Loma Linda University Behavioral Medicine Center (BMC)

All Charges

Charge

Type

Setting

Price

CISATRACURIUM 2 MG/ML INTRAVENOUS SOLUTION [16168]

Facility

$1.09

Service Code	NDC 70069-161-10
Hospital Charge Code	1721072
Hospital Revenue Code	250
Min. Negotiated Rate	$0.60
Max. Negotiated Rate	$0.87
Rate for Payer: Cash Price	$0.49
Rate for Payer: Cigna of CA HMO/PPO	$0.87
Rate for Payer: Health Smart Auto/Commercial	$0.65
Rate for Payer: LLUH Dept of Risk Management WC	$0.60
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$0.82

CISATRACURIUM 2 MG/ML INTRAVENOUS SOLUTION [16168]

Facility

$2.79

Service Code	NDC 0409-1208-11
Hospital Charge Code	1721072
Hospital Revenue Code	250
Min. Negotiated Rate	$1.53
Max. Negotiated Rate	$2.23
Rate for Payer: Cash Price	$1.26
Rate for Payer: Cigna of CA HMO/PPO	$2.23
Rate for Payer: Health Smart Auto/Commercial	$1.67
Rate for Payer: LLUH Dept of Risk Management WC	$1.53
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$2.09

CISATRACURIUM 2 MG/ML INTRAVENOUS SOLUTION [16168]

Facility

$2.79

Service Code	NDC 0409-7083-01
Hospital Charge Code	1721072
Hospital Revenue Code	250
Min. Negotiated Rate	$1.53
Max. Negotiated Rate	$2.23
Rate for Payer: Cash Price	$1.26
Rate for Payer: Cigna of CA HMO/PPO	$2.23
Rate for Payer: Health Smart Auto/Commercial	$1.67
Rate for Payer: LLUH Dept of Risk Management WC	$1.53
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$2.09

CISATRACURIUM 2 MG/ML INTRAVENOUS SOLUTION [16168]

Facility

$1.68

Service Code	NDC 71288-712-05
Hospital Charge Code	NDG16168
Hospital Revenue Code	250
Min. Negotiated Rate	$0.92
Max. Negotiated Rate	$1.26
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$1.01
Rate for Payer: Aetna of CA Government/Medicare	$1.01
Rate for Payer: Cash Price	$0.76
Rate for Payer: Health Smart Auto/Commercial	$1.01
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$1.01
Rate for Payer: LLUH Dept of Risk Management WC	$0.92
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$1.26

CISATRACURIUM 2 MG/ML INTRAVENOUS SOLUTION [16168]

Facility

$2.79

Service Code	NDC 0409-7083-10
Hospital Charge Code	1721072
Hospital Revenue Code	250
Min. Negotiated Rate	$1.53
Max. Negotiated Rate	$2.09
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$1.67
Rate for Payer: Aetna of CA Government/Medicare	$1.67
Rate for Payer: Cash Price	$1.26
Rate for Payer: Health Smart Auto/Commercial	$1.67
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$1.67
Rate for Payer: LLUH Dept of Risk Management WC	$1.53
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$2.09

CISATRACURIUM 2 MG/ML INTRAVENOUS SOLUTION [16168]

Facility

$1.68

Service Code	NDC 71288-712-06
Hospital Charge Code	NDG16168
Hospital Revenue Code	250
Min. Negotiated Rate	$0.92
Max. Negotiated Rate	$1.34
Rate for Payer: Cash Price	$0.76
Rate for Payer: Cigna of CA HMO/PPO	$1.34
Rate for Payer: Health Smart Auto/Commercial	$1.01
Rate for Payer: LLUH Dept of Risk Management WC	$0.92
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$1.26

CISPLATIN 1 MG/ML INTRAVENOUS SOLUTION [88377]

Facility

$0.43

Service Code	CPT J9060
Hospital Charge Code	1755738
Hospital Revenue Code	636
Min. Negotiated Rate	$0.24
Max. Negotiated Rate	$0.32
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$0.26
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$0.29
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$0.22
Rate for Payer: Aetna of CA Government/Medicare	$0.26
Rate for Payer: Aetna of CA Government/Medicare	$0.29
Rate for Payer: Aetna of CA Government/Medicare	$0.22
Rate for Payer: Cash Price	$0.19
Rate for Payer: Cash Price	$0.16
Rate for Payer: Cash Price	$0.22
Rate for Payer: Health Smart Auto/Commercial	$0.29
Rate for Payer: Health Smart Auto/Commercial	$0.26
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: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$0.26
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: LLUH Dept of Risk Management WC	$0.20
Rate for Payer: LLUH Dept of Risk Management WC	$0.24
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$0.36
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$0.32
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$0.27

CISPLATIN 1 MG/ML INTRAVENOUS SOLUTION [88377]

Facility

$0.43

Service Code	CPT J9060
Hospital Charge Code	1755738
Hospital Revenue Code	636
Min. Negotiated Rate	$0.24
Max. Negotiated Rate	$0.34
Rate for Payer: Cash Price	$0.19
Rate for Payer: Cash Price	$0.16
Rate for Payer: Cash Price	$0.22
Rate for Payer: Cigna of CA HMO/PPO	$0.38
Rate for Payer: Cigna of CA HMO/PPO	$0.34
Rate for Payer: Cigna of CA HMO/PPO	$0.29
Rate for Payer: Health Smart Auto/Commercial	$0.22
Rate for Payer: Health Smart Auto/Commercial	$0.26
Rate for Payer: Health Smart Auto/Commercial	$0.29
Rate for Payer: LLUH Dept of Risk Management WC	$0.24
Rate for Payer: LLUH Dept of Risk Management WC	$0.20
Rate for Payer: LLUH Dept of Risk Management WC	$0.26
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$0.32
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$0.27
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$0.36

CISPLATIN 1 MG/ML INTRAVENOUS SOLUTION [88377]

Facility

$0.67

Service Code	CPT J9060
Hospital Charge Code	1755006
Hospital Revenue Code	636
Min. Negotiated Rate	$0.37
Max. Negotiated Rate	$0.54
Rate for Payer: Cigna of CA HMO/PPO	$0.38
Rate for Payer: Cigna of CA HMO/PPO	$0.34
Rate for Payer: Cigna of CA HMO/PPO	$0.54
Rate for Payer: Health Smart Auto/Commercial	$0.33
Rate for Payer: Health Smart Auto/Commercial	$0.40
Rate for Payer: Health Smart Auto/Commercial	$0.43
Rate for Payer: Health Smart Auto/Commercial	$0.26
Rate for Payer: Health Smart Auto/Commercial	$0.29
Rate for Payer: Cash Price	$0.30
Rate for Payer: Cash Price	$0.22
Rate for Payer: Cash Price	$0.32
Rate for Payer: Cash Price	$0.25
Rate for Payer: Cash Price	$0.19
Rate for Payer: Cigna of CA HMO/PPO	$0.44
Rate for Payer: Cigna of CA HMO/PPO	$0.58
Rate for Payer: LLUH Dept of Risk Management WC	$0.26
Rate for Payer: LLUH Dept of Risk Management WC	$0.40
Rate for Payer: LLUH Dept of Risk Management WC	$0.30
Rate for Payer: LLUH Dept of Risk Management WC	$0.24
Rate for Payer: LLUH Dept of Risk Management WC	$0.37
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$0.50
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$0.41
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$0.36
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$0.54
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$0.32

CISPLATIN 1 MG/ML INTRAVENOUS SOLUTION [88377]

Facility

$0.72

Service Code	CPT J9060
Hospital Charge Code	1755006
Hospital Revenue Code	636
Min. Negotiated Rate	$0.40
Max. Negotiated Rate	$0.54
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$0.43
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$0.40
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$0.29
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$0.33
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$0.26
Rate for Payer: Aetna of CA Government/Medicare	$0.40
Rate for Payer: Aetna of CA Government/Medicare	$0.29
Rate for Payer: Aetna of CA Government/Medicare	$0.43
Rate for Payer: Aetna of CA Government/Medicare	$0.26
Rate for Payer: Aetna of CA Government/Medicare	$0.33
Rate for Payer: Cash Price	$0.19
Rate for Payer: Cash Price	$0.22
Rate for Payer: Cash Price	$0.25
Rate for Payer: Cash Price	$0.32
Rate for Payer: Cash Price	$0.30
Rate for Payer: Health Smart Auto/Commercial	$0.29
Rate for Payer: Health Smart Auto/Commercial	$0.43
Rate for Payer: Health Smart Auto/Commercial	$0.26
Rate for Payer: Health Smart Auto/Commercial	$0.40
Rate for Payer: Health Smart Auto/Commercial	$0.33
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$0.26
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$0.40
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$0.33
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$0.43
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: LLUH Dept of Risk Management WC	$0.37
Rate for Payer: LLUH Dept of Risk Management WC	$0.30
Rate for Payer: LLUH Dept of Risk Management WC	$0.40
Rate for Payer: LLUH Dept of Risk Management WC	$0.24
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$0.54
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$0.50
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$0.32
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$0.41
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$0.36

CISPLATIN 1 MG/ML INTRAVENOUS SOLUTION [88377]

Facility

$0.66

Service Code	CPT J9060
Hospital Charge Code	NDG88377
Hospital Revenue Code	636
Min. Negotiated Rate	$0.36
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	$0.36
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$0.50

CISPLATIN 1 MG/ML INTRAVENOUS SOLUTION [88377]

Facility

$0.66

Service Code	CPT J9060
Hospital Charge Code	NDG88377
Hospital Revenue Code	636
Min. Negotiated Rate	$0.36
Max. Negotiated Rate	$0.53
Rate for Payer: Cash Price	$0.30
Rate for Payer: Cigna of CA HMO/PPO	$0.53
Rate for Payer: Health Smart Auto/Commercial	$0.40
Rate for Payer: LLUH Dept of Risk Management WC	$0.36
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$0.50

CITALOPRAM 10 MG/5 ML ORAL SOLUTION [28228]

Facility

$0.40

Service Code	NDC 0054-0062-58
Hospital Charge Code	1715168
Hospital Revenue Code	259
Min. Negotiated Rate	$0.22
Max. Negotiated Rate	$0.32
Rate for Payer: Cash Price	$0.18
Rate for Payer: Cigna of CA HMO/PPO	$0.32
Rate for Payer: Health Smart Auto/Commercial	$0.24
Rate for Payer: LLUH Dept of Risk Management WC	$0.22
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$0.30

CITALOPRAM 10 MG/5 ML ORAL SOLUTION [28228]

Facility

$0.33

Service Code	NDC 31722-564-24
Hospital Charge Code	1715168
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

CITALOPRAM 10 MG/5 ML ORAL SOLUTION [28228]

Facility

$0.33

Service Code	NDC 31722-564-24
Hospital Charge Code	1715168
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

CITALOPRAM 10 MG/5 ML ORAL SOLUTION [28228]

Facility

$0.73

Service Code	NDC 54838-540-70
Hospital Charge Code	1715168
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

CITALOPRAM 10 MG/5 ML ORAL SOLUTION [28228]

Facility

$0.73

Service Code	NDC 54838-540-70
Hospital Charge Code	1715168
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

CITALOPRAM 10 MG/5 ML ORAL SOLUTION [28228]

Facility

$0.40

Service Code	NDC 0054-0062-58
Hospital Charge Code	1715168
Hospital Revenue Code	259
Min. Negotiated Rate	$0.22
Max. Negotiated Rate	$0.30
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$0.24
Rate for Payer: Aetna of CA Government/Medicare	$0.24
Rate for Payer: Cash Price	$0.18
Rate for Payer: Health Smart Auto/Commercial	$0.24
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$0.24
Rate for Payer: LLUH Dept of Risk Management WC	$0.22
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$0.30

CITALOPRAM 10 MG TABLET [30264]

Facility

$0.09

Service Code	NDC 0378-6231-01
Hospital Charge Code	1710938
Hospital Revenue Code	259
Min. Negotiated Rate	$0.05
Max. Negotiated Rate	$0.07
Rate for Payer: Cash Price	$0.04
Rate for Payer: Cigna of CA HMO/PPO	$0.07
Rate for Payer: Health Smart Auto/Commercial	$0.05
Rate for Payer: LLUH Dept of Risk Management WC	$0.05
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$0.07

CITALOPRAM 10 MG TABLET [30264]

Facility

$0.09

Service Code	NDC 0378-6231-01
Hospital Charge Code	1710938
Hospital Revenue Code	259
Min. Negotiated Rate	$0.05
Max. Negotiated Rate	$0.07
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	$0.05
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$0.07

CITALOPRAM 10 MG TABLET [30264]

Facility

$0.07

Service Code	NDC 13668-009-01
Hospital Charge Code	1710938
Hospital Revenue Code	259
Min. Negotiated Rate	$0.04
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	$0.04
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$0.05

CITALOPRAM 10 MG TABLET [30264]

Facility

$0.07

Service Code	NDC 0904-6084-61
Hospital Charge Code	1710938
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

CITALOPRAM 10 MG TABLET [30264]

Facility

$0.07

Service Code	NDC 0904-6084-61
Hospital Charge Code	1710938
Hospital Revenue Code	259
Min. Negotiated Rate	$0.04
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	$0.04
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$0.05

CITALOPRAM 10 MG TABLET [30264]

Facility

$0.07

Service Code	NDC 13668-009-01
Hospital Charge Code	1710938
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

CITALOPRAM 20 MG TABLET [21062]

Facility

$0.13

Service Code	NDC 68084-744-11
Hospital Charge Code	1710860
Hospital Revenue Code	259
Min. Negotiated Rate	$0.07
Max. Negotiated Rate	$0.10
Rate for Payer: Cash Price	$0.06
Rate for Payer: Cigna of CA 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 Beech St/Commercial/PHCS	$0.10

Know your out-of-pocket cost for care.

All Charges