Loma Linda University Behavioral Medicine Center (BMC)

All Charges

Charge

Type

Setting

Price

PROCAINAMIDE ORAL SOLUTION (IV FORM) 50 MG/ML [4080440]

Facility

$1.29

Service Code	NDC 9994-0804-40
Hospital Charge Code	901700029
Hospital Revenue Code	259
Min. Negotiated Rate	$0.71
Max. Negotiated Rate	$1.03
Rate for Payer: Cash Price	$0.71
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$1.03
Rate for Payer: Health Smart Auto/Commercial	$0.77
Rate for Payer: LLUH Dept of Risk Management WC	$0.71
Rate for Payer: Multiplan Commercial	$0.97

PROCAINAMIDE ORAL SOLUTION (IV FORM) 50 MG/ML [4080440]

Facility

$1.29

Service Code	NDC 9994-0804-40
Hospital Charge Code	901700029
Hospital Revenue Code	259
Min. Negotiated Rate	$0.71
Max. Negotiated Rate	$1.03
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$0.77
Rate for Payer: Aetna of CA Government/Medicare	$0.77
Rate for Payer: Cash Price	$0.71
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$1.03
Rate for Payer: Health Smart Auto/Commercial	$0.77
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$0.77
Rate for Payer: LLUH Dept of Risk Management WC	$0.71
Rate for Payer: Multiplan Commercial	$0.97

PROCARBAZINE ORAL SUSPENSION COMPOUND 10 MG/ML [4080323]

Facility

$12.07

Service Code	NDC 9994-0803-23
Hospital Charge Code	901700029
Hospital Revenue Code	259
Min. Negotiated Rate	$6.64
Max. Negotiated Rate	$9.66
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$7.24
Rate for Payer: Aetna of CA Government/Medicare	$7.24
Rate for Payer: Cash Price	$6.64
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$9.66
Rate for Payer: Health Smart Auto/Commercial	$7.24
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$7.24
Rate for Payer: LLUH Dept of Risk Management WC	$6.64
Rate for Payer: Multiplan Commercial	$9.05

PROCARBAZINE ORAL SUSPENSION COMPOUND 10 MG/ML [4080323]

Facility

$12.07

Service Code	NDC 9994-0803-23
Hospital Charge Code	901700029
Hospital Revenue Code	259
Min. Negotiated Rate	$6.64
Max. Negotiated Rate	$9.66
Rate for Payer: Cash Price	$6.64
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$9.66
Rate for Payer: Health Smart Auto/Commercial	$7.24
Rate for Payer: LLUH Dept of Risk Management WC	$6.64
Rate for Payer: Multiplan Commercial	$9.05

PROCHLORPERAZINE 25 MG RECTAL SUPPOSITORY [11138]

Facility

$10.46

Service Code	NDC 0574-7226-12
Hospital Charge Code	901700029
Hospital Revenue Code	259
Min. Negotiated Rate	$5.75
Max. Negotiated Rate	$8.37
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$6.28
Rate for Payer: Aetna of CA Government/Medicare	$6.28
Rate for Payer: Cash Price	$5.75
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$8.37
Rate for Payer: Health Smart Auto/Commercial	$6.28
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$6.28
Rate for Payer: LLUH Dept of Risk Management WC	$5.75
Rate for Payer: Multiplan Commercial	$7.84

PROCHLORPERAZINE 25 MG RECTAL SUPPOSITORY [11138]

Facility

$10.45

Service Code	NDC 0713-0135-06
Hospital Charge Code	901700029
Hospital Revenue Code	259
Min. Negotiated Rate	$5.75
Max. Negotiated Rate	$8.36
Rate for Payer: Cash Price	$5.75
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$8.36
Rate for Payer: Health Smart Auto/Commercial	$6.27
Rate for Payer: LLUH Dept of Risk Management WC	$5.75
Rate for Payer: Multiplan Commercial	$7.84

PROCHLORPERAZINE 25 MG RECTAL SUPPOSITORY [11138]

Facility

$10.45

Service Code	NDC 0713-0135-06
Hospital Charge Code	901700029
Hospital Revenue Code	259
Min. Negotiated Rate	$5.75
Max. Negotiated Rate	$8.36
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$6.27
Rate for Payer: Aetna of CA Government/Medicare	$6.27
Rate for Payer: Cash Price	$5.75
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$8.36
Rate for Payer: Health Smart Auto/Commercial	$6.27
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$6.27
Rate for Payer: LLUH Dept of Risk Management WC	$5.75
Rate for Payer: Multiplan Commercial	$7.84

PROCHLORPERAZINE 25 MG RECTAL SUPPOSITORY [11138]

Facility

$10.46

Service Code	NDC 0574-7226-12
Hospital Charge Code	901700029
Hospital Revenue Code	259
Min. Negotiated Rate	$5.75
Max. Negotiated Rate	$8.37
Rate for Payer: Cash Price	$5.75
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$8.37
Rate for Payer: Health Smart Auto/Commercial	$6.28
Rate for Payer: LLUH Dept of Risk Management WC	$5.75
Rate for Payer: Multiplan Commercial	$7.84

PROCHLORPERAZINE EDISYLATE 10 MG/2 ML (5 MG/ML) INJECTION SOLUTION [153823]

Facility

$2.78

Service Code	HCPCS J0780
Hospital Charge Code	901700025
Hospital Revenue Code	636
Min. Negotiated Rate	$1.53
Max. Negotiated Rate	$2.22
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$1.67
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$2.12
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$1.65
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$1.91
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$2.02
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$1.96
Rate for Payer: Aetna of CA Government/Medicare	$1.65
Rate for Payer: Aetna of CA Government/Medicare	$1.96
Rate for Payer: Aetna of CA Government/Medicare	$1.91
Rate for Payer: Aetna of CA Government/Medicare	$2.02
Rate for Payer: Aetna of CA Government/Medicare	$2.12
Rate for Payer: Aetna of CA Government/Medicare	$1.67
Rate for Payer: Cash Price	$1.53
Rate for Payer: Cash Price	$1.95
Rate for Payer: Cash Price	$1.80
Rate for Payer: Cash Price	$1.75
Rate for Payer: Cash Price	$1.85
Rate for Payer: Cash Price	$1.51
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$2.69
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$2.61
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$2.54
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$2.22
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$2.20
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$2.83
Rate for Payer: Health Smart Auto/Commercial	$1.67
Rate for Payer: Health Smart Auto/Commercial	$2.02
Rate for Payer: Health Smart Auto/Commercial	$1.65
Rate for Payer: Health Smart Auto/Commercial	$2.12
Rate for Payer: Health Smart Auto/Commercial	$1.91
Rate for Payer: Health Smart Auto/Commercial	$1.96
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$1.67
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$1.65
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$1.96
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$2.02
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$2.12
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$1.91
Rate for Payer: LLUH Dept of Risk Management WC	$1.75
Rate for Payer: LLUH Dept of Risk Management WC	$1.85
Rate for Payer: LLUH Dept of Risk Management WC	$1.53
Rate for Payer: LLUH Dept of Risk Management WC	$1.95
Rate for Payer: LLUH Dept of Risk Management WC	$1.79
Rate for Payer: LLUH Dept of Risk Management WC	$1.51
Rate for Payer: Multiplan Commercial	$2.06
Rate for Payer: Multiplan Commercial	$2.52
Rate for Payer: Multiplan Commercial	$2.65
Rate for Payer: Multiplan Commercial	$2.38
Rate for Payer: Multiplan Commercial	$2.08
Rate for Payer: Multiplan Commercial	$2.44

PROCHLORPERAZINE EDISYLATE 10 MG/2 ML (5 MG/ML) INJECTION SOLUTION [153823]

Facility

$3.26

Service Code	HCPCS J0780
Hospital Charge Code	901700025
Hospital Revenue Code	636
Min. Negotiated Rate	$1.79
Max. Negotiated Rate	$2.61
Rate for Payer: Cash Price	$1.80
Rate for Payer: Cash Price	$1.51
Rate for Payer: Cash Price	$1.95
Rate for Payer: Cash Price	$1.85
Rate for Payer: Cash Price	$1.75
Rate for Payer: Cash Price	$1.53
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$2.54
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$2.61
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$2.83
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$2.22
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$2.69
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$2.20
Rate for Payer: Health Smart Auto/Commercial	$1.65
Rate for Payer: Health Smart Auto/Commercial	$1.67
Rate for Payer: Health Smart Auto/Commercial	$1.91
Rate for Payer: Health Smart Auto/Commercial	$1.96
Rate for Payer: Health Smart Auto/Commercial	$2.02
Rate for Payer: Health Smart Auto/Commercial	$2.12
Rate for Payer: LLUH Dept of Risk Management WC	$1.53
Rate for Payer: LLUH Dept of Risk Management WC	$1.75
Rate for Payer: LLUH Dept of Risk Management WC	$1.51
Rate for Payer: LLUH Dept of Risk Management WC	$1.79
Rate for Payer: LLUH Dept of Risk Management WC	$1.95
Rate for Payer: LLUH Dept of Risk Management WC	$1.85
Rate for Payer: Multiplan Commercial	$2.65
Rate for Payer: Multiplan Commercial	$2.44
Rate for Payer: Multiplan Commercial	$2.08
Rate for Payer: Multiplan Commercial	$2.52
Rate for Payer: Multiplan Commercial	$2.06
Rate for Payer: Multiplan Commercial	$2.38

PROCHLORPERAZINE MALEATE 10 MG TABLET [6582]

Facility

$1.43

Service Code	NDC 50268-685-11
Hospital Charge Code	901700029
Hospital Revenue Code	259
Min. Negotiated Rate	$0.79
Max. Negotiated Rate	$1.14
Rate for Payer: Cash Price	$0.79
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$1.14
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	$1.07

PROCHLORPERAZINE MALEATE 10 MG TABLET [6582]

Facility

$0.63

Service Code	NDC 59746-115-06
Hospital Charge Code	901700029
Hospital Revenue Code	259
Min. Negotiated Rate	$0.35
Max. Negotiated Rate	$0.50
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$0.38
Rate for Payer: Aetna of CA Government/Medicare	$0.38
Rate for Payer: Cash Price	$0.35
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$0.50
Rate for Payer: Health Smart Auto/Commercial	$0.38
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$0.38
Rate for Payer: LLUH Dept of Risk Management WC	$0.35
Rate for Payer: Multiplan Commercial	$0.47

PROCHLORPERAZINE MALEATE 10 MG TABLET [6582]

Facility

$1.74

Service Code	NDC 60687-825-11
Hospital Charge Code	901700029
Hospital Revenue Code	259
Min. Negotiated Rate	$0.96
Max. Negotiated Rate	$1.39
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$1.04
Rate for Payer: Aetna of CA Government/Medicare	$1.04
Rate for Payer: Cash Price	$0.96
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$1.39
Rate for Payer: Health Smart Auto/Commercial	$1.04
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$1.04
Rate for Payer: LLUH Dept of Risk Management WC	$0.96
Rate for Payer: Multiplan Commercial	$1.30

PROCHLORPERAZINE MALEATE 10 MG TABLET [6582]

Facility

$1.43

Service Code	NDC 50268-685-11
Hospital Charge Code	901700029
Hospital Revenue Code	259
Min. Negotiated Rate	$0.79
Max. Negotiated Rate	$1.14
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	$1.14
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	$1.07

PROCHLORPERAZINE MALEATE 10 MG TABLET [6582]

Facility

$0.63

Service Code	NDC 59746-115-06
Hospital Charge Code	901700029
Hospital Revenue Code	259
Min. Negotiated Rate	$0.35
Max. Negotiated Rate	$0.50
Rate for Payer: Cash Price	$0.35
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$0.50
Rate for Payer: Health Smart Auto/Commercial	$0.38
Rate for Payer: LLUH Dept of Risk Management WC	$0.35
Rate for Payer: Multiplan Commercial	$0.47

PROCHLORPERAZINE MALEATE 10 MG TABLET [6582]

Facility

$1.74

Service Code	NDC 60687-825-65
Hospital Charge Code	901700029
Hospital Revenue Code	259
Min. Negotiated Rate	$0.96
Max. Negotiated Rate	$1.39
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$1.04
Rate for Payer: Aetna of CA Government/Medicare	$1.04
Rate for Payer: Cash Price	$0.96
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$1.39
Rate for Payer: Health Smart Auto/Commercial	$1.04
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$1.04
Rate for Payer: LLUH Dept of Risk Management WC	$0.96
Rate for Payer: Multiplan Commercial	$1.30

PROCHLORPERAZINE MALEATE 10 MG TABLET [6582]

Facility

$1.74

Service Code	NDC 60687-825-65
Hospital Charge Code	901700029
Hospital Revenue Code	259
Min. Negotiated Rate	$0.96
Max. Negotiated Rate	$1.39
Rate for Payer: Cash Price	$0.96
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$1.39
Rate for Payer: Health Smart Auto/Commercial	$1.04
Rate for Payer: LLUH Dept of Risk Management WC	$0.96
Rate for Payer: Multiplan Commercial	$1.30

PROCHLORPERAZINE MALEATE 10 MG TABLET [6582]

Facility

$1.74

Service Code	NDC 60687-825-11
Hospital Charge Code	901700029
Hospital Revenue Code	259
Min. Negotiated Rate	$0.96
Max. Negotiated Rate	$1.39
Rate for Payer: Cash Price	$0.96
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$1.39
Rate for Payer: Health Smart Auto/Commercial	$1.04
Rate for Payer: LLUH Dept of Risk Management WC	$0.96
Rate for Payer: Multiplan Commercial	$1.30

PROCHLORPERAZINE MALEATE 5 MG TABLET [6583]

Facility

$1.54

Service Code	NDC 60687-814-11
Hospital Charge Code	901700029
Hospital Revenue Code	259
Min. Negotiated Rate	$0.85
Max. Negotiated Rate	$1.23
Rate for Payer: Cash Price	$0.85
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$1.23
Rate for Payer: Health Smart Auto/Commercial	$0.92
Rate for Payer: LLUH Dept of Risk Management WC	$0.85
Rate for Payer: Multiplan Commercial	$1.16

PROCHLORPERAZINE MALEATE 5 MG TABLET [6583]

Facility

$1.54

Service Code	NDC 60687-814-65
Hospital Charge Code	901700029
Hospital Revenue Code	259
Min. Negotiated Rate	$0.85
Max. Negotiated Rate	$1.23
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$0.92
Rate for Payer: Aetna of CA Government/Medicare	$0.92
Rate for Payer: Cash Price	$0.85
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$1.23
Rate for Payer: Health Smart Auto/Commercial	$0.92
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$0.92
Rate for Payer: LLUH Dept of Risk Management WC	$0.85
Rate for Payer: Multiplan Commercial	$1.16

PROCHLORPERAZINE MALEATE 5 MG TABLET [6583]

Facility

$0.42

Service Code	NDC 59746-113-06
Hospital Charge Code	901700029
Hospital Revenue Code	259
Min. Negotiated Rate	$0.23
Max. Negotiated Rate	$0.34
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	$0.23
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$0.34
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 Commercial	$0.32

PROCHLORPERAZINE MALEATE 5 MG TABLET [6583]

Facility

$1.54

Service Code	NDC 60687-814-65
Hospital Charge Code	901700029
Hospital Revenue Code	259
Min. Negotiated Rate	$0.85
Max. Negotiated Rate	$1.23
Rate for Payer: Cash Price	$0.85
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$1.23
Rate for Payer: Health Smart Auto/Commercial	$0.92
Rate for Payer: LLUH Dept of Risk Management WC	$0.85
Rate for Payer: Multiplan Commercial	$1.16

PROCHLORPERAZINE MALEATE 5 MG TABLET [6583]

Facility

$0.42

Service Code	NDC 59746-113-06
Hospital Charge Code	901700029
Hospital Revenue Code	259
Min. Negotiated Rate	$0.23
Max. Negotiated Rate	$0.34
Rate for Payer: Cash Price	$0.23
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$0.34
Rate for Payer: Health Smart Auto/Commercial	$0.25
Rate for Payer: LLUH Dept of Risk Management WC	$0.23
Rate for Payer: Multiplan Commercial	$0.32

PROCHLORPERAZINE MALEATE 5 MG TABLET [6583]

Facility

$1.54

Service Code	NDC 60687-814-11
Hospital Charge Code	901700029
Hospital Revenue Code	259
Min. Negotiated Rate	$0.85
Max. Negotiated Rate	$1.23
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$0.92
Rate for Payer: Aetna of CA Government/Medicare	$0.92
Rate for Payer: Cash Price	$0.85
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$1.23
Rate for Payer: Health Smart Auto/Commercial	$0.92
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$0.92
Rate for Payer: LLUH Dept of Risk Management WC	$0.85
Rate for Payer: Multiplan Commercial	$1.16

PROGESTERONE 50 MG/ML INTRAMUSCULAR OIL [6597]

Facility

$2.40

Service Code	HCPCS J2675
Hospital Charge Code	901700025
Hospital Revenue Code	636
Min. Negotiated Rate	$1.32
Max. Negotiated Rate	$1.92
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$1.44
Rate for Payer: Aetna of CA Government/Medicare	$1.44
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: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$1.44
Rate for Payer: LLUH Dept of Risk Management WC	$1.32
Rate for Payer: Multiplan Commercial	$1.80

Know your out-of-pocket cost for care.

All Charges