Loma Linda University Behavioral Medicine Center (BMC)

All Charges

Charge

Type

Setting

Price

NOREPINEPHRINE BITARTRATE 1 MG/ML INTRAVENOUS SOLUTION [10734]

Facility

$2.40

Service Code	NDC 25021-316-04
Hospital Charge Code	901700004
Hospital Revenue Code	250
Min. Negotiated Rate	$1.32
Max. Negotiated Rate	$1.92
Rate for Payer: Cash Price	$1.32
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$1.92
Rate for Payer: Health Smart Auto/Commercial	$1.44
Rate for Payer: LLUH Dept of Risk Management WC	$1.32
Rate for Payer: Multiplan Commercial	$1.80

NOREPINEPHRINE BITARTRATE 1 MG/ML INTRAVENOUS SOLUTION [10734]

Facility

$1.80

Service Code	NDC 63323-940-21
Hospital Charge Code	901700004
Hospital Revenue Code	250
Min. Negotiated Rate	$0.99
Max. Negotiated Rate	$1.44
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$1.08
Rate for Payer: Aetna of CA Government/Medicare	$1.08
Rate for Payer: Cash Price	$0.99
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$1.44
Rate for Payer: Health Smart Auto/Commercial	$1.08
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$1.08
Rate for Payer: LLUH Dept of Risk Management WC	$0.99
Rate for Payer: Multiplan Commercial	$1.35

NOREPINEPHRINE BITARTRATE 1 MG/ML INTRAVENOUS SOLUTION [10734]

Facility

$5.24

Service Code	NDC 67457-852-04
Hospital Charge Code	901700004
Hospital Revenue Code	250
Min. Negotiated Rate	$2.88
Max. Negotiated Rate	$4.19
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$3.14
Rate for Payer: Aetna of CA Government/Medicare	$3.14
Rate for Payer: Cash Price	$2.88
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$4.19
Rate for Payer: Health Smart Auto/Commercial	$3.14
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$3.14
Rate for Payer: LLUH Dept of Risk Management WC	$2.88
Rate for Payer: Multiplan Commercial	$3.93

NOREPINEPHRINE BITARTRATE 1 MG/ML INTRAVENOUS SOLUTION [10734]

Facility

$5.24

Service Code	NDC 67457-852-00
Hospital Charge Code	901700004
Hospital Revenue Code	250
Min. Negotiated Rate	$2.88
Max. Negotiated Rate	$4.19
Rate for Payer: Cash Price	$2.88
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$4.19
Rate for Payer: Health Smart Auto/Commercial	$3.14
Rate for Payer: LLUH Dept of Risk Management WC	$2.88
Rate for Payer: Multiplan Commercial	$3.93

NOREPINEPHRINE BITARTRATE 1 MG/ML INTRAVENOUS SOLUTION [10734]

Facility

$1.50

Service Code	NDC 43066-997-01
Hospital Charge Code	901700004
Hospital Revenue Code	250
Min. Negotiated Rate	$0.83
Max. Negotiated Rate	$1.20
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$0.90
Rate for Payer: Aetna of CA Government/Medicare	$0.90
Rate for Payer: Cash Price	$0.83
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$1.20
Rate for Payer: Health Smart Auto/Commercial	$0.90
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$0.90
Rate for Payer: LLUH Dept of Risk Management WC	$0.83
Rate for Payer: Multiplan Commercial	$1.12

NOREPINEPHRINE BITARTRATE 1 MG/ML INTRAVENOUS SOLUTION [10734]

Facility

$4.32

Service Code	NDC 0143-9318-01
Hospital Charge Code	901700004
Hospital Revenue Code	250
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 Government/Medicare	$2.59
Rate for Payer: Cash Price	$2.38
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$3.46
Rate for Payer: Health Smart Auto/Commercial	$2.59
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: Multiplan Commercial	$3.24

NOREPINEPHRINE BITARTRATE 1 MG/ML INTRAVENOUS SOLUTION [10734]

Facility

$5.41

Service Code	NDC 70121-1576-1
Hospital Charge Code	901700004
Hospital Revenue Code	250
Min. Negotiated Rate	$2.98
Max. Negotiated Rate	$4.33
Rate for Payer: Cash Price	$2.97
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$4.33
Rate for Payer: Health Smart Auto/Commercial	$3.25
Rate for Payer: LLUH Dept of Risk Management WC	$2.98
Rate for Payer: Multiplan Commercial	$4.06

NOREPINEPHRINE BITARTRATE 1 MG/ML INTRAVENOUS SOLUTION [10734]

Facility

$4.32

Service Code	NDC 0143-9318-10
Hospital Charge Code	901700004
Hospital Revenue Code	250
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 Government/Medicare	$2.59
Rate for Payer: Cash Price	$2.38
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$3.46
Rate for Payer: Health Smart Auto/Commercial	$2.59
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: Multiplan Commercial	$3.24

NOREPINEPHRINE BITARTRATE 1 MG/ML INTRAVENOUS SOLUTION [10734]

Facility

$5.24

Service Code	NDC 67457-852-04
Hospital Charge Code	901700004
Hospital Revenue Code	250
Min. Negotiated Rate	$2.88
Max. Negotiated Rate	$4.19
Rate for Payer: Cash Price	$2.88
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$4.19
Rate for Payer: Health Smart Auto/Commercial	$3.14
Rate for Payer: LLUH Dept of Risk Management WC	$2.88
Rate for Payer: Multiplan Commercial	$3.93

NOREPINEPHRINE BITARTRATE 1 MG/ML INTRAVENOUS SOLUTION [10734]

Facility

$5.24

Service Code	NDC 67457-852-00
Hospital Charge Code	901700004
Hospital Revenue Code	250
Min. Negotiated Rate	$2.88
Max. Negotiated Rate	$4.19
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$3.14
Rate for Payer: Aetna of CA Government/Medicare	$3.14
Rate for Payer: Cash Price	$2.88
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$4.19
Rate for Payer: Health Smart Auto/Commercial	$3.14
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$3.14
Rate for Payer: LLUH Dept of Risk Management WC	$2.88
Rate for Payer: Multiplan Commercial	$3.93

NOREPINEPHRINE BITARTRATE 1 MG/ML INTRAVENOUS SOLUTION [10734]

Facility

$1.50

Service Code	NDC 43066-997-01
Hospital Charge Code	901700004
Hospital Revenue Code	250
Min. Negotiated Rate	$0.83
Max. Negotiated Rate	$1.20
Rate for Payer: Cash Price	$0.83
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$1.20
Rate for Payer: Health Smart Auto/Commercial	$0.90
Rate for Payer: LLUH Dept of Risk Management WC	$0.83
Rate for Payer: Multiplan Commercial	$1.12

NOREPINEPHRINE BITARTRATE 1 MG/ML INTRAVENOUS SOLUTION [10734]

Facility

$5.41

Service Code	NDC 70121-1576-7
Hospital Charge Code	901700004
Hospital Revenue Code	250
Min. Negotiated Rate	$2.98
Max. Negotiated Rate	$4.33
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$3.25
Rate for Payer: Aetna of CA Government/Medicare	$3.25
Rate for Payer: Cash Price	$2.97
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$4.33
Rate for Payer: Health Smart Auto/Commercial	$3.25
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$3.25
Rate for Payer: LLUH Dept of Risk Management WC	$2.98
Rate for Payer: Multiplan Commercial	$4.06

NOREPINEPHRINE BITARTRATE 1 MG/ML INTRAVENOUS SOLUTION FOR DRIPS [40810734]

Facility

$2.50

Service Code	NDC 36000-162-01
Hospital Charge Code	901700004
Hospital Revenue Code	250
Min. Negotiated Rate	$1.38
Max. Negotiated Rate	$2.00
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$1.50
Rate for Payer: Aetna of CA Government/Medicare	$1.50
Rate for Payer: Cash Price	$1.37
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$2.00
Rate for Payer: Health Smart Auto/Commercial	$1.50
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$1.50
Rate for Payer: LLUH Dept of Risk Management WC	$1.38
Rate for Payer: Multiplan Commercial	$1.88

NOREPINEPHRINE BITARTRATE 1 MG/ML INTRAVENOUS SOLUTION FOR DRIPS [40810734]

Facility

$6.74

Service Code	NDC 0409-3375-04
Hospital Charge Code	901700004
Hospital Revenue Code	250
Min. Negotiated Rate	$3.71
Max. Negotiated Rate	$5.39
Rate for Payer: Cash Price	$3.71
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$5.39
Rate for Payer: Health Smart Auto/Commercial	$4.04
Rate for Payer: LLUH Dept of Risk Management WC	$3.71
Rate for Payer: Multiplan Commercial	$5.05

NOREPINEPHRINE BITARTRATE 1 MG/ML INTRAVENOUS SOLUTION FOR DRIPS [40810734]

Facility

$6.74

Service Code	NDC 0409-3375-04
Hospital Charge Code	901700004
Hospital Revenue Code	250
Min. Negotiated Rate	$3.71
Max. Negotiated Rate	$5.39
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$4.04
Rate for Payer: Aetna of CA Government/Medicare	$4.04
Rate for Payer: Cash Price	$3.71
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$5.39
Rate for Payer: Health Smart Auto/Commercial	$4.04
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$4.04
Rate for Payer: LLUH Dept of Risk Management WC	$3.71
Rate for Payer: Multiplan Commercial	$5.05

NOREPINEPHRINE BITARTRATE 1 MG/ML INTRAVENOUS SOLUTION FOR DRIPS [40810734]

Facility

$2.50

Service Code	NDC 36000-162-10
Hospital Charge Code	901700004
Hospital Revenue Code	250
Min. Negotiated Rate	$1.38
Max. Negotiated Rate	$2.00
Rate for Payer: Cash Price	$1.37
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$2.00
Rate for Payer: Health Smart Auto/Commercial	$1.50
Rate for Payer: LLUH Dept of Risk Management WC	$1.38
Rate for Payer: Multiplan Commercial	$1.88

NOREPINEPHRINE BITARTRATE 1 MG/ML INTRAVENOUS SOLUTION FOR DRIPS [40810734]

Facility

$2.50

Service Code	NDC 36000-162-10
Hospital Charge Code	901700004
Hospital Revenue Code	250
Min. Negotiated Rate	$1.38
Max. Negotiated Rate	$2.00
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$1.50
Rate for Payer: Aetna of CA Government/Medicare	$1.50
Rate for Payer: Cash Price	$1.37
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$2.00
Rate for Payer: Health Smart Auto/Commercial	$1.50
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$1.50
Rate for Payer: LLUH Dept of Risk Management WC	$1.38
Rate for Payer: Multiplan Commercial	$1.88

NOREPINEPHRINE BITARTRATE 1 MG/ML INTRAVENOUS SOLUTION FOR DRIPS [40810734]

Facility

$2.50

Service Code	NDC 36000-162-01
Hospital Charge Code	901700004
Hospital Revenue Code	250
Min. Negotiated Rate	$1.38
Max. Negotiated Rate	$2.00
Rate for Payer: Cash Price	$1.37
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$2.00
Rate for Payer: Health Smart Auto/Commercial	$1.50
Rate for Payer: LLUH Dept of Risk Management WC	$1.38
Rate for Payer: Multiplan Commercial	$1.88

NOREPINEPHRINE BITARTRATE 8 MG/250 ML (32 MCG/ML) IN DEXTROSE 5 % IV [121298]

Facility

$0.04

Service Code	NDC 9994-0814-06
Hospital Charge Code	901700004
Hospital Revenue Code	250
Min. Negotiated Rate	$0.02
Max. Negotiated Rate	$0.03
Rate for Payer: Cash Price	$0.02
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$0.03
Rate for Payer: Health Smart Auto/Commercial	$0.02
Rate for Payer: LLUH Dept of Risk Management WC	$0.02
Rate for Payer: Multiplan Commercial	$0.03

NOREPINEPHRINE BITARTRATE 8 MG/250 ML (32 MCG/ML) IN DEXTROSE 5 % IV [121298]

Facility

$0.04

Service Code	NDC 9994-0814-06
Hospital Charge Code	901700004
Hospital Revenue Code	250
Min. Negotiated Rate	$0.02
Max. Negotiated Rate	$0.03
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$0.02
Rate for Payer: Aetna of CA Government/Medicare	$0.02
Rate for Payer: Cash Price	$0.02
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$0.03
Rate for Payer: Health Smart Auto/Commercial	$0.02
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$0.02
Rate for Payer: LLUH Dept of Risk Management WC	$0.02
Rate for Payer: Multiplan Commercial	$0.03

NORETHINDRONE 0.5 MG-ETHINYL ESTRADIOL 35 MCG TABLET [10741]

Facility

$0.93

Service Code	NDC 0555-9008-79
Hospital Charge Code	901700029
Hospital Revenue Code	259
Min. Negotiated Rate	$0.51
Max. Negotiated Rate	$0.74
Rate for Payer: Cash Price	$0.51
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$0.74
Rate for Payer: Health Smart Auto/Commercial	$0.56
Rate for Payer: LLUH Dept of Risk Management WC	$0.51
Rate for Payer: Multiplan Commercial	$0.70

NORETHINDRONE 0.5 MG-ETHINYL ESTRADIOL 35 MCG TABLET [10741]

Facility

$0.93

Service Code	NDC 0555-9008-79
Hospital Charge Code	901700029
Hospital Revenue Code	259
Min. Negotiated Rate	$0.51
Max. Negotiated Rate	$0.74
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$0.56
Rate for Payer: Aetna of CA Government/Medicare	$0.56
Rate for Payer: Cash Price	$0.51
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$0.74
Rate for Payer: Health Smart Auto/Commercial	$0.56
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$0.56
Rate for Payer: LLUH Dept of Risk Management WC	$0.51
Rate for Payer: Multiplan Commercial	$0.70

NORETHINDRONE ACETATE 5 MG TABLET [10747]

Facility

$2.22

Service Code	NDC 0555-0211-10
Hospital Charge Code	901700029
Hospital Revenue Code	259
Min. Negotiated Rate	$1.22
Max. Negotiated Rate	$1.78
Rate for Payer: Cash Price	$1.22
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$1.78
Rate for Payer: Health Smart Auto/Commercial	$1.33
Rate for Payer: LLUH Dept of Risk Management WC	$1.22
Rate for Payer: Multiplan Commercial	$1.67

NORETHINDRONE ACETATE 5 MG TABLET [10747]

Facility

$0.72

Service Code	NDC 68462-304-50
Hospital Charge Code	901700029
Hospital Revenue Code	259
Min. Negotiated Rate	$0.40
Max. Negotiated Rate	$0.58
Rate for Payer: Cash Price	$0.40
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$0.58
Rate for Payer: Health Smart Auto/Commercial	$0.43
Rate for Payer: LLUH Dept of Risk Management WC	$0.40
Rate for Payer: Multiplan Commercial	$0.54

NORETHINDRONE ACETATE 5 MG TABLET [10747]

Facility

$0.72

Service Code	NDC 68462-304-50
Hospital Charge Code	901700029
Hospital Revenue Code	259
Min. Negotiated Rate	$0.40
Max. Negotiated Rate	$0.58
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$0.43
Rate for Payer: Aetna of CA Government/Medicare	$0.43
Rate for Payer: Cash Price	$0.40
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$0.58
Rate for Payer: Health Smart Auto/Commercial	$0.43
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$0.43
Rate for Payer: LLUH Dept of Risk Management WC	$0.40
Rate for Payer: Multiplan Commercial	$0.54

Know your out-of-pocket cost for care.

All Charges