Loma Linda University Behavioral Medicine Center (BMC)

All Charges

Charge

Type

Setting

Price

ALBUTEROL SULFATE 2.5 MG/3 ML (0.083 %) SOLUTION FOR NEBULIZATION [250]

Facility

$0.12

Service Code	NDC 0487950101
Hospital Charge Code	901700029
Hospital Revenue Code	259
Min. Negotiated Rate	$0.07
Max. Negotiated Rate	$0.10
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: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$0.10
Rate for Payer: Health Smart Auto/Commercial	$0.07
Rate for Payer: Kaiser Foundation Hospitals Commercial/Medi-Cal/Medicare Advantage	$0.07
Rate for Payer: LLUH Dept of Risk Management WC	$0.07
Rate for Payer: Multiplan Commercial	$0.09

ALBUTEROL SULFATE 2 MG TABLET [253]

Facility

$7.47

Service Code	NDC 6808494995
Hospital Charge Code	901700029
Hospital Revenue Code	259
Min. Negotiated Rate	$4.11
Max. Negotiated Rate	$5.98
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$4.48
Rate for Payer: Aetna of CA Government/Medicare	$4.48
Rate for Payer: Cash Price	$3.36
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$5.98
Rate for Payer: Health Smart Auto/Commercial	$4.48
Rate for Payer: Kaiser Foundation Hospitals Commercial/Medi-Cal/Medicare Advantage	$4.48
Rate for Payer: LLUH Dept of Risk Management WC	$4.11
Rate for Payer: Multiplan Commercial	$5.60

ALBUTEROL SULFATE 2 MG TABLET [253]

Facility

$0.72

Service Code	NDC 6923813441
Hospital Charge Code	901700029
Hospital Revenue Code	259
Min. Negotiated Rate	$0.40
Max. Negotiated Rate	$0.58
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$0.43
Rate for Payer: Aetna of CA Government/Medicare	$0.43
Rate for Payer: Cash Price	$0.32
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$0.58
Rate for Payer: Health Smart Auto/Commercial	$0.43
Rate for Payer: Kaiser Foundation Hospitals Commercial/Medi-Cal/Medicare Advantage	$0.43
Rate for Payer: LLUH Dept of Risk Management WC	$0.40
Rate for Payer: Multiplan Commercial	$0.54

ALBUTEROL SULFATE 2 MG TABLET [253]

Facility

$7.47

Service Code	NDC 6808494995
Hospital Charge Code	901700029
Hospital Revenue Code	259
Min. Negotiated Rate	$4.11
Max. Negotiated Rate	$5.98
Rate for Payer: Cash Price	$3.36
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$5.98
Rate for Payer: Health Smart Auto/Commercial	$4.48
Rate for Payer: LLUH Dept of Risk Management WC	$4.11
Rate for Payer: Multiplan Commercial	$5.60

ALBUTEROL SULFATE 2 MG TABLET [253]

Facility

$7.47

Service Code	NDC 6808494925
Hospital Charge Code	901700029
Hospital Revenue Code	259
Min. Negotiated Rate	$4.11
Max. Negotiated Rate	$5.98
Rate for Payer: Cash Price	$3.36
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$5.98
Rate for Payer: Health Smart Auto/Commercial	$4.48
Rate for Payer: LLUH Dept of Risk Management WC	$4.11
Rate for Payer: Multiplan Commercial	$5.60

ALBUTEROL SULFATE 2 MG TABLET [253]

Facility

$7.47

Service Code	NDC 6808494925
Hospital Charge Code	901700029
Hospital Revenue Code	259
Min. Negotiated Rate	$4.11
Max. Negotiated Rate	$5.98
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$4.48
Rate for Payer: Aetna of CA Government/Medicare	$4.48
Rate for Payer: Cash Price	$3.36
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$5.98
Rate for Payer: Health Smart Auto/Commercial	$4.48
Rate for Payer: Kaiser Foundation Hospitals Commercial/Medi-Cal/Medicare Advantage	$4.48
Rate for Payer: LLUH Dept of Risk Management WC	$4.11
Rate for Payer: Multiplan Commercial	$5.60

ALBUTEROL SULFATE 2 MG TABLET [253]

Facility

$0.72

Service Code	NDC 6923813441
Hospital Charge Code	901700029
Hospital Revenue Code	259
Min. Negotiated Rate	$0.40
Max. Negotiated Rate	$0.58
Rate for Payer: Cash Price	$0.32
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$0.58
Rate for Payer: Health Smart Auto/Commercial	$0.43
Rate for Payer: LLUH Dept of Risk Management WC	$0.40
Rate for Payer: Multiplan Commercial	$0.54

ALBUTEROL SULFATE CONCENTRATE 2.5 MG/0.5 ML SOLN FOR NEBULIZATION FOR STATUS ASTHMATICUS [4081891]

Facility

$4.32

Service Code	NDC 0487990130
Hospital Charge Code	901700029
Hospital Revenue Code	259
Min. Negotiated Rate	$2.38
Max. Negotiated Rate	$3.46
Rate for Payer: Cash Price	$1.94
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$3.46
Rate for Payer: Health Smart Auto/Commercial	$2.59
Rate for Payer: LLUH Dept of Risk Management WC	$2.38
Rate for Payer: Multiplan Commercial	$3.24

ALBUTEROL SULFATE CONCENTRATE 2.5 MG/0.5 ML SOLN FOR NEBULIZATION FOR STATUS ASTHMATICUS [4081891]

Facility

$4.32

Service Code	NDC 0487990130
Hospital Charge Code	901700029
Hospital Revenue Code	259
Min. Negotiated Rate	$2.38
Max. Negotiated Rate	$3.46
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$2.59
Rate for Payer: Aetna of CA Government/Medicare	$2.59
Rate for Payer: Cash Price	$1.94
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$3.46
Rate for Payer: Health Smart Auto/Commercial	$2.59
Rate for Payer: Kaiser Foundation Hospitals Commercial/Medi-Cal/Medicare Advantage	$2.59
Rate for Payer: LLUH Dept of Risk Management WC	$2.38
Rate for Payer: Multiplan Commercial	$3.24

ALBUTEROL SULFATE CONCENTRATE 2.5 MG/0.5 ML SOLUTION FOR NEBULIZATION [116907]

Facility

$4.32

Service Code	NDC 0487990130
Hospital Charge Code	901700029
Hospital Revenue Code	259
Min. Negotiated Rate	$2.38
Max. Negotiated Rate	$3.46
Rate for Payer: Cash Price	$1.94
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$3.46
Rate for Payer: Health Smart Auto/Commercial	$2.59
Rate for Payer: LLUH Dept of Risk Management WC	$2.38
Rate for Payer: Multiplan Commercial	$3.24

ALBUTEROL SULFATE CONCENTRATE 2.5 MG/0.5 ML SOLUTION FOR NEBULIZATION [116907]

Facility

$4.32

Service Code	NDC 0487990130
Hospital Charge Code	901700029
Hospital Revenue Code	259
Min. Negotiated Rate	$2.38
Max. Negotiated Rate	$3.46
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$2.59
Rate for Payer: Aetna of CA Government/Medicare	$2.59
Rate for Payer: Cash Price	$1.94
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$3.46
Rate for Payer: Health Smart Auto/Commercial	$2.59
Rate for Payer: Kaiser Foundation Hospitals Commercial/Medi-Cal/Medicare Advantage	$2.59
Rate for Payer: LLUH Dept of Risk Management WC	$2.38
Rate for Payer: Multiplan Commercial	$3.24

ALBUTEROL SULFATE CONCENTRATE 5 MG/ML(0.5 %) SOLUTION FOR NEBULIZATION [251]

Facility

$3.00

Service Code	NDC 7317714633
Hospital Charge Code	901700029
Hospital Revenue Code	259
Min. Negotiated Rate	$1.65
Max. Negotiated Rate	$2.40
Rate for Payer: Cash Price	$1.35
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$2.40
Rate for Payer: Health Smart Auto/Commercial	$1.80
Rate for Payer: LLUH Dept of Risk Management WC	$1.65
Rate for Payer: Multiplan Commercial	$2.25

ALBUTEROL SULFATE CONCENTRATE 5 MG/ML(0.5 %) SOLUTION FOR NEBULIZATION [251]

Facility

$3.00

Service Code	NDC 7317714633
Hospital Charge Code	901700029
Hospital Revenue Code	259
Min. Negotiated Rate	$1.65
Max. Negotiated Rate	$2.40
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$1.80
Rate for Payer: Aetna of CA Government/Medicare	$1.80
Rate for Payer: Cash Price	$1.35
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$2.40
Rate for Payer: Health Smart Auto/Commercial	$1.80
Rate for Payer: Kaiser Foundation Hospitals Commercial/Medi-Cal/Medicare Advantage	$1.80
Rate for Payer: LLUH Dept of Risk Management WC	$1.65
Rate for Payer: Multiplan Commercial	$2.25

ALECTINIB 150 MG CAPSULE [212384]

Facility

$102.20

Service Code	NDC 5024213001
Hospital Charge Code	901700029
Hospital Revenue Code	259
Min. Negotiated Rate	$56.21
Max. Negotiated Rate	$81.76
Rate for Payer: Cash Price	$45.99
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$81.76
Rate for Payer: Health Smart Auto/Commercial	$61.32
Rate for Payer: LLUH Dept of Risk Management WC	$56.21
Rate for Payer: Multiplan Commercial	$76.65

ALECTINIB 150 MG CAPSULE [212384]

Facility

$102.20

Service Code	NDC 5024213001
Hospital Charge Code	901700029
Hospital Revenue Code	259
Min. Negotiated Rate	$56.21
Max. Negotiated Rate	$81.76
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$61.32
Rate for Payer: Aetna of CA Government/Medicare	$61.32
Rate for Payer: Cash Price	$45.99
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$81.76
Rate for Payer: Health Smart Auto/Commercial	$61.32
Rate for Payer: Kaiser Foundation Hospitals Commercial/Medi-Cal/Medicare Advantage	$61.32
Rate for Payer: LLUH Dept of Risk Management WC	$56.21
Rate for Payer: Multiplan Commercial	$76.65

ALEMTUZUMAB 12 MG/1.2 ML INTRAVENOUS SOLUTION [208005]

Facility

$30,041.68

Service Code	HCPCS J0202
Hospital Charge Code	901700025
Hospital Revenue Code	636
Min. Negotiated Rate	$16,522.92
Max. Negotiated Rate	$24,033.34
Rate for Payer: Cash Price	$13,518.76
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$24,033.34
Rate for Payer: Health Smart Auto/Commercial	$18,025.01
Rate for Payer: LLUH Dept of Risk Management WC	$16,522.92
Rate for Payer: Multiplan Commercial	$22,531.26

ALEMTUZUMAB 12 MG/1.2 ML INTRAVENOUS SOLUTION [208005]

Facility

$30,041.68

Service Code	HCPCS J0202
Hospital Charge Code	901700025
Hospital Revenue Code	636
Min. Negotiated Rate	$2,440.42
Max. Negotiated Rate	$24,033.34
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$18,025.01
Rate for Payer: Aetna of CA Government/Medicare	$18,025.01
Rate for Payer: Cash Price	$13,518.76
Rate for Payer: Cash Price	$13,518.76
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$24,033.34
Rate for Payer: Health Smart Auto/Commercial	$18,025.01
Rate for Payer: Intervalley Health Plan Commercial	$2,440.42
Rate for Payer: Kaiser Foundation Hospitals Commercial/Medi-Cal/Medicare Advantage	$18,025.01
Rate for Payer: LLUH Dept of Risk Management WC	$16,522.92
Rate for Payer: Multiplan Commercial	$22,531.26

ALENDRONATE 10 MG TABLET [15661]

Facility

$0.24

Service Code	NDC 6498034003
Hospital Charge Code	901700029
Hospital Revenue Code	259
Min. Negotiated Rate	$0.13
Max. Negotiated Rate	$0.19
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$0.14
Rate for Payer: Aetna of CA Government/Medicare	$0.14
Rate for Payer: Cash Price	$0.11
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$0.19
Rate for Payer: Health Smart Auto/Commercial	$0.14
Rate for Payer: Kaiser Foundation Hospitals Commercial/Medi-Cal/Medicare Advantage	$0.14
Rate for Payer: LLUH Dept of Risk Management WC	$0.13
Rate for Payer: Multiplan Commercial	$0.18

ALENDRONATE 10 MG TABLET [15661]

Facility

$0.24

Service Code	NDC 6498034003
Hospital Charge Code	901700029
Hospital Revenue Code	259
Min. Negotiated Rate	$0.13
Max. Negotiated Rate	$0.19
Rate for Payer: Cash Price	$0.11
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$0.19
Rate for Payer: Health Smart Auto/Commercial	$0.14
Rate for Payer: LLUH Dept of Risk Management WC	$0.13
Rate for Payer: Multiplan Commercial	$0.18

ALENDRONATE 70 MG/75 ML ORAL SOLUTION [37640]

Facility

$1.10

Service Code	NDC 0054028259
Hospital Charge Code	901700029
Hospital Revenue Code	259
Min. Negotiated Rate	$0.61
Max. Negotiated Rate	$0.88
Rate for Payer: Cash Price	$0.50
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$0.88
Rate for Payer: Health Smart Auto/Commercial	$0.66
Rate for Payer: LLUH Dept of Risk Management WC	$0.61
Rate for Payer: Multiplan Commercial	$0.83

ALENDRONATE 70 MG/75 ML ORAL SOLUTION [37640]

Facility

$1.10

Service Code	NDC 0054028259
Hospital Charge Code	901700029
Hospital Revenue Code	259
Min. Negotiated Rate	$0.61
Max. Negotiated Rate	$0.88
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$0.66
Rate for Payer: Aetna of CA Government/Medicare	$0.66
Rate for Payer: Cash Price	$0.50
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$0.88
Rate for Payer: Health Smart Auto/Commercial	$0.66
Rate for Payer: Kaiser Foundation Hospitals Commercial/Medi-Cal/Medicare Advantage	$0.66
Rate for Payer: LLUH Dept of Risk Management WC	$0.61
Rate for Payer: Multiplan Commercial	$0.83

ALENDRONATE 70 MG TABLET [29048]

Facility

$0.75

Service Code	NDC 6498034214
Hospital Charge Code	901700029
Hospital Revenue Code	259
Min. Negotiated Rate	$0.41
Max. Negotiated Rate	$0.60
Rate for Payer: Cash Price	$0.34
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$0.60
Rate for Payer: Health Smart Auto/Commercial	$0.45
Rate for Payer: LLUH Dept of Risk Management WC	$0.41
Rate for Payer: Multiplan Commercial	$0.56

ALENDRONATE 70 MG TABLET [29048]

Facility

$0.75

Service Code	NDC 6498034214
Hospital Charge Code	901700029
Hospital Revenue Code	259
Min. Negotiated Rate	$0.41
Max. Negotiated Rate	$0.60
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$0.45
Rate for Payer: Aetna of CA Government/Medicare	$0.45
Rate for Payer: Cash Price	$0.34
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$0.60
Rate for Payer: Health Smart Auto/Commercial	$0.45
Rate for Payer: Kaiser Foundation Hospitals Commercial/Medi-Cal/Medicare Advantage	$0.45
Rate for Payer: LLUH Dept of Risk Management WC	$0.41
Rate for Payer: Multiplan Commercial	$0.56

ALENDRONATE 70 MG TABLET [29048]

Facility

$1.65

Service Code	NDC 6586232904
Hospital Charge Code	901700029
Hospital Revenue Code	259
Min. Negotiated Rate	$0.91
Max. Negotiated Rate	$1.32
Rate for Payer: Cash Price	$0.74
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$1.32
Rate for Payer: Health Smart Auto/Commercial	$0.99
Rate for Payer: LLUH Dept of Risk Management WC	$0.91
Rate for Payer: Multiplan Commercial	$1.24

ALENDRONATE 70 MG TABLET [29048]

Facility

$1.65

Service Code	NDC 6586232904
Hospital Charge Code	901700029
Hospital Revenue Code	259
Min. Negotiated Rate	$0.91
Max. Negotiated Rate	$1.32
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$0.99
Rate for Payer: Aetna of CA Government/Medicare	$0.99
Rate for Payer: Cash Price	$0.74
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$1.32
Rate for Payer: Health Smart Auto/Commercial	$0.99
Rate for Payer: Kaiser Foundation Hospitals Commercial/Medi-Cal/Medicare Advantage	$0.99
Rate for Payer: LLUH Dept of Risk Management WC	$0.91
Rate for Payer: Multiplan Commercial	$1.24

Know your out-of-pocket cost for care.

All Charges