Loma Linda University Behavioral Medicine Center (BMC)

All Charges

Charge

Type

Setting

Price

IPRATROPIUM BROMIDE 0.02 % SOLUTION FOR INHALATION [12580]

Facility

$0.15

Service Code	NDC 76204-100-30
Hospital Charge Code	901700029
Hospital Revenue Code	259
Min. Negotiated Rate	$0.08
Max. Negotiated Rate	$0.12
Rate for Payer: Cash Price	$0.08
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO 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 Commercial	$0.11

IPRATROPIUM BROMIDE 0.02 % SOLUTION FOR INHALATION [12580]

Facility

$0.15

Service Code	NDC 76204-100-30
Hospital Charge Code	901700029
Hospital Revenue Code	259
Min. Negotiated Rate	$0.08
Max. Negotiated Rate	$0.12
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$0.09
Rate for Payer: Aetna of CA Government/Medicare	$0.09
Rate for Payer: Cash Price	$0.08
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$0.12
Rate for Payer: Health Smart Auto/Commercial	$0.09
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$0.09
Rate for Payer: LLUH Dept of Risk Management WC	$0.08
Rate for Payer: Multiplan Commercial	$0.11

IPRATROPIUM BROMIDE 0.02 % SOLUTION FOR INHALATION [12580]

Facility

$0.14

Service Code	NDC 0487-9801-01
Hospital Charge Code	901700029
Hospital Revenue Code	259
Min. Negotiated Rate	$0.08
Max. Negotiated Rate	$0.11
Rate for Payer: Cash Price	$0.08
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$0.11
Rate for Payer: Health Smart Auto/Commercial	$0.08
Rate for Payer: LLUH Dept of Risk Management WC	$0.08
Rate for Payer: Multiplan Commercial	$0.11

IPRATROPIUM BROMIDE 0.02 % SOLUTION FOR INHALATION [12580]

Facility

$0.14

Service Code	NDC 60687-394-79
Hospital Charge Code	901700029
Hospital Revenue Code	259
Min. Negotiated Rate	$0.08
Max. Negotiated Rate	$0.11
Rate for Payer: Cash Price	$0.08
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$0.11
Rate for Payer: Health Smart Auto/Commercial	$0.08
Rate for Payer: LLUH Dept of Risk Management WC	$0.08
Rate for Payer: Multiplan Commercial	$0.11

IPRATROPIUM BROMIDE 0.02 % SOLUTION FOR INHALATION [12580]

Facility

$0.14

Service Code	NDC 60687-394-79
Hospital Charge Code	901700029
Hospital Revenue Code	259
Min. Negotiated Rate	$0.08
Max. Negotiated Rate	$0.11
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$0.08
Rate for Payer: Aetna of CA Government/Medicare	$0.08
Rate for Payer: Cash Price	$0.08
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$0.11
Rate for Payer: Health Smart Auto/Commercial	$0.08
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$0.08
Rate for Payer: LLUH Dept of Risk Management WC	$0.08
Rate for Payer: Multiplan Commercial	$0.11

IPRATROPIUM BROMIDE 0.02 % SOLUTION FOR INHALATION [12580]

Facility

$0.14

Service Code	NDC 60687-394-83
Hospital Charge Code	901700029
Hospital Revenue Code	259
Min. Negotiated Rate	$0.08
Max. Negotiated Rate	$0.11
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$0.08
Rate for Payer: Aetna of CA Government/Medicare	$0.08
Rate for Payer: Cash Price	$0.08
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$0.11
Rate for Payer: Health Smart Auto/Commercial	$0.08
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$0.08
Rate for Payer: LLUH Dept of Risk Management WC	$0.08
Rate for Payer: Multiplan Commercial	$0.11

IPRATROPIUM BROMIDE 0.02 % SOLUTION FOR INHALATION [12580]

Facility

$0.14

Service Code	NDC 0487-9801-01
Hospital Charge Code	901700029
Hospital Revenue Code	259
Min. Negotiated Rate	$0.08
Max. Negotiated Rate	$0.11
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$0.08
Rate for Payer: Aetna of CA Government/Medicare	$0.08
Rate for Payer: Cash Price	$0.08
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$0.11
Rate for Payer: Health Smart Auto/Commercial	$0.08
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$0.08
Rate for Payer: LLUH Dept of Risk Management WC	$0.08
Rate for Payer: Multiplan Commercial	$0.11

IPRATROPIUM BROMIDE 0.02 % SOLUTION FOR INHALATION [12580]

Facility

$0.14

Service Code	NDC 60687-394-83
Hospital Charge Code	901700029
Hospital Revenue Code	259
Min. Negotiated Rate	$0.08
Max. Negotiated Rate	$0.11
Rate for Payer: Cash Price	$0.08
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$0.11
Rate for Payer: Health Smart Auto/Commercial	$0.08
Rate for Payer: LLUH Dept of Risk Management WC	$0.08
Rate for Payer: Multiplan Commercial	$0.11

IPRATROPIUM BROMIDE 17 MCG/ACTUATION HFA AEROSOL INHALER [41142]

Facility

$28.54

Service Code	NDC 0597-0087-17
Hospital Charge Code	901700029
Hospital Revenue Code	259
Min. Negotiated Rate	$15.70
Max. Negotiated Rate	$22.83
Rate for Payer: Cash Price	$15.70
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$22.83
Rate for Payer: Health Smart Auto/Commercial	$17.12
Rate for Payer: LLUH Dept of Risk Management WC	$15.70
Rate for Payer: Multiplan Commercial	$21.41

IPRATROPIUM BROMIDE 17 MCG/ACTUATION HFA AEROSOL INHALER [41142]

Facility

$28.54

Service Code	NDC 0597-0087-17
Hospital Charge Code	901700029
Hospital Revenue Code	259
Min. Negotiated Rate	$15.70
Max. Negotiated Rate	$22.83
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$17.12
Rate for Payer: Aetna of CA Government/Medicare	$17.12
Rate for Payer: Cash Price	$15.70
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$22.83
Rate for Payer: Health Smart Auto/Commercial	$17.12
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$17.12
Rate for Payer: LLUH Dept of Risk Management WC	$15.70
Rate for Payer: Multiplan Commercial	$21.41

IPRATROPIUM BROMIDE 21 MCG (0.03 %) NASAL SPRAY [16070]

Facility

$1.46

Service Code	NDC 24208-398-30
Hospital Charge Code	901700029
Hospital Revenue Code	259
Min. Negotiated Rate	$0.80
Max. Negotiated Rate	$1.17
Rate for Payer: Cash Price	$0.80
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$1.17
Rate for Payer: Health Smart Auto/Commercial	$0.88
Rate for Payer: LLUH Dept of Risk Management WC	$0.80
Rate for Payer: Multiplan Commercial	$1.09

IPRATROPIUM BROMIDE 21 MCG (0.03 %) NASAL SPRAY [16070]

Facility

$1.44

Service Code	NDC 0054-0045-44
Hospital Charge Code	901700029
Hospital Revenue Code	259
Min. Negotiated Rate	$0.79
Max. Negotiated Rate	$1.15
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$0.86
Rate for Payer: Aetna of CA Government/Medicare	$0.86
Rate for Payer: Cash Price	$0.79
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$1.15
Rate for Payer: Health Smart Auto/Commercial	$0.86
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$0.86
Rate for Payer: LLUH Dept of Risk Management WC	$0.79
Rate for Payer: Multiplan Commercial	$1.08

IPRATROPIUM BROMIDE 21 MCG (0.03 %) NASAL SPRAY [16070]

Facility

$1.44

Service Code	NDC 0054-0045-44
Hospital Charge Code	901700029
Hospital Revenue Code	259
Min. Negotiated Rate	$0.79
Max. Negotiated Rate	$1.15
Rate for Payer: Cash Price	$0.79
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$1.15
Rate for Payer: Health Smart Auto/Commercial	$0.86
Rate for Payer: LLUH Dept of Risk Management WC	$0.79
Rate for Payer: Multiplan Commercial	$1.08

IPRATROPIUM BROMIDE 21 MCG (0.03 %) NASAL SPRAY [16070]

Facility

$1.46

Service Code	NDC 24208-398-30
Hospital Charge Code	901700029
Hospital Revenue Code	259
Min. Negotiated Rate	$0.80
Max. Negotiated Rate	$1.17
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$0.88
Rate for Payer: Aetna of CA Government/Medicare	$0.88
Rate for Payer: Cash Price	$0.80
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$1.17
Rate for Payer: Health Smart Auto/Commercial	$0.88
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$0.88
Rate for Payer: LLUH Dept of Risk Management WC	$0.80
Rate for Payer: Multiplan Commercial	$1.09

IPRATROPIUM BROMIDE 42 MCG (0.06 %) NASAL SPRAY [16071]

Facility

$2.92

Service Code	NDC 24208-399-15
Hospital Charge Code	901700029
Hospital Revenue Code	259
Min. Negotiated Rate	$1.61
Max. Negotiated Rate	$2.34
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$1.75
Rate for Payer: Aetna of CA Government/Medicare	$1.75
Rate for Payer: Cash Price	$1.61
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$2.34
Rate for Payer: Health Smart Auto/Commercial	$1.75
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$1.75
Rate for Payer: LLUH Dept of Risk Management WC	$1.61
Rate for Payer: Multiplan Commercial	$2.19

IPRATROPIUM BROMIDE 42 MCG (0.06 %) NASAL SPRAY [16071]

Facility

$2.88

Service Code	NDC 0054-0046-41
Hospital Charge Code	901700029
Hospital Revenue Code	259
Min. Negotiated Rate	$1.58
Max. Negotiated Rate	$2.30
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$1.73
Rate for Payer: Aetna of CA Government/Medicare	$1.73
Rate for Payer: Cash Price	$1.58
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$2.30
Rate for Payer: Health Smart Auto/Commercial	$1.73
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$1.73
Rate for Payer: LLUH Dept of Risk Management WC	$1.58
Rate for Payer: Multiplan Commercial	$2.16

IPRATROPIUM BROMIDE 42 MCG (0.06 %) NASAL SPRAY [16071]

Facility

$2.88

Service Code	NDC 0054-0046-41
Hospital Charge Code	901700029
Hospital Revenue Code	259
Min. Negotiated Rate	$1.58
Max. Negotiated Rate	$2.30
Rate for Payer: Cash Price	$1.58
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$2.30
Rate for Payer: Health Smart Auto/Commercial	$1.73
Rate for Payer: LLUH Dept of Risk Management WC	$1.58
Rate for Payer: Multiplan Commercial	$2.16

IPRATROPIUM BROMIDE 42 MCG (0.06 %) NASAL SPRAY [16071]

Facility

$2.92

Service Code	NDC 24208-399-15
Hospital Charge Code	901700029
Hospital Revenue Code	259
Min. Negotiated Rate	$1.61
Max. Negotiated Rate	$2.34
Rate for Payer: Cash Price	$1.61
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$2.34
Rate for Payer: Health Smart Auto/Commercial	$1.75
Rate for Payer: LLUH Dept of Risk Management WC	$1.61
Rate for Payer: Multiplan Commercial	$2.19

IRBESARTAN 75 MG TABLET [21847]

Facility

$0.25

Service Code	NDC 33342-047-10
Hospital Charge Code	901700029
Hospital Revenue Code	259
Min. Negotiated Rate	$0.14
Max. Negotiated Rate	$0.20
Rate for Payer: Cash Price	$0.14
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$0.20
Rate for Payer: Health Smart Auto/Commercial	$0.15
Rate for Payer: LLUH Dept of Risk Management WC	$0.14
Rate for Payer: Multiplan Commercial	$0.19

IRBESARTAN 75 MG TABLET [21847]

Facility

$0.25

Service Code	NDC 33342-047-10
Hospital Charge Code	901700029
Hospital Revenue Code	259
Min. Negotiated Rate	$0.14
Max. Negotiated Rate	$0.20
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$0.15
Rate for Payer: Aetna of CA Government/Medicare	$0.15
Rate for Payer: Cash Price	$0.14
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$0.20
Rate for Payer: Health Smart Auto/Commercial	$0.15
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$0.15
Rate for Payer: LLUH Dept of Risk Management WC	$0.14
Rate for Payer: Multiplan Commercial	$0.19

IRINOTECAN 100 MG/5 ML INTRAVENOUS SOLUTION [91054]

Facility

$4.32

Service Code	HCPCS J9206
Hospital Charge Code	901700025
Hospital Revenue Code	636
Min. Negotiated Rate	$2.38
Max. Negotiated Rate	$3.46
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$2.59
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$2.16
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$4.90
Rate for Payer: Aetna of CA Government/Medicare	$2.16
Rate for Payer: Aetna of CA Government/Medicare	$4.90
Rate for Payer: Aetna of CA Government/Medicare	$2.59
Rate for Payer: Cash Price	$4.49
Rate for Payer: Cash Price	$1.98
Rate for Payer: Cash Price	$2.38
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$2.88
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$3.46
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$6.53
Rate for Payer: Health Smart Auto/Commercial	$4.90
Rate for Payer: Health Smart Auto/Commercial	$2.59
Rate for Payer: Health Smart Auto/Commercial	$2.16
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$4.90
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$2.16
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$2.59
Rate for Payer: LLUH Dept of Risk Management WC	$2.38
Rate for Payer: LLUH Dept of Risk Management WC	$1.98
Rate for Payer: LLUH Dept of Risk Management WC	$4.49
Rate for Payer: Multiplan Commercial	$2.70
Rate for Payer: Multiplan Commercial	$6.12
Rate for Payer: Multiplan Commercial	$3.24

IRINOTECAN 100 MG/5 ML INTRAVENOUS SOLUTION [91054]

Facility

$3.60

Service Code	HCPCS J9206
Hospital Charge Code	901700025
Hospital Revenue Code	636
Min. Negotiated Rate	$1.98
Max. Negotiated Rate	$2.88
Rate for Payer: Cash Price	$1.98
Rate for Payer: Cash Price	$2.38
Rate for Payer: Cash Price	$4.49
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$6.53
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$2.88
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$3.46
Rate for Payer: Health Smart Auto/Commercial	$2.16
Rate for Payer: Health Smart Auto/Commercial	$2.59
Rate for Payer: Health Smart Auto/Commercial	$4.90
Rate for Payer: LLUH Dept of Risk Management WC	$1.98
Rate for Payer: LLUH Dept of Risk Management WC	$2.38
Rate for Payer: LLUH Dept of Risk Management WC	$4.49
Rate for Payer: Multiplan Commercial	$2.70
Rate for Payer: Multiplan Commercial	$6.12
Rate for Payer: Multiplan Commercial	$3.24

IRINOTECAN 500 MG/25 ML INTRAVENOUS SOLUTION [94341]

Facility

$7.73

Service Code	HCPCS J9206
Hospital Charge Code	901700025
Hospital Revenue Code	636
Min. Negotiated Rate	$4.25
Max. Negotiated Rate	$6.18
Rate for Payer: Cash Price	$4.25
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$6.18
Rate for Payer: Health Smart Auto/Commercial	$4.64
Rate for Payer: LLUH Dept of Risk Management WC	$4.25
Rate for Payer: Multiplan Commercial	$5.80

IRINOTECAN 500 MG/25 ML INTRAVENOUS SOLUTION [94341]

Facility

$7.73

Service Code	HCPCS J9206
Hospital Charge Code	901700025
Hospital Revenue Code	636
Min. Negotiated Rate	$4.25
Max. Negotiated Rate	$6.18
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$4.64
Rate for Payer: Aetna of CA Government/Medicare	$4.64
Rate for Payer: Cash Price	$4.25
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$6.18
Rate for Payer: Health Smart Auto/Commercial	$4.64
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$4.64
Rate for Payer: LLUH Dept of Risk Management WC	$4.25
Rate for Payer: Multiplan Commercial	$5.80

IRINOTECAN LIPOSOMAL 4.3 MG/ML INTRAVENOUS [211718]

Facility

$357.48

Service Code	HCPCS J9205
Hospital Charge Code	901700025
Hospital Revenue Code	636
Min. Negotiated Rate	$196.61
Max. Negotiated Rate	$285.98
Rate for Payer: Cash Price	$196.61
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$285.98
Rate for Payer: Health Smart Auto/Commercial	$214.49
Rate for Payer: LLUH Dept of Risk Management WC	$196.61
Rate for Payer: Multiplan Commercial	$268.11

Know your out-of-pocket cost for care.

All Charges