Loma Linda University Behavioral Medicine Center (BMC)

All Charges

Charge

Type

Setting

Price

CAPTOPRIL ORAL SUSPENSION COMPOUND 1 MG/ML [4080250]

Facility

$0.06

Service Code	NDC 9994-0802-50
Hospital Charge Code	1715941
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

CAPTOPRIL ORAL SUSPENSION COMPOUND 1 MG/ML [4080250]

Facility

$0.06

Service Code	NDC 9994-0802-50
Hospital Charge Code	1715941
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

CARBACHOL 0.01 % INTRAOCULAR SOLUTION [19704]

Facility

$33.72

Service Code	NDC 0065-0023-15
Hospital Charge Code	1740242
Hospital Revenue Code	250
Min. Negotiated Rate	$18.55
Max. Negotiated Rate	$25.29
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$20.23
Rate for Payer: Aetna of CA Government/Medicare	$20.23
Rate for Payer: Cash Price	$15.17
Rate for Payer: Health Smart Auto/Commercial	$20.23
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$20.23
Rate for Payer: LLUH Dept of Risk Management WC	$18.55
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$25.29

CARBACHOL 0.01 % INTRAOCULAR SOLUTION [19704]

Facility

$33.72

Service Code	NDC 0065-0023-15
Hospital Charge Code	1740242
Hospital Revenue Code	250
Min. Negotiated Rate	$18.55
Max. Negotiated Rate	$26.98
Rate for Payer: Cash Price	$15.17
Rate for Payer: Cigna of CA HMO/PPO	$26.98
Rate for Payer: Health Smart Auto/Commercial	$20.23
Rate for Payer: LLUH Dept of Risk Management WC	$18.55
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$25.29

CARBAMAZEPINE 100 MG/5 ML (5 ML) ORAL SUSPENSION [120742]

Facility

$0.73

Service Code	NDC 68094-007-62
Hospital Charge Code	NDG120742
Hospital Revenue Code	259
Min. Negotiated Rate	$0.40
Max. Negotiated Rate	$0.55
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$0.44
Rate for Payer: Aetna of CA Government/Medicare	$0.44
Rate for Payer: Cash Price	$0.33
Rate for Payer: Health Smart Auto/Commercial	$0.44
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$0.44
Rate for Payer: LLUH Dept of Risk Management WC	$0.40
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$0.55

CARBAMAZEPINE 100 MG/5 ML (5 ML) ORAL SUSPENSION [120742]

Facility

$0.73

Service Code	NDC 68094-007-62
Hospital Charge Code	NDG120742
Hospital Revenue Code	259
Min. Negotiated Rate	$0.40
Max. Negotiated Rate	$0.58
Rate for Payer: Cash Price	$0.33
Rate for Payer: Cigna of CA HMO/PPO	$0.58
Rate for Payer: Health Smart Auto/Commercial	$0.44
Rate for Payer: LLUH Dept of Risk Management WC	$0.40
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$0.55

CARBAMAZEPINE 100 MG/5 ML (5 ML) ORAL SUSPENSION [120742]

Facility

$0.73

Service Code	NDC 68094-007-59
Hospital Charge Code	NDG120742
Hospital Revenue Code	259
Min. Negotiated Rate	$0.40
Max. Negotiated Rate	$0.58
Rate for Payer: Cash Price	$0.33
Rate for Payer: Cigna of CA HMO/PPO	$0.58
Rate for Payer: Health Smart Auto/Commercial	$0.44
Rate for Payer: LLUH Dept of Risk Management WC	$0.40
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$0.55

CARBAMAZEPINE 100 MG/5 ML (5 ML) ORAL SUSPENSION [120742]

Facility

$0.73

Service Code	NDC 68094-007-59
Hospital Charge Code	NDG120742
Hospital Revenue Code	259
Min. Negotiated Rate	$0.40
Max. Negotiated Rate	$0.55
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$0.44
Rate for Payer: Aetna of CA Government/Medicare	$0.44
Rate for Payer: Cash Price	$0.33
Rate for Payer: Health Smart Auto/Commercial	$0.44
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$0.44
Rate for Payer: LLUH Dept of Risk Management WC	$0.40
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$0.55

CARBAMAZEPINE 100 MG/5 ML ORAL SUSPENSION [111849]

Facility

$0.19

Service Code	NDC 70954-240-10
Hospital Charge Code	NDG111849
Hospital Revenue Code	259
Min. Negotiated Rate	$0.10
Max. Negotiated Rate	$0.15
Rate for Payer: Cash Price	$0.09
Rate for Payer: Cigna of CA HMO/PPO	$0.15
Rate for Payer: Health Smart Auto/Commercial	$0.11
Rate for Payer: LLUH Dept of Risk Management WC	$0.10
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$0.14

CARBAMAZEPINE 100 MG/5 ML ORAL SUSPENSION [111849]

Facility

$0.19

Service Code	NDC 70954-240-10
Hospital Charge Code	NDG111849
Hospital Revenue Code	259
Min. Negotiated Rate	$0.10
Max. Negotiated Rate	$0.14
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$0.11
Rate for Payer: Aetna of CA Government/Medicare	$0.11
Rate for Payer: Cash Price	$0.09
Rate for Payer: Health Smart Auto/Commercial	$0.11
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$0.11
Rate for Payer: LLUH Dept of Risk Management WC	$0.10
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$0.14

CARBAMAZEPINE 100 MG/5 ML ORAL SUSPENSION [111849]

Facility

$0.19

Service Code	NDC 51672-4047-9
Hospital Charge Code	NDG111849
Hospital Revenue Code	259
Min. Negotiated Rate	$0.10
Max. Negotiated Rate	$0.15
Rate for Payer: Cash Price	$0.09
Rate for Payer: Cigna of CA HMO/PPO	$0.15
Rate for Payer: Health Smart Auto/Commercial	$0.11
Rate for Payer: LLUH Dept of Risk Management WC	$0.10
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$0.14

CARBAMAZEPINE 100 MG/5 ML ORAL SUSPENSION [111849]

Facility

$0.19

Service Code	NDC 51672-4047-9
Hospital Charge Code	NDG111849
Hospital Revenue Code	259
Min. Negotiated Rate	$0.10
Max. Negotiated Rate	$0.14
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$0.11
Rate for Payer: Aetna of CA Government/Medicare	$0.11
Rate for Payer: Cash Price	$0.09
Rate for Payer: Health Smart Auto/Commercial	$0.11
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$0.11
Rate for Payer: LLUH Dept of Risk Management WC	$0.10
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$0.14

CARBAMAZEPINE 100 MG CHEWABLE TABLET [1355]

Facility

$0.48

Service Code	NDC 51672-4041-1
Hospital Charge Code	1711075
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

CARBAMAZEPINE 100 MG CHEWABLE TABLET [1355]

Facility

$0.61

Service Code	NDC 0904-3854-61
Hospital Charge Code	1711075
Hospital Revenue Code	259
Min. Negotiated Rate	$0.34
Max. Negotiated Rate	$0.49
Rate for Payer: Cash Price	$0.27
Rate for Payer: Cigna of CA HMO/PPO	$0.49
Rate for Payer: Health Smart Auto/Commercial	$0.37
Rate for Payer: LLUH Dept of Risk Management WC	$0.34
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$0.46

CARBAMAZEPINE 100 MG CHEWABLE TABLET [1355]

Facility

$0.48

Service Code	NDC 51079-870-01
Hospital Charge Code	1711075
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

CARBAMAZEPINE 100 MG CHEWABLE TABLET [1355]

Facility

$0.63

Service Code	NDC 13668-271-01
Hospital Charge Code	1711075
Hospital Revenue Code	259
Min. Negotiated Rate	$0.35
Max. Negotiated Rate	$0.47
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$0.38
Rate for Payer: Aetna of CA Government/Medicare	$0.38
Rate for Payer: Cash Price	$0.28
Rate for Payer: Health Smart Auto/Commercial	$0.38
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$0.38
Rate for Payer: LLUH Dept of Risk Management WC	$0.35
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$0.47

CARBAMAZEPINE 100 MG CHEWABLE TABLET [1355]

Facility

$0.63

Service Code	NDC 13668-271-01
Hospital Charge Code	1711075
Hospital Revenue Code	259
Min. Negotiated Rate	$0.35
Max. Negotiated Rate	$0.50
Rate for Payer: Cash Price	$0.28
Rate for Payer: Cigna of CA HMO/PPO	$0.50
Rate for Payer: Health Smart Auto/Commercial	$0.38
Rate for Payer: LLUH Dept of Risk Management WC	$0.35
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$0.47

CARBAMAZEPINE 100 MG CHEWABLE TABLET [1355]

Facility

$0.61

Service Code	NDC 0904-3854-61
Hospital Charge Code	1711075
Hospital Revenue Code	259
Min. Negotiated Rate	$0.34
Max. Negotiated Rate	$0.46
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$0.37
Rate for Payer: Aetna of CA Government/Medicare	$0.37
Rate for Payer: Cash Price	$0.27
Rate for Payer: Health Smart Auto/Commercial	$0.37
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$0.37
Rate for Payer: LLUH Dept of Risk Management WC	$0.34
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$0.46

CARBAMAZEPINE 100 MG CHEWABLE TABLET [1355]

Facility

$0.48

Service Code	NDC 51672-4041-1
Hospital Charge Code	1711075
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

CARBAMAZEPINE 100 MG CHEWABLE TABLET [1355]

Facility

$0.63

Service Code	NDC 0093-0778-01
Hospital Charge Code	1711075
Hospital Revenue Code	259
Min. Negotiated Rate	$0.35
Max. Negotiated Rate	$0.47
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$0.38
Rate for Payer: Aetna of CA Government/Medicare	$0.38
Rate for Payer: Cash Price	$0.28
Rate for Payer: Health Smart Auto/Commercial	$0.38
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$0.38
Rate for Payer: LLUH Dept of Risk Management WC	$0.35
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$0.47

CARBAMAZEPINE 100 MG CHEWABLE TABLET [1355]

Facility

$0.59

Service Code	NDC 60687-479-11
Hospital Charge Code	1711075
Hospital Revenue Code	259
Min. Negotiated Rate	$0.32
Max. Negotiated Rate	$0.44
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$0.35
Rate for Payer: Aetna of CA Government/Medicare	$0.35
Rate for Payer: Cash Price	$0.27
Rate for Payer: Health Smart Auto/Commercial	$0.35
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$0.35
Rate for Payer: LLUH Dept of Risk Management WC	$0.32
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$0.44

CARBAMAZEPINE 100 MG CHEWABLE TABLET [1355]

Facility

$0.48

Service Code	NDC 51079-870-01
Hospital Charge Code	1711075
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

CARBAMAZEPINE 100 MG CHEWABLE TABLET [1355]

Facility

$0.63

Service Code	NDC 0093-0778-01
Hospital Charge Code	1711075
Hospital Revenue Code	259
Min. Negotiated Rate	$0.35
Max. Negotiated Rate	$0.50
Rate for Payer: Cash Price	$0.28
Rate for Payer: Cigna of CA HMO/PPO	$0.50
Rate for Payer: Health Smart Auto/Commercial	$0.38
Rate for Payer: LLUH Dept of Risk Management WC	$0.35
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$0.47

CARBAMAZEPINE 100 MG CHEWABLE TABLET [1355]

Facility

$0.59

Service Code	NDC 60687-479-11
Hospital Charge Code	1711075
Hospital Revenue Code	259
Min. Negotiated Rate	$0.32
Max. Negotiated Rate	$0.47
Rate for Payer: Cash Price	$0.27
Rate for Payer: Cigna of CA HMO/PPO	$0.47
Rate for Payer: Health Smart Auto/Commercial	$0.35
Rate for Payer: LLUH Dept of Risk Management WC	$0.32
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$0.44

CARBAMAZEPINE 200 MG/10 ML ORAL SUSPENSION [1356]

Facility

$0.45

Service Code	NDC 0121-1894-10
Hospital Charge Code	NDG1356
Hospital Revenue Code	259
Min. Negotiated Rate	$0.25
Max. Negotiated Rate	$0.36
Rate for Payer: Cash Price	$0.20
Rate for Payer: Cigna of CA HMO/PPO	$0.36
Rate for Payer: Health Smart Auto/Commercial	$0.27
Rate for Payer: LLUH Dept of Risk Management WC	$0.25
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$0.34

Know your out-of-pocket cost for care.

All Charges