Loma Linda University Behavioral Medicine Center (BMC)

All Charges

Charge

Type

Setting

Price

PACLITAXEL PROTEIN-BOUND 100 MG INTRAVENOUS SUSPENSION [40475]

Facility

$1,896.07

Service Code	NDC 68817-134-50
Hospital Charge Code	1755722
Hospital Revenue Code	636
Min. Negotiated Rate	$1,042.84
Max. Negotiated Rate	$1,422.05
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$1,137.64
Rate for Payer: Aetna of CA Government/Medicare	$1,137.64
Rate for Payer: Cash Price	$853.23
Rate for Payer: Health Smart Auto/Commercial	$1,137.64
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$1,137.64
Rate for Payer: LLUH Dept of Risk Management WC	$1,042.84
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$1,422.05

PALIFERMIN 6.25 MG INTRAVENOUS SOLUTION [40400]

Facility

$3,751.26

Service Code	CPT J2425
Hospital Charge Code	1753463
Hospital Revenue Code	636
Min. Negotiated Rate	$2,063.19
Max. Negotiated Rate	$2,813.44
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$2,250.76
Rate for Payer: Aetna of CA Government/Medicare	$2,250.76
Rate for Payer: Cash Price	$1,688.07
Rate for Payer: Health Smart Auto/Commercial	$2,250.76
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$2,250.76
Rate for Payer: LLUH Dept of Risk Management WC	$2,063.19
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$2,813.44

PALIFERMIN 6.25 MG INTRAVENOUS SOLUTION [40400]

Facility

$3,751.26

Service Code	CPT J2425
Hospital Charge Code	1753463
Hospital Revenue Code	636
Min. Negotiated Rate	$2,063.19
Max. Negotiated Rate	$3,001.01
Rate for Payer: Cash Price	$1,688.07
Rate for Payer: Cigna of CA HMO/PPO	$3,001.01
Rate for Payer: Health Smart Auto/Commercial	$2,250.76
Rate for Payer: LLUH Dept of Risk Management WC	$2,063.19
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$2,813.44

PALIPERIDONE PALMITATE 156 MG/ML INTRAMUSCULAR SYRINGE [99702]

Facility

$2,678.57

Service Code	CPT J2426
Hospital Charge Code	NDG99702
Hospital Revenue Code	636
Min. Negotiated Rate	$1,473.21
Max. Negotiated Rate	$2,008.93
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$1,607.14
Rate for Payer: Aetna of CA Government/Medicare	$1,607.14
Rate for Payer: Cash Price	$1,205.36
Rate for Payer: Health Smart Auto/Commercial	$1,607.14
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$1,607.14
Rate for Payer: LLUH Dept of Risk Management WC	$1,473.21
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$2,008.93

PALIPERIDONE PALMITATE 156 MG/ML INTRAMUSCULAR SYRINGE [99702]

Facility

$2,678.57

Service Code	CPT J2426
Hospital Charge Code	NDG99702
Hospital Revenue Code	636
Min. Negotiated Rate	$1,473.21
Max. Negotiated Rate	$2,142.86
Rate for Payer: Cash Price	$1,205.36
Rate for Payer: Cigna of CA HMO/PPO	$2,142.86
Rate for Payer: Health Smart Auto/Commercial	$1,607.14
Rate for Payer: LLUH Dept of Risk Management WC	$1,473.21
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$2,008.93

PALIPERIDONE PALMITATE 234 MG/1.5 ML INTRAMUSCULAR SYRINGE [108109]

Facility

$2,678.50

Service Code	CPT J2426
Hospital Charge Code	1712607
Hospital Revenue Code	636
Min. Negotiated Rate	$1,473.18
Max. Negotiated Rate	$2,008.88
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$1,607.10
Rate for Payer: Aetna of CA Government/Medicare	$1,607.10
Rate for Payer: Cash Price	$1,205.33
Rate for Payer: Health Smart Auto/Commercial	$1,607.10
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$1,607.10
Rate for Payer: LLUH Dept of Risk Management WC	$1,473.18
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$2,008.88

PALIPERIDONE PALMITATE 234 MG/1.5 ML INTRAMUSCULAR SYRINGE [108109]

Facility

$2,678.50

Service Code	CPT J2426
Hospital Charge Code	1712607
Hospital Revenue Code	636
Min. Negotiated Rate	$1,473.18
Max. Negotiated Rate	$2,142.80
Rate for Payer: Cash Price	$1,205.33
Rate for Payer: Cigna of CA HMO/PPO	$2,142.80
Rate for Payer: Health Smart Auto/Commercial	$1,607.10
Rate for Payer: LLUH Dept of Risk Management WC	$1,473.18
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$2,008.88

PALIVIZUMAB 100 MG/ML INTRAMUSCULAR SOLUTION [41675]

Facility

$4,125.50

Service Code	CPT 90378
Hospital Charge Code	NDG41675
Hospital Revenue Code	636
Min. Negotiated Rate	$2,269.02
Max. Negotiated Rate	$3,094.12
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$2,475.30
Rate for Payer: Aetna of CA Government/Medicare	$2,475.30
Rate for Payer: Cash Price	$1,856.48
Rate for Payer: Health Smart Auto/Commercial	$2,475.30
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$2,475.30
Rate for Payer: LLUH Dept of Risk Management WC	$2,269.02
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$3,094.12

PALIVIZUMAB 100 MG/ML INTRAMUSCULAR SOLUTION [41675]

Facility

$4,125.50

Service Code	CPT 90378
Hospital Charge Code	NDG41675
Hospital Revenue Code	636
Min. Negotiated Rate	$2,269.02
Max. Negotiated Rate	$3,300.40
Rate for Payer: Cash Price	$1,856.48
Rate for Payer: Cigna of CA HMO/PPO	$3,300.40
Rate for Payer: Health Smart Auto/Commercial	$2,475.30
Rate for Payer: LLUH Dept of Risk Management WC	$2,269.02
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$3,094.12

PALONOSETRON 0.25 MG/5 ML INTRAVENOUS SOLUTION [36591]

Facility

$24.00

Service Code	CPT J2469
Hospital Charge Code	1720944
Hospital Revenue Code	636
Min. Negotiated Rate	$13.20
Max. Negotiated Rate	$19.20
Rate for Payer: Cash Price	$10.80
Rate for Payer: Cash Price	$3.78
Rate for Payer: Cigna of CA HMO/PPO	$19.20
Rate for Payer: Cigna of CA HMO/PPO	$6.72
Rate for Payer: Health Smart Auto/Commercial	$5.04
Rate for Payer: Health Smart Auto/Commercial	$14.40
Rate for Payer: LLUH Dept of Risk Management WC	$4.62
Rate for Payer: LLUH Dept of Risk Management WC	$13.20
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$18.00
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$6.30

PALONOSETRON 0.25 MG/5 ML INTRAVENOUS SOLUTION [36591]

Facility

$24.00

Service Code	CPT J2469
Hospital Charge Code	1720944
Hospital Revenue Code	636
Min. Negotiated Rate	$13.20
Max. Negotiated Rate	$18.00
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$14.40
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$5.04
Rate for Payer: Aetna of CA Government/Medicare	$14.40
Rate for Payer: Aetna of CA Government/Medicare	$5.04
Rate for Payer: Cash Price	$10.80
Rate for Payer: Cash Price	$3.78
Rate for Payer: Health Smart Auto/Commercial	$5.04
Rate for Payer: Health Smart Auto/Commercial	$14.40
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$5.04
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$14.40
Rate for Payer: LLUH Dept of Risk Management WC	$4.62
Rate for Payer: LLUH Dept of Risk Management WC	$13.20
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$6.30
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$18.00

PALONOSETRON 0.25 MG/5 ML INTRAVENOUS SOLUTION. [40836591]

Facility

$12.00

Service Code	CPT J2469
Hospital Charge Code	1720944
Hospital Revenue Code	636
Min. Negotiated Rate	$6.60
Max. Negotiated Rate	$9.00
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$7.20
Rate for Payer: Aetna of CA Government/Medicare	$7.20
Rate for Payer: Cash Price	$5.40
Rate for Payer: Health Smart Auto/Commercial	$7.20
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$7.20
Rate for Payer: LLUH Dept of Risk Management WC	$6.60
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$9.00

PALONOSETRON 0.25 MG/5 ML INTRAVENOUS SOLUTION. [40836591]

Facility

$12.00

Service Code	CPT J2469
Hospital Charge Code	1720944
Hospital Revenue Code	636
Min. Negotiated Rate	$6.60
Max. Negotiated Rate	$9.60
Rate for Payer: Cash Price	$5.40
Rate for Payer: Cigna of CA HMO/PPO	$9.60
Rate for Payer: Health Smart Auto/Commercial	$7.20
Rate for Payer: LLUH Dept of Risk Management WC	$6.60
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$9.00

PALONOSETRON 0.25 MG/5 ML INTRAVENOUS SYRINGE [222773]

Facility

$12.00

Service Code	CPT J2469
Hospital Charge Code	1720944
Hospital Revenue Code	636
Min. Negotiated Rate	$6.60
Max. Negotiated Rate	$9.00
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$7.20
Rate for Payer: Aetna of CA Government/Medicare	$7.20
Rate for Payer: Cash Price	$5.40
Rate for Payer: Health Smart Auto/Commercial	$7.20
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$7.20
Rate for Payer: LLUH Dept of Risk Management WC	$6.60
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$9.00

PALONOSETRON 0.25 MG/5 ML INTRAVENOUS SYRINGE [222773]

Facility

$12.00

Service Code	CPT J2469
Hospital Charge Code	1720944
Hospital Revenue Code	636
Min. Negotiated Rate	$6.60
Max. Negotiated Rate	$9.60
Rate for Payer: Cash Price	$5.40
Rate for Payer: Cigna of CA HMO/PPO	$9.60
Rate for Payer: Health Smart Auto/Commercial	$7.20
Rate for Payer: LLUH Dept of Risk Management WC	$6.60
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$9.00

PAMIDRONATE 30 MG/10 ML (3 MG/ML) INTRAVENOUS SOLUTION [32589]

Facility

$3.24

Service Code	CPT J2430
Hospital Charge Code	NDG32589
Hospital Revenue Code	636
Min. Negotiated Rate	$1.78
Max. Negotiated Rate	$2.43
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$1.94
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$1.01
Rate for Payer: Aetna of CA Government/Medicare	$1.01
Rate for Payer: Aetna of CA Government/Medicare	$1.94
Rate for Payer: Cash Price	$0.76
Rate for Payer: Cash Price	$1.46
Rate for Payer: Health Smart Auto/Commercial	$1.94
Rate for Payer: Health Smart Auto/Commercial	$1.01
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$1.01
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$1.94
Rate for Payer: LLUH Dept of Risk Management WC	$1.78
Rate for Payer: LLUH Dept of Risk Management WC	$0.92
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$1.26
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$2.43

PAMIDRONATE 30 MG/10 ML (3 MG/ML) INTRAVENOUS SOLUTION [32589]

Facility

$1.68

Service Code	CPT J2430
Hospital Charge Code	NDG32589
Hospital Revenue Code	636
Min. Negotiated Rate	$0.92
Max. Negotiated Rate	$1.34
Rate for Payer: Cash Price	$0.76
Rate for Payer: Cash Price	$1.46
Rate for Payer: Cigna of CA HMO/PPO	$2.59
Rate for Payer: Cigna of CA HMO/PPO	$1.34
Rate for Payer: Health Smart Auto/Commercial	$1.94
Rate for Payer: Health Smart Auto/Commercial	$1.01
Rate for Payer: LLUH Dept of Risk Management WC	$0.92
Rate for Payer: LLUH Dept of Risk Management WC	$1.78
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$1.26
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$2.43

PAMIDRONATE 30 MG INTRAVENOUS SOLUTION [10845]

Facility

$22.55

Service Code	CPT J2430
Hospital Charge Code	1759468
Hospital Revenue Code	636
Min. Negotiated Rate	$12.40
Max. Negotiated Rate	$18.04
Rate for Payer: Cash Price	$10.15
Rate for Payer: Cigna of CA HMO/PPO	$18.04
Rate for Payer: Health Smart Auto/Commercial	$13.53
Rate for Payer: LLUH Dept of Risk Management WC	$12.40
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$16.91

PAMIDRONATE 30 MG INTRAVENOUS SOLUTION [10845]

Facility

$22.55

Service Code	CPT J2430
Hospital Charge Code	1759468
Hospital Revenue Code	636
Min. Negotiated Rate	$12.40
Max. Negotiated Rate	$16.91
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$13.53
Rate for Payer: Aetna of CA Government/Medicare	$13.53
Rate for Payer: Cash Price	$10.15
Rate for Payer: Health Smart Auto/Commercial	$13.53
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$13.53
Rate for Payer: LLUH Dept of Risk Management WC	$12.40
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$16.91

PAMIDRONATE 60 MG/10 ML (6 MG/ML) INTRAVENOUS SOLUTION [33886]

Facility

$4.09

Service Code	CPT J2430
Hospital Charge Code	1755744
Hospital Revenue Code	636
Min. Negotiated Rate	$2.25
Max. Negotiated Rate	$3.27
Rate for Payer: Cash Price	$1.84
Rate for Payer: Cigna of CA HMO/PPO	$3.27
Rate for Payer: Health Smart Auto/Commercial	$2.45
Rate for Payer: LLUH Dept of Risk Management WC	$2.25
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$3.07

PAMIDRONATE 60 MG/10 ML (6 MG/ML) INTRAVENOUS SOLUTION [33886]

Facility

$4.09

Service Code	CPT J2430
Hospital Charge Code	1755744
Hospital Revenue Code	636
Min. Negotiated Rate	$2.25
Max. Negotiated Rate	$3.07
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$2.45
Rate for Payer: Aetna of CA Government/Medicare	$2.45
Rate for Payer: Cash Price	$1.84
Rate for Payer: Health Smart Auto/Commercial	$2.45
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$2.45
Rate for Payer: LLUH Dept of Risk Management WC	$2.25
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$3.07

PAMIDRONATE 90 MG/10 ML (9 MG/ML) INTRAVENOUS SOLUTION [32855]

Facility

$11.23

Service Code	CPT J2430
Hospital Charge Code	NDG32855
Hospital Revenue Code	636
Min. Negotiated Rate	$6.18
Max. Negotiated Rate	$8.98
Rate for Payer: Cash Price	$5.05
Rate for Payer: Cash Price	$5.70
Rate for Payer: Cigna of CA HMO/PPO	$8.98
Rate for Payer: Cigna of CA HMO/PPO	$10.14
Rate for Payer: Health Smart Auto/Commercial	$6.74
Rate for Payer: Health Smart Auto/Commercial	$7.60
Rate for Payer: LLUH Dept of Risk Management WC	$6.18
Rate for Payer: LLUH Dept of Risk Management WC	$6.97
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$8.42
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$9.50

PAMIDRONATE 90 MG/10 ML (9 MG/ML) INTRAVENOUS SOLUTION [32855]

Facility

$12.67

Service Code	CPT J2430
Hospital Charge Code	NDG32855
Hospital Revenue Code	636
Min. Negotiated Rate	$6.97
Max. Negotiated Rate	$9.50
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$6.74
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$7.60
Rate for Payer: Aetna of CA Government/Medicare	$7.60
Rate for Payer: Aetna of CA Government/Medicare	$6.74
Rate for Payer: Cash Price	$5.05
Rate for Payer: Cash Price	$5.70
Rate for Payer: Health Smart Auto/Commercial	$7.60
Rate for Payer: Health Smart Auto/Commercial	$6.74
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$6.74
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$7.60
Rate for Payer: LLUH Dept of Risk Management WC	$6.97
Rate for Payer: LLUH Dept of Risk Management WC	$6.18
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$8.42
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$9.50

PANCURONIUM 1 MG/ML INTRAVENOUS SOLUTION [6013]

Facility

$0.69

Service Code	NDC 0409-4646-01
Hospital Charge Code	1720288
Hospital Revenue Code	250
Min. Negotiated Rate	$0.38
Max. Negotiated Rate	$0.55
Rate for Payer: Cash Price	$0.31
Rate for Payer: Cigna of CA HMO/PPO	$0.55
Rate for Payer: Health Smart Auto/Commercial	$0.41
Rate for Payer: LLUH Dept of Risk Management WC	$0.38
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$0.52

PANCURONIUM 1 MG/ML INTRAVENOUS SOLUTION [6013]

Facility

$0.69

Service Code	NDC 0409-4646-01
Hospital Charge Code	1720288
Hospital Revenue Code	250
Min. Negotiated Rate	$0.38
Max. Negotiated Rate	$0.52
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$0.41
Rate for Payer: Aetna of CA Government/Medicare	$0.41
Rate for Payer: Cash Price	$0.31
Rate for Payer: Health Smart Auto/Commercial	$0.41
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$0.41
Rate for Payer: LLUH Dept of Risk Management WC	$0.38
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$0.52

Know your out-of-pocket cost for care.

All Charges