Loma Linda University Behavioral Medicine Center (BMC)

All Charges

Charge

Type

Setting

Price

OXYMETAZOLINE 0.05 % NASAL SPRAY [5943]

Facility

$0.08

Service Code	NDC 45802-410-59
Hospital Charge Code	1740040
Hospital Revenue Code	259
Min. Negotiated Rate	$0.04
Max. Negotiated Rate	$0.06
Rate for Payer: Cash Price	$0.04
Rate for Payer: Cigna of CA HMO/PPO	$0.06
Rate for Payer: Health Smart Auto/Commercial	$0.05
Rate for Payer: LLUH Dept of Risk Management WC	$0.04
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$0.06

OXYMETAZOLINE 0.05 % NASAL SPRAY [5943]

Facility

$0.38

Service Code	NDC 11523-1167-6
Hospital Charge Code	1740011
Hospital Revenue Code	259
Min. Negotiated Rate	$0.21
Max. Negotiated Rate	$0.30
Rate for Payer: Cash Price	$0.17
Rate for Payer: Cigna of CA HMO/PPO	$0.30
Rate for Payer: Health Smart Auto/Commercial	$0.23
Rate for Payer: LLUH Dept of Risk Management WC	$0.21
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$0.29

OXYMETAZOLINE 0.05 % NASAL SPRAY [5943]

Facility

$0.11

Service Code	NDC 8770189900
Hospital Charge Code	1740040
Hospital Revenue Code	259
Min. Negotiated Rate	$0.06
Max. Negotiated Rate	$0.08
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$0.07
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	$0.06
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$0.08

OXYMETAZOLINE 0.05 % NASAL SPRAY [5943]

Facility

$0.11

Service Code	NDC 46122-165-10
Hospital Charge Code	1740040
Hospital Revenue Code	259
Min. Negotiated Rate	$0.06
Max. Negotiated Rate	$0.08
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$0.07
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	$0.06
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$0.08

OXYTOCIN 10 UNIT/ML INJECTION SOLUTION [5944]

Facility

$1.68

Service Code	CPT J2590
Hospital Charge Code	1720915
Hospital Revenue Code	636
Min. Negotiated Rate	$0.92
Max. Negotiated Rate	$1.26
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$1.01
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$0.65
Rate for Payer: Aetna of CA Government/Medicare	$0.65
Rate for Payer: Aetna of CA Government/Medicare	$1.01
Rate for Payer: Cash Price	$0.49
Rate for Payer: Cash Price	$0.76
Rate for Payer: Health Smart Auto/Commercial	$0.65
Rate for Payer: Health Smart Auto/Commercial	$1.01
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$0.65
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$1.01
Rate for Payer: LLUH Dept of Risk Management WC	$0.59
Rate for Payer: LLUH Dept of Risk Management WC	$0.92
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$0.81
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$1.26

OXYTOCIN 10 UNIT/ML INJECTION SOLUTION [5944]

Facility

$4.14

Service Code	CPT J2590
Hospital Charge Code	1757732
Hospital Revenue Code	636
Min. Negotiated Rate	$2.28
Max. Negotiated Rate	$3.10
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$2.48
Rate for Payer: Aetna of CA Government/Medicare	$2.48
Rate for Payer: Cash Price	$1.86
Rate for Payer: Health Smart Auto/Commercial	$2.48
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$2.48
Rate for Payer: LLUH Dept of Risk Management WC	$2.28
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$3.10

OXYTOCIN 10 UNIT/ML INJECTION SOLUTION [5944]

Facility

$1.08

Service Code	CPT J2590
Hospital Charge Code	1720915
Hospital Revenue Code	636
Min. Negotiated Rate	$0.59
Max. Negotiated Rate	$0.86
Rate for Payer: Cash Price	$0.49
Rate for Payer: Cash Price	$0.76
Rate for Payer: Cigna of CA HMO/PPO	$0.86
Rate for Payer: Cigna of CA HMO/PPO	$1.34
Rate for Payer: Health Smart Auto/Commercial	$1.01
Rate for Payer: Health Smart Auto/Commercial	$0.65
Rate for Payer: LLUH Dept of Risk Management WC	$0.92
Rate for Payer: LLUH Dept of Risk Management WC	$0.59
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$1.26
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$0.81

OXYTOCIN 10 UNIT/ML INJECTION SOLUTION [5944]

Facility

$4.14

Service Code	CPT J2590
Hospital Charge Code	1757732
Hospital Revenue Code	636
Min. Negotiated Rate	$2.28
Max. Negotiated Rate	$3.31
Rate for Payer: Cash Price	$1.86
Rate for Payer: Cigna of CA HMO/PPO	$3.31
Rate for Payer: Health Smart Auto/Commercial	$2.48
Rate for Payer: LLUH Dept of Risk Management WC	$2.28
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$3.10

OXYTOCIN 30 UNIT/500 ML IN 0.9 % SODIUM CHLORIDE INTRAVENOUS [117335]

Facility

$0.05

Service Code	CPT J2590
Hospital Charge Code	NDG117335
Hospital Revenue Code	636
Min. Negotiated Rate	$0.03
Max. Negotiated Rate	$0.04
Rate for Payer: Cash Price	$0.01
Rate for Payer: Cigna of CA HMO/PPO	$0.04
Rate for Payer: Cigna of CA HMO/PPO	$0.01
Rate for Payer: Cigna of CA HMO/PPO	$0.02
Rate for Payer: Health Smart Auto/Commercial	$0.02
Rate for Payer: Health Smart Auto/Commercial	$0.03
Rate for Payer: Health Smart Auto/Commercial	$0.01
Rate for Payer: Cash Price	$0.02
Rate for Payer: LLUH Dept of Risk Management WC	$0.03
Rate for Payer: LLUH Dept of Risk Management WC	$0.01
Rate for Payer: LLUH Dept of Risk Management WC	$0.02
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$0.02
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$0.04
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$0.01

OXYTOCIN 30 UNIT/500 ML IN 0.9 % SODIUM CHLORIDE INTRAVENOUS [117335]

Facility

$0.05

Service Code	CPT J2590
Hospital Revenue Code	636
Min. Negotiated Rate	$0.03
Max. Negotiated Rate	$0.04
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$0.03
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: Aetna of CA Government/Medicare	$0.03
Rate for Payer: Cash Price	$0.02
Rate for Payer: Health Smart Auto/Commercial	$0.01
Rate for Payer: Health Smart Auto/Commercial	$0.03
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$0.01
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$0.03
Rate for Payer: LLUH Dept of Risk Management WC	$0.03
Rate for Payer: LLUH Dept of Risk Management WC	$0.01
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$0.01
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$0.04

OXYTOCIN 30 UNIT/500 ML IN 0.9 % SODIUM CHLORIDE INTRAVENOUS [117335]

Facility

$0.01

Service Code	CPT J2590
Hospital Charge Code	NDG117335
Hospital Revenue Code	636
Min. Negotiated Rate	$0.01
Max. Negotiated Rate	$0.01
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$0.01
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$0.02
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$0.03
Rate for Payer: Aetna of CA Government/Medicare	$0.03
Rate for Payer: Aetna of CA Government/Medicare	$0.01
Rate for Payer: Aetna of CA Government/Medicare	$0.02
Rate for Payer: Cash Price	$0.01
Rate for Payer: Cash Price	$0.02
Rate for Payer: Health Smart Auto/Commercial	$0.01
Rate for Payer: Health Smart Auto/Commercial	$0.02
Rate for Payer: Health Smart Auto/Commercial	$0.03
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$0.02
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$0.01
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$0.03
Rate for Payer: LLUH Dept of Risk Management WC	$0.01
Rate for Payer: LLUH Dept of Risk Management WC	$0.03
Rate for Payer: LLUH Dept of Risk Management WC	$0.02
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$0.02
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$0.04
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$0.01

OXYTOCIN 30 UNIT/500 ML IN 0.9 % SODIUM CHLORIDE INTRAVENOUS [117335]

Facility

$0.05

Service Code	CPT J2590
Hospital Revenue Code	636
Min. Negotiated Rate	$0.03
Max. Negotiated Rate	$0.04
Rate for Payer: Cash Price	$0.02
Rate for Payer: Cigna of CA HMO/PPO	$0.01
Rate for Payer: Cigna of CA HMO/PPO	$0.04
Rate for Payer: Health Smart Auto/Commercial	$0.01
Rate for Payer: Health Smart Auto/Commercial	$0.03
Rate for Payer: LLUH Dept of Risk Management WC	$0.01
Rate for Payer: LLUH Dept of Risk Management WC	$0.03
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$0.01
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$0.04

OXYTOCIN CONTINUOUS INFUSION (MILLI-UNITS/MIN) 30 UNITS/500 ML LR PREMIX [4081758]

Facility

$0.03

Service Code	CPT J2590
Hospital Charge Code	ERX4081758
Hospital Revenue Code	636
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

OXYTOCIN CONTINUOUS INFUSION (MILLI-UNITS/MIN) 30 UNITS/500 ML LR PREMIX [4081758]

Facility

$0.03

Service Code	CPT J2590
Hospital Charge Code	ERX4081758
Hospital Revenue Code	636
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

OXYTOCIN IN LACTATED RINGERS 30 UNIT/500 ML INTRAVENOUS SOLUTION [117913]

Facility

$0.05

Service Code	CPT J2590
Hospital Charge Code	NDG117913
Hospital Revenue Code	636
Min. Negotiated Rate	$0.03
Max. Negotiated Rate	$0.04
Rate for Payer: Cash Price	$0.02
Rate for Payer: Cigna of CA HMO/PPO	$0.04
Rate for Payer: Health Smart Auto/Commercial	$0.03
Rate for Payer: LLUH Dept of Risk Management WC	$0.03
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$0.04

OXYTOCIN IN LACTATED RINGERS 30 UNIT/500 ML INTRAVENOUS SOLUTION [117913]

Facility

$0.05

Service Code	CPT J2590
Hospital Charge Code	NDG117913
Hospital Revenue Code	636
Min. Negotiated Rate	$0.03
Max. Negotiated Rate	$0.04
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$0.03
Rate for Payer: Aetna of CA Government/Medicare	$0.03
Rate for Payer: Cash Price	$0.02
Rate for Payer: Health Smart Auto/Commercial	$0.03
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$0.03
Rate for Payer: LLUH Dept of Risk Management WC	$0.03
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$0.04

OXYTOCIN (ML/HR) CONTINUOUS INFUSION 30 UNITS/500 ML LR PREMIX [4081759]

Facility

$0.40

Service Code	CPT J2590
Hospital Charge Code	ERX4081759
Hospital Revenue Code	636
Min. Negotiated Rate	$0.22
Max. Negotiated Rate	$0.32
Rate for Payer: Cash Price	$0.18
Rate for Payer: Cigna of CA HMO/PPO	$0.32
Rate for Payer: Health Smart Auto/Commercial	$0.24
Rate for Payer: LLUH Dept of Risk Management WC	$0.22
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$0.30

OXYTOCIN (ML/HR) CONTINUOUS INFUSION 30 UNITS/500 ML LR PREMIX [4081759]

Facility

$0.40

Service Code	CPT J2590
Hospital Charge Code	ERX4081759
Hospital Revenue Code	636
Min. Negotiated Rate	$0.22
Max. Negotiated Rate	$0.30
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$0.24
Rate for Payer: Aetna of CA Government/Medicare	$0.24
Rate for Payer: Cash Price	$0.18
Rate for Payer: Health Smart Auto/Commercial	$0.24
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$0.24
Rate for Payer: LLUH Dept of Risk Management WC	$0.22
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$0.30

PACLITAXEL 6 MG/ML CONCENTRATE,INTRAVENOUS [10843]

Facility

$2.84

Service Code	CPT J9267
Hospital Charge Code	1755742
Hospital Revenue Code	636
Min. Negotiated Rate	$1.56
Max. Negotiated Rate	$2.27
Rate for Payer: Cash Price	$1.28
Rate for Payer: Cigna of CA HMO/PPO	$2.27
Rate for Payer: Health Smart Auto/Commercial	$1.70
Rate for Payer: LLUH Dept of Risk Management WC	$1.56
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$2.13

PACLITAXEL 6 MG/ML CONCENTRATE,INTRAVENOUS [10843]

Facility

$2.40

Service Code	CPT J9267
Hospital Charge Code	1759501
Hospital Revenue Code	636
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

PACLITAXEL 6 MG/ML CONCENTRATE,INTRAVENOUS [10843]

Facility

$2.40

Service Code	CPT J9267
Hospital Charge Code	1759501
Hospital Revenue Code	636
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

PACLITAXEL 6 MG/ML CONCENTRATE,INTRAVENOUS [10843]

Facility

$2.84

Service Code	CPT J9267
Hospital Charge Code	1755742
Hospital Revenue Code	636
Min. Negotiated Rate	$1.56
Max. Negotiated Rate	$2.13
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$1.70
Rate for Payer: Aetna of CA Government/Medicare	$1.70
Rate for Payer: Cash Price	$1.28
Rate for Payer: Health Smart Auto/Commercial	$1.70
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$1.70
Rate for Payer: LLUH Dept of Risk Management WC	$1.56
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$2.13

PACLITAXEL 6 MG/ML CONCENTRATE,INTRAVENOUS [10843]

Facility

$1.71

Service Code	CPT J9267
Hospital Charge Code	1755743
Hospital Revenue Code	636
Min. Negotiated Rate	$0.94
Max. Negotiated Rate	$1.37
Rate for Payer: Cash Price	$0.77
Rate for Payer: Cash Price	$1.08
Rate for Payer: Cigna of CA HMO/PPO	$1.92
Rate for Payer: Cigna of CA HMO/PPO	$1.37
Rate for Payer: Health Smart Auto/Commercial	$1.03
Rate for Payer: Health Smart Auto/Commercial	$1.44
Rate for Payer: LLUH Dept of Risk Management WC	$0.94
Rate for Payer: LLUH Dept of Risk Management WC	$1.32
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$1.28
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$1.80

PACLITAXEL 6 MG/ML CONCENTRATE,INTRAVENOUS [10843]

Facility

$2.40

Service Code	CPT J9267
Hospital Charge Code	1755743
Hospital Revenue Code	636
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 EPO/HMO/POS/PPO	$1.03
Rate for Payer: Aetna of CA Government/Medicare	$1.44
Rate for Payer: Aetna of CA Government/Medicare	$1.03
Rate for Payer: Cash Price	$0.77
Rate for Payer: Cash Price	$1.08
Rate for Payer: Health Smart Auto/Commercial	$1.44
Rate for Payer: Health Smart Auto/Commercial	$1.03
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$1.44
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$1.03
Rate for Payer: LLUH Dept of Risk Management WC	$0.94
Rate for Payer: LLUH Dept of Risk Management WC	$1.32
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$1.80
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$1.28

PACLITAXEL PROTEIN-BOUND 100 MG INTRAVENOUS SUSPENSION [40475]

Facility

$1,896.07

Service Code	NDC 68817-134-50
Hospital Charge Code	1755722
Hospital Revenue Code	636
Min. Negotiated Rate	$1,042.84
Max. Negotiated Rate	$1,516.86
Rate for Payer: Cash Price	$853.23
Rate for Payer: Cigna of CA HMO/PPO	$1,516.86
Rate for Payer: Health Smart Auto/Commercial	$1,137.64
Rate for Payer: LLUH Dept of Risk Management WC	$1,042.84
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$1,422.05

Know your out-of-pocket cost for care.

All Charges