Loma Linda University Behavioral Medicine Center (BMC)

All Charges

Charge

Type

Setting

Price

CEFAZOLIN 1 GRAM SOLUTION FOR INJECTION [1445]

Facility

$1.72

Service Code	HCPCS J0690
Hospital Charge Code	901700025
Hospital Revenue Code	636
Min. Negotiated Rate	$0.95
Max. Negotiated Rate	$1.38
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$1.03
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$1.08
Rate for Payer: Aetna of CA Government/Medicare	$1.08
Rate for Payer: Aetna of CA Government/Medicare	$1.03
Rate for Payer: Cash Price	$0.99
Rate for Payer: Cash Price	$0.94
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$1.38
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$1.44
Rate for Payer: Health Smart Auto/Commercial	$1.03
Rate for Payer: Health Smart Auto/Commercial	$1.08
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$1.03
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$1.08
Rate for Payer: LLUH Dept of Risk Management WC	$0.95
Rate for Payer: LLUH Dept of Risk Management WC	$0.99
Rate for Payer: Multiplan Commercial	$1.35
Rate for Payer: Multiplan Commercial	$1.29

CEFAZOLIN 2 GRAM/50 ML IN DEXTROSE (ISO-OSMOTIC) INTRAVENOUS PIGGYBACK [154193]

Facility

$17.71

Service Code	HCPCS J0690
Hospital Charge Code	901700025
Hospital Revenue Code	636
Min. Negotiated Rate	$9.74
Max. Negotiated Rate	$14.17
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$10.63
Rate for Payer: Aetna of CA Government/Medicare	$10.63
Rate for Payer: Cash Price	$9.74
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$14.17
Rate for Payer: Health Smart Auto/Commercial	$10.63
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$10.63
Rate for Payer: LLUH Dept of Risk Management WC	$9.74
Rate for Payer: Multiplan Commercial	$13.28

CEFAZOLIN 2 GRAM/50 ML IN DEXTROSE (ISO-OSMOTIC) INTRAVENOUS PIGGYBACK [154193]

Facility

$17.71

Service Code	HCPCS J0690
Hospital Charge Code	901700025
Hospital Revenue Code	636
Min. Negotiated Rate	$9.74
Max. Negotiated Rate	$14.17
Rate for Payer: Cash Price	$9.74
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$14.17
Rate for Payer: Health Smart Auto/Commercial	$10.63
Rate for Payer: LLUH Dept of Risk Management WC	$9.74
Rate for Payer: Multiplan Commercial	$13.28

CEFAZOLIN 300 GRAM SOLUTION FOR INJECTION [31087]

Facility

$366.00

Service Code	HCPCS J0690
Hospital Charge Code	901700025
Hospital Revenue Code	636
Min. Negotiated Rate	$201.30
Max. Negotiated Rate	$292.80
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$219.60
Rate for Payer: Aetna of CA Government/Medicare	$219.60
Rate for Payer: Cash Price	$201.30
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$292.80
Rate for Payer: Health Smart Auto/Commercial	$219.60
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$219.60
Rate for Payer: LLUH Dept of Risk Management WC	$201.30
Rate for Payer: Multiplan Commercial	$274.50

CEFAZOLIN 300 GRAM SOLUTION FOR INJECTION [31087]

Facility

$366.00

Service Code	HCPCS J0690
Hospital Charge Code	901700025
Hospital Revenue Code	636
Min. Negotiated Rate	$201.30
Max. Negotiated Rate	$292.80
Rate for Payer: Cash Price	$201.30
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$292.80
Rate for Payer: Health Smart Auto/Commercial	$219.60
Rate for Payer: LLUH Dept of Risk Management WC	$201.30
Rate for Payer: Multiplan Commercial	$274.50

CEFAZOLIN 500 MG SOLUTION FOR INJECTION [1448]

Facility

$1.01

Service Code	HCPCS J0690
Hospital Charge Code	901700025
Hospital Revenue Code	636
Min. Negotiated Rate	$0.56
Max. Negotiated Rate	$0.81
Rate for Payer: Cash Price	$0.55
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$0.81
Rate for Payer: Health Smart Auto/Commercial	$0.61
Rate for Payer: LLUH Dept of Risk Management WC	$0.56
Rate for Payer: Multiplan Commercial	$0.76

CEFAZOLIN 500 MG SOLUTION FOR INJECTION [1448]

Facility

$1.92

Service Code	HCPCS J0687
Hospital Charge Code	901700025
Hospital Revenue Code	636
Min. Negotiated Rate	$1.06
Max. Negotiated Rate	$1.54
Rate for Payer: Cash Price	$1.06
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$1.54
Rate for Payer: Health Smart Auto/Commercial	$1.15
Rate for Payer: LLUH Dept of Risk Management WC	$1.06
Rate for Payer: Multiplan Commercial	$1.44

CEFAZOLIN 500 MG SOLUTION FOR INJECTION [1448]

Facility

$1.01

Service Code	HCPCS J0690
Hospital Charge Code	901700025
Hospital Revenue Code	636
Min. Negotiated Rate	$0.56
Max. Negotiated Rate	$0.81
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$0.61
Rate for Payer: Aetna of CA Government/Medicare	$0.61
Rate for Payer: Cash Price	$0.55
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$0.81
Rate for Payer: Health Smart Auto/Commercial	$0.61
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$0.61
Rate for Payer: LLUH Dept of Risk Management WC	$0.56
Rate for Payer: Multiplan Commercial	$0.76

CEFAZOLIN 500 MG SOLUTION FOR INJECTION [1448]

Facility

$1.92

Service Code	HCPCS J0687
Hospital Charge Code	901700025
Hospital Revenue Code	636
Min. Negotiated Rate	$1.06
Max. Negotiated Rate	$1.54
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$1.15
Rate for Payer: Aetna of CA Government/Medicare	$1.15
Rate for Payer: Cash Price	$1.06
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$1.54
Rate for Payer: Health Smart Auto/Commercial	$1.15
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$1.15
Rate for Payer: LLUH Dept of Risk Management WC	$1.06
Rate for Payer: Multiplan Commercial	$1.44

CEFAZOLIN (ANCEF) 1G/10ML FROZEN SYRINGE [4081257]

Facility

$0.13

Service Code	HCPCS J0690
Hospital Charge Code	901700025
Hospital Revenue Code	636
Min. Negotiated Rate	$0.07
Max. Negotiated Rate	$0.10
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$0.08
Rate for Payer: Aetna of CA Government/Medicare	$0.08
Rate for Payer: Cash Price	$0.07
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$0.10
Rate for Payer: Health Smart Auto/Commercial	$0.08
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$0.08
Rate for Payer: LLUH Dept of Risk Management WC	$0.07
Rate for Payer: Multiplan Commercial	$0.10

CEFAZOLIN (ANCEF) 1G/10ML FROZEN SYRINGE [4081257]

Facility

$0.13

Service Code	HCPCS J0690
Hospital Charge Code	901700025
Hospital Revenue Code	636
Min. Negotiated Rate	$0.07
Max. Negotiated Rate	$0.10
Rate for Payer: Cash Price	$0.07
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$0.10
Rate for Payer: Health Smart Auto/Commercial	$0.08
Rate for Payer: LLUH Dept of Risk Management WC	$0.07
Rate for Payer: Multiplan Commercial	$0.10

CEFAZOLIN (ANCEF) 2G/20ML FROZEN SYRINGE [4081258]

Facility

$0.13

Service Code	HCPCS J0690
Hospital Charge Code	901700025
Hospital Revenue Code	636
Min. Negotiated Rate	$0.07
Max. Negotiated Rate	$0.10
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$0.08
Rate for Payer: Aetna of CA Government/Medicare	$0.08
Rate for Payer: Cash Price	$0.07
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$0.10
Rate for Payer: Health Smart Auto/Commercial	$0.08
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$0.08
Rate for Payer: LLUH Dept of Risk Management WC	$0.07
Rate for Payer: Multiplan Commercial	$0.10

CEFAZOLIN (ANCEF) 2G/20ML FROZEN SYRINGE [4081258]

Facility

$0.13

Service Code	HCPCS J0690
Hospital Charge Code	901700025
Hospital Revenue Code	636
Min. Negotiated Rate	$0.07
Max. Negotiated Rate	$0.10
Rate for Payer: Cash Price	$0.07
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$0.10
Rate for Payer: Health Smart Auto/Commercial	$0.08
Rate for Payer: LLUH Dept of Risk Management WC	$0.07
Rate for Payer: Multiplan Commercial	$0.10

CEFAZOLIN SUBCONJUNCTIVAL INJECTION [4080087]

Facility

$1.72

Service Code	HCPCS J0690
Hospital Charge Code	901700025
Hospital Revenue Code	636
Min. Negotiated Rate	$0.95
Max. Negotiated Rate	$1.38
Rate for Payer: Cash Price	$0.94
Rate for Payer: Cash Price	$0.51
Rate for Payer: Cash Price	$1.15
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$1.67
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$0.75
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$1.38
Rate for Payer: Health Smart Auto/Commercial	$1.25
Rate for Payer: Health Smart Auto/Commercial	$1.03
Rate for Payer: Health Smart Auto/Commercial	$0.56
Rate for Payer: LLUH Dept of Risk Management WC	$0.52
Rate for Payer: LLUH Dept of Risk Management WC	$0.95
Rate for Payer: LLUH Dept of Risk Management WC	$1.15
Rate for Payer: Multiplan Commercial	$1.29
Rate for Payer: Multiplan Commercial	$0.71
Rate for Payer: Multiplan Commercial	$1.57

CEFAZOLIN SUBCONJUNCTIVAL INJECTION [4080087]

Facility

$1.72

Service Code	HCPCS J0690
Hospital Charge Code	901700025
Hospital Revenue Code	636
Min. Negotiated Rate	$0.95
Max. Negotiated Rate	$1.38
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$1.03
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$0.56
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$1.25
Rate for Payer: Aetna of CA Government/Medicare	$1.03
Rate for Payer: Aetna of CA Government/Medicare	$0.56
Rate for Payer: Aetna of CA Government/Medicare	$1.25
Rate for Payer: Cash Price	$1.15
Rate for Payer: Cash Price	$0.51
Rate for Payer: Cash Price	$0.94
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$0.75
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$1.38
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$1.67
Rate for Payer: Health Smart Auto/Commercial	$0.56
Rate for Payer: Health Smart Auto/Commercial	$1.03
Rate for Payer: Health Smart Auto/Commercial	$1.25
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$1.25
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$1.03
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$0.56
Rate for Payer: LLUH Dept of Risk Management WC	$0.52
Rate for Payer: LLUH Dept of Risk Management WC	$0.95
Rate for Payer: LLUH Dept of Risk Management WC	$1.15
Rate for Payer: Multiplan Commercial	$0.71
Rate for Payer: Multiplan Commercial	$1.29
Rate for Payer: Multiplan Commercial	$1.57

CEFDINIR 250 MG/5 ML ORAL SUSPENSION [39522]

Facility

$0.18

Service Code	NDC 67877-548-88
Hospital Charge Code	901700029
Hospital Revenue Code	259
Min. Negotiated Rate	$0.10
Max. Negotiated Rate	$0.14
Rate for Payer: Cash Price	$0.10
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$0.14
Rate for Payer: Health Smart Auto/Commercial	$0.11
Rate for Payer: LLUH Dept of Risk Management WC	$0.10
Rate for Payer: Multiplan Commercial	$0.14

CEFDINIR 250 MG/5 ML ORAL SUSPENSION [39522]

Facility

$0.18

Service Code	NDC 67877-548-88
Hospital Charge Code	901700029
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	$0.10
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$0.14
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 Commercial	$0.14

CEFDINIR 300 MG CAPSULE [22289]

Facility

$1.00

Service Code	NDC 65862-177-60
Hospital Charge Code	901700029
Hospital Revenue Code	259
Min. Negotiated Rate	$0.55
Max. Negotiated Rate	$0.80
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$0.60
Rate for Payer: Aetna of CA Government/Medicare	$0.60
Rate for Payer: Cash Price	$0.55
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$0.80
Rate for Payer: Health Smart Auto/Commercial	$0.60
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$0.60
Rate for Payer: LLUH Dept of Risk Management WC	$0.55
Rate for Payer: Multiplan Commercial	$0.75

CEFDINIR 300 MG CAPSULE [22289]

Facility

$0.80

Service Code	NDC 68180-711-60
Hospital Charge Code	901700029
Hospital Revenue Code	259
Min. Negotiated Rate	$0.44
Max. Negotiated Rate	$0.64
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$0.48
Rate for Payer: Aetna of CA Government/Medicare	$0.48
Rate for Payer: Cash Price	$0.44
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$0.64
Rate for Payer: Health Smart Auto/Commercial	$0.48
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$0.48
Rate for Payer: LLUH Dept of Risk Management WC	$0.44
Rate for Payer: Multiplan Commercial	$0.60

CEFDINIR 300 MG CAPSULE [22289]

Facility

$1.45

Service Code	NDC 68001-362-06
Hospital Charge Code	901700029
Hospital Revenue Code	259
Min. Negotiated Rate	$0.80
Max. Negotiated Rate	$1.16
Rate for Payer: Cash Price	$0.80
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$1.16
Rate for Payer: Health Smart Auto/Commercial	$0.87
Rate for Payer: LLUH Dept of Risk Management WC	$0.80
Rate for Payer: Multiplan Commercial	$1.09

CEFDINIR 300 MG CAPSULE [22289]

Facility

$1.00

Service Code	NDC 57237-099-60
Hospital Charge Code	901700029
Hospital Revenue Code	259
Min. Negotiated Rate	$0.55
Max. Negotiated Rate	$0.80
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$0.60
Rate for Payer: Aetna of CA Government/Medicare	$0.60
Rate for Payer: Cash Price	$0.55
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$0.80
Rate for Payer: Health Smart Auto/Commercial	$0.60
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$0.60
Rate for Payer: LLUH Dept of Risk Management WC	$0.55
Rate for Payer: Multiplan Commercial	$0.75

CEFDINIR 300 MG CAPSULE [22289]

Facility

$1.00

Service Code	NDC 65862-177-60
Hospital Charge Code	901700029
Hospital Revenue Code	259
Min. Negotiated Rate	$0.55
Max. Negotiated Rate	$0.80
Rate for Payer: Cash Price	$0.55
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$0.80
Rate for Payer: Health Smart Auto/Commercial	$0.60
Rate for Payer: LLUH Dept of Risk Management WC	$0.55
Rate for Payer: Multiplan Commercial	$0.75

CEFDINIR 300 MG CAPSULE [22289]

Facility

$1.45

Service Code	NDC 68001-362-06
Hospital Charge Code	901700029
Hospital Revenue Code	259
Min. Negotiated Rate	$0.80
Max. Negotiated Rate	$1.16
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$0.87
Rate for Payer: Aetna of CA Government/Medicare	$0.87
Rate for Payer: Cash Price	$0.80
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$1.16
Rate for Payer: Health Smart Auto/Commercial	$0.87
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$0.87
Rate for Payer: LLUH Dept of Risk Management WC	$0.80
Rate for Payer: Multiplan Commercial	$1.09

CEFDINIR 300 MG CAPSULE [22289]

Facility

$0.80

Service Code	NDC 68180-711-60
Hospital Charge Code	901700029
Hospital Revenue Code	259
Min. Negotiated Rate	$0.44
Max. Negotiated Rate	$0.64
Rate for Payer: Cash Price	$0.44
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$0.64
Rate for Payer: Health Smart Auto/Commercial	$0.48
Rate for Payer: LLUH Dept of Risk Management WC	$0.44
Rate for Payer: Multiplan Commercial	$0.60

CEFDINIR 300 MG CAPSULE [22289]

Facility

$1.00

Service Code	NDC 57237-099-60
Hospital Charge Code	901700029
Hospital Revenue Code	259
Min. Negotiated Rate	$0.55
Max. Negotiated Rate	$0.80
Rate for Payer: Cash Price	$0.55
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$0.80
Rate for Payer: Health Smart Auto/Commercial	$0.60
Rate for Payer: LLUH Dept of Risk Management WC	$0.55
Rate for Payer: Multiplan Commercial	$0.75

Know your out-of-pocket cost for care.

All Charges