Loma Linda University Behavioral Medicine Center (BMC)

All Charges

Charge

Type

Setting

Price

CAMPHOR-EUCALYPTUS OIL-MENTHOL 4.8 %-1.2 %-2.6 % TOPICAL OINTMENT [76967]

Facility

$0.10

Service Code	NDC 2390003920
Hospital Charge Code	NDG28132
Hospital Revenue Code	259
Min. Negotiated Rate	$0.06
Max. Negotiated Rate	$0.08
Rate for Payer: Cash Price	$0.05
Rate for Payer: Cigna of CA HMO/PPO	$0.08
Rate for Payer: Health Smart Auto/Commercial	$0.06
Rate for Payer: LLUH Dept of Risk Management WC	$0.06
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$0.08

CAMPHOR-EUCALYPTUS OIL-MENTHOL 4.8 %-1.2 %-2.6 % TOPICAL OINTMENT [76967]

Facility

$0.07

Service Code	NDC 37000-544-06
Hospital Charge Code	NDG76967A
Hospital Revenue Code	259
Min. Negotiated Rate	$0.04
Max. Negotiated Rate	$0.06
Rate for Payer: Cash Price	$0.03
Rate for Payer: Cigna of CA HMO/PPO	$0.06
Rate for Payer: Health Smart Auto/Commercial	$0.04
Rate for Payer: LLUH Dept of Risk Management WC	$0.04
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$0.05

CAMPHOR-MENTHOL 0.5 %-0.5 % LOTION [23063]

Facility

$0.03

Service Code	NDC 46122-573-10
Hospital Charge Code	1743717
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

CAMPHOR-MENTHOL 0.5 %-0.5 % LOTION [23063]

Facility

$0.03

Service Code	NDC 46122-573-10
Hospital Charge Code	1743717
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

CAMPHOR-MENTHOL 0.5 %-0.5 % LOTION [23063]

Facility

$0.04

Service Code	NDC 0316-0229-75
Hospital Charge Code	1743717
Hospital Revenue Code	259
Min. Negotiated Rate	$0.02
Max. Negotiated Rate	$0.03
Rate for Payer: Cash Price	$0.02
Rate for Payer: Cigna of CA HMO/PPO	$0.03
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	$0.03

CAMPHOR-MENTHOL 0.5 %-0.5 % LOTION [23063]

Facility

$0.04

Service Code	NDC 0316-0229-75
Hospital Charge Code	1743717
Hospital Revenue Code	259
Min. Negotiated Rate	$0.02
Max. Negotiated Rate	$0.03
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	$0.02
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	$0.03

CAMPHOR-PHENOL 10.8 %-4.7 % TOPICAL SOLUTION [12562]

Facility

$0.12

Service Code	NDC 0024-5150-06
Hospital Charge Code	1743140
Hospital Revenue Code	259
Min. Negotiated Rate	$0.07
Max. Negotiated Rate	$0.10
Rate for Payer: Cash Price	$0.05
Rate for Payer: Cigna of CA HMO/PPO	$0.10
Rate for Payer: Health Smart Auto/Commercial	$0.07
Rate for Payer: LLUH Dept of Risk Management WC	$0.07
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$0.09

CAMPHOR-PHENOL 10.8 %-4.7 % TOPICAL SOLUTION [12562]

Facility

$0.12

Service Code	NDC 0024-5150-05
Hospital Charge Code	NDG12562
Hospital Revenue Code	259
Min. Negotiated Rate	$0.07
Max. Negotiated Rate	$0.10
Rate for Payer: Cash Price	$0.05
Rate for Payer: Cigna of CA HMO/PPO	$0.10
Rate for Payer: Health Smart Auto/Commercial	$0.07
Rate for Payer: LLUH Dept of Risk Management WC	$0.07
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$0.09

CAMPHOR-PHENOL 10.8 %-4.7 % TOPICAL SOLUTION [12562]

Facility

$0.12

Service Code	NDC 0024-5150-06
Hospital Charge Code	1743140
Hospital Revenue Code	259
Min. Negotiated Rate	$0.07
Max. Negotiated Rate	$0.09
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	$0.07
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$0.09

CAMPHOR-PHENOL 10.8 %-4.7 % TOPICAL SOLUTION [12562]

Facility

$0.12

Service Code	NDC 0024-5150-05
Hospital Charge Code	NDG12562
Hospital Revenue Code	259
Min. Negotiated Rate	$0.07
Max. Negotiated Rate	$0.09
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	$0.07
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$0.09

CANAGLIFLOZIN 100 MG TABLET [201798]

Facility

$23.94

Service Code	NDC 50458-140-30
Hospital Charge Code	ERX201798
Hospital Revenue Code	259
Min. Negotiated Rate	$13.17
Max. Negotiated Rate	$17.96
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$14.36
Rate for Payer: Aetna of CA Government/Medicare	$14.36
Rate for Payer: Cash Price	$10.77
Rate for Payer: Health Smart Auto/Commercial	$14.36
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$14.36
Rate for Payer: LLUH Dept of Risk Management WC	$13.17
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$17.96

CANAGLIFLOZIN 100 MG TABLET [201798]

Facility

$23.94

Service Code	NDC 50458-140-30
Hospital Charge Code	ERX201798
Hospital Revenue Code	259
Min. Negotiated Rate	$13.17
Max. Negotiated Rate	$19.15
Rate for Payer: Cash Price	$10.77
Rate for Payer: Cigna of CA HMO/PPO	$19.15
Rate for Payer: Health Smart Auto/Commercial	$14.36
Rate for Payer: LLUH Dept of Risk Management WC	$13.17
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$17.96

CANDESARTAN 32 MG TABLET [23232]

Facility

$2.04

Service Code	NDC 33342-117-07
Hospital Charge Code	1712295
Hospital Revenue Code	259
Min. Negotiated Rate	$1.12
Max. Negotiated Rate	$1.63
Rate for Payer: Cash Price	$0.92
Rate for Payer: Cigna of CA HMO/PPO	$1.63
Rate for Payer: Health Smart Auto/Commercial	$1.22
Rate for Payer: LLUH Dept of Risk Management WC	$1.12
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$1.53

CANDESARTAN 32 MG TABLET [23232]

Facility

$3.82

Service Code	NDC 49884-661-09
Hospital Charge Code	1712295
Hospital Revenue Code	259
Min. Negotiated Rate	$2.10
Max. Negotiated Rate	$3.06
Rate for Payer: Cash Price	$1.72
Rate for Payer: Cigna of CA HMO/PPO	$3.06
Rate for Payer: Health Smart Auto/Commercial	$2.29
Rate for Payer: LLUH Dept of Risk Management WC	$2.10
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$2.86

CANDESARTAN 32 MG TABLET [23232]

Facility

$2.04

Service Code	NDC 0378-3232-93
Hospital Charge Code	1712295
Hospital Revenue Code	259
Min. Negotiated Rate	$1.12
Max. Negotiated Rate	$1.53
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$1.22
Rate for Payer: Aetna of CA Government/Medicare	$1.22
Rate for Payer: Cash Price	$0.92
Rate for Payer: Health Smart Auto/Commercial	$1.22
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$1.22
Rate for Payer: LLUH Dept of Risk Management WC	$1.12
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$1.53

CANDESARTAN 32 MG TABLET [23232]

Facility

$2.04

Service Code	NDC 33342-117-07
Hospital Charge Code	1712295
Hospital Revenue Code	259
Min. Negotiated Rate	$1.12
Max. Negotiated Rate	$1.53
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$1.22
Rate for Payer: Aetna of CA Government/Medicare	$1.22
Rate for Payer: Cash Price	$0.92
Rate for Payer: Health Smart Auto/Commercial	$1.22
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$1.22
Rate for Payer: LLUH Dept of Risk Management WC	$1.12
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$1.53

CANDESARTAN 32 MG TABLET [23232]

Facility

$3.82

Service Code	NDC 49884-661-09
Hospital Charge Code	1712295
Hospital Revenue Code	259
Min. Negotiated Rate	$2.10
Max. Negotiated Rate	$2.86
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$2.29
Rate for Payer: Aetna of CA Government/Medicare	$2.29
Rate for Payer: Cash Price	$1.72
Rate for Payer: Health Smart Auto/Commercial	$2.29
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$2.29
Rate for Payer: LLUH Dept of Risk Management WC	$2.10
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$2.86

CANDESARTAN 32 MG TABLET [23232]

Facility

$2.04

Service Code	NDC 0378-3232-93
Hospital Charge Code	1712295
Hospital Revenue Code	259
Min. Negotiated Rate	$1.12
Max. Negotiated Rate	$1.63
Rate for Payer: Cash Price	$0.92
Rate for Payer: Cigna of CA HMO/PPO	$1.63
Rate for Payer: Health Smart Auto/Commercial	$1.22
Rate for Payer: LLUH Dept of Risk Management WC	$1.12
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$1.53

CANGRELOR 50 MG INTRAVENOUS SOLUTION [210327]

Facility

$1,070.39

Service Code	CPT C9460
Hospital Charge Code	ERX210327
Hospital Revenue Code	636
Min. Negotiated Rate	$588.71
Max. Negotiated Rate	$802.79
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$642.23
Rate for Payer: Aetna of CA Government/Medicare	$642.23
Rate for Payer: Cash Price	$481.68
Rate for Payer: Health Smart Auto/Commercial	$642.23
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$642.23
Rate for Payer: LLUH Dept of Risk Management WC	$588.71
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$802.79

CANGRELOR 50 MG INTRAVENOUS SOLUTION [210327]

Facility

$1,070.39

Service Code	CPT C9460
Hospital Charge Code	ERX210327
Hospital Revenue Code	636
Min. Negotiated Rate	$588.71
Max. Negotiated Rate	$856.31
Rate for Payer: Cash Price	$481.68
Rate for Payer: Cigna of CA HMO/PPO	$856.31
Rate for Payer: Health Smart Auto/Commercial	$642.23
Rate for Payer: LLUH Dept of Risk Management WC	$588.71
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$802.79

CANNABIDIOL 100 MG/ML ORAL SOLUTION [222792]

Facility

$18.84

Service Code	NDC 70127-100-01
Hospital Charge Code	NDG22792
Hospital Revenue Code	259
Min. Negotiated Rate	$10.36
Max. Negotiated Rate	$15.07
Rate for Payer: Cash Price	$8.48
Rate for Payer: Cigna of CA HMO/PPO	$15.07
Rate for Payer: Health Smart Auto/Commercial	$11.30
Rate for Payer: LLUH Dept of Risk Management WC	$10.36
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$14.13

CANNABIDIOL 100 MG/ML ORAL SOLUTION [222792]

Facility

$18.84

Service Code	NDC 70127-100-10
Hospital Charge Code	NDG22792
Hospital Revenue Code	259
Min. Negotiated Rate	$10.36
Max. Negotiated Rate	$14.13
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$11.30
Rate for Payer: Aetna of CA Government/Medicare	$11.30
Rate for Payer: Cash Price	$8.48
Rate for Payer: Health Smart Auto/Commercial	$11.30
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$11.30
Rate for Payer: LLUH Dept of Risk Management WC	$10.36
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$14.13

CANNABIDIOL 100 MG/ML ORAL SOLUTION [222792]

Facility

$18.84

Service Code	NDC 70127-100-10
Hospital Charge Code	NDG22792
Hospital Revenue Code	259
Min. Negotiated Rate	$10.36
Max. Negotiated Rate	$15.07
Rate for Payer: Cash Price	$8.48
Rate for Payer: Cigna of CA HMO/PPO	$15.07
Rate for Payer: Health Smart Auto/Commercial	$11.30
Rate for Payer: LLUH Dept of Risk Management WC	$10.36
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$14.13

CANNABIDIOL 100 MG/ML ORAL SOLUTION [222792]

Facility

$18.84

Service Code	NDC 70127-100-01
Hospital Charge Code	NDG22792
Hospital Revenue Code	259
Min. Negotiated Rate	$10.36
Max. Negotiated Rate	$14.13
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$11.30
Rate for Payer: Aetna of CA Government/Medicare	$11.30
Rate for Payer: Cash Price	$8.48
Rate for Payer: Health Smart Auto/Commercial	$11.30
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$11.30
Rate for Payer: LLUH Dept of Risk Management WC	$10.36
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$14.13

CAPMATINIB 150 MG TABLET [228060]

Facility

$231.18

Service Code	NDC 0078-0709-56
Hospital Charge Code	ERX228060
Hospital Revenue Code	259
Min. Negotiated Rate	$127.15
Max. Negotiated Rate	$184.94
Rate for Payer: Cash Price	$104.03
Rate for Payer: Cigna of CA HMO/PPO	$184.94
Rate for Payer: Health Smart Auto/Commercial	$138.71
Rate for Payer: LLUH Dept of Risk Management WC	$127.15
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$173.38

Know your out-of-pocket cost for care.

All Charges