Loma Linda University Behavioral Medicine Center (BMC)

All Charges

Charge

Type

Setting

Price

EPIRUBICIN 50 MG/25 ML INTRAVENOUS SOLUTION [88008]

Facility

$2.24

Service Code	CPT J9178
Hospital Charge Code	1755705
Hospital Revenue Code	636
Min. Negotiated Rate	$1.23
Max. Negotiated Rate	$1.79
Rate for Payer: Cash Price	$1.01
Rate for Payer: Cigna of CA HMO/PPO	$1.79
Rate for Payer: Health Smart Auto/Commercial	$1.34
Rate for Payer: LLUH Dept of Risk Management WC	$1.23
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$1.68

EPIRUBICIN 50 MG/25 ML INTRAVENOUS SOLUTION [88008]

Facility

$2.24

Service Code	CPT J9178
Hospital Charge Code	1755705
Hospital Revenue Code	636
Min. Negotiated Rate	$1.23
Max. Negotiated Rate	$1.68
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$1.34
Rate for Payer: Aetna of CA Government/Medicare	$1.34
Rate for Payer: Cash Price	$1.01
Rate for Payer: Health Smart Auto/Commercial	$1.34
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$1.34
Rate for Payer: LLUH Dept of Risk Management WC	$1.23
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$1.68

EPIRUBICIN 50 MG INTRAVENOUS SOLUTION [76923]

Facility

$46.25

Service Code	CPT J9178
Hospital Charge Code	ERX76923
Hospital Revenue Code	636
Min. Negotiated Rate	$25.44
Max. Negotiated Rate	$37.00
Rate for Payer: Cash Price	$20.81
Rate for Payer: Cigna of CA HMO/PPO	$37.00
Rate for Payer: Health Smart Auto/Commercial	$27.75
Rate for Payer: LLUH Dept of Risk Management WC	$25.44
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$34.69

EPIRUBICIN 50 MG INTRAVENOUS SOLUTION [76923]

Facility

$46.25

Service Code	CPT J9178
Hospital Charge Code	ERX76923
Hospital Revenue Code	636
Min. Negotiated Rate	$25.44
Max. Negotiated Rate	$34.69
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$27.75
Rate for Payer: Aetna of CA Government/Medicare	$27.75
Rate for Payer: Cash Price	$20.81
Rate for Payer: Health Smart Auto/Commercial	$27.75
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$27.75
Rate for Payer: LLUH Dept of Risk Management WC	$25.44
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$34.69

EPLERENONE 25 MG TABLET [36983]

Facility

$1.68

Service Code	NDC 0378-1030-93
Hospital Charge Code	1712284
Hospital Revenue Code	259
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

EPLERENONE 25 MG TABLET [36983]

Facility

$1.68

Service Code	NDC 0378-1030-93
Hospital Charge Code	1712284
Hospital Revenue Code	259
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

EPLERENONE 25 MG TABLET [36983]

Facility

$1.68

Service Code	NDC 16729-293-10
Hospital Charge Code	1712284
Hospital Revenue Code	259
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

EPLERENONE 25 MG TABLET [36983]

Facility

$1.68

Service Code	NDC 16729-293-10
Hospital Charge Code	1712284
Hospital Revenue Code	259
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

EPOETIN ALFA 10,000 UNIT/ML INJECTION SOLUTION [9938]

Facility

$320.70

Service Code	CPT J0885
Hospital Charge Code	NDG9938
Hospital Revenue Code	636
Min. Negotiated Rate	$176.38
Max. Negotiated Rate	$240.52
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$192.42
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$192.41
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$119.38
Rate for Payer: Aetna of CA Government/Medicare	$192.41
Rate for Payer: Aetna of CA Government/Medicare	$192.42
Rate for Payer: Aetna of CA Government/Medicare	$119.38
Rate for Payer: Cash Price	$89.53
Rate for Payer: Cash Price	$144.31
Rate for Payer: Cash Price	$144.32
Rate for Payer: Health Smart Auto/Commercial	$192.42
Rate for Payer: Health Smart Auto/Commercial	$192.41
Rate for Payer: Health Smart Auto/Commercial	$119.38
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$192.42
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$192.41
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$119.38
Rate for Payer: LLUH Dept of Risk Management WC	$176.38
Rate for Payer: LLUH Dept of Risk Management WC	$109.43
Rate for Payer: LLUH Dept of Risk Management WC	$176.38
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$240.52
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$149.22
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$240.52

EPOETIN ALFA 10,000 UNIT/ML INJECTION SOLUTION [9938]

Facility

$198.96

Service Code	CPT J0885
Hospital Charge Code	NDG9938
Hospital Revenue Code	636
Min. Negotiated Rate	$109.43
Max. Negotiated Rate	$159.17
Rate for Payer: Cash Price	$89.53
Rate for Payer: Cash Price	$144.31
Rate for Payer: Cash Price	$144.32
Rate for Payer: Cigna of CA HMO/PPO	$256.55
Rate for Payer: Cigna of CA HMO/PPO	$159.17
Rate for Payer: Cigna of CA HMO/PPO	$256.56
Rate for Payer: Health Smart Auto/Commercial	$119.38
Rate for Payer: Health Smart Auto/Commercial	$192.42
Rate for Payer: Health Smart Auto/Commercial	$192.41
Rate for Payer: LLUH Dept of Risk Management WC	$176.38
Rate for Payer: LLUH Dept of Risk Management WC	$176.38
Rate for Payer: LLUH Dept of Risk Management WC	$109.43
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$149.22
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$240.52
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$240.52

EPOETIN ALFA 20,000 UNIT/2 ML INJECTION SOLUTION [117367]

Facility

$198.96

Service Code	CPT J0885
Hospital Charge Code	1756546
Hospital Revenue Code	636
Min. Negotiated Rate	$109.43
Max. Negotiated Rate	$149.22
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$119.38
Rate for Payer: Aetna of CA Government/Medicare	$119.38
Rate for Payer: Cash Price	$89.53
Rate for Payer: Health Smart Auto/Commercial	$119.38
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$119.38
Rate for Payer: LLUH Dept of Risk Management WC	$109.43
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$149.22

EPOETIN ALFA 20,000 UNIT/2 ML INJECTION SOLUTION [117367]

Facility

$198.96

Service Code	CPT J0885
Hospital Charge Code	1756546
Hospital Revenue Code	636
Min. Negotiated Rate	$109.43
Max. Negotiated Rate	$159.17
Rate for Payer: Cash Price	$89.53
Rate for Payer: Cigna of CA HMO/PPO	$159.17
Rate for Payer: Health Smart Auto/Commercial	$119.38
Rate for Payer: LLUH Dept of Risk Management WC	$109.43
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$149.22

EPOETIN ALFA 20,000 UNIT/ML INJECTION SOLUTION [14643]

Facility

$641.40

Service Code	CPT J0885
Hospital Charge Code	1756591
Hospital Revenue Code	636
Min. Negotiated Rate	$352.77
Max. Negotiated Rate	$481.05
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$384.84
Rate for Payer: Aetna of CA Government/Medicare	$384.84
Rate for Payer: Cash Price	$288.63
Rate for Payer: Health Smart Auto/Commercial	$384.84
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$384.84
Rate for Payer: LLUH Dept of Risk Management WC	$352.77
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$481.05

EPOETIN ALFA 20,000 UNIT/ML INJECTION SOLUTION [14643]

Facility

$641.40

Service Code	CPT J0885
Hospital Charge Code	1756591
Hospital Revenue Code	636
Min. Negotiated Rate	$352.77
Max. Negotiated Rate	$513.12
Rate for Payer: Cash Price	$288.63
Rate for Payer: Cigna of CA HMO/PPO	$513.12
Rate for Payer: Health Smart Auto/Commercial	$384.84
Rate for Payer: LLUH Dept of Risk Management WC	$352.77
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$481.05

EPOETIN ALFA 2,000 UNIT/ML INJECTION SOLUTION [9939]

Facility

$39.79

Service Code	CPT J0885
Hospital Charge Code	1720614
Hospital Revenue Code	636
Min. Negotiated Rate	$21.88
Max. Negotiated Rate	$31.83
Rate for Payer: Cash Price	$17.91
Rate for Payer: Cash Price	$28.87
Rate for Payer: Cigna of CA HMO/PPO	$51.32
Rate for Payer: Cigna of CA HMO/PPO	$31.83
Rate for Payer: Health Smart Auto/Commercial	$23.87
Rate for Payer: Health Smart Auto/Commercial	$38.49
Rate for Payer: LLUH Dept of Risk Management WC	$21.88
Rate for Payer: LLUH Dept of Risk Management WC	$35.28
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$29.84
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$48.11

EPOETIN ALFA 2,000 UNIT/ML INJECTION SOLUTION [9939]

Facility

$64.15

Service Code	CPT J0885
Hospital Charge Code	1720614
Hospital Revenue Code	636
Min. Negotiated Rate	$35.28
Max. Negotiated Rate	$48.11
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$38.49
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$23.87
Rate for Payer: Aetna of CA Government/Medicare	$38.49
Rate for Payer: Aetna of CA Government/Medicare	$23.87
Rate for Payer: Cash Price	$17.91
Rate for Payer: Cash Price	$28.87
Rate for Payer: Health Smart Auto/Commercial	$38.49
Rate for Payer: Health Smart Auto/Commercial	$23.87
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$23.87
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$38.49
Rate for Payer: LLUH Dept of Risk Management WC	$21.88
Rate for Payer: LLUH Dept of Risk Management WC	$35.28
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$48.11
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$29.84

EPOETIN ALFA 3,000 UNIT/ML INJECTION SOLUTION [9940]

Facility

$59.69

Service Code	CPT J0885
Hospital Charge Code	1720677
Hospital Revenue Code	636
Min. Negotiated Rate	$32.83
Max. Negotiated Rate	$44.77
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$35.81
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$57.73
Rate for Payer: Aetna of CA Government/Medicare	$57.73
Rate for Payer: Aetna of CA Government/Medicare	$35.81
Rate for Payer: Cash Price	$43.30
Rate for Payer: Cash Price	$26.86
Rate for Payer: Health Smart Auto/Commercial	$35.81
Rate for Payer: Health Smart Auto/Commercial	$57.73
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$57.73
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$35.81
Rate for Payer: LLUH Dept of Risk Management WC	$52.92
Rate for Payer: LLUH Dept of Risk Management WC	$32.83
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$44.77
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$72.16

EPOETIN ALFA 3,000 UNIT/ML INJECTION SOLUTION [9940]

Facility

$96.22

Service Code	CPT J0885
Hospital Charge Code	1720677
Hospital Revenue Code	636
Min. Negotiated Rate	$52.92
Max. Negotiated Rate	$76.98
Rate for Payer: Cash Price	$43.30
Rate for Payer: Cash Price	$26.86
Rate for Payer: Cigna of CA HMO/PPO	$47.75
Rate for Payer: Cigna of CA HMO/PPO	$76.98
Rate for Payer: Health Smart Auto/Commercial	$57.73
Rate for Payer: Health Smart Auto/Commercial	$35.81
Rate for Payer: LLUH Dept of Risk Management WC	$52.92
Rate for Payer: LLUH Dept of Risk Management WC	$32.83
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$44.77
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$72.16

EPOETIN ALFA 40,000 UNIT/ML INJECTION SOLUTION [24513]

Facility

$1,282.80

Service Code	CPT J0885
Hospital Charge Code	1756547
Hospital Revenue Code	636
Min. Negotiated Rate	$705.54
Max. Negotiated Rate	$1,026.24
Rate for Payer: Cash Price	$577.26
Rate for Payer: Cigna of CA HMO/PPO	$1,026.24
Rate for Payer: Health Smart Auto/Commercial	$769.68
Rate for Payer: LLUH Dept of Risk Management WC	$705.54
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$962.10

EPOETIN ALFA 40,000 UNIT/ML INJECTION SOLUTION [24513]

Facility

$1,282.80

Service Code	CPT J0885
Hospital Charge Code	1756547
Hospital Revenue Code	636
Min. Negotiated Rate	$705.54
Max. Negotiated Rate	$962.10
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$769.68
Rate for Payer: Aetna of CA Government/Medicare	$769.68
Rate for Payer: Cash Price	$577.26
Rate for Payer: Health Smart Auto/Commercial	$769.68
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$769.68
Rate for Payer: LLUH Dept of Risk Management WC	$705.54
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$962.10

EPOETIN ALFA 4,000 UNIT/ML INJECTION SOLUTION [9941]

Facility

$128.28

Service Code	CPT J0885
Hospital Charge Code	1720619
Hospital Revenue Code	636
Min. Negotiated Rate	$70.55
Max. Negotiated Rate	$96.21
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$76.97
Rate for Payer: Aetna of CA Government/Medicare	$76.97
Rate for Payer: Cash Price	$57.73
Rate for Payer: Health Smart Auto/Commercial	$76.97
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$76.97
Rate for Payer: LLUH Dept of Risk Management WC	$70.55
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$96.21

EPOETIN ALFA 4,000 UNIT/ML INJECTION SOLUTION [9941]

Facility

$128.28

Service Code	CPT J0885
Hospital Charge Code	1720619
Hospital Revenue Code	636
Min. Negotiated Rate	$70.55
Max. Negotiated Rate	$102.62
Rate for Payer: Cash Price	$57.73
Rate for Payer: Cigna of CA HMO/PPO	$102.62
Rate for Payer: Health Smart Auto/Commercial	$76.97
Rate for Payer: LLUH Dept of Risk Management WC	$70.55
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$96.21

EPOETIN ALFA-EPBX 10,000 UNIT/ML INJECTION SOLUTION [221922]

Facility

$132.36

Service Code	CPT Q5106
Hospital Charge Code	NDG221922
Hospital Revenue Code	636
Min. Negotiated Rate	$72.80
Max. Negotiated Rate	$99.27
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$79.42
Rate for Payer: Aetna of CA Government/Medicare	$79.42
Rate for Payer: Cash Price	$59.56
Rate for Payer: Health Smart Auto/Commercial	$79.42
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$79.42
Rate for Payer: LLUH Dept of Risk Management WC	$72.80
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$99.27

EPOETIN ALFA-EPBX 10,000 UNIT/ML INJECTION SOLUTION [221922]

Facility

$132.36

Service Code	CPT Q5106
Hospital Charge Code	NDG221922
Hospital Revenue Code	636
Min. Negotiated Rate	$72.80
Max. Negotiated Rate	$105.89
Rate for Payer: Health Smart Auto/Commercial	$79.42
Rate for Payer: Cash Price	$59.56
Rate for Payer: Cigna of CA HMO/PPO	$105.89
Rate for Payer: LLUH Dept of Risk Management WC	$72.80
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$99.27

EPOETIN ALFA-EPBX 20,000 UNIT/ML INJECTION SOLUTION [229807]

Facility

$264.72

Service Code	CPT Q5106
Hospital Charge Code	NDG229807
Hospital Revenue Code	636
Min. Negotiated Rate	$145.60
Max. Negotiated Rate	$211.78
Rate for Payer: Cash Price	$119.12
Rate for Payer: Cigna of CA HMO/PPO	$211.78
Rate for Payer: Health Smart Auto/Commercial	$158.83
Rate for Payer: LLUH Dept of Risk Management WC	$145.60
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$198.54

Know your out-of-pocket cost for care.

All Charges