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

$0.10

Service Code	NDC 76204-200-30
Hospital Charge Code	1781155
Hospital Revenue Code	259
Min. Negotiated Rate	$0.06
Max. Negotiated Rate	$0.08
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$0.06
Rate for Payer: Aetna of CA Government/Medicare	$0.06
Rate for Payer: Cash Price	$0.05
Rate for Payer: Health Smart Auto/Commercial	$0.06
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$0.06
Rate for Payer: LLUH Dept of Risk Management WC	$0.06
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$0.08

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

Facility

$0.12

Service Code	NDC 0487-9501-01
Hospital Charge Code	1781155
Hospital Revenue Code	259
Min. Negotiated Rate	$0.07
Max. Negotiated Rate	$0.09
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: Health Smart Auto/Commercial	$0.07
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$0.07
Rate for Payer: LLUH Dept of Risk Management WC	$0.07
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$0.09

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

Facility

$0.10

Service Code	NDC 76204-200-25
Hospital Charge Code	1781155
Hospital Revenue Code	259
Min. Negotiated Rate	$0.06
Max. Negotiated Rate	$0.08
Rate for Payer: Cash Price	$0.05
Rate for Payer: Cigna of CA HMO/PPO	$0.08
Rate for Payer: Health Smart Auto/Commercial	$0.06
Rate for Payer: LLUH Dept of Risk Management WC	$0.06
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$0.08

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

Facility

$0.06

Service Code	NDC 0378-8270-52
Hospital Charge Code	1781155
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

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

Facility

$0.10

Service Code	NDC 76204-200-25
Hospital Charge Code	1781155
Hospital Revenue Code	259
Min. Negotiated Rate	$0.06
Max. Negotiated Rate	$0.08
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$0.06
Rate for Payer: Aetna of CA Government/Medicare	$0.06
Rate for Payer: Cash Price	$0.05
Rate for Payer: Health Smart Auto/Commercial	$0.06
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$0.06
Rate for Payer: LLUH Dept of Risk Management WC	$0.06
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$0.08

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

Facility

$0.10

Service Code	NDC 76204-200-60
Hospital Charge Code	1781155
Hospital Revenue Code	259
Min. Negotiated Rate	$0.06
Max. Negotiated Rate	$0.08
Rate for Payer: Cash Price	$0.05
Rate for Payer: Cigna of CA HMO/PPO	$0.08
Rate for Payer: Health Smart Auto/Commercial	$0.06
Rate for Payer: LLUH Dept of Risk Management WC	$0.06
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$0.08

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

Facility

$0.06

Service Code	NDC 0378-8270-52
Hospital Charge Code	1781155
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

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

Facility

$0.06

Service Code	NDC 0378-8270-91
Hospital Charge Code	1781155
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

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

Facility

$0.10

Service Code	NDC 76204-200-60
Hospital Charge Code	1781155
Hospital Revenue Code	259
Min. Negotiated Rate	$0.06
Max. Negotiated Rate	$0.08
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$0.06
Rate for Payer: Aetna of CA Government/Medicare	$0.06
Rate for Payer: Cash Price	$0.05
Rate for Payer: Health Smart Auto/Commercial	$0.06
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$0.06
Rate for Payer: LLUH Dept of Risk Management WC	$0.06
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$0.08

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

Facility

$0.06

Service Code	NDC 0487-9501-03
Hospital Charge Code	1781155
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

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

Facility

$0.06

Service Code	NDC 0378-8270-62
Hospital Charge Code	1781155
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

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

Facility

$0.06

Service Code	NDC 0378-8270-62
Hospital Charge Code	1781155
Hospital Revenue Code	259
Min. Negotiated Rate	$0.03
Max. Negotiated Rate	$0.05
Rate for Payer: Health Smart Auto/Commercial	$0.04
Rate for Payer: Cash Price	$0.03
Rate for Payer: Cigna of CA HMO/PPO	$0.05
Rate for Payer: LLUH Dept of Risk Management WC	$0.03
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$0.05

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

Facility

$0.12

Service Code	NDC 0487-9501-01
Hospital Charge Code	1781155
Hospital Revenue Code	259
Min. Negotiated Rate	$0.07
Max. Negotiated Rate	$0.10
Rate for Payer: Cash Price	$0.05
Rate for Payer: Cigna of CA HMO/PPO	$0.10
Rate for Payer: Health Smart Auto/Commercial	$0.07
Rate for Payer: LLUH Dept of Risk Management WC	$0.07
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$0.09

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

Facility

$0.06

Service Code	NDC 0487-9501-03
Hospital Charge Code	1781155
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

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

Facility

$0.06

Service Code	NDC 0487-9501-25
Hospital Charge Code	1781155
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

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

Facility

$0.08

Service Code	NDC 76204-200-01
Hospital Charge Code	1781155
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

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

Facility

$0.08

Service Code	NDC 0378-8270-93
Hospital Charge Code	1781155
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

ALBUTEROL SULFATE 2 MG TABLET [253]

Facility

$7.47

Service Code	NDC 68084-949-95
Hospital Charge Code	1711295
Hospital Revenue Code	259
Min. Negotiated Rate	$4.11
Max. Negotiated Rate	$5.98
Rate for Payer: Cash Price	$3.36
Rate for Payer: Cigna of CA 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 Beech St/Commercial/PHCS	$5.60

ALBUTEROL SULFATE 2 MG TABLET [253]

Facility

$7.47

Service Code	NDC 68084-949-25
Hospital Charge Code	1711295
Hospital Revenue Code	259
Min. Negotiated Rate	$4.11
Max. Negotiated Rate	$5.98
Rate for Payer: Cash Price	$3.36
Rate for Payer: Cigna of CA 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 Beech St/Commercial/PHCS	$5.60

ALBUTEROL SULFATE 2 MG TABLET [253]

Facility

$7.47

Service Code	NDC 68084-949-95
Hospital Charge Code	1711295
Hospital Revenue Code	259
Min. Negotiated Rate	$4.11
Max. Negotiated Rate	$5.60
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: Health Smart Auto/Commercial	$4.48
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$4.48
Rate for Payer: LLUH Dept of Risk Management WC	$4.11
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$5.60

ALBUTEROL SULFATE 2 MG TABLET [253]

Facility

$7.05

Service Code	NDC 51079-657-01
Hospital Charge Code	1711295
Hospital Revenue Code	259
Min. Negotiated Rate	$3.88
Max. Negotiated Rate	$5.29
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$4.23
Rate for Payer: Aetna of CA Government/Medicare	$4.23
Rate for Payer: Cash Price	$3.17
Rate for Payer: Health Smart Auto/Commercial	$4.23
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$4.23
Rate for Payer: LLUH Dept of Risk Management WC	$3.88
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$5.29

ALBUTEROL SULFATE 2 MG TABLET [253]

Facility

$7.05

Service Code	NDC 51079-657-20
Hospital Charge Code	1711295
Hospital Revenue Code	259
Min. Negotiated Rate	$3.88
Max. Negotiated Rate	$5.29
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$4.23
Rate for Payer: Aetna of CA Government/Medicare	$4.23
Rate for Payer: Cash Price	$3.17
Rate for Payer: Health Smart Auto/Commercial	$4.23
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$4.23
Rate for Payer: LLUH Dept of Risk Management WC	$3.88
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$5.29

ALBUTEROL SULFATE 2 MG TABLET [253]

Facility

$1.19

Service Code	NDC 69543-290-10
Hospital Charge Code	1711295
Hospital Revenue Code	259
Min. Negotiated Rate	$0.65
Max. Negotiated Rate	$0.95
Rate for Payer: Cash Price	$0.54
Rate for Payer: Cigna of CA HMO/PPO	$0.95
Rate for Payer: Health Smart Auto/Commercial	$0.71
Rate for Payer: LLUH Dept of Risk Management WC	$0.65
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$0.89

ALBUTEROL SULFATE 2 MG TABLET [253]

Facility

$0.72

Service Code	NDC 69238-1344-1
Hospital Charge Code	1711295
Hospital Revenue Code	259
Min. Negotiated Rate	$0.40
Max. Negotiated Rate	$0.58
Rate for Payer: Cash Price	$0.32
Rate for Payer: Cigna of CA 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 Beech St/Commercial/PHCS	$0.54

ALBUTEROL SULFATE 2 MG TABLET [253]

Facility

$7.05

Service Code	NDC 51079-657-01
Hospital Charge Code	1711295
Hospital Revenue Code	259
Min. Negotiated Rate	$3.88
Max. Negotiated Rate	$5.64
Rate for Payer: Cash Price	$3.17
Rate for Payer: Cigna of CA HMO/PPO	$5.64
Rate for Payer: Health Smart Auto/Commercial	$4.23
Rate for Payer: LLUH Dept of Risk Management WC	$3.88
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$5.29

Know your out-of-pocket cost for care.

All Charges