Loma Linda University Behavioral Medicine Center (BMC)

All Charges

Charge

Type

Setting

Price

ASCORBIC ACID (VITAMIN C) 500 MG/5 ML ORAL LIQUID [227420]

Facility

$0.05

Service Code	NDC 6961801854
Hospital Charge Code	NDG216878
Hospital Revenue Code	259
Min. Negotiated Rate	$0.03
Max. Negotiated Rate	$0.04
Rate for Payer: Cash Price	$0.02
Rate for Payer: Cigna of CA HMO/PPO	$0.04
Rate for Payer: Health Smart Auto/Commercial	$0.03
Rate for Payer: LLUH Dept of Risk Management WC	$0.03
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$0.04

ASCORBIC ACID (VITAMIN C) 500 MG/5 ML ORAL LIQUID [227420]

Facility

$0.05

Service Code	NDC 6961801854
Hospital Charge Code	NDG216878
Hospital Revenue Code	259
Min. Negotiated Rate	$0.03
Max. Negotiated Rate	$0.04
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$0.03
Rate for Payer: Aetna of CA Government/Medicare	$0.03
Rate for Payer: Cash Price	$0.02
Rate for Payer: Health Smart Auto/Commercial	$0.03
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$0.03
Rate for Payer: LLUH Dept of Risk Management WC	$0.03
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$0.04

ASCORBIC ACID (VITAMIN C) 500 MG/5 ML ORAL SYRUP [115152]

Facility

$0.03

Service Code	NDC 5789684216
Hospital Charge Code	1719087
Hospital Revenue Code	259
Min. Negotiated Rate	$0.02
Max. Negotiated Rate	$0.02
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$0.02
Rate for Payer: Aetna of CA Government/Medicare	$0.02
Rate for Payer: Cash Price	$0.01
Rate for Payer: Health Smart Auto/Commercial	$0.02
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$0.02
Rate for Payer: LLUH Dept of Risk Management WC	$0.02
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$0.02

ASCORBIC ACID (VITAMIN C) 500 MG/5 ML ORAL SYRUP [115152]

Facility

$0.03

Service Code	NDC 5789684216
Hospital Charge Code	1719087
Hospital Revenue Code	259
Min. Negotiated Rate	$0.02
Max. Negotiated Rate	$0.02
Rate for Payer: Cash Price	$0.01
Rate for Payer: Cigna of CA HMO/PPO	$0.02
Rate for Payer: Health Smart Auto/Commercial	$0.02
Rate for Payer: LLUH Dept of Risk Management WC	$0.02
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$0.02

ASCORBIC ACID (VITAMIN C) 500 MG/ML INJECTION SOLUTION [654]

Facility

$2.17

Service Code	NDC 67457-118-50
Hospital Charge Code	1757957
Hospital Revenue Code	250
Min. Negotiated Rate	$1.19
Max. Negotiated Rate	$1.74
Rate for Payer: Cash Price	$0.98
Rate for Payer: Cigna of CA HMO/PPO	$1.74
Rate for Payer: Health Smart Auto/Commercial	$1.30
Rate for Payer: LLUH Dept of Risk Management WC	$1.19
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$1.63

ASCORBIC ACID (VITAMIN C) 500 MG/ML INJECTION SOLUTION [654]

Facility

$2.17

Service Code	NDC 67457-118-50
Hospital Charge Code	1757957
Hospital Revenue Code	250
Min. Negotiated Rate	$1.19
Max. Negotiated Rate	$1.63
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$1.30
Rate for Payer: Aetna of CA Government/Medicare	$1.30
Rate for Payer: Cash Price	$0.98
Rate for Payer: Health Smart Auto/Commercial	$1.30
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$1.30
Rate for Payer: LLUH Dept of Risk Management WC	$1.19
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$1.63

ASCORBIC ACID (VITAMIN C) 500 MG/ML INTRAVENOUS SOLUTION [221033]

Facility

$6.49

Service Code	NDC 67157-101-50
Hospital Charge Code	1757957
Hospital Revenue Code	250
Min. Negotiated Rate	$3.57
Max. Negotiated Rate	$5.19
Rate for Payer: Cash Price	$2.92
Rate for Payer: Cigna of CA HMO/PPO	$5.19
Rate for Payer: Health Smart Auto/Commercial	$3.89
Rate for Payer: LLUH Dept of Risk Management WC	$3.57
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$4.87

ASCORBIC ACID (VITAMIN C) 500 MG/ML INTRAVENOUS SOLUTION [221033]

Facility

$6.49

Service Code	NDC 67157-101-50
Hospital Charge Code	1757957
Hospital Revenue Code	250
Min. Negotiated Rate	$3.57
Max. Negotiated Rate	$4.87
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$3.89
Rate for Payer: Aetna of CA Government/Medicare	$3.89
Rate for Payer: Cash Price	$2.92
Rate for Payer: Health Smart Auto/Commercial	$3.89
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$3.89
Rate for Payer: LLUH Dept of Risk Management WC	$3.57
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$4.87

ASCORBIC ACID (VITAMIN C) 500 MG/ML INTRAVENOUS SOLUTION [221033]

Facility

$6.42

Service Code	NDC 67157-101-51
Hospital Charge Code	1757957
Hospital Revenue Code	250
Min. Negotiated Rate	$3.53
Max. Negotiated Rate	$4.82
Rate for Payer: Health Smart Auto/Commercial	$3.85
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$3.85
Rate for Payer: Aetna of CA Government/Medicare	$3.85
Rate for Payer: Cash Price	$2.89
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$3.85
Rate for Payer: LLUH Dept of Risk Management WC	$3.53
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$4.82

ASCORBIC ACID (VITAMIN C) 500 MG/ML INTRAVENOUS SOLUTION [221033]

Facility

$6.42

Service Code	NDC 67157-101-51
Hospital Charge Code	1757957
Hospital Revenue Code	250
Min. Negotiated Rate	$3.53
Max. Negotiated Rate	$5.14
Rate for Payer: Cash Price	$2.89
Rate for Payer: Cigna of CA HMO/PPO	$5.14
Rate for Payer: Health Smart Auto/Commercial	$3.85
Rate for Payer: LLUH Dept of Risk Management WC	$3.53
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$4.82

ASCORBIC ACID (VITAMIN C) 500 MG TABLET [664]

Facility

$0.04

Service Code	NDC 904052361
Hospital Charge Code	1711030
Hospital Revenue Code	259
Min. Negotiated Rate	$0.02
Max. Negotiated Rate	$0.03
Rate for Payer: Cash Price	$0.02
Rate for Payer: Cigna of CA HMO/PPO	$0.03
Rate for Payer: Health Smart Auto/Commercial	$0.02
Rate for Payer: LLUH Dept of Risk Management WC	$0.02
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$0.03

ASCORBIC ACID (VITAMIN C) 500 MG TABLET [664]

Facility

$0.04

Service Code	NDC 8770140739
Hospital Charge Code	1711030
Hospital Revenue Code	259
Min. Negotiated Rate	$0.02
Max. Negotiated Rate	$0.03
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$0.02
Rate for Payer: Aetna of CA Government/Medicare	$0.02
Rate for Payer: Cash Price	$0.02
Rate for Payer: Health Smart Auto/Commercial	$0.02
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$0.02
Rate for Payer: LLUH Dept of Risk Management WC	$0.02
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$0.03

ASCORBIC ACID (VITAMIN C) 500 MG TABLET [664]

Facility

$0.03

Service Code	NDC 8770140741
Hospital Charge Code	1711030
Hospital Revenue Code	259
Min. Negotiated Rate	$0.02
Max. Negotiated Rate	$0.02
Rate for Payer: Cash Price	$0.01
Rate for Payer: Cigna of CA HMO/PPO	$0.02
Rate for Payer: Health Smart Auto/Commercial	$0.02
Rate for Payer: LLUH Dept of Risk Management WC	$0.02
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$0.02

ASCORBIC ACID (VITAMIN C) 500 MG TABLET [664]

Facility

$0.04

Service Code	NDC 8770140739
Hospital Charge Code	1711030
Hospital Revenue Code	259
Min. Negotiated Rate	$0.02
Max. Negotiated Rate	$0.03
Rate for Payer: Cash Price	$0.02
Rate for Payer: Cigna of CA HMO/PPO	$0.03
Rate for Payer: Health Smart Auto/Commercial	$0.02
Rate for Payer: LLUH Dept of Risk Management WC	$0.02
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$0.03

ASCORBIC ACID (VITAMIN C) 500 MG TABLET [664]

Facility

$0.04

Service Code	NDC 904052361
Hospital Charge Code	1711030
Hospital Revenue Code	259
Min. Negotiated Rate	$0.02
Max. Negotiated Rate	$0.03
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$0.02
Rate for Payer: Aetna of CA Government/Medicare	$0.02
Rate for Payer: Cash Price	$0.02
Rate for Payer: Health Smart Auto/Commercial	$0.02
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$0.02
Rate for Payer: LLUH Dept of Risk Management WC	$0.02
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$0.03

ASCORBIC ACID (VITAMIN C) 500 MG TABLET [664]

Facility

$0.03

Service Code	NDC 5789684101
Hospital Charge Code	1711030
Hospital Revenue Code	259
Min. Negotiated Rate	$0.02
Max. Negotiated Rate	$0.02
Rate for Payer: Cash Price	$0.01
Rate for Payer: Cigna of CA HMO/PPO	$0.02
Rate for Payer: Health Smart Auto/Commercial	$0.02
Rate for Payer: LLUH Dept of Risk Management WC	$0.02
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$0.02

ASCORBIC ACID (VITAMIN C) 500 MG TABLET [664]

Facility

$0.03

Service Code	NDC 8770140741
Hospital Charge Code	1711030
Hospital Revenue Code	259
Min. Negotiated Rate	$0.02
Max. Negotiated Rate	$0.02
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$0.02
Rate for Payer: Aetna of CA Government/Medicare	$0.02
Rate for Payer: Cash Price	$0.01
Rate for Payer: Health Smart Auto/Commercial	$0.02
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$0.02
Rate for Payer: LLUH Dept of Risk Management WC	$0.02
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$0.02

ASCORBIC ACID (VITAMIN C) 500 MG TABLET [664]

Facility

$0.02

Service Code	NDC 904052372
Hospital Charge Code	1711030
Hospital Revenue Code	259
Min. Negotiated Rate	$0.01
Max. Negotiated Rate	$0.02
Rate for Payer: Cash Price	$0.01
Rate for Payer: Cigna of CA HMO/PPO	$0.02
Rate for Payer: Health Smart Auto/Commercial	$0.01
Rate for Payer: LLUH Dept of Risk Management WC	$0.01
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$0.02

ASCORBIC ACID (VITAMIN C) 500 MG TABLET [664]

Facility

$0.03

Service Code	NDC 904052360
Hospital Charge Code	1711030
Hospital Revenue Code	259
Min. Negotiated Rate	$0.02
Max. Negotiated Rate	$0.02
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$0.02
Rate for Payer: Aetna of CA Government/Medicare	$0.02
Rate for Payer: Cash Price	$0.01
Rate for Payer: Health Smart Auto/Commercial	$0.02
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$0.02
Rate for Payer: LLUH Dept of Risk Management WC	$0.02
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$0.02

ASCORBIC ACID (VITAMIN C) 500 MG TABLET [664]

Facility

$0.03

Service Code	NDC 5789684101
Hospital Charge Code	1711030
Hospital Revenue Code	259
Min. Negotiated Rate	$0.02
Max. Negotiated Rate	$0.02
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$0.02
Rate for Payer: Aetna of CA Government/Medicare	$0.02
Rate for Payer: Cash Price	$0.01
Rate for Payer: Health Smart Auto/Commercial	$0.02
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$0.02
Rate for Payer: LLUH Dept of Risk Management WC	$0.02
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$0.02

ASCORBIC ACID (VITAMIN C) 500 MG TABLET [664]

Facility

$0.02

Service Code	NDC 904052372
Hospital Charge Code	1711030
Hospital Revenue Code	259
Min. Negotiated Rate	$0.01
Max. Negotiated Rate	$0.02
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$0.01
Rate for Payer: Aetna of CA Government/Medicare	$0.01
Rate for Payer: Cash Price	$0.01
Rate for Payer: Health Smart Auto/Commercial	$0.01
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$0.01
Rate for Payer: LLUH Dept of Risk Management WC	$0.01
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$0.02

ASCORBIC ACID (VITAMIN C) 500 MG TABLET [664]

Facility

$0.03

Service Code	NDC 904052360
Hospital Charge Code	1711030
Hospital Revenue Code	259
Min. Negotiated Rate	$0.02
Max. Negotiated Rate	$0.02
Rate for Payer: Cash Price	$0.01
Rate for Payer: Cigna of CA HMO/PPO	$0.02
Rate for Payer: Health Smart Auto/Commercial	$0.02
Rate for Payer: LLUH Dept of Risk Management WC	$0.02
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$0.02

ASPARAGINASE (ERWINIA CHRYSANTHEMI) 10,000 UNIT SOLUTION FOR INJECTION [153020]

Facility

$4,837.01

Service Code	CPT J9019
Hospital Charge Code	ERX188876
Hospital Revenue Code	636
Min. Negotiated Rate	$2,660.36
Max. Negotiated Rate	$3,627.76
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$2,902.21
Rate for Payer: Aetna of CA Government/Medicare	$2,902.21
Rate for Payer: Cash Price	$2,176.65
Rate for Payer: Health Smart Auto/Commercial	$2,902.21
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$2,902.21
Rate for Payer: LLUH Dept of Risk Management WC	$2,660.36
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$3,627.76

ASPARAGINASE (ERWINIA CHRYSANTHEMI) 10,000 UNIT SOLUTION FOR INJECTION [153020]

Facility

$4,837.01

Service Code	CPT J9019
Hospital Charge Code	ERX188876
Hospital Revenue Code	636
Min. Negotiated Rate	$2,660.36
Max. Negotiated Rate	$3,869.61
Rate for Payer: Cash Price	$2,176.65
Rate for Payer: Cigna of CA HMO/PPO	$3,869.61
Rate for Payer: Health Smart Auto/Commercial	$2,902.21
Rate for Payer: LLUH Dept of Risk Management WC	$2,660.36
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$3,627.76

ASPIRIN 25 MG-DIPYRIDAMOLE 200 MG CAPSULE,EXT.RELEASE 12 HR MULTIPHASE [27644]

Facility

$1.20

Service Code	NDC 65162-596-06
Hospital Charge Code	1712234
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

Know your out-of-pocket cost for care.

All Charges