Loma Linda University Behavioral Medicine Center (BMC)

All Charges

Charge

Type

Setting

Price

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

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

$7.05

Service Code	NDC 51079-657-20
Hospital Charge Code	1711295
Hospital Revenue Code	259
Min. Negotiated Rate	$3.88
Max. Negotiated Rate	$5.64
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

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

Facility

$4.32

Service Code	NDC 0487-9901-30
Hospital Charge Code	1781093
Hospital Revenue Code	259
Min. Negotiated Rate	$2.38
Max. Negotiated Rate	$3.46
Rate for Payer: Cash Price	$1.94
Rate for Payer: Cigna of CA 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 Beech St/Commercial/PHCS	$3.24

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

Facility

$4.32

Service Code	NDC 0487-9901-30
Hospital Charge Code	1781093
Hospital Revenue Code	259
Min. Negotiated Rate	$2.38
Max. Negotiated Rate	$3.24
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: Health Smart Auto/Commercial	$2.59
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$2.59
Rate for Payer: LLUH Dept of Risk Management WC	$2.38
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$3.24

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

Facility

$4.32

Service Code	NDC 0487-9901-30
Hospital Charge Code	1781093
Hospital Revenue Code	259
Min. Negotiated Rate	$2.38
Max. Negotiated Rate	$3.24
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: Health Smart Auto/Commercial	$2.59
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$2.59
Rate for Payer: LLUH Dept of Risk Management WC	$2.38
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$3.24

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

Facility

$4.32

Service Code	NDC 0487-9901-30
Hospital Charge Code	1781093
Hospital Revenue Code	259
Min. Negotiated Rate	$2.38
Max. Negotiated Rate	$3.46
Rate for Payer: Cash Price	$1.94
Rate for Payer: Cigna of CA 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 Beech St/Commercial/PHCS	$3.24

ALBUTEROL SULFATE CONCENTRATE 5 MG/ML (0.5%) SOLN FOR NEBULIZATION FOR STATUS ASTHMATICUS [4081888]

Facility

$2.90

Service Code	NDC 50383-741-20
Hospital Charge Code	1744054
Hospital Revenue Code	259
Min. Negotiated Rate	$1.60
Max. Negotiated Rate	$2.32
Rate for Payer: Cash Price	$1.31
Rate for Payer: Cigna of CA HMO/PPO	$2.32
Rate for Payer: Health Smart Auto/Commercial	$1.74
Rate for Payer: LLUH Dept of Risk Management WC	$1.60
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$2.18

ALBUTEROL SULFATE CONCENTRATE 5 MG/ML (0.5%) SOLN FOR NEBULIZATION FOR STATUS ASTHMATICUS [4081888]

Facility

$2.90

Service Code	NDC 50383-741-20
Hospital Charge Code	1744054
Hospital Revenue Code	259
Min. Negotiated Rate	$1.60
Max. Negotiated Rate	$2.18
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$1.74
Rate for Payer: Aetna of CA Government/Medicare	$1.74
Rate for Payer: Cash Price	$1.31
Rate for Payer: Health Smart Auto/Commercial	$1.74
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$1.74
Rate for Payer: LLUH Dept of Risk Management WC	$1.60
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$2.18

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

Facility

$3.00

Service Code	NDC 73177-146-33
Hospital Charge Code	1744054
Hospital Revenue Code	259
Min. Negotiated Rate	$1.65
Max. Negotiated Rate	$2.40
Rate for Payer: Cash Price	$1.35
Rate for Payer: Cigna of CA 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 Beech St/Commercial/PHCS	$2.25

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

Facility

$3.00

Service Code	NDC 73177-146-33
Hospital Charge Code	1744054
Hospital Revenue Code	259
Min. Negotiated Rate	$1.65
Max. Negotiated Rate	$2.25
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: Health Smart Auto/Commercial	$1.80
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$1.80
Rate for Payer: LLUH Dept of Risk Management WC	$1.65
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$2.25

ALBUTEROL SULFATE HFA 90 MCG/ACTUATION AEROSOL INHALER [17837]

Facility

$5.08

Service Code	NDC 68180-963-01
Hospital Charge Code	1744112
Hospital Revenue Code	259
Min. Negotiated Rate	$2.79
Max. Negotiated Rate	$3.81
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$3.05
Rate for Payer: Aetna of CA Government/Medicare	$3.05
Rate for Payer: Cash Price	$2.29
Rate for Payer: Health Smart Auto/Commercial	$3.05
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$3.05
Rate for Payer: LLUH Dept of Risk Management WC	$2.79
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$3.81

ALBUTEROL SULFATE HFA 90 MCG/ACTUATION AEROSOL INHALER [17837]

Facility

$3.41

Service Code	NDC 0173-0682-24
Hospital Charge Code	1744126
Hospital Revenue Code	259
Min. Negotiated Rate	$1.88
Max. Negotiated Rate	$2.56
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$2.05
Rate for Payer: Aetna of CA Government/Medicare	$2.05
Rate for Payer: Cash Price	$1.53
Rate for Payer: Health Smart Auto/Commercial	$2.05
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$2.05
Rate for Payer: LLUH Dept of Risk Management WC	$1.88
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$2.56

ALBUTEROL SULFATE HFA 90 MCG/ACTUATION AEROSOL INHALER [17837]

Facility

$3.41

Service Code	NDC 0173-0682-24
Hospital Charge Code	1744126
Hospital Revenue Code	259
Min. Negotiated Rate	$1.88
Max. Negotiated Rate	$2.73
Rate for Payer: Cash Price	$1.53
Rate for Payer: Cigna of CA HMO/PPO	$2.73
Rate for Payer: Health Smart Auto/Commercial	$2.05
Rate for Payer: LLUH Dept of Risk Management WC	$1.88
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$2.56

ALBUTEROL SULFATE HFA 90 MCG/ACTUATION AEROSOL INHALER [17837]

Facility

$5.08

Service Code	NDC 68180-963-01
Hospital Charge Code	1744112
Hospital Revenue Code	259
Min. Negotiated Rate	$2.79
Max. Negotiated Rate	$4.06
Rate for Payer: Cash Price	$2.29
Rate for Payer: Cigna of CA HMO/PPO	$4.06
Rate for Payer: Health Smart Auto/Commercial	$3.05
Rate for Payer: LLUH Dept of Risk Management WC	$2.79
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$3.81

ALECTINIB 150 MG CAPSULE [212384]

Facility

$87.45

Service Code	NDC 50242-130-01
Hospital Charge Code	ERX212384
Hospital Revenue Code	259
Min. Negotiated Rate	$48.10
Max. Negotiated Rate	$65.59
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$52.47
Rate for Payer: Aetna of CA Government/Medicare	$52.47
Rate for Payer: Cash Price	$39.35
Rate for Payer: Health Smart Auto/Commercial	$52.47
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$52.47
Rate for Payer: LLUH Dept of Risk Management WC	$48.10
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$65.59

ALECTINIB 150 MG CAPSULE [212384]

Facility

$87.45

Service Code	NDC 50242-130-01
Hospital Charge Code	ERX212384
Hospital Revenue Code	259
Min. Negotiated Rate	$48.10
Max. Negotiated Rate	$69.96
Rate for Payer: Cash Price	$39.35
Rate for Payer: Cigna of CA HMO/PPO	$69.96
Rate for Payer: Health Smart Auto/Commercial	$52.47
Rate for Payer: LLUH Dept of Risk Management WC	$48.10
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$65.59

ALEMTUZUMAB 12 MG/1.2 ML INTRAVENOUS SOLUTION [208005]

Facility

$28,798.18

Service Code	CPT J0202
Hospital Charge Code	NDG208005
Hospital Revenue Code	636
Min. Negotiated Rate	$15,839.00
Max. Negotiated Rate	$23,038.54
Rate for Payer: Cash Price	$12,959.18
Rate for Payer: Cigna of CA HMO/PPO	$23,038.54
Rate for Payer: Health Smart Auto/Commercial	$17,278.91
Rate for Payer: LLUH Dept of Risk Management WC	$15,839.00
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$21,598.64

ALEMTUZUMAB 12 MG/1.2 ML INTRAVENOUS SOLUTION [208005]

Facility

$28,798.18

Service Code	CPT J0202
Hospital Charge Code	NDG208005
Hospital Revenue Code	636
Min. Negotiated Rate	$15,839.00
Max. Negotiated Rate	$21,598.64
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$17,278.91
Rate for Payer: Aetna of CA Government/Medicare	$17,278.91
Rate for Payer: Cash Price	$12,959.18
Rate for Payer: Health Smart Auto/Commercial	$17,278.91
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$17,278.91
Rate for Payer: LLUH Dept of Risk Management WC	$15,839.00
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$21,598.64

ALENDRONATE 10 MG TABLET [15661]

Facility

$0.24

Service Code	NDC 64980-340-03
Hospital Charge Code	1711759
Hospital Revenue Code	259
Min. Negotiated Rate	$0.13
Max. Negotiated Rate	$0.19
Rate for Payer: Cash Price	$0.11
Rate for Payer: Cigna of CA 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 Beech St/Commercial/PHCS	$0.18

ALENDRONATE 10 MG TABLET [15661]

Facility

$0.24

Service Code	NDC 64980-340-03
Hospital Charge Code	1711759
Hospital Revenue Code	259
Min. Negotiated Rate	$0.13
Max. Negotiated Rate	$0.18
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: Health Smart Auto/Commercial	$0.14
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$0.14
Rate for Payer: LLUH Dept of Risk Management WC	$0.13
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$0.18

ALENDRONATE 70 MG/75 ML ORAL SOLUTION [37640]

Facility

$1.10

Service Code	NDC 0054-0282-59
Hospital Charge Code	1715162
Hospital Revenue Code	259
Min. Negotiated Rate	$0.61
Max. Negotiated Rate	$0.88
Rate for Payer: Cash Price	$0.50
Rate for Payer: Cigna of CA 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 Beech St/Commercial/PHCS	$0.83

ALENDRONATE 70 MG/75 ML ORAL SOLUTION [37640]

Facility

$1.10

Service Code	NDC 0054-0282-59
Hospital Charge Code	1715162
Hospital Revenue Code	259
Min. Negotiated Rate	$0.61
Max. Negotiated Rate	$0.83
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: Health Smart Auto/Commercial	$0.66
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$0.66
Rate for Payer: LLUH Dept of Risk Management WC	$0.61
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$0.83

ALENDRONATE 70 MG TABLET [29048]

Facility

$1.65

Service Code	NDC 65862-329-04
Hospital Charge Code	1710931
Hospital Revenue Code	259
Min. Negotiated Rate	$0.91
Max. Negotiated Rate	$1.32
Rate for Payer: Cash Price	$0.74
Rate for Payer: Cigna of CA 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 Beech St/Commercial/PHCS	$1.24

Know your out-of-pocket cost for care.

All Charges