Loma Linda University Behavioral Medicine Center (BMC)

All Charges

Charge

Type

Setting

Price

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

Facility

$0.41

Service Code	NDC 0069-0058-02
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 (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

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

Facility

$0.29

Service Code	NDC 63323-540-33
Hospital Charge Code	1759630
Hospital Revenue Code	636
Min. Negotiated Rate	$0.16
Max. Negotiated Rate	$0.22
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$0.17
Rate for Payer: Aetna of CA Government/Medicare	$0.17
Rate for Payer: Cash Price	$0.13
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: LLUH Dept of Risk Management WC	$0.16
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$0.22

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

Facility

$0.31

Service Code	NDC 0409-2720-03
Hospital Charge Code	1759630
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 (PORCINE) 1,000 UNIT/ML INJECTION SOLUTION [10176]

Facility

$0.31

Service Code	NDC 0409-2720-32
Hospital Charge Code	1759630
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 (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	$3.71
Rate for Payer: Cash Price	$2.09
Rate for Payer: Cigna of CA HMO/PPO	$3.71
Rate for Payer: Health Smart Auto/Commercial	$2.78
Rate for Payer: LLUH Dept of Risk Management WC	$2.55
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$3.48

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

Facility

$4.64

Service Code	NDC 63323-540-03
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

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

Facility

$0.29

Service Code	NDC 63323-540-33
Hospital Charge Code	1759630
Hospital Revenue Code	636
Min. Negotiated Rate	$0.16
Max. Negotiated Rate	$0.23
Rate for Payer: Cash Price	$0.13
Rate for Payer: Cigna of CA HMO/PPO	$0.23
Rate for Payer: Health Smart Auto/Commercial	$0.17
Rate for Payer: LLUH Dept of Risk Management WC	$0.16
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$0.22

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

Facility

$0.29

Service Code	NDC 63323-540-36
Hospital Charge Code	1759630
Hospital Revenue Code	636
Min. Negotiated Rate	$0.16
Max. Negotiated Rate	$0.22
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$0.17
Rate for Payer: Aetna of CA Government/Medicare	$0.17
Rate for Payer: Cash Price	$0.13
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: LLUH Dept of Risk Management WC	$0.16
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$0.22

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

Facility

$0.41

Service Code	NDC 0409-2720-02
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

$0.31

Service Code	NDC 67457-384-31
Hospital Charge Code	1759630
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 (PORCINE) 1,000 UNIT/ML INJECTION SOLUTION [10176]

Facility

$0.31

Service Code	NDC 67457-384-99
Hospital Charge Code	1759630
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 (PORCINE) 1,000 UNIT/ML INJECTION SOLUTION [10176]

Facility

$0.41

Service Code	NDC 0409-2720-02
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 (PORCINE) 1,000 UNIT/ML INJECTION SOLUTION [10176]

Facility

$0.41

Service Code	NDC 0069-0058-02
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

$0.41

Service Code	NDC 0069-0058-01
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

$0.50

Service Code	NDC 67457-385-99
Hospital Charge Code	1720069
Hospital Revenue Code	636
Min. Negotiated Rate	$0.28
Max. Negotiated Rate	$0.40
Rate for Payer: Cash Price	$0.23
Rate for Payer: Cigna of CA HMO/PPO	$0.40
Rate for Payer: Health Smart Auto/Commercial	$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

$0.29

Service Code	NDC 63323-540-36
Hospital Charge Code	1759630
Hospital Revenue Code	636
Min. Negotiated Rate	$0.16
Max. Negotiated Rate	$0.23
Rate for Payer: Cash Price	$0.13
Rate for Payer: Cigna of CA HMO/PPO	$0.23
Rate for Payer: Health Smart Auto/Commercial	$0.17
Rate for Payer: LLUH Dept of Risk Management WC	$0.16
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$0.22

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

Facility

$0.31

Service Code	NDC 0409-2720-32
Hospital Charge Code	1759630
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 (PORCINE) 1,000 UNIT/ML INJECTION SOLUTION [10176]

Facility

$2.23

Service Code	NDC 0409-2720-01
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 (PORCINE) 1,000 UNIT/ML INJECTION SOLUTION [10176]

Facility

$0.41

Service Code	NDC 0069-0058-01
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 (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	$0.31
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 (PORCINE) 1,000 UNIT/ML INJECTION SOLUTION [10176]

Facility

$2.23

Service Code	NDC 0409-2720-30
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 (PORCINE) 1,000 UNIT/ML INJECTION SOLUTION [10176]

Facility

$0.50

Service Code	NDC 67457-385-10
Hospital Charge Code	1720069
Hospital Revenue Code	636
Min. Negotiated Rate	$0.28
Max. Negotiated Rate	$0.40
Rate for Payer: Cash Price	$0.23
Rate for Payer: Cigna of CA HMO/PPO	$0.40
Rate for Payer: Health Smart Auto/Commercial	$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

$0.31

Service Code	NDC 67457-384-99
Hospital Charge Code	1759630
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 (PORCINE) 1,000 UNIT/ML INJECTION SOLUTION [10176]

Facility

$2.23

Service Code	NDC 0409-2720-01
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

Know your out-of-pocket cost for care.

All Charges