rate for Payer: Cash Price	$0.96
Rate for Payer: Health Smart Auto/Commercial	$1.28
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$1.28
Rate for Payer: LLUH Dept of Risk Management WC	$1.17
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$1.60

NICOTINE 7 MG/24 HR DAILY TRANSDERMAL PATCH [27860]

Facility

$2.06

Service Code	NDC 0536-5894-33
Hospital Charge Code	1743654
Hospital Revenue Code	259
Min. Negotiated Rate	$1.13
Max. Negotiated Rate	$1.54
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$1.24
Rate for Payer: Aetna of CA Government/Medicare	$1.24
Rate for Payer: Cash Price	$0.93
Rate for Payer: Health Smart Auto/Commercial	$1.24
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$1.24
Rate for Payer: LLUH Dept of Risk Management WC	$1.13
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$1.54

Know your out-of-pocket cost for care.

All Charges