Loma Linda University Behavioral Medicine Center (BMC)

All Charges

Charge

Type

Setting

Price

PARENTERAL AMINO ACID 15 % COMBINATION NO.6 INTRAVENOUS SOLUTION [224619]

Facility

$0.05

Service Code	NDC 0264-4500-00
Hospital Charge Code	901700001
Hospital Revenue Code	250
Min. Negotiated Rate	$0.03
Max. Negotiated Rate	$0.04
Rate for Payer: Cash Price	$0.03
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$0.04
Rate for Payer: Health Smart Auto/Commercial	$0.03
Rate for Payer: LLUH Dept of Risk Management WC	$0.03
Rate for Payer: Multiplan Commercial	$0.04

PARICALCITOL 1 MCG CAPSULE [41497]

Facility

$1.20

Service Code	NDC 49483-687-03
Hospital Charge Code	901700029
Hospital Revenue Code	259
Min. Negotiated Rate	$0.66
Max. Negotiated Rate	$0.96
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$0.72
Rate for Payer: Aetna of CA Government/Medicare	$0.72
Rate for Payer: Cash Price	$0.66
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$0.96
Rate for Payer: Health Smart Auto/Commercial	$0.72
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$0.72
Rate for Payer: LLUH Dept of Risk Management WC	$0.66
Rate for Payer: Multiplan Commercial	$0.90

PARICALCITOL 1 MCG CAPSULE [41497]

Facility

$1.20

Service Code	NDC 49483-687-03
Hospital Charge Code	901700029
Hospital Revenue Code	259
Min. Negotiated Rate	$0.66
Max. Negotiated Rate	$0.96
Rate for Payer: Cash Price	$0.66
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$0.96
Rate for Payer: Health Smart Auto/Commercial	$0.72
Rate for Payer: LLUH Dept of Risk Management WC	$0.66
Rate for Payer: Multiplan Commercial	$0.90

PARICALCITOL 1 MCG CAPSULE [41497]

Facility

$1.78

Service Code	NDC 65862-936-30
Hospital Charge Code	901700029
Hospital Revenue Code	259
Min. Negotiated Rate	$0.98
Max. Negotiated Rate	$1.42
Rate for Payer: Cash Price	$0.98
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$1.42
Rate for Payer: Health Smart Auto/Commercial	$1.07
Rate for Payer: LLUH Dept of Risk Management WC	$0.98
Rate for Payer: Multiplan Commercial	$1.33

PARICALCITOL 1 MCG CAPSULE [41497]

Facility

$1.78

Service Code	NDC 65862-936-30
Hospital Charge Code	901700029
Hospital Revenue Code	259
Min. Negotiated Rate	$0.98
Max. Negotiated Rate	$1.42
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$1.07
Rate for Payer: Aetna of CA Government/Medicare	$1.07
Rate for Payer: Cash Price	$0.98
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$1.42
Rate for Payer: Health Smart Auto/Commercial	$1.07
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$1.07
Rate for Payer: LLUH Dept of Risk Management WC	$0.98
Rate for Payer: Multiplan Commercial	$1.33

PARICALCITOL 2 MCG CAPSULE [41498]

Facility

$10.00

Service Code	NDC 69452-146-13
Hospital Charge Code	901700029
Hospital Revenue Code	259
Min. Negotiated Rate	$5.50
Max. Negotiated Rate	$8.00
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$6.00
Rate for Payer: Aetna of CA Government/Medicare	$6.00
Rate for Payer: Cash Price	$5.50
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$8.00
Rate for Payer: Health Smart Auto/Commercial	$6.00
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$6.00
Rate for Payer: LLUH Dept of Risk Management WC	$5.50
Rate for Payer: Multiplan Commercial	$7.50

PARICALCITOL 2 MCG CAPSULE [41498]

Facility

$3.54

Service Code	NDC 65862-937-30
Hospital Charge Code	901700029
Hospital Revenue Code	259
Min. Negotiated Rate	$1.95
Max. Negotiated Rate	$2.83
Rate for Payer: Cash Price	$1.95
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$2.83
Rate for Payer: Health Smart Auto/Commercial	$2.12
Rate for Payer: LLUH Dept of Risk Management WC	$1.95
Rate for Payer: Multiplan Commercial	$2.65

PARICALCITOL 2 MCG CAPSULE [41498]

Facility

$3.54

Service Code	NDC 65862-937-30
Hospital Charge Code	901700029
Hospital Revenue Code	259
Min. Negotiated Rate	$1.95
Max. Negotiated Rate	$2.83
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$2.12
Rate for Payer: Aetna of CA Government/Medicare	$2.12
Rate for Payer: Cash Price	$1.95
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$2.83
Rate for Payer: Health Smart Auto/Commercial	$2.12
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$2.12
Rate for Payer: LLUH Dept of Risk Management WC	$1.95
Rate for Payer: Multiplan Commercial	$2.65

PARICALCITOL 2 MCG CAPSULE [41498]

Facility

$10.00

Service Code	NDC 69452-146-13
Hospital Charge Code	901700029
Hospital Revenue Code	259
Min. Negotiated Rate	$5.50
Max. Negotiated Rate	$8.00
Rate for Payer: Cash Price	$5.50
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$8.00
Rate for Payer: Health Smart Auto/Commercial	$6.00
Rate for Payer: LLUH Dept of Risk Management WC	$5.50
Rate for Payer: Multiplan Commercial	$7.50

PARICALCITOL 2 MCG/ML INTRAVENOUS SOLUTION [31688]

Facility

$7.27

Service Code	HCPCS J2501
Hospital Charge Code	901700025
Hospital Revenue Code	636
Min. Negotiated Rate	$4.00
Max. Negotiated Rate	$5.82
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$4.36
Rate for Payer: Aetna of CA Government/Medicare	$4.36
Rate for Payer: Cash Price	$4.00
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$5.82
Rate for Payer: Health Smart Auto/Commercial	$4.36
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$4.36
Rate for Payer: LLUH Dept of Risk Management WC	$4.00
Rate for Payer: Multiplan Commercial	$5.45

PARICALCITOL 2 MCG/ML INTRAVENOUS SOLUTION [31688]

Facility

$7.27

Service Code	HCPCS J2501
Hospital Charge Code	901700025
Hospital Revenue Code	636
Min. Negotiated Rate	$4.00
Max. Negotiated Rate	$5.82
Rate for Payer: Cash Price	$4.00
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$5.82
Rate for Payer: Health Smart Auto/Commercial	$4.36
Rate for Payer: LLUH Dept of Risk Management WC	$4.00
Rate for Payer: Multiplan Commercial	$5.45

PARICALCITOL 5 MCG/ML INTRAVENOUS SOLUTION [22960]

Facility

$18.18

Service Code	HCPCS J2501
Hospital Charge Code	901700025
Hospital Revenue Code	636
Min. Negotiated Rate	$10.00
Max. Negotiated Rate	$14.54
Rate for Payer: Cash Price	$10.00
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$14.54
Rate for Payer: Health Smart Auto/Commercial	$10.91
Rate for Payer: LLUH Dept of Risk Management WC	$10.00
Rate for Payer: Multiplan Commercial	$13.63

PARICALCITOL 5 MCG/ML INTRAVENOUS SOLUTION [22960]

Facility

$18.18

Service Code	HCPCS J2501
Hospital Charge Code	901700025
Hospital Revenue Code	636
Min. Negotiated Rate	$10.00
Max. Negotiated Rate	$14.54
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$10.91
Rate for Payer: Aetna of CA Government/Medicare	$10.91
Rate for Payer: Cash Price	$10.00
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$14.54
Rate for Payer: Health Smart Auto/Commercial	$10.91
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$10.91
Rate for Payer: LLUH Dept of Risk Management WC	$10.00
Rate for Payer: Multiplan Commercial	$13.63

PAROXETINE 10 MG/5 ML ORAL SUSPENSION [22959]

Facility

$2.13

Service Code	NDC 60505-0402-5
Hospital Charge Code	901700029
Hospital Revenue Code	259
Min. Negotiated Rate	$1.17
Max. Negotiated Rate	$1.70
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$1.28
Rate for Payer: Aetna of CA Government/Medicare	$1.28
Rate for Payer: Cash Price	$1.17
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$1.70
Rate for Payer: Health Smart Auto/Commercial	$1.28
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$1.28
Rate for Payer: LLUH Dept of Risk Management WC	$1.17
Rate for Payer: Multiplan Commercial	$1.60

PAROXETINE 10 MG/5 ML ORAL SUSPENSION [22959]

Facility

$2.13

Service Code	NDC 60505-0402-5
Hospital Charge Code	901700029
Hospital Revenue Code	259
Min. Negotiated Rate	$1.17
Max. Negotiated Rate	$1.70
Rate for Payer: Cash Price	$1.17
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$1.70
Rate for Payer: Health Smart Auto/Commercial	$1.28
Rate for Payer: LLUH Dept of Risk Management WC	$1.17
Rate for Payer: Multiplan Commercial	$1.60

PAROXETINE 10 MG/5 ML ORAL SUSPENSION [22959]

Facility

$1.76

Service Code	NDC 70954-319-10
Hospital Charge Code	901700029
Hospital Revenue Code	259
Min. Negotiated Rate	$0.97
Max. Negotiated Rate	$1.41
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$1.06
Rate for Payer: Aetna of CA Government/Medicare	$1.06
Rate for Payer: Cash Price	$0.97
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$1.41
Rate for Payer: Health Smart Auto/Commercial	$1.06
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$1.06
Rate for Payer: LLUH Dept of Risk Management WC	$0.97
Rate for Payer: Multiplan Commercial	$1.32

PAROXETINE 10 MG/5 ML ORAL SUSPENSION [22959]

Facility

$1.76

Service Code	NDC 70954-319-10
Hospital Charge Code	901700029
Hospital Revenue Code	259
Min. Negotiated Rate	$0.97
Max. Negotiated Rate	$1.41
Rate for Payer: Cash Price	$0.97
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$1.41
Rate for Payer: Health Smart Auto/Commercial	$1.06
Rate for Payer: LLUH Dept of Risk Management WC	$0.97
Rate for Payer: Multiplan Commercial	$1.32

PAROXETINE 10 MG TABLET [16632]

Facility

$0.80

Service Code	NDC 50268-640-11
Hospital Charge Code	901700029
Hospital Revenue Code	259
Min. Negotiated Rate	$0.44
Max. Negotiated Rate	$0.64
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$0.48
Rate for Payer: Aetna of CA Government/Medicare	$0.48
Rate for Payer: Cash Price	$0.44
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$0.64
Rate for Payer: Health Smart Auto/Commercial	$0.48
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$0.48
Rate for Payer: LLUH Dept of Risk Management WC	$0.44
Rate for Payer: Multiplan Commercial	$0.60

PAROXETINE 10 MG TABLET [16632]

Facility

$0.80

Service Code	NDC 50268-640-11
Hospital Charge Code	901700029
Hospital Revenue Code	259
Min. Negotiated Rate	$0.44
Max. Negotiated Rate	$0.64
Rate for Payer: Cash Price	$0.44
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$0.64
Rate for Payer: Health Smart Auto/Commercial	$0.48
Rate for Payer: LLUH Dept of Risk Management WC	$0.44
Rate for Payer: Multiplan Commercial	$0.60

PAROXETINE 10 MG TABLET [16632]

Facility

$0.14

Service Code	NDC 68382-097-06
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

PAROXETINE 10 MG TABLET [16632]

Facility

$1.02

Service Code	NDC 68084-044-11
Hospital Charge Code	901700029
Hospital Revenue Code	259
Min. Negotiated Rate	$0.56
Max. Negotiated Rate	$0.82
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: Cash Price	$0.56
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$0.82
Rate for Payer: Health Smart Auto/Commercial	$0.61
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$0.61
Rate for Payer: LLUH Dept of Risk Management WC	$0.56
Rate for Payer: Multiplan Commercial	$0.77

PAROXETINE 10 MG TABLET [16632]

Facility

$0.80

Service Code	NDC 50268-640-15
Hospital Charge Code	901700029
Hospital Revenue Code	259
Min. Negotiated Rate	$0.44
Max. Negotiated Rate	$0.64
Rate for Payer: Cash Price	$0.44
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$0.64
Rate for Payer: Health Smart Auto/Commercial	$0.48
Rate for Payer: LLUH Dept of Risk Management WC	$0.44
Rate for Payer: Multiplan Commercial	$0.60

PAROXETINE 10 MG TABLET [16632]

Facility

$0.14

Service Code	NDC 0378-7001-93
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

PAROXETINE 10 MG TABLET [16632]

Facility

$0.14

Service Code	NDC 0378-7001-93
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

PAROXETINE 10 MG TABLET [16632]

Facility

$0.14

Service Code	NDC 68382-097-06
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

Know your out-of-pocket cost for care.

All Charges