Loma Linda University Behavioral Medicine Center (BMC)

All Charges

Charge

Type

Setting

Price

ATENOLOL 50 MG TABLET [718]

Facility

$0.04

Service Code	NDC 0093-0752-01
Hospital Charge Code	901700029
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: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$0.03
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 Commercial	$0.03

ATENOLOL 50 MG TABLET [718]

Facility

$0.04

Service Code	NDC 65862-169-01
Hospital Charge Code	901700029
Hospital Revenue Code	259
Min. Negotiated Rate	$0.02
Max. Negotiated Rate	$0.03
Rate for Payer: Cash Price	$0.02
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO 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 Commercial	$0.03

ATENOLOL 50 MG TABLET [718]

Facility

$0.11

Service Code	NDC 51079-684-01
Hospital Charge Code	901700029
Hospital Revenue Code	259
Min. Negotiated Rate	$0.06
Max. Negotiated Rate	$0.09
Rate for Payer: Cash Price	$0.06
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$0.09
Rate for Payer: Health Smart Auto/Commercial	$0.07
Rate for Payer: LLUH Dept of Risk Management WC	$0.06
Rate for Payer: Multiplan Commercial	$0.08

ATENOLOL 50 MG TABLET [718]

Facility

$0.04

Service Code	NDC 65862-169-01
Hospital Charge Code	901700029
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: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$0.03
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 Commercial	$0.03

ATENOLOL 50 MG TABLET [718]

Facility

$0.11

Service Code	NDC 51079-684-01
Hospital Charge Code	901700029
Hospital Revenue Code	259
Min. Negotiated Rate	$0.06
Max. Negotiated Rate	$0.09
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$0.07
Rate for Payer: Aetna of CA Government/Medicare	$0.07
Rate for Payer: Cash Price	$0.06
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$0.09
Rate for Payer: Health Smart Auto/Commercial	$0.07
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$0.07
Rate for Payer: LLUH Dept of Risk Management WC	$0.06
Rate for Payer: Multiplan Commercial	$0.08

ATENOLOL 50 MG TABLET [718]

Facility

$0.11

Service Code	NDC 51079-684-20
Hospital Charge Code	901700029
Hospital Revenue Code	259
Min. Negotiated Rate	$0.06
Max. Negotiated Rate	$0.09
Rate for Payer: Cash Price	$0.06
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$0.09
Rate for Payer: Health Smart Auto/Commercial	$0.07
Rate for Payer: LLUH Dept of Risk Management WC	$0.06
Rate for Payer: Multiplan Commercial	$0.08

ATENOLOL 50 MG TABLET [718]

Facility

$0.04

Service Code	NDC 0093-0752-01
Hospital Charge Code	901700029
Hospital Revenue Code	259
Min. Negotiated Rate	$0.02
Max. Negotiated Rate	$0.03
Rate for Payer: Cash Price	$0.02
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO 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 Commercial	$0.03

ATENOLOL 50 MG TABLET [718]

Facility

$0.09

Service Code	NDC 0378-0231-01
Hospital Charge Code	901700029
Hospital Revenue Code	259
Min. Negotiated Rate	$0.05
Max. Negotiated Rate	$0.07
Rate for Payer: Cash Price	$0.05
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$0.07
Rate for Payer: Health Smart Auto/Commercial	$0.05
Rate for Payer: LLUH Dept of Risk Management WC	$0.05
Rate for Payer: Multiplan Commercial	$0.07

ATENOLOL 50 MG TABLET [718]

Facility

$0.11

Service Code	NDC 51079-684-20
Hospital Charge Code	901700029
Hospital Revenue Code	259
Min. Negotiated Rate	$0.06
Max. Negotiated Rate	$0.09
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$0.07
Rate for Payer: Aetna of CA Government/Medicare	$0.07
Rate for Payer: Cash Price	$0.06
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$0.09
Rate for Payer: Health Smart Auto/Commercial	$0.07
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$0.07
Rate for Payer: LLUH Dept of Risk Management WC	$0.06
Rate for Payer: Multiplan Commercial	$0.08

ATENOLOL 50 MG TABLET [718]

Facility

$0.09

Service Code	NDC 0378-0231-01
Hospital Charge Code	901700029
Hospital Revenue Code	259
Min. Negotiated Rate	$0.05
Max. Negotiated Rate	$0.07
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$0.05
Rate for Payer: Aetna of CA Government/Medicare	$0.05
Rate for Payer: Cash Price	$0.05
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$0.07
Rate for Payer: Health Smart Auto/Commercial	$0.05
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$0.05
Rate for Payer: LLUH Dept of Risk Management WC	$0.05
Rate for Payer: Multiplan Commercial	$0.07

ATENOLOL ORAL SUSPENSION COMPOUND 2 MG/ML [4080244]

Facility

$0.89

Service Code	NDC 9994-0802-44
Hospital Charge Code	901700029
Hospital Revenue Code	259
Min. Negotiated Rate	$0.49
Max. Negotiated Rate	$0.71
Rate for Payer: Cash Price	$0.49
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$0.71
Rate for Payer: Health Smart Auto/Commercial	$0.53
Rate for Payer: LLUH Dept of Risk Management WC	$0.49
Rate for Payer: Multiplan Commercial	$0.67

ATENOLOL ORAL SUSPENSION COMPOUND 2 MG/ML [4080244]

Facility

$0.89

Service Code	NDC 9994-0802-44
Hospital Charge Code	901700029
Hospital Revenue Code	259
Min. Negotiated Rate	$0.49
Max. Negotiated Rate	$0.71
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$0.53
Rate for Payer: Aetna of CA Government/Medicare	$0.53
Rate for Payer: Cash Price	$0.49
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$0.71
Rate for Payer: Health Smart Auto/Commercial	$0.53
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$0.53
Rate for Payer: LLUH Dept of Risk Management WC	$0.49
Rate for Payer: Multiplan Commercial	$0.67

ATEZOLIZUMAB 1,200 MG/20 ML (60 MG/ML) INTRAVENOUS SOLUTION [214353]

Facility

$695.36

Service Code	HCPCS J9022
Hospital Charge Code	901700025
Hospital Revenue Code	636
Min. Negotiated Rate	$382.45
Max. Negotiated Rate	$556.29
Rate for Payer: Cash Price	$382.45
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$556.29
Rate for Payer: Health Smart Auto/Commercial	$417.22
Rate for Payer: LLUH Dept of Risk Management WC	$382.45
Rate for Payer: Multiplan Commercial	$521.52

ATEZOLIZUMAB 1,200 MG/20 ML (60 MG/ML) INTRAVENOUS SOLUTION [214353]

Facility

$695.36

Service Code	HCPCS J9022
Hospital Charge Code	901700025
Hospital Revenue Code	636
Min. Negotiated Rate	$382.45
Max. Negotiated Rate	$556.29
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$417.22
Rate for Payer: Aetna of CA Government/Medicare	$417.22
Rate for Payer: Cash Price	$382.45
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$556.29
Rate for Payer: Health Smart Auto/Commercial	$417.22
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$417.22
Rate for Payer: LLUH Dept of Risk Management WC	$382.45
Rate for Payer: Multiplan Commercial	$521.52

ATEZOLIZUMAB 840 MG/14 ML (60 MG/ML) INTRAVENOUS SOLUTION [224360]

Facility

$695.36

Service Code	HCPCS J9022
Hospital Charge Code	901700025
Hospital Revenue Code	636
Min. Negotiated Rate	$382.45
Max. Negotiated Rate	$556.29
Rate for Payer: Cash Price	$382.45
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$556.29
Rate for Payer: Health Smart Auto/Commercial	$417.22
Rate for Payer: LLUH Dept of Risk Management WC	$382.45
Rate for Payer: Multiplan Commercial	$521.52

ATEZOLIZUMAB 840 MG/14 ML (60 MG/ML) INTRAVENOUS SOLUTION [224360]

Facility

$695.36

Service Code	HCPCS J9022
Hospital Charge Code	901700025
Hospital Revenue Code	636
Min. Negotiated Rate	$382.45
Max. Negotiated Rate	$556.29
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$417.22
Rate for Payer: Aetna of CA Government/Medicare	$417.22
Rate for Payer: Cash Price	$382.45
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$556.29
Rate for Payer: Health Smart Auto/Commercial	$417.22
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$417.22
Rate for Payer: LLUH Dept of Risk Management WC	$382.45
Rate for Payer: Multiplan Commercial	$521.52

ATOMOXETINE 10 MG CAPSULE [34444]

Facility

$1.95

Service Code	NDC 64980-373-03
Hospital Charge Code	901700029
Hospital Revenue Code	259
Min. Negotiated Rate	$1.07
Max. Negotiated Rate	$1.56
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$1.17
Rate for Payer: Aetna of CA Government/Medicare	$1.17
Rate for Payer: Cash Price	$1.07
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$1.56
Rate for Payer: Health Smart Auto/Commercial	$1.17
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$1.17
Rate for Payer: LLUH Dept of Risk Management WC	$1.07
Rate for Payer: Multiplan Commercial	$1.46

ATOMOXETINE 10 MG CAPSULE [34444]

Facility

$4.44

Service Code	NDC 0093-3542-56
Hospital Charge Code	901700029
Hospital Revenue Code	259
Min. Negotiated Rate	$2.44
Max. Negotiated Rate	$3.55
Rate for Payer: Cash Price	$2.44
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$3.55
Rate for Payer: Health Smart Auto/Commercial	$2.66
Rate for Payer: LLUH Dept of Risk Management WC	$2.44
Rate for Payer: Multiplan Commercial	$3.33

ATOMOXETINE 10 MG CAPSULE [34444]

Facility

$1.95

Service Code	NDC 31722-714-30
Hospital Charge Code	901700029
Hospital Revenue Code	259
Min. Negotiated Rate	$1.07
Max. Negotiated Rate	$1.56
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$1.17
Rate for Payer: Aetna of CA Government/Medicare	$1.17
Rate for Payer: Cash Price	$1.07
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$1.56
Rate for Payer: Health Smart Auto/Commercial	$1.17
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$1.17
Rate for Payer: LLUH Dept of Risk Management WC	$1.07
Rate for Payer: Multiplan Commercial	$1.46

ATOMOXETINE 10 MG CAPSULE [34444]

Facility

$1.95

Service Code	NDC 55111-519-30
Hospital Charge Code	901700029
Hospital Revenue Code	259
Min. Negotiated Rate	$1.07
Max. Negotiated Rate	$1.56
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$1.17
Rate for Payer: Aetna of CA Government/Medicare	$1.17
Rate for Payer: Cash Price	$1.07
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$1.56
Rate for Payer: Health Smart Auto/Commercial	$1.17
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$1.17
Rate for Payer: LLUH Dept of Risk Management WC	$1.07
Rate for Payer: Multiplan Commercial	$1.46

ATOMOXETINE 10 MG CAPSULE [34444]

Facility

$1.95

Service Code	NDC 31722-714-30
Hospital Charge Code	901700029
Hospital Revenue Code	259
Min. Negotiated Rate	$1.07
Max. Negotiated Rate	$1.56
Rate for Payer: Cash Price	$1.07
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$1.56
Rate for Payer: Health Smart Auto/Commercial	$1.17
Rate for Payer: LLUH Dept of Risk Management WC	$1.07
Rate for Payer: Multiplan Commercial	$1.46

ATOMOXETINE 10 MG CAPSULE [34444]

Facility

$4.44

Service Code	NDC 0093-3542-56
Hospital Charge Code	901700029
Hospital Revenue Code	259
Min. Negotiated Rate	$2.44
Max. Negotiated Rate	$3.55
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$2.66
Rate for Payer: Aetna of CA Government/Medicare	$2.66
Rate for Payer: Cash Price	$2.44
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$3.55
Rate for Payer: Health Smart Auto/Commercial	$2.66
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$2.66
Rate for Payer: LLUH Dept of Risk Management WC	$2.44
Rate for Payer: Multiplan Commercial	$3.33

ATOMOXETINE 10 MG CAPSULE [34444]

Facility

$1.95

Service Code	NDC 55111-519-30
Hospital Charge Code	901700029
Hospital Revenue Code	259
Min. Negotiated Rate	$1.07
Max. Negotiated Rate	$1.56
Rate for Payer: Cash Price	$1.07
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$1.56
Rate for Payer: Health Smart Auto/Commercial	$1.17
Rate for Payer: LLUH Dept of Risk Management WC	$1.07
Rate for Payer: Multiplan Commercial	$1.46

ATOMOXETINE 10 MG CAPSULE [34444]

Facility

$1.95

Service Code	NDC 64980-373-03
Hospital Charge Code	901700029
Hospital Revenue Code	259
Min. Negotiated Rate	$1.07
Max. Negotiated Rate	$1.56
Rate for Payer: Cash Price	$1.07
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$1.56
Rate for Payer: Health Smart Auto/Commercial	$1.17
Rate for Payer: LLUH Dept of Risk Management WC	$1.07
Rate for Payer: Multiplan Commercial	$1.46

ATOMOXETINE 10 MG CAPSULE [34444]

Facility

$1.90

Service Code	NDC 68462-265-30
Hospital Charge Code	901700029
Hospital Revenue Code	259
Min. Negotiated Rate	$1.04
Max. Negotiated Rate	$1.52
Rate for Payer: Cash Price	$1.05
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$1.52
Rate for Payer: Health Smart Auto/Commercial	$1.14
Rate for Payer: LLUH Dept of Risk Management WC	$1.04
Rate for Payer: Multiplan Commercial	$1.43

Know your out-of-pocket cost for care.

All Charges