Loma Linda University Behavioral Medicine Center (BMC)

All Charges

Charge

Type

Setting

Price

ATORVASTATIN 80 MG TABLET [28645]

Facility

$0.19

Service Code	NDC 0378-3953-77
Hospital Charge Code	ERX28645
Hospital Revenue Code	259
Min. Negotiated Rate	$0.10
Max. Negotiated Rate	$0.15
Rate for Payer: Cash Price	$0.09
Rate for Payer: Cigna of CA HMO/PPO	$0.15
Rate for Payer: Health Smart Auto/Commercial	$0.11
Rate for Payer: LLUH Dept of Risk Management WC	$0.10
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$0.14

ATORVASTATIN 80 MG TABLET [28645]

Facility

$0.21

Service Code	NDC 63304-830-90
Hospital Charge Code	ERX28645
Hospital Revenue Code	259
Min. Negotiated Rate	$0.12
Max. Negotiated Rate	$0.16
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$0.13
Rate for Payer: Aetna of CA Government/Medicare	$0.13
Rate for Payer: Cash Price	$0.09
Rate for Payer: Health Smart Auto/Commercial	$0.13
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$0.13
Rate for Payer: LLUH Dept of Risk Management WC	$0.12
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$0.16

ATOVAQUONE 250 MG-PROGUANIL 100 MG TABLET [23814]

Facility

$8.24

Service Code	NDC 0173-0675-02
Hospital Charge Code	1711905
Hospital Revenue Code	259
Min. Negotiated Rate	$4.53
Max. Negotiated Rate	$6.18
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$4.94
Rate for Payer: Aetna of CA Government/Medicare	$4.94
Rate for Payer: Cash Price	$3.71
Rate for Payer: Health Smart Auto/Commercial	$4.94
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$4.94
Rate for Payer: LLUH Dept of Risk Management WC	$4.53
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$6.18

ATOVAQUONE 250 MG-PROGUANIL 100 MG TABLET [23814]

Facility

$8.24

Service Code	NDC 0173-0675-02
Hospital Charge Code	1711905
Hospital Revenue Code	259
Min. Negotiated Rate	$4.53
Max. Negotiated Rate	$6.59
Rate for Payer: Cash Price	$3.71
Rate for Payer: Cigna of CA HMO/PPO	$6.59
Rate for Payer: Health Smart Auto/Commercial	$4.94
Rate for Payer: LLUH Dept of Risk Management WC	$4.53
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$6.18

ATOVAQUONE 750 MG/5 ML ORAL SUSPENSION [14953]

Facility

$2.29

Service Code	NDC 70748-299-01
Hospital Charge Code	1715181
Hospital Revenue Code	259
Min. Negotiated Rate	$1.26
Max. Negotiated Rate	$1.83
Rate for Payer: Cash Price	$1.03
Rate for Payer: Cigna of CA HMO/PPO	$1.83
Rate for Payer: Health Smart Auto/Commercial	$1.37
Rate for Payer: LLUH Dept of Risk Management WC	$1.26
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$1.72

ATOVAQUONE 750 MG/5 ML ORAL SUSPENSION [14953]

Facility

$2.29

Service Code	NDC 68462-421-21
Hospital Charge Code	1715181
Hospital Revenue Code	259
Min. Negotiated Rate	$1.26
Max. Negotiated Rate	$1.83
Rate for Payer: Cash Price	$1.03
Rate for Payer: Cigna of CA HMO/PPO	$1.83
Rate for Payer: Health Smart Auto/Commercial	$1.37
Rate for Payer: LLUH Dept of Risk Management WC	$1.26
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$1.72

ATOVAQUONE 750 MG/5 ML ORAL SUSPENSION [14953]

Facility

$2.29

Service Code	NDC 70748-299-01
Hospital Charge Code	1715181
Hospital Revenue Code	259
Min. Negotiated Rate	$1.26
Max. Negotiated Rate	$1.72
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$1.37
Rate for Payer: Aetna of CA Government/Medicare	$1.37
Rate for Payer: Cash Price	$1.03
Rate for Payer: Health Smart Auto/Commercial	$1.37
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$1.37
Rate for Payer: LLUH Dept of Risk Management WC	$1.26
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$1.72

ATOVAQUONE 750 MG/5 ML ORAL SUSPENSION [14953]

Facility

$2.29

Service Code	NDC 68462-421-21
Hospital Charge Code	1715181
Hospital Revenue Code	259
Min. Negotiated Rate	$1.26
Max. Negotiated Rate	$1.72
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$1.37
Rate for Payer: Aetna of CA Government/Medicare	$1.37
Rate for Payer: Cash Price	$1.03
Rate for Payer: Health Smart Auto/Commercial	$1.37
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$1.37
Rate for Payer: LLUH Dept of Risk Management WC	$1.26
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$1.72

ATRACURIUM 10 MG/ML INTRAVENOUS SOLUTION [9168]

Facility

$1.92

Service Code	NDC 25021-659-05
Hospital Charge Code	1758684
Hospital Revenue Code	250
Min. Negotiated Rate	$1.06
Max. Negotiated Rate	$1.54
Rate for Payer: Cash Price	$0.86
Rate for Payer: Cigna of CA HMO/PPO	$1.54
Rate for Payer: Health Smart Auto/Commercial	$1.15
Rate for Payer: LLUH Dept of Risk Management WC	$1.06
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$1.44

ATRACURIUM 10 MG/ML INTRAVENOUS SOLUTION [9168]

Facility

$1.92

Service Code	NDC 25021-659-05
Hospital Charge Code	1758684
Hospital Revenue Code	250
Min. Negotiated Rate	$1.06
Max. Negotiated Rate	$1.44
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$1.15
Rate for Payer: Aetna of CA Government/Medicare	$1.15
Rate for Payer: Cash Price	$0.86
Rate for Payer: Health Smart Auto/Commercial	$1.15
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$1.15
Rate for Payer: LLUH Dept of Risk Management WC	$1.06
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$1.44

ATROPINE 0.1 MG/ML INJECTION SYRINGE [730]

Facility

$1.25

Service Code	CPT J0461
Hospital Charge Code	1721188
Hospital Revenue Code	636
Min. Negotiated Rate	$0.69
Max. Negotiated Rate	$1.00
Rate for Payer: Cash Price	$0.56
Rate for Payer: Cash Price	$0.49
Rate for Payer: Cash Price	$0.46
Rate for Payer: Cigna of CA HMO/PPO	$0.82
Rate for Payer: Cigna of CA HMO/PPO	$1.00
Rate for Payer: Cigna of CA HMO/PPO	$0.86
Rate for Payer: Health Smart Auto/Commercial	$0.75
Rate for Payer: Health Smart Auto/Commercial	$0.65
Rate for Payer: Health Smart Auto/Commercial	$0.61
Rate for Payer: LLUH Dept of Risk Management WC	$0.56
Rate for Payer: LLUH Dept of Risk Management WC	$0.69
Rate for Payer: LLUH Dept of Risk Management WC	$0.59
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$0.81
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$0.94
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$0.77

ATROPINE 0.1 MG/ML INJECTION SYRINGE [730]

Facility

$1.25

Service Code	CPT J0461
Hospital Charge Code	1721188
Hospital Revenue Code	636
Min. Negotiated Rate	$0.69
Max. Negotiated Rate	$0.94
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$0.75
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$0.65
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$0.61
Rate for Payer: Aetna of CA Government/Medicare	$0.61
Rate for Payer: Aetna of CA Government/Medicare	$0.65
Rate for Payer: Aetna of CA Government/Medicare	$0.75
Rate for Payer: Cash Price	$0.56
Rate for Payer: Cash Price	$0.49
Rate for Payer: Cash Price	$0.46
Rate for Payer: Health Smart Auto/Commercial	$0.61
Rate for Payer: Health Smart Auto/Commercial	$0.75
Rate for Payer: Health Smart Auto/Commercial	$0.65
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$0.75
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$0.65
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$0.61
Rate for Payer: LLUH Dept of Risk Management WC	$0.69
Rate for Payer: LLUH Dept of Risk Management WC	$0.56
Rate for Payer: LLUH Dept of Risk Management WC	$0.59
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$0.81
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$0.77
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$0.94

ATROPINE 0.4 MG/ML INJECTION SOLUTION [731]

Facility

$9.60

Service Code	CPT J0461
Hospital Charge Code	1721184
Hospital Revenue Code	636
Min. Negotiated Rate	$5.28
Max. Negotiated Rate	$7.68
Rate for Payer: Cash Price	$4.32
Rate for Payer: Cash Price	$0.95
Rate for Payer: Cigna of CA HMO/PPO	$1.69
Rate for Payer: Cigna of CA HMO/PPO	$7.68
Rate for Payer: Health Smart Auto/Commercial	$5.76
Rate for Payer: Health Smart Auto/Commercial	$1.27
Rate for Payer: LLUH Dept of Risk Management WC	$1.16
Rate for Payer: LLUH Dept of Risk Management WC	$5.28
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$1.58
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$7.20

ATROPINE 0.4 MG/ML INJECTION SOLUTION [731]

Facility

$9.60

Service Code	CPT J0461
Hospital Charge Code	1721184
Hospital Revenue Code	636
Min. Negotiated Rate	$5.28
Max. Negotiated Rate	$7.20
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$5.76
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$1.27
Rate for Payer: Aetna of CA Government/Medicare	$5.76
Rate for Payer: Aetna of CA Government/Medicare	$1.27
Rate for Payer: Cash Price	$0.95
Rate for Payer: Cash Price	$4.32
Rate for Payer: Health Smart Auto/Commercial	$5.76
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: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$5.76
Rate for Payer: LLUH Dept of Risk Management WC	$1.16
Rate for Payer: LLUH Dept of Risk Management WC	$5.28
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$7.20
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$1.58

ATROPINE 0.4 MG/ML INJECTION SOLUTION [731]

Facility

$2.11

Service Code	CPT J0461
Hospital Charge Code	1721186
Hospital Revenue Code	636
Min. Negotiated Rate	$1.16
Max. Negotiated Rate	$1.69
Rate for Payer: Cash Price	$0.95
Rate for Payer: Cigna of CA HMO/PPO	$1.69
Rate for Payer: Health Smart Auto/Commercial	$1.27
Rate for Payer: LLUH Dept of Risk Management WC	$1.16
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$1.58

ATROPINE 0.4 MG/ML INJECTION SOLUTION [731]

Facility

$2.11

Service Code	CPT J0461
Hospital Charge Code	1721186
Hospital Revenue Code	636
Min. Negotiated Rate	$1.16
Max. Negotiated Rate	$1.58
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	$1.16
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$1.58

ATROPINE 0.4 MG/ML INTRAVENOUS SOLUTION [230343]

Facility

$12.96

Service Code	CPT J0461
Hospital Charge Code	NDG230343
Hospital Revenue Code	636
Min. Negotiated Rate	$7.13
Max. Negotiated Rate	$10.37
Rate for Payer: Cash Price	$5.83
Rate for Payer: Cigna of CA HMO/PPO	$10.37
Rate for Payer: Health Smart Auto/Commercial	$7.78
Rate for Payer: LLUH Dept of Risk Management WC	$7.13
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$9.72

ATROPINE 0.4 MG/ML INTRAVENOUS SOLUTION [230343]

Facility

$12.96

Service Code	CPT J0461
Hospital Charge Code	NDG230343
Hospital Revenue Code	636
Min. Negotiated Rate	$7.13
Max. Negotiated Rate	$9.72
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$7.78
Rate for Payer: Aetna of CA Government/Medicare	$7.78
Rate for Payer: Cash Price	$5.83
Rate for Payer: Health Smart Auto/Commercial	$7.78
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$7.78
Rate for Payer: LLUH Dept of Risk Management WC	$7.13
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$9.72

ATROPINE 0.5 MG/5 ML OR 0.1 MG/1 ML SYRINGE - CODE [4080579]

Facility

$1.08

Service Code	CPT J0461
Hospital Charge Code	1721188
Hospital Revenue Code	636
Min. Negotiated Rate	$0.59
Max. Negotiated Rate	$0.86
Rate for Payer: Cash Price	$0.49
Rate for Payer: Cigna of CA HMO/PPO	$0.86
Rate for Payer: Health Smart Auto/Commercial	$0.65
Rate for Payer: LLUH Dept of Risk Management WC	$0.59
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$0.81

ATROPINE 0.5 MG/5 ML OR 0.1 MG/1 ML SYRINGE - CODE [4080579]

Facility

$3.20

Service Code	CPT J0461
Hospital Charge Code	1721187
Hospital Revenue Code	636
Min. Negotiated Rate	$1.76
Max. Negotiated Rate	$2.40
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$1.92
Rate for Payer: Aetna of CA Government/Medicare	$1.92
Rate for Payer: Cash Price	$1.44
Rate for Payer: Health Smart Auto/Commercial	$1.92
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$1.92
Rate for Payer: LLUH Dept of Risk Management WC	$1.76
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$2.40

ATROPINE 0.5 MG/5 ML OR 0.1 MG/1 ML SYRINGE - CODE [4080579]

Facility

$1.08

Service Code	CPT J0461
Hospital Charge Code	1721188
Hospital Revenue Code	636
Min. Negotiated Rate	$0.59
Max. Negotiated Rate	$0.81
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$0.65
Rate for Payer: Aetna of CA Government/Medicare	$0.65
Rate for Payer: Cash Price	$0.49
Rate for Payer: Health Smart Auto/Commercial	$0.65
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$0.65
Rate for Payer: LLUH Dept of Risk Management WC	$0.59
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$0.81

ATROPINE 0.5 MG/5 ML OR 0.1 MG/1 ML SYRINGE - CODE [4080579]

Facility

$3.20

Service Code	CPT J0461
Hospital Charge Code	1721187
Hospital Revenue Code	636
Min. Negotiated Rate	$1.76
Max. Negotiated Rate	$2.56
Rate for Payer: Cash Price	$1.44
Rate for Payer: Cigna of CA HMO/PPO	$2.56
Rate for Payer: Health Smart Auto/Commercial	$1.92
Rate for Payer: LLUH Dept of Risk Management WC	$1.76
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$2.40

ATROPINE 1 % EYE DROPS < 2 ML (PROCEDURAL) [408736]

Facility

$10.56

Service Code	NDC 17478-215-15
Hospital Charge Code	NDG736
Hospital Revenue Code	259
Min. Negotiated Rate	$5.81
Max. Negotiated Rate	$7.92
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$6.34
Rate for Payer: Aetna of CA Government/Medicare	$6.34
Rate for Payer: Cash Price	$4.75
Rate for Payer: Health Smart Auto/Commercial	$6.34
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$6.34
Rate for Payer: LLUH Dept of Risk Management WC	$5.81
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$7.92

ATROPINE 1 % EYE DROPS < 2 ML (PROCEDURAL) [408736]

Facility

$13.03

Service Code	NDC 0065-0817-01
Hospital Charge Code	1740156
Hospital Revenue Code	259
Min. Negotiated Rate	$7.17
Max. Negotiated Rate	$10.42
Rate for Payer: Cash Price	$5.86
Rate for Payer: Cigna of CA HMO/PPO	$10.42
Rate for Payer: Health Smart Auto/Commercial	$7.82
Rate for Payer: LLUH Dept of Risk Management WC	$7.17
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$9.77

ATROPINE 1 % EYE DROPS < 2 ML (PROCEDURAL) [408736]

Facility

$13.03

Service Code	NDC 0065-0817-01
Hospital Charge Code	1740156
Hospital Revenue Code	259
Min. Negotiated Rate	$7.17
Max. Negotiated Rate	$9.77
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$7.82
Rate for Payer: Aetna of CA Government/Medicare	$7.82
Rate for Payer: Cash Price	$5.86
Rate for Payer: Health Smart Auto/Commercial	$7.82
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$7.82
Rate for Payer: LLUH Dept of Risk Management WC	$7.17
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$9.77

Know your out-of-pocket cost for care.

All Charges