Loma Linda University Behavioral Medicine Center (BMC)

All Charges

Charge

Type

Setting

Price

CARBOXYMETHYLCELLULOSE SODIUM 0.5 % EYE DROPS [111282]

Facility

$0.67

Service Code	NDC 0023-0798-15
Hospital Charge Code	1740385
Hospital Revenue Code	259
Min. Negotiated Rate	$0.37
Max. Negotiated Rate	$0.54
Rate for Payer: Cash Price	$0.30
Rate for Payer: Cigna of CA HMO/PPO	$0.54
Rate for Payer: Health Smart Auto/Commercial	$0.40
Rate for Payer: LLUH Dept of Risk Management WC	$0.37
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$0.50

CARBOXYMETHYLCELLULOSE SODIUM 0.5 % EYE DROPS [111282]

Facility

$0.67

Service Code	NDC 0023-0798-15
Hospital Charge Code	1740385
Hospital Revenue Code	259
Min. Negotiated Rate	$0.37
Max. Negotiated Rate	$0.50
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$0.40
Rate for Payer: Aetna of CA Government/Medicare	$0.40
Rate for Payer: Cash Price	$0.30
Rate for Payer: Health Smart Auto/Commercial	$0.40
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$0.40
Rate for Payer: LLUH Dept of Risk Management WC	$0.37
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$0.50

CARBOXYMETHYLCELLULOSE SODIUM 0.5 % EYE DROPS [111282]

Facility

$0.61

Service Code	NDC 50268-068-15
Hospital Charge Code	1740385
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

CARBOXYMETHYLCELLULOSE SODIUM 0.5 % EYE DROPS [111282]

Facility

$0.61

Service Code	NDC 50268-068-15
Hospital Charge Code	1740385
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

CARBOXYMETHYLCELLULOSE SODIUM 0.5 % EYE DROPS IN A DROPPERETTE [27991]

Facility

$0.33

Service Code	NDC 0023-0403-50
Hospital Charge Code	ERX27991
Hospital Revenue Code	259
Min. Negotiated Rate	$0.18
Max. Negotiated Rate	$0.25
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$0.20
Rate for Payer: Aetna of CA Government/Medicare	$0.20
Rate for Payer: Cash Price	$0.15
Rate for Payer: Health Smart Auto/Commercial	$0.20
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$0.20
Rate for Payer: LLUH Dept of Risk Management WC	$0.18
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$0.25

CARBOXYMETHYLCELLULOSE SODIUM 0.5 % EYE DROPS IN A DROPPERETTE [27991]

Facility

$0.36

Service Code	NDC 0023-0403-30
Hospital Charge Code	ERX27991
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

CARBOXYMETHYLCELLULOSE SODIUM 0.5 % EYE DROPS IN A DROPPERETTE [27991]

Facility

$0.36

Service Code	NDC 0023-0403-30
Hospital Charge Code	ERX27991
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

CARBOXYMETHYLCELLULOSE SODIUM 0.5 % EYE DROPS IN A DROPPERETTE [27991]

Facility

$0.33

Service Code	NDC 0023-0403-50
Hospital Charge Code	ERX27991
Hospital Revenue Code	259
Min. Negotiated Rate	$0.18
Max. Negotiated Rate	$0.26
Rate for Payer: Cash Price	$0.15
Rate for Payer: Cigna of CA HMO/PPO	$0.26
Rate for Payer: Health Smart Auto/Commercial	$0.20
Rate for Payer: LLUH Dept of Risk Management WC	$0.18
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$0.25

CARBOXYMETHYLCELLULOSE SODIUM 1 % EYE GEL IN A DROPPERETTE [38321]

Facility

$0.44

Service Code	NDC 0023-4554-30
Hospital Charge Code	1740288
Hospital Revenue Code	259
Min. Negotiated Rate	$0.24
Max. Negotiated Rate	$0.35
Rate for Payer: Cash Price	$0.20
Rate for Payer: Cigna of CA HMO/PPO	$0.35
Rate for Payer: Health Smart Auto/Commercial	$0.26
Rate for Payer: LLUH Dept of Risk Management WC	$0.24
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$0.33

CARBOXYMETHYLCELLULOSE SODIUM 1 % EYE GEL IN A DROPPERETTE [38321]

Facility

$0.44

Service Code	NDC 0023-4554-30
Hospital Charge Code	1740288
Hospital Revenue Code	259
Min. Negotiated Rate	$0.24
Max. Negotiated Rate	$0.33
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$0.26
Rate for Payer: Aetna of CA Government/Medicare	$0.26
Rate for Payer: Cash Price	$0.20
Rate for Payer: Health Smart Auto/Commercial	$0.26
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$0.26
Rate for Payer: LLUH Dept of Risk Management WC	$0.24
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$0.33

CARBOXYMETHYLCELLULOSE SODIUM 1 % EYE LIQUID GEL DROPS [27992]

Facility

$0.69

Service Code	NDC 0023-9205-15
Hospital Charge Code	1740305
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

CARBOXYMETHYLCELLULOSE SODIUM 1 % EYE LIQUID GEL DROPS [27992]

Facility

$0.69

Service Code	NDC 0023-9205-15
Hospital Charge Code	1740305
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

CARFILZOMIB 10 MG INTRAVENOUS SOLUTION [222456]

Facility

$595.84

Service Code	CPT J9047
Hospital Charge Code	ERX222456
Hospital Revenue Code	636
Min. Negotiated Rate	$327.71
Max. Negotiated Rate	$476.67
Rate for Payer: Cash Price	$268.13
Rate for Payer: Cigna of CA HMO/PPO	$476.67
Rate for Payer: Health Smart Auto/Commercial	$357.50
Rate for Payer: LLUH Dept of Risk Management WC	$327.71
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$446.88

CARFILZOMIB 10 MG INTRAVENOUS SOLUTION [222456]

Facility

$595.84

Service Code	CPT J9047
Hospital Charge Code	ERX222456
Hospital Revenue Code	636
Min. Negotiated Rate	$327.71
Max. Negotiated Rate	$446.88
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$357.50
Rate for Payer: Aetna of CA Government/Medicare	$357.50
Rate for Payer: Cash Price	$268.13
Rate for Payer: Health Smart Auto/Commercial	$357.50
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$357.50
Rate for Payer: LLUH Dept of Risk Management WC	$327.71
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$446.88

CARFILZOMIB 30 MG INTRAVENOUS SOLUTION [214890]

Facility

$1,787.52

Service Code	CPT J9047
Hospital Charge Code	ERX214890
Hospital Revenue Code	636
Min. Negotiated Rate	$983.14
Max. Negotiated Rate	$1,430.02
Rate for Payer: Cash Price	$804.38
Rate for Payer: Cigna of CA HMO/PPO	$1,430.02
Rate for Payer: Health Smart Auto/Commercial	$1,072.51
Rate for Payer: LLUH Dept of Risk Management WC	$983.14
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$1,340.64

CARFILZOMIB 30 MG INTRAVENOUS SOLUTION [214890]

Facility

$1,787.52

Service Code	CPT J9047
Hospital Charge Code	ERX214890
Hospital Revenue Code	636
Min. Negotiated Rate	$983.14
Max. Negotiated Rate	$1,340.64
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$1,072.51
Rate for Payer: Aetna of CA Government/Medicare	$1,072.51
Rate for Payer: Cash Price	$804.38
Rate for Payer: Health Smart Auto/Commercial	$1,072.51
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$1,072.51
Rate for Payer: LLUH Dept of Risk Management WC	$983.14
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$1,340.64

CARFILZOMIB 60 MG INTRAVENOUS SOLUTION [196893]

Facility

$3,575.04

Service Code	NDC 76075-101-01
Hospital Charge Code	1755799
Hospital Revenue Code	636
Min. Negotiated Rate	$1,966.27
Max. Negotiated Rate	$2,681.28
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$2,145.02
Rate for Payer: Aetna of CA Government/Medicare	$2,145.02
Rate for Payer: Cash Price	$1,608.77
Rate for Payer: Health Smart Auto/Commercial	$2,145.02
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$2,145.02
Rate for Payer: LLUH Dept of Risk Management WC	$1,966.27
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$2,681.28

CARFILZOMIB 60 MG INTRAVENOUS SOLUTION [196893]

Facility

$3,575.04

Service Code	NDC 76075-101-01
Hospital Charge Code	1755799
Hospital Revenue Code	636
Min. Negotiated Rate	$1,966.27
Max. Negotiated Rate	$2,860.03
Rate for Payer: Cash Price	$1,608.77
Rate for Payer: Cigna of CA HMO/PPO	$2,860.03
Rate for Payer: Health Smart Auto/Commercial	$2,145.02
Rate for Payer: LLUH Dept of Risk Management WC	$1,966.27
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$2,681.28

CARISOPRODOL 350 MG TABLET [1395]

Facility

$0.08

Service Code	NDC 69584-111-10
Hospital Charge Code	1711179
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

CARISOPRODOL 350 MG TABLET [1395]

Facility

$0.08

Service Code	NDC 69584-111-10
Hospital Charge Code	1711179
Hospital Revenue Code	259
Min. Negotiated Rate	$0.04
Max. Negotiated Rate	$0.06
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$0.05
Rate for Payer: Aetna of CA Government/Medicare	$0.05
Rate for Payer: Cash Price	$0.04
Rate for Payer: Health Smart Auto/Commercial	$0.05
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$0.05
Rate for Payer: LLUH Dept of Risk Management WC	$0.04
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$0.06

CARISOPRODOL 350 MG TABLET [1395]

Facility

$0.14

Service Code	NDC 50228-109-01
Hospital Charge Code	1711179
Hospital Revenue Code	259
Min. Negotiated Rate	$0.08
Max. Negotiated Rate	$0.11
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	$0.06
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	$0.08
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$0.11

CARISOPRODOL 350 MG TABLET [1395]

Facility

$0.14

Service Code	NDC 50228-109-01
Hospital Charge Code	1711179
Hospital Revenue Code	259
Min. Negotiated Rate	$0.08
Max. Negotiated Rate	$0.11
Rate for Payer: Cash Price	$0.06
Rate for Payer: Cigna of CA HMO/PPO	$0.11
Rate for Payer: Health Smart Auto/Commercial	$0.08
Rate for Payer: LLUH Dept of Risk Management WC	$0.08
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$0.11

CARMUSTINE 100 MG INTRAVENOUS SOLUTION [28911]

Facility

$900.00

Service Code	CPT J9050
Hospital Charge Code	1755109
Hospital Revenue Code	636
Min. Negotiated Rate	$495.00
Max. Negotiated Rate	$675.00
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$540.00
Rate for Payer: Aetna of CA Government/Medicare	$540.00
Rate for Payer: Cash Price	$405.00
Rate for Payer: Health Smart Auto/Commercial	$540.00
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$540.00
Rate for Payer: LLUH Dept of Risk Management WC	$495.00
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$675.00

CARMUSTINE 100 MG INTRAVENOUS SOLUTION [28911]

Facility

$900.00

Service Code	CPT J9050
Hospital Charge Code	1755109
Hospital Revenue Code	636
Min. Negotiated Rate	$495.00
Max. Negotiated Rate	$720.00
Rate for Payer: Cash Price	$405.00
Rate for Payer: Cigna of CA HMO/PPO	$720.00
Rate for Payer: Health Smart Auto/Commercial	$540.00
Rate for Payer: LLUH Dept of Risk Management WC	$495.00
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$675.00

CARVEDILOL 12.5 MG TABLET [15749]

Facility

$0.16

Service Code	NDC 51079-931-20
Hospital Charge Code	1711679
Hospital Revenue Code	259
Min. Negotiated Rate	$0.09
Max. Negotiated Rate	$0.13
Rate for Payer: Cash Price	$0.07
Rate for Payer: Cigna of CA HMO/PPO	$0.13
Rate for Payer: Health Smart Auto/Commercial	$0.10
Rate for Payer: LLUH Dept of Risk Management WC	$0.09
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$0.12

Know your out-of-pocket cost for care.

All Charges