Loma Linda University Behavioral Medicine Center (BMC)

All Charges

Charge

Type

Setting

Price

ATOMOXETINE 10 MG CAPSULE [34444]

Facility

$1.95

Service Code	NDC 55111-519-30
Hospital Charge Code	1711821
Hospital Revenue Code	259
Min. Negotiated Rate	$1.07
Max. Negotiated Rate	$1.56
Rate for Payer: Cash Price	$0.88
Rate for Payer: Cigna of CA 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 Beech St/Commercial/PHCS	$1.46

ATOMOXETINE 10 MG CAPSULE [34444]

Facility

$1.90

Service Code	NDC 68462-265-30
Hospital Charge Code	1711821
Hospital Revenue Code	259
Min. Negotiated Rate	$1.04
Max. Negotiated Rate	$1.52
Rate for Payer: Cash Price	$0.86
Rate for Payer: Cigna of CA 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 Beech St/Commercial/PHCS	$1.42

ATOMOXETINE 10 MG CAPSULE [34444]

Facility

$4.44

Service Code	NDC 0093-3542-56
Hospital Charge Code	1711821
Hospital Revenue Code	259
Min. Negotiated Rate	$2.44
Max. Negotiated Rate	$3.55
Rate for Payer: Cash Price	$2.00
Rate for Payer: Cigna of CA 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 Beech St/Commercial/PHCS	$3.33

ATOMOXETINE 10 MG CAPSULE [34444]

Facility

$1.95

Service Code	NDC 55111-519-30
Hospital Charge Code	1711821
Hospital Revenue Code	259
Min. Negotiated Rate	$1.07
Max. Negotiated Rate	$1.46
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	$0.88
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 Beech St/Commercial/PHCS	$1.46

ATOMOXETINE 10 MG CAPSULE [34444]

Facility

$2.20

Service Code	NDC 31722-714-30
Hospital Charge Code	1711821
Hospital Revenue Code	259
Min. Negotiated Rate	$1.21
Max. Negotiated Rate	$1.76
Rate for Payer: Cash Price	$0.99
Rate for Payer: Cigna of CA HMO/PPO	$1.76
Rate for Payer: Health Smart Auto/Commercial	$1.32
Rate for Payer: LLUH Dept of Risk Management WC	$1.21
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$1.65

ATOMOXETINE 18 MG CAPSULE [34445]

Facility

$15.82

Service Code	NDC 0002-3238-30
Hospital Charge Code	1711822
Hospital Revenue Code	259
Min. Negotiated Rate	$8.70
Max. Negotiated Rate	$12.66
Rate for Payer: Cash Price	$7.12
Rate for Payer: Cigna of CA HMO/PPO	$12.66
Rate for Payer: Health Smart Auto/Commercial	$9.49
Rate for Payer: LLUH Dept of Risk Management WC	$8.70
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$11.86

ATOMOXETINE 18 MG CAPSULE [34445]

Facility

$15.82

Service Code	NDC 0002-3238-30
Hospital Charge Code	1711822
Hospital Revenue Code	259
Min. Negotiated Rate	$8.70
Max. Negotiated Rate	$11.86
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$9.49
Rate for Payer: Aetna of CA Government/Medicare	$9.49
Rate for Payer: Cash Price	$7.12
Rate for Payer: Health Smart Auto/Commercial	$9.49
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$9.49
Rate for Payer: LLUH Dept of Risk Management WC	$8.70
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$11.86

ATOMOXETINE 25 MG CAPSULE [34446]

Facility

$4.40

Service Code	NDC 60687-567-21
Hospital Charge Code	1711823
Hospital Revenue Code	259
Min. Negotiated Rate	$2.42
Max. Negotiated Rate	$3.30
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$2.64
Rate for Payer: Aetna of CA Government/Medicare	$2.64
Rate for Payer: Cash Price	$1.98
Rate for Payer: Health Smart Auto/Commercial	$2.64
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$2.64
Rate for Payer: LLUH Dept of Risk Management WC	$2.42
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$3.30

ATOMOXETINE 25 MG CAPSULE [34446]

Facility

$4.40

Service Code	NDC 60687-567-21
Hospital Charge Code	1711823
Hospital Revenue Code	259
Min. Negotiated Rate	$2.42
Max. Negotiated Rate	$3.52
Rate for Payer: Cash Price	$1.98
Rate for Payer: Cigna of CA HMO/PPO	$3.52
Rate for Payer: Health Smart Auto/Commercial	$2.64
Rate for Payer: LLUH Dept of Risk Management WC	$2.42
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$3.30

ATOMOXETINE 25 MG CAPSULE [34446]

Facility

$4.40

Service Code	NDC 60687-567-11
Hospital Charge Code	1711823
Hospital Revenue Code	259
Min. Negotiated Rate	$2.42
Max. Negotiated Rate	$3.52
Rate for Payer: Cash Price	$1.98
Rate for Payer: Cigna of CA HMO/PPO	$3.52
Rate for Payer: Health Smart Auto/Commercial	$2.64
Rate for Payer: LLUH Dept of Risk Management WC	$2.42
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$3.30

ATOMOXETINE 25 MG CAPSULE [34446]

Facility

$4.40

Service Code	NDC 60687-567-11
Hospital Charge Code	1711823
Hospital Revenue Code	259
Min. Negotiated Rate	$2.42
Max. Negotiated Rate	$3.30
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$2.64
Rate for Payer: Aetna of CA Government/Medicare	$2.64
Rate for Payer: Cash Price	$1.98
Rate for Payer: Health Smart Auto/Commercial	$2.64
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$2.64
Rate for Payer: LLUH Dept of Risk Management WC	$2.42
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$3.30

ATOMOXETINE 40 MG CAPSULE [34447]

Facility

$7.59

Service Code	NDC 60687-326-95
Hospital Charge Code	1711824
Hospital Revenue Code	259
Min. Negotiated Rate	$4.17
Max. Negotiated Rate	$5.69
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$4.55
Rate for Payer: Aetna of CA Government/Medicare	$4.55
Rate for Payer: Cash Price	$3.42
Rate for Payer: Health Smart Auto/Commercial	$4.55
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$4.55
Rate for Payer: LLUH Dept of Risk Management WC	$4.17
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$5.69

ATOMOXETINE 40 MG CAPSULE [34447]

Facility

$7.59

Service Code	NDC 60687-326-25
Hospital Charge Code	1711824
Hospital Revenue Code	259
Min. Negotiated Rate	$4.17
Max. Negotiated Rate	$5.69
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$4.55
Rate for Payer: Aetna of CA Government/Medicare	$4.55
Rate for Payer: Cash Price	$3.42
Rate for Payer: Health Smart Auto/Commercial	$4.55
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$4.55
Rate for Payer: LLUH Dept of Risk Management WC	$4.17
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$5.69

ATOMOXETINE 40 MG CAPSULE [34447]

Facility

$17.18

Service Code	NDC 0002-3229-30
Hospital Charge Code	1711824
Hospital Revenue Code	259
Min. Negotiated Rate	$9.45
Max. Negotiated Rate	$12.88
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$10.31
Rate for Payer: Aetna of CA Government/Medicare	$10.31
Rate for Payer: Cash Price	$7.73
Rate for Payer: Health Smart Auto/Commercial	$10.31
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$10.31
Rate for Payer: LLUH Dept of Risk Management WC	$9.45
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$12.88

ATOMOXETINE 40 MG CAPSULE [34447]

Facility

$7.59

Service Code	NDC 60687-326-25
Hospital Charge Code	1711824
Hospital Revenue Code	259
Min. Negotiated Rate	$4.17
Max. Negotiated Rate	$6.07
Rate for Payer: Cash Price	$3.42
Rate for Payer: Cigna of CA HMO/PPO	$6.07
Rate for Payer: Health Smart Auto/Commercial	$4.55
Rate for Payer: LLUH Dept of Risk Management WC	$4.17
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$5.69

ATOMOXETINE 40 MG CAPSULE [34447]

Facility

$4.83

Service Code	NDC 35573-418-30
Hospital Charge Code	1711824
Hospital Revenue Code	259
Min. Negotiated Rate	$2.66
Max. Negotiated Rate	$3.62
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$2.90
Rate for Payer: Aetna of CA Government/Medicare	$2.90
Rate for Payer: Cash Price	$2.17
Rate for Payer: Health Smart Auto/Commercial	$2.90
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$2.90
Rate for Payer: LLUH Dept of Risk Management WC	$2.66
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$3.62

ATOMOXETINE 40 MG CAPSULE [34447]

Facility

$17.18

Service Code	NDC 0002-3229-30
Hospital Charge Code	1711824
Hospital Revenue Code	259
Min. Negotiated Rate	$9.45
Max. Negotiated Rate	$13.74
Rate for Payer: Cash Price	$7.73
Rate for Payer: Cigna of CA HMO/PPO	$13.74
Rate for Payer: Health Smart Auto/Commercial	$10.31
Rate for Payer: LLUH Dept of Risk Management WC	$9.45
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$12.88

ATOMOXETINE 40 MG CAPSULE [34447]

Facility

$2.12

Service Code	NDC 64980-376-03
Hospital Charge Code	1711824
Hospital Revenue Code	259
Min. Negotiated Rate	$1.17
Max. Negotiated Rate	$1.59
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$1.27
Rate for Payer: Aetna of CA Government/Medicare	$1.27
Rate for Payer: Cash Price	$0.95
Rate for Payer: Health Smart Auto/Commercial	$1.27
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$1.27
Rate for Payer: LLUH Dept of Risk Management WC	$1.17
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$1.59

ATOMOXETINE 40 MG CAPSULE [34447]

Facility

$4.83

Service Code	NDC 35573-418-30
Hospital Charge Code	1711824
Hospital Revenue Code	259
Min. Negotiated Rate	$2.66
Max. Negotiated Rate	$3.86
Rate for Payer: Cash Price	$2.17
Rate for Payer: Cigna of CA HMO/PPO	$3.86
Rate for Payer: Health Smart Auto/Commercial	$2.90
Rate for Payer: LLUH Dept of Risk Management WC	$2.66
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$3.62

ATOMOXETINE 40 MG CAPSULE [34447]

Facility

$7.59

Service Code	NDC 60687-326-95
Hospital Charge Code	1711824
Hospital Revenue Code	259
Min. Negotiated Rate	$4.17
Max. Negotiated Rate	$6.07
Rate for Payer: Cash Price	$3.42
Rate for Payer: Cigna of CA HMO/PPO	$6.07
Rate for Payer: Health Smart Auto/Commercial	$4.55
Rate for Payer: LLUH Dept of Risk Management WC	$4.17
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$5.69

ATOMOXETINE 40 MG CAPSULE [34447]

Facility

$2.12

Service Code	NDC 64980-376-03
Hospital Charge Code	1711824
Hospital Revenue Code	259
Min. Negotiated Rate	$1.17
Max. Negotiated Rate	$1.70
Rate for Payer: Cash Price	$0.95
Rate for Payer: Cigna of CA HMO/PPO	$1.70
Rate for Payer: Health Smart Auto/Commercial	$1.27
Rate for Payer: LLUH Dept of Risk Management WC	$1.17
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$1.59

ATORVASTATIN 10 MG TABLET [19176]

Facility

$0.44

Service Code	NDC 68084-097-11
Hospital Charge Code	1711689
Hospital Revenue Code	259
Min. Negotiated Rate	$0.24
Max. Negotiated Rate	$0.35
Rate for Payer: Cash Price	$0.20
Rate for Payer: Cigna of CA HMO/PPO	$0.35
Rate for Payer: Health Smart Auto/Commercial	$0.26
Rate for Payer: LLUH Dept of Risk Management WC	$0.24
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$0.33

ATORVASTATIN 10 MG TABLET [19176]

Facility

$0.20

Service Code	NDC 60505-2578-9
Hospital Charge Code	1711689
Hospital Revenue Code	259
Min. Negotiated Rate	$0.11
Max. Negotiated Rate	$0.16
Rate for Payer: Cash Price	$0.09
Rate for Payer: Cigna of CA HMO/PPO	$0.16
Rate for Payer: Health Smart Auto/Commercial	$0.12
Rate for Payer: LLUH Dept of Risk Management WC	$0.11
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$0.15

ATORVASTATIN 10 MG TABLET [19176]

Facility

$0.44

Service Code	NDC 68084-097-01
Hospital Charge Code	1711689
Hospital Revenue Code	259
Min. Negotiated Rate	$0.24
Max. Negotiated Rate	$0.33
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$0.26
Rate for Payer: Aetna of CA Government/Medicare	$0.26
Rate for Payer: Cash Price	$0.20
Rate for Payer: Health Smart Auto/Commercial	$0.26
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$0.26
Rate for Payer: LLUH Dept of Risk Management WC	$0.24
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$0.33

ATORVASTATIN 10 MG TABLET [19176]

Facility

$0.15

Service Code	NDC 63304-827-90
Hospital Charge Code	1711689
Hospital Revenue Code	259
Min. Negotiated Rate	$0.08
Max. Negotiated Rate	$0.12
Rate for Payer: Cash Price	$0.07
Rate for Payer: Cigna of CA HMO/PPO	$0.12
Rate for Payer: Health Smart Auto/Commercial	$0.09
Rate for Payer: LLUH Dept of Risk Management WC	$0.08
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$0.11

Know your out-of-pocket cost for care.

All Charges