Loma Linda University Behavioral Medicine Center (BMC)

All Charges

Charge

Type

Setting

Price

HALOPERIDOL 2.5 MG 1/2 TABLET [4081945]

Facility

$1.09

Service Code	NDC 51079-736-20
Hospital Charge Code	ERX4081945
Hospital Revenue Code	259
Min. Negotiated Rate	$0.60
Max. Negotiated Rate	$0.82
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$0.65
Rate for Payer: Aetna of CA Government/Medicare	$0.65
Rate for Payer: Cash Price	$0.49
Rate for Payer: Health Smart Auto/Commercial	$0.65
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$0.65
Rate for Payer: LLUH Dept of Risk Management WC	$0.60
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$0.82

HALOPERIDOL 2.5 MG 1/2 TABLET [4081945]

Facility

$1.09

Service Code	NDC 60687-161-11
Hospital Charge Code	ERX4081945
Hospital Revenue Code	259
Min. Negotiated Rate	$0.60
Max. Negotiated Rate	$0.87
Rate for Payer: Cash Price	$0.49
Rate for Payer: Cigna of CA HMO/PPO	$0.87
Rate for Payer: Health Smart Auto/Commercial	$0.65
Rate for Payer: LLUH Dept of Risk Management WC	$0.60
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$0.82

HALOPERIDOL 2.5 MG 1/2 TABLET [4081945]

Facility

$1.09

Service Code	NDC 51079-736-01
Hospital Charge Code	ERX4081945
Hospital Revenue Code	259
Min. Negotiated Rate	$0.60
Max. Negotiated Rate	$0.82
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$0.65
Rate for Payer: Aetna of CA Government/Medicare	$0.65
Rate for Payer: Cash Price	$0.49
Rate for Payer: Health Smart Auto/Commercial	$0.65
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$0.65
Rate for Payer: LLUH Dept of Risk Management WC	$0.60
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$0.82

HALOPERIDOL 2.5 MG 1/2 TABLET [4081945]

Facility

$1.09

Service Code	NDC 51079-736-20
Hospital Charge Code	ERX4081945
Hospital Revenue Code	259
Min. Negotiated Rate	$0.60
Max. Negotiated Rate	$0.87
Rate for Payer: Cash Price	$0.49
Rate for Payer: Cigna of CA HMO/PPO	$0.87
Rate for Payer: Health Smart Auto/Commercial	$0.65
Rate for Payer: LLUH Dept of Risk Management WC	$0.60
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$0.82

HALOPERIDOL 2.5 MG 1/2 TABLET [4081945]

Facility

$1.09

Service Code	NDC 51079-736-01
Hospital Charge Code	ERX4081945
Hospital Revenue Code	259
Min. Negotiated Rate	$0.60
Max. Negotiated Rate	$0.87
Rate for Payer: Cash Price	$0.49
Rate for Payer: Cigna of CA HMO/PPO	$0.87
Rate for Payer: Health Smart Auto/Commercial	$0.65
Rate for Payer: LLUH Dept of Risk Management WC	$0.60
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$0.82

HALOPERIDOL 2 MG/ML ORAL CONCENTRATE BOTTLE [4080733]

Facility

$0.28

Service Code	NDC 0121-0581-04
Hospital Charge Code	1715142
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

HALOPERIDOL 2 MG/ML ORAL CONCENTRATE BOTTLE [4080733]

Facility

$0.28

Service Code	NDC 0121-0581-04
Hospital Charge Code	1715142
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

HALOPERIDOL 2 MG/ML ORAL CONCENTRATE BOTTLE [4080733]

Facility

$0.28

Service Code	NDC 54838-501-40
Hospital Charge Code	1715142
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

HALOPERIDOL 2 MG/ML ORAL CONCENTRATE BOTTLE [4080733]

Facility

$0.28

Service Code	NDC 54838-501-40
Hospital Charge Code	1715142
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

HALOPERIDOL 2 MG TABLET [3581]

Facility

$0.67

Service Code	NDC 51079-735-20
Hospital Charge Code	1710022
Hospital Revenue Code	259
Min. Negotiated Rate	$0.37
Max. Negotiated Rate	$0.50
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$0.40
Rate for Payer: Aetna of CA Government/Medicare	$0.40
Rate for Payer: Cash Price	$0.30
Rate for Payer: Health Smart Auto/Commercial	$0.40
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$0.40
Rate for Payer: LLUH Dept of Risk Management WC	$0.37
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$0.50

HALOPERIDOL 2 MG TABLET [3581]

Facility

$0.67

Service Code	NDC 51079-735-01
Hospital Charge Code	1710022
Hospital Revenue Code	259
Min. Negotiated Rate	$0.37
Max. Negotiated Rate	$0.54
Rate for Payer: Cash Price	$0.30
Rate for Payer: Cigna of CA HMO/PPO	$0.54
Rate for Payer: Health Smart Auto/Commercial	$0.40
Rate for Payer: LLUH Dept of Risk Management WC	$0.37
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$0.50

HALOPERIDOL 2 MG TABLET [3581]

Facility

$0.61

Service Code	NDC 0378-0214-01
Hospital Charge Code	1710022
Hospital Revenue Code	259
Min. Negotiated Rate	$0.34
Max. Negotiated Rate	$0.46
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$0.37
Rate for Payer: Aetna of CA Government/Medicare	$0.37
Rate for Payer: Cash Price	$0.27
Rate for Payer: Health Smart Auto/Commercial	$0.37
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$0.37
Rate for Payer: LLUH Dept of Risk Management WC	$0.34
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$0.46

HALOPERIDOL 2 MG TABLET [3581]

Facility

$0.67

Service Code	NDC 51079-735-01
Hospital Charge Code	1710022
Hospital Revenue Code	259
Min. Negotiated Rate	$0.37
Max. Negotiated Rate	$0.50
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$0.40
Rate for Payer: Aetna of CA Government/Medicare	$0.40
Rate for Payer: Cash Price	$0.30
Rate for Payer: Health Smart Auto/Commercial	$0.40
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$0.40
Rate for Payer: LLUH Dept of Risk Management WC	$0.37
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$0.50

HALOPERIDOL 2 MG TABLET [3581]

Facility

$0.61

Service Code	NDC 0378-0214-01
Hospital Charge Code	1710022
Hospital Revenue Code	259
Min. Negotiated Rate	$0.34
Max. Negotiated Rate	$0.49
Rate for Payer: Cash Price	$0.27
Rate for Payer: Cigna of CA HMO/PPO	$0.49
Rate for Payer: Health Smart Auto/Commercial	$0.37
Rate for Payer: LLUH Dept of Risk Management WC	$0.34
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$0.46

HALOPERIDOL 2 MG TABLET [3581]

Facility

$0.67

Service Code	NDC 51079-735-20
Hospital Charge Code	1710022
Hospital Revenue Code	259
Min. Negotiated Rate	$0.37
Max. Negotiated Rate	$0.54
Rate for Payer: Cash Price	$0.30
Rate for Payer: Cigna of CA HMO/PPO	$0.54
Rate for Payer: Health Smart Auto/Commercial	$0.40
Rate for Payer: LLUH Dept of Risk Management WC	$0.37
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$0.50

HALOPERIDOL 5 MG TABLET [3583]

Facility

$1.09

Service Code	NDC 51079-736-20
Hospital Charge Code	1710044
Hospital Revenue Code	259
Min. Negotiated Rate	$0.60
Max. Negotiated Rate	$0.82
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$0.65
Rate for Payer: Aetna of CA Government/Medicare	$0.65
Rate for Payer: Cash Price	$0.49
Rate for Payer: Health Smart Auto/Commercial	$0.65
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$0.65
Rate for Payer: LLUH Dept of Risk Management WC	$0.60
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$0.82

HALOPERIDOL 5 MG TABLET [3583]

Facility

$1.09

Service Code	NDC 51079-736-01
Hospital Charge Code	1710044
Hospital Revenue Code	259
Min. Negotiated Rate	$0.60
Max. Negotiated Rate	$0.82
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$0.65
Rate for Payer: Aetna of CA Government/Medicare	$0.65
Rate for Payer: Cash Price	$0.49
Rate for Payer: Health Smart Auto/Commercial	$0.65
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$0.65
Rate for Payer: LLUH Dept of Risk Management WC	$0.60
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$0.82

HALOPERIDOL 5 MG TABLET [3583]

Facility

$1.09

Service Code	NDC 51079-736-01
Hospital Charge Code	1710044
Hospital Revenue Code	259
Min. Negotiated Rate	$0.60
Max. Negotiated Rate	$0.87
Rate for Payer: Cash Price	$0.49
Rate for Payer: Cigna of CA HMO/PPO	$0.87
Rate for Payer: Health Smart Auto/Commercial	$0.65
Rate for Payer: LLUH Dept of Risk Management WC	$0.60
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$0.82

HALOPERIDOL 5 MG TABLET [3583]

Facility

$1.09

Service Code	NDC 51079-736-20
Hospital Charge Code	1710044
Hospital Revenue Code	259
Min. Negotiated Rate	$0.60
Max. Negotiated Rate	$0.87
Rate for Payer: Cash Price	$0.49
Rate for Payer: Cigna of CA HMO/PPO	$0.87
Rate for Payer: Health Smart Auto/Commercial	$0.65
Rate for Payer: LLUH Dept of Risk Management WC	$0.60
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$0.82

HALOPERIDOL 5 MG TABLET [3583]

Facility

$1.09

Service Code	NDC 60687-161-11
Hospital Charge Code	1710044
Hospital Revenue Code	259
Min. Negotiated Rate	$0.60
Max. Negotiated Rate	$0.87
Rate for Payer: Cash Price	$0.49
Rate for Payer: Cigna of CA HMO/PPO	$0.87
Rate for Payer: Health Smart Auto/Commercial	$0.65
Rate for Payer: LLUH Dept of Risk Management WC	$0.60
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$0.82

HALOPERIDOL 5 MG TABLET [3583]

Facility

$1.09

Service Code	NDC 60687-161-11
Hospital Charge Code	1710044
Hospital Revenue Code	259
Min. Negotiated Rate	$0.60
Max. Negotiated Rate	$0.82
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$0.65
Rate for Payer: Aetna of CA Government/Medicare	$0.65
Rate for Payer: Cash Price	$0.49
Rate for Payer: Health Smart Auto/Commercial	$0.65
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$0.65
Rate for Payer: LLUH Dept of Risk Management WC	$0.60
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$0.82

HALOPERIDOL DECANOATE 100 MG/ML INTRAMUSCULAR SOLUTION [10162]

Facility

$50.40

Service Code	CPT J1631
Hospital Charge Code	1722029
Hospital Revenue Code	636
Min. Negotiated Rate	$27.72
Max. Negotiated Rate	$40.32
Rate for Payer: Cash Price	$22.68
Rate for Payer: Cash Price	$23.76
Rate for Payer: Cigna of CA HMO/PPO	$42.24
Rate for Payer: Cigna of CA HMO/PPO	$40.32
Rate for Payer: Health Smart Auto/Commercial	$31.68
Rate for Payer: Health Smart Auto/Commercial	$30.24
Rate for Payer: LLUH Dept of Risk Management WC	$29.04
Rate for Payer: LLUH Dept of Risk Management WC	$27.72
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$37.80
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$39.60

HALOPERIDOL DECANOATE 100 MG/ML INTRAMUSCULAR SOLUTION [10162]

Facility

$50.40

Service Code	CPT J1631
Hospital Charge Code	1722029
Hospital Revenue Code	636
Min. Negotiated Rate	$27.72
Max. Negotiated Rate	$37.80
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$30.24
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$31.68
Rate for Payer: Aetna of CA Government/Medicare	$30.24
Rate for Payer: Aetna of CA Government/Medicare	$31.68
Rate for Payer: Cash Price	$22.68
Rate for Payer: Cash Price	$23.76
Rate for Payer: Health Smart Auto/Commercial	$30.24
Rate for Payer: Health Smart Auto/Commercial	$31.68
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$31.68
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$30.24
Rate for Payer: LLUH Dept of Risk Management WC	$27.72
Rate for Payer: LLUH Dept of Risk Management WC	$29.04
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$39.60
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$37.80

HALOPERIDOL DECANOATE 50 MG/ML INTRAMUSCULAR SOLUTION [10163]

Facility

$33.70

Service Code	CPT J1631
Hospital Charge Code	1720525
Hospital Revenue Code	636
Min. Negotiated Rate	$18.54
Max. Negotiated Rate	$25.28
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$20.22
Rate for Payer: Aetna of CA Government/Medicare	$20.22
Rate for Payer: Cash Price	$15.17
Rate for Payer: Health Smart Auto/Commercial	$20.22
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$20.22
Rate for Payer: LLUH Dept of Risk Management WC	$18.54
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$25.28

HALOPERIDOL DECANOATE 50 MG/ML INTRAMUSCULAR SOLUTION [10163]

Facility

$33.70

Service Code	CPT J1631
Hospital Charge Code	1720525
Hospital Revenue Code	636
Min. Negotiated Rate	$18.54
Max. Negotiated Rate	$26.96
Rate for Payer: Cash Price	$15.17
Rate for Payer: Cigna of CA HMO/PPO	$26.96
Rate for Payer: Health Smart Auto/Commercial	$20.22
Rate for Payer: LLUH Dept of Risk Management WC	$18.54
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$25.28

Know your out-of-pocket cost for care.

All Charges