Loma Linda University Behavioral Medicine Center (BMC)

All Charges

Charge

Type

Setting

Price

COENZYME Q10 200 MG CAPSULE [41804]

Facility

$0.40

Service Code	NDC 9629511766
Hospital Charge Code	1712553
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

COENZYME Q10 200 MG CAPSULE [41804]

Facility

$0.35

Service Code	NDC 8770140817
Hospital Charge Code	1712553
Hospital Revenue Code	259
Min. Negotiated Rate	$0.19
Max. Negotiated Rate	$0.26
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$0.21
Rate for Payer: Aetna of CA Government/Medicare	$0.21
Rate for Payer: Cash Price	$0.16
Rate for Payer: Health Smart Auto/Commercial	$0.21
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$0.21
Rate for Payer: LLUH Dept of Risk Management WC	$0.19
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$0.26

COENZYME Q10 200 MG CAPSULE [41804]

Facility

$0.35

Service Code	NDC 8770140817
Hospital Charge Code	1712553
Hospital Revenue Code	259
Min. Negotiated Rate	$0.19
Max. Negotiated Rate	$0.28
Rate for Payer: Cash Price	$0.16
Rate for Payer: Cigna of CA HMO/PPO	$0.28
Rate for Payer: Health Smart Auto/Commercial	$0.21
Rate for Payer: LLUH Dept of Risk Management WC	$0.19
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$0.26

COENZYME Q10 200 MG CAPSULE [41804]

Facility

$0.40

Service Code	NDC 9629511766
Hospital Charge Code	1712553
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

COENZYME Q10 30 MG CAPSULE [13257]

Facility

$0.16

Service Code	NDC 4098521341
Hospital Charge Code	1710866
Hospital Revenue Code	259
Min. Negotiated Rate	$0.09
Max. Negotiated Rate	$0.12
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$0.10
Rate for Payer: Aetna of CA Government/Medicare	$0.10
Rate for Payer: Cash Price	$0.07
Rate for Payer: Health Smart Auto/Commercial	$0.10
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$0.10
Rate for Payer: LLUH Dept of Risk Management WC	$0.09
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$0.12

COENZYME Q10 30 MG CAPSULE [13257]

Facility

$0.21

Service Code	NDC 8068110400
Hospital Charge Code	1710866
Hospital Revenue Code	259
Min. Negotiated Rate	$0.12
Max. Negotiated Rate	$0.17
Rate for Payer: Cash Price	$0.09
Rate for Payer: Cigna of CA HMO/PPO	$0.17
Rate for Payer: Health Smart Auto/Commercial	$0.13
Rate for Payer: LLUH Dept of Risk Management WC	$0.12
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$0.16

COENZYME Q10 30 MG CAPSULE [13257]

Facility

$0.16

Service Code	NDC 4098521341
Hospital Charge Code	1710866
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

COENZYME Q10 30 MG CAPSULE [13257]

Facility

$0.21

Service Code	NDC 8068110400
Hospital Charge Code	1710866
Hospital Revenue Code	259
Min. Negotiated Rate	$0.12
Max. Negotiated Rate	$0.16
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$0.13
Rate for Payer: Aetna of CA Government/Medicare	$0.13
Rate for Payer: Cash Price	$0.09
Rate for Payer: Health Smart Auto/Commercial	$0.13
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$0.13
Rate for Payer: LLUH Dept of Risk Management WC	$0.12
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$0.16

COENZYME Q10 50 MG CAPSULE [35228]

Facility

$0.26

Service Code	NDC 7985400848
Hospital Charge Code	1712403
Hospital Revenue Code	259
Min. Negotiated Rate	$0.14
Max. Negotiated Rate	$0.20
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$0.16
Rate for Payer: Aetna of CA Government/Medicare	$0.16
Rate for Payer: Cash Price	$0.12
Rate for Payer: Health Smart Auto/Commercial	$0.16
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$0.16
Rate for Payer: LLUH Dept of Risk Management WC	$0.14
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$0.20

COENZYME Q10 50 MG CAPSULE [35228]

Facility

$0.26

Service Code	NDC 54629-0848-00
Hospital Charge Code	1712403
Hospital Revenue Code	259
Min. Negotiated Rate	$0.14
Max. Negotiated Rate	$0.20
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$0.16
Rate for Payer: Aetna of CA Government/Medicare	$0.16
Rate for Payer: Cash Price	$0.12
Rate for Payer: Health Smart Auto/Commercial	$0.16
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$0.16
Rate for Payer: LLUH Dept of Risk Management WC	$0.14
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$0.20

COENZYME Q10 50 MG CAPSULE [35228]

Facility

$0.26

Service Code	NDC 7985400848
Hospital Charge Code	1712403
Hospital Revenue Code	259
Min. Negotiated Rate	$0.14
Max. Negotiated Rate	$0.21
Rate for Payer: Cash Price	$0.12
Rate for Payer: Cigna of CA HMO/PPO	$0.21
Rate for Payer: Health Smart Auto/Commercial	$0.16
Rate for Payer: LLUH Dept of Risk Management WC	$0.14
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$0.20

COENZYME Q10 50 MG CAPSULE [35228]

Facility

$0.26

Service Code	NDC 54629-0848-00
Hospital Charge Code	1712403
Hospital Revenue Code	259
Min. Negotiated Rate	$0.14
Max. Negotiated Rate	$0.21
Rate for Payer: Cash Price	$0.12
Rate for Payer: Cigna of CA HMO/PPO	$0.21
Rate for Payer: Health Smart Auto/Commercial	$0.16
Rate for Payer: LLUH Dept of Risk Management WC	$0.14
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$0.20

COENZYME Q10 50 MG CAPSULE [35228]

Facility

$0.28

Service Code	NDC 4746916109
Hospital Charge Code	1712403
Hospital Revenue Code	259
Min. Negotiated Rate	$0.15
Max. Negotiated Rate	$0.21
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$0.17
Rate for Payer: Aetna of CA Government/Medicare	$0.17
Rate for Payer: Cash Price	$0.13
Rate for Payer: Health Smart Auto/Commercial	$0.17
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$0.17
Rate for Payer: LLUH Dept of Risk Management WC	$0.15
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$0.21

COENZYME Q10 50 MG CAPSULE [35228]

Facility

$0.28

Service Code	NDC 4746916109
Hospital Charge Code	1712403
Hospital Revenue Code	259
Min. Negotiated Rate	$0.15
Max. Negotiated Rate	$0.22
Rate for Payer: Cash Price	$0.13
Rate for Payer: Cigna of CA HMO/PPO	$0.22
Rate for Payer: Health Smart Auto/Commercial	$0.17
Rate for Payer: LLUH Dept of Risk Management WC	$0.15
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$0.21

COENZYME Q10 (LIPOSOMAL UBIQUINOL) 100 MG/5 ML ORAL SUSPENSION [119471]

Facility

$0.46

Service Code	NDC 33739-318-60
Hospital Charge Code	NDG119471
Hospital Revenue Code	259
Min. Negotiated Rate	$0.25
Max. Negotiated Rate	$0.35
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$0.28
Rate for Payer: Aetna of CA Government/Medicare	$0.28
Rate for Payer: Cash Price	$0.21
Rate for Payer: Health Smart Auto/Commercial	$0.28
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$0.28
Rate for Payer: LLUH Dept of Risk Management WC	$0.25
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$0.35

COENZYME Q10 (LIPOSOMAL UBIQUINOL) 100 MG/5 ML ORAL SUSPENSION [119471]

Facility

$0.46

Service Code	NDC 33739-318-60
Hospital Charge Code	NDG119471
Hospital Revenue Code	259
Min. Negotiated Rate	$0.25
Max. Negotiated Rate	$0.37
Rate for Payer: Cash Price	$0.21
Rate for Payer: Cigna of CA HMO/PPO	$0.37
Rate for Payer: Health Smart Auto/Commercial	$0.28
Rate for Payer: LLUH Dept of Risk Management WC	$0.25
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$0.35

COLCHICINE 0.3 MG 1/2 TAB [4081490]

Facility

$6.27

Service Code	NDC 9994-0814-90
Hospital Charge Code	ERX4081490
Hospital Revenue Code	259
Min. Negotiated Rate	$3.45
Max. Negotiated Rate	$5.02
Rate for Payer: Cash Price	$2.82
Rate for Payer: Cigna of CA HMO/PPO	$5.02
Rate for Payer: Health Smart Auto/Commercial	$3.76
Rate for Payer: LLUH Dept of Risk Management WC	$3.45
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$4.70

COLCHICINE 0.3 MG 1/2 TAB [4081490]

Facility

$6.27

Service Code	NDC 9994-0814-90
Hospital Charge Code	ERX4081490
Hospital Revenue Code	259
Min. Negotiated Rate	$3.45
Max. Negotiated Rate	$4.70
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$3.76
Rate for Payer: Aetna of CA Government/Medicare	$3.76
Rate for Payer: Cash Price	$2.82
Rate for Payer: Health Smart Auto/Commercial	$3.76
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$3.76
Rate for Payer: LLUH Dept of Risk Management WC	$3.45
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$4.70

COLCHICINE 0.6 MG CAPSULE [207785]

Facility

$8.16

Service Code	NDC 60687-358-25
Hospital Charge Code	ERX207785
Hospital Revenue Code	259
Min. Negotiated Rate	$4.49
Max. Negotiated Rate	$6.12
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$4.90
Rate for Payer: Aetna of CA Government/Medicare	$4.90
Rate for Payer: Cash Price	$3.67
Rate for Payer: Health Smart Auto/Commercial	$4.90
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$4.90
Rate for Payer: LLUH Dept of Risk Management WC	$4.49
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$6.12

COLCHICINE 0.6 MG CAPSULE [207785]

Facility

$7.20

Service Code	NDC 0143-3018-01
Hospital Charge Code	ERX207785
Hospital Revenue Code	259
Min. Negotiated Rate	$3.96
Max. Negotiated Rate	$5.40
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$4.32
Rate for Payer: Aetna of CA Government/Medicare	$4.32
Rate for Payer: Cash Price	$3.24
Rate for Payer: Health Smart Auto/Commercial	$4.32
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$4.32
Rate for Payer: LLUH Dept of Risk Management WC	$3.96
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$5.40

COLCHICINE 0.6 MG CAPSULE [207785]

Facility

$8.16

Service Code	NDC 60687-358-25
Hospital Charge Code	ERX207785
Hospital Revenue Code	259
Min. Negotiated Rate	$4.49
Max. Negotiated Rate	$6.53
Rate for Payer: Cash Price	$3.67
Rate for Payer: Cigna of CA HMO/PPO	$6.53
Rate for Payer: Health Smart Auto/Commercial	$4.90
Rate for Payer: LLUH Dept of Risk Management WC	$4.49
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$6.12

COLCHICINE 0.6 MG CAPSULE [207785]

Facility

$7.20

Service Code	NDC 0143-3018-01
Hospital Charge Code	ERX207785
Hospital Revenue Code	259
Min. Negotiated Rate	$3.96
Max. Negotiated Rate	$5.76
Rate for Payer: Cash Price	$3.24
Rate for Payer: Cigna of CA HMO/PPO	$5.76
Rate for Payer: Health Smart Auto/Commercial	$4.32
Rate for Payer: LLUH Dept of Risk Management WC	$3.96
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$5.40

COLCHICINE 0.6 MG CAPSULE [207785]

Facility

$8.16

Service Code	NDC 60687-358-95
Hospital Charge Code	ERX207785
Hospital Revenue Code	259
Min. Negotiated Rate	$4.49
Max. Negotiated Rate	$6.12
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$4.90
Rate for Payer: Aetna of CA Government/Medicare	$4.90
Rate for Payer: Cash Price	$3.67
Rate for Payer: Health Smart Auto/Commercial	$4.90
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$4.90
Rate for Payer: LLUH Dept of Risk Management WC	$4.49
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$6.12

COLCHICINE 0.6 MG CAPSULE [207785]

Facility

$8.16

Service Code	NDC 60687-358-95
Hospital Charge Code	ERX207785
Hospital Revenue Code	259
Min. Negotiated Rate	$4.49
Max. Negotiated Rate	$6.53
Rate for Payer: Health Smart Auto/Commercial	$4.90
Rate for Payer: Cash Price	$3.67
Rate for Payer: Cigna of CA HMO/PPO	$6.53
Rate for Payer: LLUH Dept of Risk Management WC	$4.49
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$6.12

COLCHICINE 0.6 MG TABLET [1821]

Facility

$1.57

Service Code	NDC 43598-372-30
Hospital Charge Code	1710835
Hospital Revenue Code	259
Min. Negotiated Rate	$0.86
Max. Negotiated Rate	$1.26
Rate for Payer: Cash Price	$0.71
Rate for Payer: Cigna of CA HMO/PPO	$1.26
Rate for Payer: Health Smart Auto/Commercial	$0.94
Rate for Payer: LLUH Dept of Risk Management WC	$0.86
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$1.18

Know your out-of-pocket cost for care.

All Charges