Loma Linda University Behavioral Medicine Center (BMC)

All Charges

Charge

Type

Setting

Price

ARGININE 25 MG/ML-LYSINE 25 MG/ML IN 0.9 % NACL INTRAVENOUS SOLUTION [223945]

Facility

$0.45

Service Code	NDC 08252-0001-75
Hospital Charge Code	NDG223945
Hospital Revenue Code	250
Min. Negotiated Rate	$0.25
Max. Negotiated Rate	$0.36
Rate for Payer: Cash Price	$0.20
Rate for Payer: Cigna of CA HMO/PPO	$0.36
Rate for Payer: Health Smart Auto/Commercial	$0.27
Rate for Payer: LLUH Dept of Risk Management WC	$0.25
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$0.34

ARGININE 25 MG/ML-LYSINE 25 MG/ML IN 0.9 % NACL INTRAVENOUS SOLUTION [223945]

Facility

$0.45

Service Code	NDC 08252-0001-75
Hospital Charge Code	NDG223945
Hospital Revenue Code	250
Min. Negotiated Rate	$0.25
Max. Negotiated Rate	$0.34
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$0.27
Rate for Payer: Aetna of CA Government/Medicare	$0.27
Rate for Payer: Cash Price	$0.20
Rate for Payer: Health Smart Auto/Commercial	$0.27
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$0.27
Rate for Payer: LLUH Dept of Risk Management WC	$0.25
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$0.34

ARGININE 7 GRAM-GLUTAM 7 GRAM-CAHMB 1.5 GRAM-COLLA-MV-MIN ORAL PWD PKT [220244]

Facility

$2.84

Service Code	NDC 5978166694
Hospital Revenue Code	259
Min. Negotiated Rate	$1.56
Max. Negotiated Rate	$2.13
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$1.70
Rate for Payer: Aetna of CA Government/Medicare	$1.70
Rate for Payer: Cash Price	$1.28
Rate for Payer: Health Smart Auto/Commercial	$1.70
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$1.70
Rate for Payer: LLUH Dept of Risk Management WC	$1.56
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$2.13

ARGININE 7 GRAM-GLUTAM 7 GRAM-CAHMB 1.5 GRAM-COLLA-MV-MIN ORAL PWD PKT [220244]

Facility

$2.84

Service Code	NDC 5978166694
Hospital Revenue Code	259
Min. Negotiated Rate	$1.56
Max. Negotiated Rate	$2.27
Rate for Payer: Health Smart Auto/Commercial	$1.70
Rate for Payer: Cash Price	$1.28
Rate for Payer: Cigna of CA HMO/PPO	$2.27
Rate for Payer: LLUH Dept of Risk Management WC	$1.56
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$2.13

ARGININE HCL (L-ARGININE) 10 % CONTINUOUS INFUSION [203805]

Facility

$0.17

Service Code	NDC 0009-0436-01
Hospital Charge Code	NDG9123
Hospital Revenue Code	250
Min. Negotiated Rate	$0.09
Max. Negotiated Rate	$0.13
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	$0.08
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	$0.13

ARGININE HCL (L-ARGININE) 10 % CONTINUOUS INFUSION [203805]

Facility

$0.17

Service Code	NDC 0009-0436-01
Hospital Charge Code	NDG9123
Hospital Revenue Code	250
Min. Negotiated Rate	$0.09
Max. Negotiated Rate	$0.14
Rate for Payer: Cash Price	$0.08
Rate for Payer: Cigna of CA HMO/PPO	$0.14
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	$0.13

ARGININE ORAL SOLN (IV FORM) 100 MG/ML (0.475 MEQ/ML) [4080420]

Facility

$0.16

Service Code	NDC 9994-0804-20
Hospital Charge Code	1715995
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

ARGININE ORAL SOLN (IV FORM) 100 MG/ML (0.475 MEQ/ML) [4080420]

Facility

$0.16

Service Code	NDC 9994-0804-20
Hospital Charge Code	1715995
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

ARIPIPRAZOLE 10 MG TABLET [34369]

Facility

$0.75

Service Code	NDC 50268-089-15
Hospital Charge Code	1711827
Hospital Revenue Code	259
Min. Negotiated Rate	$0.41
Max. Negotiated Rate	$0.56
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$0.45
Rate for Payer: Aetna of CA Government/Medicare	$0.45
Rate for Payer: Cash Price	$0.34
Rate for Payer: Health Smart Auto/Commercial	$0.45
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$0.45
Rate for Payer: LLUH Dept of Risk Management WC	$0.41
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$0.56

ARIPIPRAZOLE 10 MG TABLET [34369]

Facility

$0.75

Service Code	NDC 50268-089-11
Hospital Charge Code	1711827
Hospital Revenue Code	259
Min. Negotiated Rate	$0.41
Max. Negotiated Rate	$0.60
Rate for Payer: Cash Price	$0.34
Rate for Payer: Cigna of CA HMO/PPO	$0.60
Rate for Payer: Health Smart Auto/Commercial	$0.45
Rate for Payer: LLUH Dept of Risk Management WC	$0.41
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$0.56

ARIPIPRAZOLE 10 MG TABLET [34369]

Facility

$0.75

Service Code	NDC 50268-089-15
Hospital Charge Code	1711827
Hospital Revenue Code	259
Min. Negotiated Rate	$0.41
Max. Negotiated Rate	$0.60
Rate for Payer: Cash Price	$0.34
Rate for Payer: Cigna of CA HMO/PPO	$0.60
Rate for Payer: Health Smart Auto/Commercial	$0.45
Rate for Payer: LLUH Dept of Risk Management WC	$0.41
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$0.56

ARIPIPRAZOLE 10 MG TABLET [34369]

Facility

$0.75

Service Code	NDC 50268-089-11
Hospital Charge Code	1711827
Hospital Revenue Code	259
Min. Negotiated Rate	$0.41
Max. Negotiated Rate	$0.56
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$0.45
Rate for Payer: Aetna of CA Government/Medicare	$0.45
Rate for Payer: Cash Price	$0.34
Rate for Payer: Health Smart Auto/Commercial	$0.45
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$0.45
Rate for Payer: LLUH Dept of Risk Management WC	$0.41
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$0.56

ARIPIPRAZOLE 15 MG TABLET [34370]

Facility

$0.42

Service Code	NDC 62332-100-30
Hospital Charge Code	1711828
Hospital Revenue Code	259
Min. Negotiated Rate	$0.23
Max. Negotiated Rate	$0.32
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$0.25
Rate for Payer: Aetna of CA Government/Medicare	$0.25
Rate for Payer: Cash Price	$0.19
Rate for Payer: Health Smart Auto/Commercial	$0.25
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$0.25
Rate for Payer: LLUH Dept of Risk Management WC	$0.23
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$0.32

ARIPIPRAZOLE 15 MG TABLET [34370]

Facility

$0.42

Service Code	NDC 62332-100-30
Hospital Charge Code	1711828
Hospital Revenue Code	259
Min. Negotiated Rate	$0.23
Max. Negotiated Rate	$0.34
Rate for Payer: Cash Price	$0.19
Rate for Payer: Cigna of CA HMO/PPO	$0.34
Rate for Payer: Health Smart Auto/Commercial	$0.25
Rate for Payer: LLUH Dept of Risk Management WC	$0.23
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$0.32

ARIPIPRAZOLE 1 MG/ML ORAL SOLUTION [40446]

Facility

$1.20

Service Code	NDC 66689-735-05
Hospital Charge Code	1715222
Hospital Revenue Code	259
Min. Negotiated Rate	$0.66
Max. Negotiated Rate	$0.96
Rate for Payer: Cash Price	$0.54
Rate for Payer: Cigna of CA HMO/PPO	$0.96
Rate for Payer: Health Smart Auto/Commercial	$0.72
Rate for Payer: LLUH Dept of Risk Management WC	$0.66
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$0.90

ARIPIPRAZOLE 1 MG/ML ORAL SOLUTION [40446]

Facility

$1.20

Service Code	NDC 66689-735-05
Hospital Charge Code	1715222
Hospital Revenue Code	259
Min. Negotiated Rate	$0.66
Max. Negotiated Rate	$0.90
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$0.72
Rate for Payer: Aetna of CA Government/Medicare	$0.72
Rate for Payer: Cash Price	$0.54
Rate for Payer: Health Smart Auto/Commercial	$0.72
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$0.72
Rate for Payer: LLUH Dept of Risk Management WC	$0.66
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$0.90

ARIPIPRAZOLE 2 MG TABLET [70306]

Facility

$0.28

Service Code	NDC 67877-430-03
Hospital Charge Code	1712401
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

ARIPIPRAZOLE 2 MG TABLET [70306]

Facility

$0.42

Service Code	NDC 62332-097-30
Hospital Charge Code	1712401
Hospital Revenue Code	259
Min. Negotiated Rate	$0.23
Max. Negotiated Rate	$0.34
Rate for Payer: Cash Price	$0.19
Rate for Payer: Cigna of CA HMO/PPO	$0.34
Rate for Payer: Health Smart Auto/Commercial	$0.25
Rate for Payer: LLUH Dept of Risk Management WC	$0.23
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$0.32

ARIPIPRAZOLE 2 MG TABLET [70306]

Facility

$0.42

Service Code	NDC 62332-097-30
Hospital Charge Code	1712401
Hospital Revenue Code	259
Min. Negotiated Rate	$0.23
Max. Negotiated Rate	$0.32
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$0.25
Rate for Payer: Aetna of CA Government/Medicare	$0.25
Rate for Payer: Cash Price	$0.19
Rate for Payer: Health Smart Auto/Commercial	$0.25
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$0.25
Rate for Payer: LLUH Dept of Risk Management WC	$0.23
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$0.32

ARIPIPRAZOLE 2 MG TABLET [70306]

Facility

$0.28

Service Code	NDC 67877-430-03
Hospital Charge Code	1712401
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

ARIPIPRAZOLE 5 MG TABLET [36438]

Facility

$0.42

Service Code	NDC 62332-098-30
Hospital Charge Code	1712297
Hospital Revenue Code	259
Min. Negotiated Rate	$0.23
Max. Negotiated Rate	$0.32
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$0.25
Rate for Payer: Aetna of CA Government/Medicare	$0.25
Rate for Payer: Cash Price	$0.19
Rate for Payer: Health Smart Auto/Commercial	$0.25
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$0.25
Rate for Payer: LLUH Dept of Risk Management WC	$0.23
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$0.32

ARIPIPRAZOLE 5 MG TABLET [36438]

Facility

$0.42

Service Code	NDC 62332-098-30
Hospital Charge Code	1712297
Hospital Revenue Code	259
Min. Negotiated Rate	$0.23
Max. Negotiated Rate	$0.34
Rate for Payer: Cash Price	$0.19
Rate for Payer: Cigna of CA HMO/PPO	$0.34
Rate for Payer: Health Smart Auto/Commercial	$0.25
Rate for Payer: LLUH Dept of Risk Management WC	$0.23
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$0.32

ARSENIC TRIOXIDE 2 MG/ML INTRAVENOUS SOLUTION [220455]

Facility

$213.28

Service Code	CPT J9017
Hospital Charge Code	NDG220455
Hospital Revenue Code	636
Min. Negotiated Rate	$117.30
Max. Negotiated Rate	$159.96
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$127.97
Rate for Payer: Aetna of CA Government/Medicare	$127.97
Rate for Payer: Cash Price	$95.98
Rate for Payer: Health Smart Auto/Commercial	$127.97
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$127.97
Rate for Payer: LLUH Dept of Risk Management WC	$117.30
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$159.96

ARSENIC TRIOXIDE 2 MG/ML INTRAVENOUS SOLUTION [220455]

Facility

$213.28

Service Code	CPT J9017
Hospital Charge Code	NDG220455
Hospital Revenue Code	636
Min. Negotiated Rate	$117.30
Max. Negotiated Rate	$170.62
Rate for Payer: Cash Price	$95.98
Rate for Payer: Cigna of CA HMO/PPO	$170.62
Rate for Payer: Health Smart Auto/Commercial	$127.97
Rate for Payer: LLUH Dept of Risk Management WC	$117.30
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$159.96

ARTEMETHER-LUMEFANTRINE 20 MG-120 MG TABLET [96948]

Facility

$6.74

Service Code	NDC 0078-0568-45
Hospital Charge Code	1712541
Hospital Revenue Code	259
Min. Negotiated Rate	$3.71
Max. Negotiated Rate	$5.06
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$4.04
Rate for Payer: Aetna of CA Government/Medicare	$4.04
Rate for Payer: Cash Price	$3.03
Rate for Payer: Health Smart Auto/Commercial	$4.04
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$4.04
Rate for Payer: LLUH Dept of Risk Management WC	$3.71
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$5.06

Know your out-of-pocket cost for care.

All Charges