Loma Linda University Behavioral Medicine Center (BMC)

All Charges

Charge

Type

Setting

Price

SILDENAFIL 25 MG TABLET [22836]

Facility

$99.92

Service Code	NDC 0069-4200-30
Hospital Charge Code	1710917
Hospital Revenue Code	259
Min. Negotiated Rate	$54.96
Max. Negotiated Rate	$79.94
Rate for Payer: Cash Price	$44.96
Rate for Payer: Cigna of CA HMO/PPO	$79.94
Rate for Payer: Health Smart Auto/Commercial	$59.95
Rate for Payer: LLUH Dept of Risk Management WC	$54.96
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$74.94

SILDENAFIL ORAL SUSPENSION COMPOUND 2.5 MG/ML [4080335]

Facility

$2.81

Service Code	NDC 9994-0803-35
Hospital Charge Code	1715001
Hospital Revenue Code	259
Min. Negotiated Rate	$1.55
Max. Negotiated Rate	$2.11
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$1.69
Rate for Payer: Aetna of CA Government/Medicare	$1.69
Rate for Payer: Cash Price	$1.26
Rate for Payer: Health Smart Auto/Commercial	$1.69
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$1.69
Rate for Payer: LLUH Dept of Risk Management WC	$1.55
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$2.11

SILDENAFIL ORAL SUSPENSION COMPOUND 2.5 MG/ML [4080335]

Facility

$2.81

Service Code	NDC 9994-0803-35
Hospital Charge Code	1715001
Hospital Revenue Code	259
Min. Negotiated Rate	$1.55
Max. Negotiated Rate	$2.25
Rate for Payer: Cash Price	$1.26
Rate for Payer: Cigna of CA HMO/PPO	$2.25
Rate for Payer: Health Smart Auto/Commercial	$1.69
Rate for Payer: LLUH Dept of Risk Management WC	$1.55
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$2.11

SILDENAFIL (PULMONARY HYPERTENSION) 20 MG TABLET [41832]

Facility

$1.40

Service Code	CPT S0090
Hospital Charge Code	1711956
Hospital Revenue Code	259
Min. Negotiated Rate	$0.77
Max. Negotiated Rate	$1.12
Rate for Payer: Cash Price	$0.63
Rate for Payer: Cash Price	$0.40
Rate for Payer: Cigna of CA HMO/PPO	$0.71
Rate for Payer: Cigna of CA HMO/PPO	$1.12
Rate for Payer: Health Smart Auto/Commercial	$0.53
Rate for Payer: Health Smart Auto/Commercial	$0.84
Rate for Payer: LLUH Dept of Risk Management WC	$0.49
Rate for Payer: LLUH Dept of Risk Management WC	$0.77
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$0.67
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$1.05

SILDENAFIL (PULMONARY HYPERTENSION) 20 MG TABLET [41832]

Facility

$0.89

Service Code	CPT S0090
Hospital Charge Code	1711956
Hospital Revenue Code	259
Min. Negotiated Rate	$0.49
Max. Negotiated Rate	$0.67
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$0.53
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$0.84
Rate for Payer: Aetna of CA Government/Medicare	$0.84
Rate for Payer: Aetna of CA Government/Medicare	$0.53
Rate for Payer: Cash Price	$0.40
Rate for Payer: Cash Price	$0.63
Rate for Payer: Health Smart Auto/Commercial	$0.53
Rate for Payer: Health Smart Auto/Commercial	$0.84
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$0.84
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$0.53
Rate for Payer: LLUH Dept of Risk Management WC	$0.77
Rate for Payer: LLUH Dept of Risk Management WC	$0.49
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$0.67
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$1.05

SILTUXIMAB 100 MG INTRAVENOUS SOLUTION [205871]

Facility

$1,703.24

Service Code	CPT J2860
Hospital Charge Code	ERX205871
Hospital Revenue Code	636
Min. Negotiated Rate	$936.78
Max. Negotiated Rate	$1,277.43
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$1,021.94
Rate for Payer: Aetna of CA Government/Medicare	$1,021.94
Rate for Payer: Cash Price	$766.46
Rate for Payer: Health Smart Auto/Commercial	$1,021.94
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$1,021.94
Rate for Payer: LLUH Dept of Risk Management WC	$936.78
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$1,277.43

SILTUXIMAB 100 MG INTRAVENOUS SOLUTION [205871]

Facility

$1,703.24

Service Code	CPT J2860
Hospital Charge Code	ERX205871
Hospital Revenue Code	636
Min. Negotiated Rate	$936.78
Max. Negotiated Rate	$1,362.59
Rate for Payer: Cash Price	$766.46
Rate for Payer: Cigna of CA HMO/PPO	$1,362.59
Rate for Payer: Health Smart Auto/Commercial	$1,021.94
Rate for Payer: LLUH Dept of Risk Management WC	$936.78
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$1,277.43

SILTUXIMAB 400 MG INTRAVENOUS SOLUTION [205872]

Facility

$6,812.98

Service Code	CPT J2860
Hospital Charge Code	ERX205872
Hospital Revenue Code	636
Min. Negotiated Rate	$3,747.14
Max. Negotiated Rate	$5,109.74
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$4,087.79
Rate for Payer: Aetna of CA Government/Medicare	$4,087.79
Rate for Payer: Cash Price	$3,065.84
Rate for Payer: Health Smart Auto/Commercial	$4,087.79
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$4,087.79
Rate for Payer: LLUH Dept of Risk Management WC	$3,747.14
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$5,109.74

SILTUXIMAB 400 MG INTRAVENOUS SOLUTION [205872]

Facility

$6,812.98

Service Code	CPT J2860
Hospital Charge Code	ERX205872
Hospital Revenue Code	636
Min. Negotiated Rate	$3,747.14
Max. Negotiated Rate	$5,450.38
Rate for Payer: Cash Price	$3,065.84
Rate for Payer: Cigna of CA HMO/PPO	$5,450.38
Rate for Payer: Health Smart Auto/Commercial	$4,087.79
Rate for Payer: LLUH Dept of Risk Management WC	$3,747.14
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$5,109.74

SILVER ER TOPICAL GEL,EXTENDED RELEASE [116931]

Facility

$0.69

Service Code	NDC 8327030909
Hospital Charge Code	1743694
Hospital Revenue Code	259
Min. Negotiated Rate	$0.38
Max. Negotiated Rate	$0.55
Rate for Payer: Cash Price	$0.31
Rate for Payer: Cigna of CA HMO/PPO	$0.55
Rate for Payer: Health Smart Auto/Commercial	$0.41
Rate for Payer: LLUH Dept of Risk Management WC	$0.38
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$0.52

SILVER ER TOPICAL GEL,EXTENDED RELEASE [116931]

Facility

$0.69

Service Code	NDC 8019629660
Hospital Charge Code	1743694
Hospital Revenue Code	259
Min. Negotiated Rate	$0.38
Max. Negotiated Rate	$0.55
Rate for Payer: Cash Price	$0.31
Rate for Payer: Cigna of CA HMO/PPO	$0.55
Rate for Payer: Health Smart Auto/Commercial	$0.41
Rate for Payer: LLUH Dept of Risk Management WC	$0.38
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$0.52

SILVER ER TOPICAL GEL,EXTENDED RELEASE [116931]

Facility

$0.69

Service Code	NDC 8327030909
Hospital Charge Code	1743694
Hospital Revenue Code	259
Min. Negotiated Rate	$0.38
Max. Negotiated Rate	$0.52
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$0.41
Rate for Payer: Aetna of CA Government/Medicare	$0.41
Rate for Payer: Cash Price	$0.31
Rate for Payer: Health Smart Auto/Commercial	$0.41
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$0.41
Rate for Payer: LLUH Dept of Risk Management WC	$0.38
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$0.52

SILVER ER TOPICAL GEL,EXTENDED RELEASE [116931]

Facility

$0.69

Service Code	NDC 8019629660
Hospital Charge Code	1743694
Hospital Revenue Code	259
Min. Negotiated Rate	$0.38
Max. Negotiated Rate	$0.52
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$0.41
Rate for Payer: Aetna of CA Government/Medicare	$0.41
Rate for Payer: Cash Price	$0.31
Rate for Payer: Health Smart Auto/Commercial	$0.41
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$0.41
Rate for Payer: LLUH Dept of Risk Management WC	$0.38
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$0.52

SILVER NITRATE APPLICATORS 75 %-25 % TOPICAL STICK [11359]

Facility

$0.84

Service Code	NDC 12870-0001-2
Hospital Charge Code	1772054
Hospital Revenue Code	259
Min. Negotiated Rate	$0.46
Max. Negotiated Rate	$0.67
Rate for Payer: Cash Price	$0.38
Rate for Payer: Cigna of CA HMO/PPO	$0.67
Rate for Payer: Health Smart Auto/Commercial	$0.50
Rate for Payer: LLUH Dept of Risk Management WC	$0.46
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$0.63

SILVER NITRATE APPLICATORS 75 %-25 % TOPICAL STICK [11359]

Facility

$0.84

Service Code	NDC 12870-0001-2
Hospital Charge Code	1772054
Hospital Revenue Code	259
Min. Negotiated Rate	$0.46
Max. Negotiated Rate	$0.63
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$0.50
Rate for Payer: Aetna of CA Government/Medicare	$0.50
Rate for Payer: Cash Price	$0.38
Rate for Payer: Health Smart Auto/Commercial	$0.50
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$0.50
Rate for Payer: LLUH Dept of Risk Management WC	$0.46
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$0.63

SILVER NITRATE APPLICATORS 75 %-25 % TOPICAL STICK [11359]

Facility

$0.91

Service Code	NDC 12870-0001-1
Hospital Charge Code	1772054
Hospital Revenue Code	259
Min. Negotiated Rate	$0.50
Max. Negotiated Rate	$0.68
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$0.55
Rate for Payer: Aetna of CA Government/Medicare	$0.55
Rate for Payer: Cash Price	$0.41
Rate for Payer: Health Smart Auto/Commercial	$0.55
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$0.55
Rate for Payer: LLUH Dept of Risk Management WC	$0.50
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$0.68

SILVER NITRATE APPLICATORS 75 %-25 % TOPICAL STICK [11359]

Facility

$0.91

Service Code	NDC 12870-0001-1
Hospital Charge Code	1772054
Hospital Revenue Code	259
Min. Negotiated Rate	$0.50
Max. Negotiated Rate	$0.73
Rate for Payer: Cash Price	$0.41
Rate for Payer: Cigna of CA HMO/PPO	$0.73
Rate for Payer: Health Smart Auto/Commercial	$0.55
Rate for Payer: LLUH Dept of Risk Management WC	$0.50
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$0.68

SILVER SULFADIAZINE 1 % TOPICAL CREAM [7224]

Facility

$0.36

Service Code	NDC 67877-124-25
Hospital Charge Code	1743588
Hospital Revenue Code	259
Min. Negotiated Rate	$0.20
Max. Negotiated Rate	$0.27
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$0.22
Rate for Payer: Aetna of CA Government/Medicare	$0.22
Rate for Payer: Cash Price	$0.16
Rate for Payer: Health Smart Auto/Commercial	$0.22
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$0.22
Rate for Payer: LLUH Dept of Risk Management WC	$0.20
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$0.27

SILVER SULFADIAZINE 1 % TOPICAL CREAM [7224]

Facility

$0.36

Service Code	NDC 43598-210-25
Hospital Charge Code	1743588
Hospital Revenue Code	259
Min. Negotiated Rate	$0.20
Max. Negotiated Rate	$0.29
Rate for Payer: Cash Price	$0.16
Rate for Payer: Cigna of CA HMO/PPO	$0.29
Rate for Payer: Health Smart Auto/Commercial	$0.22
Rate for Payer: LLUH Dept of Risk Management WC	$0.20
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$0.27

SILVER SULFADIAZINE 1 % TOPICAL CREAM [7224]

Facility

$0.36

Service Code	NDC 43598-210-25
Hospital Charge Code	1743588
Hospital Revenue Code	259
Min. Negotiated Rate	$0.20
Max. Negotiated Rate	$0.27
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$0.22
Rate for Payer: Aetna of CA Government/Medicare	$0.22
Rate for Payer: Cash Price	$0.16
Rate for Payer: Health Smart Auto/Commercial	$0.22
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$0.22
Rate for Payer: LLUH Dept of Risk Management WC	$0.20
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$0.27

SILVER SULFADIAZINE 1 % TOPICAL CREAM [7224]

Facility

$0.30

Service Code	NDC 43598-210-50
Hospital Charge Code	1743179
Hospital Revenue Code	259
Min. Negotiated Rate	$0.17
Max. Negotiated Rate	$0.23
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$0.18
Rate for Payer: Aetna of CA Government/Medicare	$0.18
Rate for Payer: Cash Price	$0.14
Rate for Payer: Health Smart Auto/Commercial	$0.18
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$0.18
Rate for Payer: LLUH Dept of Risk Management WC	$0.17
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$0.23

SILVER SULFADIAZINE 1 % TOPICAL CREAM [7224]

Facility

$0.36

Service Code	NDC 67877-124-25
Hospital Charge Code	1743588
Hospital Revenue Code	259
Min. Negotiated Rate	$0.20
Max. Negotiated Rate	$0.29
Rate for Payer: Cash Price	$0.16
Rate for Payer: Cigna of CA HMO/PPO	$0.29
Rate for Payer: Health Smart Auto/Commercial	$0.22
Rate for Payer: LLUH Dept of Risk Management WC	$0.20
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$0.27

SILVER SULFADIAZINE 1 % TOPICAL CREAM [7224]

Facility

$0.30

Service Code	NDC 61570-131-55
Hospital Charge Code	1743179
Hospital Revenue Code	259
Min. Negotiated Rate	$0.17
Max. Negotiated Rate	$0.23
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$0.18
Rate for Payer: Aetna of CA Government/Medicare	$0.18
Rate for Payer: Cash Price	$0.14
Rate for Payer: Health Smart Auto/Commercial	$0.18
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$0.18
Rate for Payer: LLUH Dept of Risk Management WC	$0.17
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$0.23

SILVER SULFADIAZINE 1 % TOPICAL CREAM [7224]

Facility

$0.29

Service Code	NDC 67877-124-50
Hospital Charge Code	1743179
Hospital Revenue Code	259
Min. Negotiated Rate	$0.16
Max. Negotiated Rate	$0.22
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	$0.16
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$0.22

SILVER SULFADIAZINE 1 % TOPICAL CREAM [7224]

Facility

$0.29

Service Code	NDC 67877-124-50
Hospital Charge Code	1743179
Hospital Revenue Code	259
Min. Negotiated Rate	$0.16
Max. Negotiated Rate	$0.23
Rate for Payer: Cash Price	$0.13
Rate for Payer: Cigna of CA HMO/PPO	$0.23
Rate for Payer: Health Smart Auto/Commercial	$0.17
Rate for Payer: LLUH Dept of Risk Management WC	$0.16
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$0.22

Know your out-of-pocket cost for care.

All Charges