Loma Linda University Behavioral Medicine Center (BMC)

All Charges

Charge

Type

Setting

Price

HEPARIN 1000 UNIT/ML INJECTION SOLUTION. [408117968]

Facility

$6.24

Service Code	CPT J1644
Hospital Charge Code	NDG117968
Hospital Revenue Code	636
Min. Negotiated Rate	$3.43
Max. Negotiated Rate	$4.68
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$3.74
Rate for Payer: Aetna of CA Government/Medicare	$3.74
Rate for Payer: Cash Price	$2.81
Rate for Payer: Health Smart Auto/Commercial	$3.74
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$3.74
Rate for Payer: LLUH Dept of Risk Management WC	$3.43
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$4.68

HEPARIN 1000 UNIT/ML INJECTION SOLUTION. [408117968]

Facility

$2.88

Service Code	CPT J1644
Hospital Charge Code	1720392
Hospital Revenue Code	636
Min. Negotiated Rate	$1.58
Max. Negotiated Rate	$2.16
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$1.73
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$2.06
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$1.34
Rate for Payer: Aetna of CA Government/Medicare	$2.06
Rate for Payer: Aetna of CA Government/Medicare	$1.34
Rate for Payer: Aetna of CA Government/Medicare	$1.73
Rate for Payer: Cash Price	$1.00
Rate for Payer: Cash Price	$1.55
Rate for Payer: Cash Price	$1.30
Rate for Payer: Health Smart Auto/Commercial	$2.06
Rate for Payer: Health Smart Auto/Commercial	$1.73
Rate for Payer: Health Smart Auto/Commercial	$1.34
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$1.73
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$2.06
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$1.34
Rate for Payer: LLUH Dept of Risk Management WC	$1.23
Rate for Payer: LLUH Dept of Risk Management WC	$1.89
Rate for Payer: LLUH Dept of Risk Management WC	$1.58
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$1.67
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$2.16
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$2.58

HEPARIN 1000 UNIT/ML INJECTION SOLUTION. [408117968]

Facility

$0.31

Service Code	CPT J1644
Hospital Charge Code	NDC4081749
Hospital Revenue Code	636
Min. Negotiated Rate	$0.17
Max. Negotiated Rate	$0.25
Rate for Payer: Cash Price	$0.14
Rate for Payer: Cigna of CA HMO/PPO	$0.25
Rate for Payer: Health Smart Auto/Commercial	$0.19
Rate for Payer: LLUH Dept of Risk Management WC	$0.17
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$0.23

HEPARIN 1000 UNIT/ML INJECTION SOLUTION. [408117968]

Facility

$0.27

Service Code	CPT J1644
Hospital Charge Code	1759630
Hospital Revenue Code	636
Min. Negotiated Rate	$0.15
Max. Negotiated Rate	$0.20
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$0.16
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$0.19
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$0.17
Rate for Payer: Aetna of CA Government/Medicare	$0.19
Rate for Payer: Aetna of CA Government/Medicare	$0.17
Rate for Payer: Aetna of CA Government/Medicare	$0.16
Rate for Payer: Cash Price	$0.13
Rate for Payer: Cash Price	$0.14
Rate for Payer: Cash Price	$0.12
Rate for Payer: Health Smart Auto/Commercial	$0.19
Rate for Payer: Health Smart Auto/Commercial	$0.16
Rate for Payer: Health Smart Auto/Commercial	$0.17
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$0.17
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$0.19
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$0.16
Rate for Payer: LLUH Dept of Risk Management WC	$0.15
Rate for Payer: LLUH Dept of Risk Management WC	$0.17
Rate for Payer: LLUH Dept of Risk Management WC	$0.15
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$0.21
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$0.20
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$0.23

HEPARIN 1000 UNIT/ML INJECTION SOLUTION. [408117968]

Facility

$0.27

Service Code	CPT J1644
Hospital Charge Code	1759630
Hospital Revenue Code	636
Min. Negotiated Rate	$0.15
Max. Negotiated Rate	$0.22
Rate for Payer: Cash Price	$0.12
Rate for Payer: Cash Price	$0.14
Rate for Payer: Cash Price	$0.13
Rate for Payer: Cigna of CA HMO/PPO	$0.25
Rate for Payer: Cigna of CA HMO/PPO	$0.22
Rate for Payer: Cigna of CA HMO/PPO	$0.22
Rate for Payer: Health Smart Auto/Commercial	$0.19
Rate for Payer: Health Smart Auto/Commercial	$0.16
Rate for Payer: Health Smart Auto/Commercial	$0.17
Rate for Payer: LLUH Dept of Risk Management WC	$0.15
Rate for Payer: LLUH Dept of Risk Management WC	$0.17
Rate for Payer: LLUH Dept of Risk Management WC	$0.15
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$0.23
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$0.21
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$0.20

HEPARIN 1000 UNIT/ML INJECTION SOLUTION. [408117968]

Facility

$0.43

Service Code	CPT J1644
Hospital Charge Code	1720069
Hospital Revenue Code	636
Min. Negotiated Rate	$0.24
Max. Negotiated Rate	$0.32
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$0.26
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$0.25
Rate for Payer: Aetna of CA Government/Medicare	$0.26
Rate for Payer: Aetna of CA Government/Medicare	$0.25
Rate for Payer: Cash Price	$0.18
Rate for Payer: Cash Price	$0.19
Rate for Payer: Health Smart Auto/Commercial	$0.26
Rate for Payer: Health Smart Auto/Commercial	$0.25
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$0.26
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$0.25
Rate for Payer: LLUH Dept of Risk Management WC	$0.23
Rate for Payer: LLUH Dept of Risk Management WC	$0.24
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$0.32
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$0.31

HEPARIN 1000 UNIT/ML INJECTION SOLUTION. [408117968]

Facility

$6.24

Service Code	CPT J1644
Hospital Charge Code	NDG117968
Hospital Revenue Code	636
Min. Negotiated Rate	$3.43
Max. Negotiated Rate	$4.99
Rate for Payer: Cash Price	$2.81
Rate for Payer: Cigna of CA HMO/PPO	$4.99
Rate for Payer: Health Smart Auto/Commercial	$3.74
Rate for Payer: LLUH Dept of Risk Management WC	$3.43
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$4.68

HEPARIN 1000 UNIT/ML INJECTION SOLUTION. [408117968]

Facility

$0.31

Service Code	CPT J1644
Hospital Charge Code	NDC4081749
Hospital Revenue Code	636
Min. Negotiated Rate	$0.17
Max. Negotiated Rate	$0.23
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$0.19
Rate for Payer: Aetna of CA Government/Medicare	$0.19
Rate for Payer: Cash Price	$0.14
Rate for Payer: Health Smart Auto/Commercial	$0.19
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$0.19
Rate for Payer: LLUH Dept of Risk Management WC	$0.17
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$0.23

HEPARIN FOR NICU TPN [4080765]

Facility

$3.37

Service Code	CPT J1642
Hospital Charge Code	ERX4080765
Hospital Revenue Code	636
Min. Negotiated Rate	$1.85
Max. Negotiated Rate	$2.53
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$2.02
Rate for Payer: Aetna of CA Government/Medicare	$2.02
Rate for Payer: Cash Price	$1.52
Rate for Payer: Health Smart Auto/Commercial	$2.02
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$2.02
Rate for Payer: LLUH Dept of Risk Management WC	$1.85
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$2.53

HEPARIN FOR NICU TPN [4080765]

Facility

$3.37

Service Code	CPT J1642
Hospital Charge Code	ERX4080765
Hospital Revenue Code	636
Min. Negotiated Rate	$1.85
Max. Negotiated Rate	$2.70
Rate for Payer: Cash Price	$1.52
Rate for Payer: Cigna of CA HMO/PPO	$2.70
Rate for Payer: Health Smart Auto/Commercial	$2.02
Rate for Payer: LLUH Dept of Risk Management WC	$1.85
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$2.53

HEPARIN FOR_TPN 1000 UNITS/ML [4080751]

Facility

$2.23

Service Code	CPT J1644
Hospital Charge Code	1720392
Hospital Revenue Code	636
Min. Negotiated Rate	$1.23
Max. Negotiated Rate	$1.78
Rate for Payer: Cash Price	$1.00
Rate for Payer: Cigna of CA HMO/PPO	$1.78
Rate for Payer: Health Smart Auto/Commercial	$1.34
Rate for Payer: LLUH Dept of Risk Management WC	$1.23
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$1.67

HEPARIN FOR_TPN 1000 UNITS/ML [4080751]

Facility

$0.41

Service Code	CPT J1644
Hospital Charge Code	1720069
Hospital Revenue Code	636
Min. Negotiated Rate	$0.23
Max. Negotiated Rate	$0.31
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$0.25
Rate for Payer: Aetna of CA Government/Medicare	$0.25
Rate for Payer: Cash Price	$0.18
Rate for Payer: Health Smart Auto/Commercial	$0.25
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$0.25
Rate for Payer: LLUH Dept of Risk Management WC	$0.23
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$0.31

HEPARIN FOR_TPN 1000 UNITS/ML [4080751]

Facility

$0.41

Service Code	CPT J1644
Hospital Charge Code	1720069
Hospital Revenue Code	636
Min. Negotiated Rate	$0.23
Max. Negotiated Rate	$0.33
Rate for Payer: Cash Price	$0.18
Rate for Payer: Cigna of CA HMO/PPO	$0.33
Rate for Payer: Health Smart Auto/Commercial	$0.25
Rate for Payer: LLUH Dept of Risk Management WC	$0.23
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$0.31

HEPARIN FOR_TPN 1000 UNITS/ML [4080751]

Facility

$2.23

Service Code	CPT J1644
Hospital Charge Code	1720392
Hospital Revenue Code	636
Min. Negotiated Rate	$1.23
Max. Negotiated Rate	$1.67
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$1.34
Rate for Payer: Aetna of CA Government/Medicare	$1.34
Rate for Payer: Cash Price	$1.00
Rate for Payer: Health Smart Auto/Commercial	$1.34
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$1.34
Rate for Payer: LLUH Dept of Risk Management WC	$1.23
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$1.67

HEPARIN LOCK FLUSH (PORCINE) 100 UNIT/ML INTRAVENOUS SOLUTION [114899]

Facility

$1.93

Service Code	CPT J1642
Hospital Charge Code	NDG114899
Hospital Revenue Code	636
Min. Negotiated Rate	$1.06
Max. Negotiated Rate	$1.45
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$1.16
Rate for Payer: Aetna of CA Government/Medicare	$1.16
Rate for Payer: Cash Price	$0.87
Rate for Payer: Health Smart Auto/Commercial	$1.16
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$1.16
Rate for Payer: LLUH Dept of Risk Management WC	$1.06
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$1.45

HEPARIN LOCK FLUSH (PORCINE) 100 UNIT/ML INTRAVENOUS SOLUTION [114899]

Facility

$1.93

Service Code	CPT J1642
Hospital Charge Code	NDG114899
Hospital Revenue Code	636
Min. Negotiated Rate	$1.06
Max. Negotiated Rate	$1.54
Rate for Payer: Cash Price	$0.87
Rate for Payer: Cigna of CA HMO/PPO	$1.54
Rate for Payer: Health Smart Auto/Commercial	$1.16
Rate for Payer: LLUH Dept of Risk Management WC	$1.06
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$1.45

HEPARIN LOCK FLUSH (PORCINE) 100 UNIT/ML INTRAVENOUS SOLUTION [114899]

Facility

$0.07

Service Code	CPT J1642
Hospital Charge Code	NDC9999114899
Hospital Revenue Code	636
Min. Negotiated Rate	$0.04
Max. Negotiated Rate	$0.05
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$0.04
Rate for Payer: Aetna of CA Government/Medicare	$0.04
Rate for Payer: Cash Price	$0.03
Rate for Payer: Health Smart Auto/Commercial	$0.04
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$0.04
Rate for Payer: LLUH Dept of Risk Management WC	$0.04
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$0.05

HEPARIN LOCK FLUSH (PORCINE) 100 UNIT/ML INTRAVENOUS SOLUTION [114899]

Facility

$0.07

Service Code	CPT J1642
Hospital Charge Code	NDC9999114899
Hospital Revenue Code	636
Min. Negotiated Rate	$0.04
Max. Negotiated Rate	$0.06
Rate for Payer: Cash Price	$0.03
Rate for Payer: Cigna of CA HMO/PPO	$0.06
Rate for Payer: Health Smart Auto/Commercial	$0.04
Rate for Payer: LLUH Dept of Risk Management WC	$0.04
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$0.05

HEPARIN LOCK FLUSH (PORCINE) 10 UNIT/ML INTRAVENOUS SOLUTION [10174]

Facility

$0.40

Service Code	CPT J1642
Hospital Charge Code	1720564
Hospital Revenue Code	636
Min. Negotiated Rate	$0.22
Max. Negotiated Rate	$0.32
Rate for Payer: Cash Price	$0.18
Rate for Payer: Cigna of CA HMO/PPO	$0.32
Rate for Payer: Health Smart Auto/Commercial	$0.24
Rate for Payer: LLUH Dept of Risk Management WC	$0.22
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$0.30

HEPARIN LOCK FLUSH (PORCINE) 10 UNIT/ML INTRAVENOUS SOLUTION [10174]

Facility

$0.40

Service Code	CPT J1642
Hospital Charge Code	1720564
Hospital Revenue Code	636
Min. Negotiated Rate	$0.22
Max. Negotiated Rate	$0.30
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$0.24
Rate for Payer: Aetna of CA Government/Medicare	$0.24
Rate for Payer: Cash Price	$0.18
Rate for Payer: Health Smart Auto/Commercial	$0.24
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$0.24
Rate for Payer: LLUH Dept of Risk Management WC	$0.22
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$0.30

HEPARIN (PORCINE) 10,000 UNIT/ML INJECTION SOLUTION [10177]

Facility

$3.95

Service Code	CPT J1644
Hospital Charge Code	NDG10177A
Hospital Revenue Code	636
Min. Negotiated Rate	$2.17
Max. Negotiated Rate	$2.96
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$2.37
Rate for Payer: Aetna of CA Government/Medicare	$2.37
Rate for Payer: Cash Price	$1.78
Rate for Payer: Health Smart Auto/Commercial	$2.37
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$2.37
Rate for Payer: LLUH Dept of Risk Management WC	$2.17
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$2.96

HEPARIN (PORCINE) 10,000 UNIT/ML INJECTION SOLUTION [10177]

Facility

$3.95

Service Code	CPT J1644
Hospital Charge Code	NDG10177A
Hospital Revenue Code	636
Min. Negotiated Rate	$2.17
Max. Negotiated Rate	$3.16
Rate for Payer: Cash Price	$1.78
Rate for Payer: Cigna of CA HMO/PPO	$3.16
Rate for Payer: Health Smart Auto/Commercial	$2.37
Rate for Payer: LLUH Dept of Risk Management WC	$2.17
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$2.96

HEPARIN (PORCINE) 1,000 UNIT/ML INJECTION SOLUTION [10176]

Facility

$0.50

Service Code	NDC 67457-385-99
Hospital Charge Code	1720069
Hospital Revenue Code	636
Min. Negotiated Rate	$0.28
Max. Negotiated Rate	$0.38
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$0.30
Rate for Payer: Aetna of CA Government/Medicare	$0.30
Rate for Payer: Cash Price	$0.23
Rate for Payer: Health Smart Auto/Commercial	$0.30
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$0.30
Rate for Payer: LLUH Dept of Risk Management WC	$0.28
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$0.38

HEPARIN (PORCINE) 1,000 UNIT/ML INJECTION SOLUTION [10176]

Facility

$0.41

Service Code	NDC 0409-2720-31
Hospital Charge Code	1720069
Hospital Revenue Code	636
Min. Negotiated Rate	$0.23
Max. Negotiated Rate	$0.33
Rate for Payer: Cash Price	$0.18
Rate for Payer: Cigna of CA HMO/PPO	$0.33
Rate for Payer: Health Smart Auto/Commercial	$0.25
Rate for Payer: LLUH Dept of Risk Management WC	$0.23
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$0.31

HEPARIN (PORCINE) 1,000 UNIT/ML INJECTION SOLUTION [10176]

Facility

$4.64

Service Code	NDC 63323-540-13
Hospital Charge Code	1720392
Hospital Revenue Code	636
Min. Negotiated Rate	$2.55
Max. Negotiated Rate	$3.48
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$2.78
Rate for Payer: Aetna of CA Government/Medicare	$2.78
Rate for Payer: Cash Price	$2.09
Rate for Payer: Health Smart Auto/Commercial	$2.78
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$2.78
Rate for Payer: LLUH Dept of Risk Management WC	$2.55
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$3.48

Know your out-of-pocket cost for care.

All Charges