Loma Linda University Behavioral Medicine Center (BMC)

All Charges

Charge

Type

Setting

Price

PRAZOSIN 5 MG CAPSULE [6470]

Facility

$0.28

Service Code	NDC 70756-440-11
Hospital Charge Code	901700029
Hospital Revenue Code	259
Min. Negotiated Rate	$0.15
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	$0.15
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$0.22
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	$0.15
Rate for Payer: Multiplan Commercial	$0.21

PRAZOSIN 5 MG CAPSULE [6470]

Facility

$1.26

Service Code	NDC 0093-4069-01
Hospital Charge Code	901700029
Hospital Revenue Code	259
Min. Negotiated Rate	$0.69
Max. Negotiated Rate	$1.01
Rate for Payer: Cash Price	$0.69
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$1.01
Rate for Payer: Health Smart Auto/Commercial	$0.76
Rate for Payer: LLUH Dept of Risk Management WC	$0.69
Rate for Payer: Multiplan Commercial	$0.95

PRAZOSIN 5 MG CAPSULE [6470]

Facility

$0.33

Service Code	NDC 70954-021-10
Hospital Charge Code	901700029
Hospital Revenue Code	259
Min. Negotiated Rate	$0.18
Max. Negotiated Rate	$0.26
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$0.20
Rate for Payer: Aetna of CA Government/Medicare	$0.20
Rate for Payer: Cash Price	$0.18
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$0.26
Rate for Payer: Health Smart Auto/Commercial	$0.20
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$0.20
Rate for Payer: LLUH Dept of Risk Management WC	$0.18
Rate for Payer: Multiplan Commercial	$0.25

PRAZOSIN 5 MG CAPSULE [6470]

Facility

$4.11

Service Code	NDC 60687-572-33
Hospital Charge Code	901700029
Hospital Revenue Code	259
Min. Negotiated Rate	$2.26
Max. Negotiated Rate	$3.29
Rate for Payer: Cash Price	$2.26
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$3.29
Rate for Payer: Health Smart Auto/Commercial	$2.47
Rate for Payer: LLUH Dept of Risk Management WC	$2.26
Rate for Payer: Multiplan Commercial	$3.08

PRAZOSIN 5 MG CAPSULE [6470]

Facility

$1.26

Service Code	NDC 0093-4069-01
Hospital Charge Code	901700029
Hospital Revenue Code	259
Min. Negotiated Rate	$0.69
Max. Negotiated Rate	$1.01
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$0.76
Rate for Payer: Aetna of CA Government/Medicare	$0.76
Rate for Payer: Cash Price	$0.69
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$1.01
Rate for Payer: Health Smart Auto/Commercial	$0.76
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$0.76
Rate for Payer: LLUH Dept of Risk Management WC	$0.69
Rate for Payer: Multiplan Commercial	$0.95

PRAZOSIN 5 MG CAPSULE [6470]

Facility

$4.31

Service Code	NDC 51079-632-01
Hospital Charge Code	901700029
Hospital Revenue Code	259
Min. Negotiated Rate	$2.37
Max. Negotiated Rate	$3.45
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	$2.37
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$3.45
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	$2.37
Rate for Payer: Multiplan Commercial	$3.23

PRAZOSIN 5 MG CAPSULE [6470]

Facility

$4.31

Service Code	NDC 51079-632-01
Hospital Charge Code	901700029
Hospital Revenue Code	259
Min. Negotiated Rate	$2.37
Max. Negotiated Rate	$3.45
Rate for Payer: Cash Price	$2.37
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$3.45
Rate for Payer: Health Smart Auto/Commercial	$2.59
Rate for Payer: LLUH Dept of Risk Management WC	$2.37
Rate for Payer: Multiplan Commercial	$3.23

PRAZOSIN 5 MG CAPSULE [6470]

Facility

$4.11

Service Code	NDC 60687-572-32
Hospital Charge Code	901700029
Hospital Revenue Code	259
Min. Negotiated Rate	$2.26
Max. Negotiated Rate	$3.29
Rate for Payer: Cash Price	$2.26
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$3.29
Rate for Payer: Health Smart Auto/Commercial	$2.47
Rate for Payer: LLUH Dept of Risk Management WC	$2.26
Rate for Payer: Multiplan Commercial	$3.08

PRAZOSIN 5 MG CAPSULE [6470]

Facility

$4.11

Service Code	NDC 60687-572-32
Hospital Charge Code	901700029
Hospital Revenue Code	259
Min. Negotiated Rate	$2.26
Max. Negotiated Rate	$3.29
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$2.47
Rate for Payer: Aetna of CA Government/Medicare	$2.47
Rate for Payer: Cash Price	$2.26
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$3.29
Rate for Payer: Health Smart Auto/Commercial	$2.47
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$2.47
Rate for Payer: LLUH Dept of Risk Management WC	$2.26
Rate for Payer: Multiplan Commercial	$3.08

PREDNISOLONE 15 MG/5 ML ORAL SOLUTION [11117]

Facility

$1.44

Service Code	HCPCS J7510
Hospital Charge Code	901700025
Hospital Revenue Code	636
Min. Negotiated Rate	$0.79
Max. Negotiated Rate	$1.15
Rate for Payer: Cash Price	$0.79
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$1.15
Rate for Payer: Health Smart Auto/Commercial	$0.86
Rate for Payer: LLUH Dept of Risk Management WC	$0.79
Rate for Payer: Multiplan Commercial	$1.08

PREDNISOLONE 15 MG/5 ML ORAL SOLUTION [11117]

Facility

$1.44

Service Code	HCPCS J7510
Hospital Charge Code	901700025
Hospital Revenue Code	636
Min. Negotiated Rate	$0.79
Max. Negotiated Rate	$1.15
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$0.86
Rate for Payer: Aetna of CA Government/Medicare	$0.86
Rate for Payer: Cash Price	$0.79
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$1.15
Rate for Payer: Health Smart Auto/Commercial	$0.86
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$0.86
Rate for Payer: LLUH Dept of Risk Management WC	$0.79
Rate for Payer: Multiplan Commercial	$1.08

PREDNISOLONE ACETATE 0.12 % EYE DROPS,SUSPENSION [27038]

Facility

$38.50

Service Code	NDC 11980-174-05
Hospital Charge Code	901700029
Hospital Revenue Code	259
Min. Negotiated Rate	$21.18
Max. Negotiated Rate	$30.80
Rate for Payer: Cash Price	$21.17
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$30.80
Rate for Payer: Health Smart Auto/Commercial	$23.10
Rate for Payer: LLUH Dept of Risk Management WC	$21.18
Rate for Payer: Multiplan Commercial	$28.88

PREDNISOLONE ACETATE 0.12 % EYE DROPS,SUSPENSION [27038]

Facility

$38.50

Service Code	NDC 11980-174-10
Hospital Charge Code	901700029
Hospital Revenue Code	259
Min. Negotiated Rate	$21.18
Max. Negotiated Rate	$30.80
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$23.10
Rate for Payer: Aetna of CA Government/Medicare	$23.10
Rate for Payer: Cash Price	$21.17
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$30.80
Rate for Payer: Health Smart Auto/Commercial	$23.10
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$23.10
Rate for Payer: LLUH Dept of Risk Management WC	$21.18
Rate for Payer: Multiplan Commercial	$28.88

PREDNISOLONE ACETATE 0.12 % EYE DROPS,SUSPENSION [27038]

Facility

$38.50

Service Code	NDC 11980-174-10
Hospital Charge Code	901700029
Hospital Revenue Code	259
Min. Negotiated Rate	$21.18
Max. Negotiated Rate	$30.80
Rate for Payer: Cash Price	$21.17
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$30.80
Rate for Payer: Health Smart Auto/Commercial	$23.10
Rate for Payer: LLUH Dept of Risk Management WC	$21.18
Rate for Payer: Multiplan Commercial	$28.88

PREDNISOLONE ACETATE 0.12 % EYE DROPS,SUSPENSION [27038]

Facility

$38.50

Service Code	NDC 11980-174-05
Hospital Charge Code	901700029
Hospital Revenue Code	259
Min. Negotiated Rate	$21.18
Max. Negotiated Rate	$30.80
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$23.10
Rate for Payer: Aetna of CA Government/Medicare	$23.10
Rate for Payer: Cash Price	$21.17
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$30.80
Rate for Payer: Health Smart Auto/Commercial	$23.10
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$23.10
Rate for Payer: LLUH Dept of Risk Management WC	$21.18
Rate for Payer: Multiplan Commercial	$28.88

PREDNISOLONE ACETATE 1 % EYE DROPS,SUSPENSION [6487]

Facility

$38.50

Service Code	NDC 11980-180-05
Hospital Charge Code	901700029
Hospital Revenue Code	259
Min. Negotiated Rate	$21.18
Max. Negotiated Rate	$30.80
Rate for Payer: Cash Price	$21.17
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$30.80
Rate for Payer: Health Smart Auto/Commercial	$23.10
Rate for Payer: LLUH Dept of Risk Management WC	$21.18
Rate for Payer: Multiplan Commercial	$28.88

PREDNISOLONE ACETATE 1 % EYE DROPS,SUSPENSION [6487]

Facility

$10.62

Service Code	NDC 61314-637-05
Hospital Charge Code	901700029
Hospital Revenue Code	259
Min. Negotiated Rate	$5.84
Max. Negotiated Rate	$8.50
Rate for Payer: Cash Price	$5.84
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$8.50
Rate for Payer: Health Smart Auto/Commercial	$6.37
Rate for Payer: LLUH Dept of Risk Management WC	$5.84
Rate for Payer: Multiplan Commercial	$7.96

PREDNISOLONE ACETATE 1 % EYE DROPS,SUSPENSION [6487]

Facility

$10.62

Service Code	NDC 61314-637-05
Hospital Charge Code	901700029
Hospital Revenue Code	259
Min. Negotiated Rate	$5.84
Max. Negotiated Rate	$8.50
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$6.37
Rate for Payer: Aetna of CA Government/Medicare	$6.37
Rate for Payer: Cash Price	$5.84
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$8.50
Rate for Payer: Health Smart Auto/Commercial	$6.37
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$6.37
Rate for Payer: LLUH Dept of Risk Management WC	$5.84
Rate for Payer: Multiplan Commercial	$7.96

PREDNISOLONE ACETATE 1 % EYE DROPS,SUSPENSION [6487]

Facility

$38.50

Service Code	NDC 11980-180-05
Hospital Charge Code	901700029
Hospital Revenue Code	259
Min. Negotiated Rate	$21.18
Max. Negotiated Rate	$30.80
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$23.10
Rate for Payer: Aetna of CA Government/Medicare	$23.10
Rate for Payer: Cash Price	$21.17
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$30.80
Rate for Payer: Health Smart Auto/Commercial	$23.10
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$23.10
Rate for Payer: LLUH Dept of Risk Management WC	$21.18
Rate for Payer: Multiplan Commercial	$28.88

PREDNISOLONE ACETATE 1 % EYE DROPS,SUSPENSION [6487]

Facility

$10.56

Service Code	NDC 60758-119-05
Hospital Charge Code	901700029
Hospital Revenue Code	259
Min. Negotiated Rate	$5.81
Max. Negotiated Rate	$8.45
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	$5.81
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$8.45
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 Commercial	$7.92

PREDNISOLONE ACETATE 1 % EYE DROPS,SUSPENSION [6487]

Facility

$10.56

Service Code	NDC 60758-119-05
Hospital Charge Code	901700029
Hospital Revenue Code	259
Min. Negotiated Rate	$5.81
Max. Negotiated Rate	$8.45
Rate for Payer: Cash Price	$5.81
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$8.45
Rate for Payer: Health Smart Auto/Commercial	$6.34
Rate for Payer: LLUH Dept of Risk Management WC	$5.81
Rate for Payer: Multiplan Commercial	$7.92

PREDNISOLONE SODIUM PHOSPHATE 15 MG/5 ML (3 MG/ML) ORAL SOLUTION [29302]

Facility

$0.26

Service Code	HCPCS J7510
Hospital Charge Code	901700025
Hospital Revenue Code	636
Min. Negotiated Rate	$0.14
Max. Negotiated Rate	$0.21
Rate for Payer: Cash Price	$0.14
Rate for Payer: Cash Price	$0.11
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$0.16
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$0.21
Rate for Payer: Health Smart Auto/Commercial	$0.16
Rate for Payer: Health Smart Auto/Commercial	$0.12
Rate for Payer: LLUH Dept of Risk Management WC	$0.11
Rate for Payer: LLUH Dept of Risk Management WC	$0.14
Rate for Payer: Multiplan Commercial	$0.15
Rate for Payer: Multiplan Commercial	$0.20

PREDNISOLONE SODIUM PHOSPHATE 15 MG/5 ML (3 MG/ML) ORAL SOLUTION [29302]

Facility

$0.20

Service Code	HCPCS J7510
Hospital Charge Code	901700025
Hospital Revenue Code	636
Min. Negotiated Rate	$0.11
Max. Negotiated Rate	$0.16
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$0.12
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$0.16
Rate for Payer: Aetna of CA Government/Medicare	$0.16
Rate for Payer: Aetna of CA Government/Medicare	$0.12
Rate for Payer: Cash Price	$0.11
Rate for Payer: Cash Price	$0.14
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$0.16
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$0.21
Rate for Payer: Health Smart Auto/Commercial	$0.12
Rate for Payer: Health Smart Auto/Commercial	$0.16
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$0.12
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$0.16
Rate for Payer: LLUH Dept of Risk Management WC	$0.14
Rate for Payer: LLUH Dept of Risk Management WC	$0.11
Rate for Payer: Multiplan Commercial	$0.15
Rate for Payer: Multiplan Commercial	$0.20

PREDNISOLONE SODIUM PHOSPHATE 1 % EYE DROPS [6489]

Facility

$6.32

Service Code	NDC 24208-715-10
Hospital Charge Code	901700029
Hospital Revenue Code	259
Min. Negotiated Rate	$3.48
Max. Negotiated Rate	$5.06
Rate for Payer: Cash Price	$3.48
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$5.06
Rate for Payer: Health Smart Auto/Commercial	$3.79
Rate for Payer: LLUH Dept of Risk Management WC	$3.48
Rate for Payer: Multiplan Commercial	$4.74

PREDNISOLONE SODIUM PHOSPHATE 1 % EYE DROPS [6489]

Facility

$6.32

Service Code	NDC 24208-715-10
Hospital Charge Code	901700029
Hospital Revenue Code	259
Min. Negotiated Rate	$3.48
Max. Negotiated Rate	$5.06
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$3.79
Rate for Payer: Aetna of CA Government/Medicare	$3.79
Rate for Payer: Cash Price	$3.48
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$5.06
Rate for Payer: Health Smart Auto/Commercial	$3.79
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$3.79
Rate for Payer: LLUH Dept of Risk Management WC	$3.48
Rate for Payer: Multiplan Commercial	$4.74

Know your out-of-pocket cost for care.

All Charges