Loma Linda University Behavioral Medicine Center (BMC)

All Charges

Charge

Type

Setting

Price

PAPAVERINE 30 MG/ML INJECTION SOLUTION [6030]

Facility

$19.50

Service Code	CPT J2440
Hospital Charge Code	NDG6030
Hospital Revenue Code	636
Min. Negotiated Rate	$10.72
Max. Negotiated Rate	$15.60
Rate for Payer: Cash Price	$8.78
Rate for Payer: Cash Price	$10.49
Rate for Payer: Cash Price	$10.13
Rate for Payer: Cash Price	$11.18
Rate for Payer: Cigna of CA HMO/PPO	$18.66
Rate for Payer: Cigna of CA HMO/PPO	$18.00
Rate for Payer: Cigna of CA HMO/PPO	$19.88
Rate for Payer: Cigna of CA HMO/PPO	$15.60
Rate for Payer: Health Smart Auto/Commercial	$11.70
Rate for Payer: Health Smart Auto/Commercial	$14.91
Rate for Payer: Health Smart Auto/Commercial	$13.50
Rate for Payer: Health Smart Auto/Commercial	$13.99
Rate for Payer: LLUH Dept of Risk Management WC	$10.72
Rate for Payer: LLUH Dept of Risk Management WC	$13.67
Rate for Payer: LLUH Dept of Risk Management WC	$12.83
Rate for Payer: LLUH Dept of Risk Management WC	$12.38
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$16.88
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$14.62
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$17.49
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$18.64

PAPAVERINE 30 MG/ML INJECTION SOLUTION [6030]

Facility

$24.85

Service Code	CPT J2440
Hospital Charge Code	NDG6030
Hospital Revenue Code	636
Min. Negotiated Rate	$13.67
Max. Negotiated Rate	$18.64
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$14.91
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$11.70
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$13.50
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$13.99
Rate for Payer: Aetna of CA Government/Medicare	$13.50
Rate for Payer: Aetna of CA Government/Medicare	$11.70
Rate for Payer: Aetna of CA Government/Medicare	$14.91
Rate for Payer: Aetna of CA Government/Medicare	$13.99
Rate for Payer: Cash Price	$11.18
Rate for Payer: Cash Price	$8.78
Rate for Payer: Cash Price	$10.49
Rate for Payer: Cash Price	$10.13
Rate for Payer: Health Smart Auto/Commercial	$11.70
Rate for Payer: Health Smart Auto/Commercial	$13.99
Rate for Payer: Health Smart Auto/Commercial	$13.50
Rate for Payer: Health Smart Auto/Commercial	$14.91
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$13.50
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$13.99
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$14.91
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$11.70
Rate for Payer: LLUH Dept of Risk Management WC	$12.38
Rate for Payer: LLUH Dept of Risk Management WC	$10.72
Rate for Payer: LLUH Dept of Risk Management WC	$13.67
Rate for Payer: LLUH Dept of Risk Management WC	$12.83
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$16.88
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$14.62
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$17.49
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$18.64

PARENTERAL AMINO ACID 15 % COMBINATION NO.5 INTRAVENOUS SOLUTION [222465]

Facility

$0.08

Service Code	NDC 0338-0502-06
Hospital Charge Code	NDG222465
Hospital Revenue Code	250
Min. Negotiated Rate	$0.04
Max. Negotiated Rate	$0.06
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$0.05
Rate for Payer: Aetna of CA Government/Medicare	$0.05
Rate for Payer: Cash Price	$0.04
Rate for Payer: Health Smart Auto/Commercial	$0.05
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$0.05
Rate for Payer: LLUH Dept of Risk Management WC	$0.04
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$0.06

PARENTERAL AMINO ACID 15 % COMBINATION NO.5 INTRAVENOUS SOLUTION [222465]

Facility

$0.08

Service Code	NDC 0338-0502-06
Hospital Charge Code	NDG222465
Hospital Revenue Code	250
Min. Negotiated Rate	$0.04
Max. Negotiated Rate	$0.06
Rate for Payer: Cash Price	$0.04
Rate for Payer: Cigna of CA HMO/PPO	$0.06
Rate for Payer: Health Smart Auto/Commercial	$0.05
Rate for Payer: LLUH Dept of Risk Management WC	$0.04
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$0.06

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

Facility

$0.05

Service Code	NDC 0264-4500-00
Hospital Charge Code	NDG119537B
Hospital Revenue Code	250
Min. Negotiated Rate	$0.03
Max. Negotiated Rate	$0.04
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$0.03
Rate for Payer: Aetna of CA Government/Medicare	$0.03
Rate for Payer: Cash Price	$0.02
Rate for Payer: Health Smart Auto/Commercial	$0.03
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$0.03
Rate for Payer: LLUH Dept of Risk Management WC	$0.03
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$0.04

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

Facility

$0.05

Service Code	NDC 0264-4500-00
Hospital Charge Code	NDG119537B
Hospital Revenue Code	250
Min. Negotiated Rate	$0.03
Max. Negotiated Rate	$0.04
Rate for Payer: Cash Price	$0.02
Rate for Payer: Cigna of CA 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 Beech St/Commercial/PHCS	$0.04

PARICALCITOL 1 MCG CAPSULE [41497]

Facility

$1.20

Service Code	NDC 49483-687-03
Hospital Charge Code	1712296
Hospital Revenue Code	259
Min. Negotiated Rate	$0.66
Max. Negotiated Rate	$0.96
Rate for Payer: Cash Price	$0.54
Rate for Payer: Cigna of CA 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 Beech St/Commercial/PHCS	$0.90

PARICALCITOL 1 MCG CAPSULE [41497]

Facility

$1.78

Service Code	NDC 65862-936-30
Hospital Charge Code	1712296
Hospital Revenue Code	259
Min. Negotiated Rate	$0.98
Max. Negotiated Rate	$1.42
Rate for Payer: Cash Price	$0.80
Rate for Payer: Cigna of CA 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 Beech St/Commercial/PHCS	$1.34

PARICALCITOL 1 MCG CAPSULE [41497]

Facility

$1.20

Service Code	NDC 49483-687-03
Hospital Charge Code	1712296
Hospital Revenue Code	259
Min. Negotiated Rate	$0.66
Max. Negotiated Rate	$0.90
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	$0.54
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 Beech St/Commercial/PHCS	$0.90

PARICALCITOL 1 MCG CAPSULE [41497]

Facility

$1.78

Service Code	NDC 65862-936-30
Hospital Charge Code	1712296
Hospital Revenue Code	259
Min. Negotiated Rate	$0.98
Max. Negotiated Rate	$1.34
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	$0.80
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 Beech St/Commercial/PHCS	$1.34

PARICALCITOL 2 MCG CAPSULE [41498]

Facility

$10.00

Service Code	NDC 69452-146-13
Hospital Charge Code	1712331
Hospital Revenue Code	259
Min. Negotiated Rate	$5.50
Max. Negotiated Rate	$7.50
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	$4.50
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 Beech St/Commercial/PHCS	$7.50

PARICALCITOL 2 MCG CAPSULE [41498]

Facility

$3.54

Service Code	NDC 65862-937-30
Hospital Charge Code	1712331
Hospital Revenue Code	259
Min. Negotiated Rate	$1.95
Max. Negotiated Rate	$2.83
Rate for Payer: Cash Price	$1.59
Rate for Payer: Cigna of CA 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 Beech St/Commercial/PHCS	$2.66

PARICALCITOL 2 MCG CAPSULE [41498]

Facility

$10.00

Service Code	NDC 69452-146-13
Hospital Charge Code	1712331
Hospital Revenue Code	259
Min. Negotiated Rate	$5.50
Max. Negotiated Rate	$8.00
Rate for Payer: Cash Price	$4.50
Rate for Payer: Cigna of CA 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 Beech St/Commercial/PHCS	$7.50

PARICALCITOL 2 MCG CAPSULE [41498]

Facility

$3.54

Service Code	NDC 65862-937-30
Hospital Charge Code	1712331
Hospital Revenue Code	259
Min. Negotiated Rate	$1.95
Max. Negotiated Rate	$2.66
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	$1.59
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 Beech St/Commercial/PHCS	$2.66

PARICALCITOL 2 MCG/ML INTRAVENOUS SOLUTION [31688]

Facility

$7.27

Service Code	CPT J2501
Hospital Charge Code	1720960
Hospital Revenue Code	636
Min. Negotiated Rate	$4.00
Max. Negotiated Rate	$5.45
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	$3.27
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 Beech St/Commercial/PHCS	$5.45

PARICALCITOL 2 MCG/ML INTRAVENOUS SOLUTION [31688]

Facility

$7.27

Service Code	CPT J2501
Hospital Charge Code	1720960
Hospital Revenue Code	636
Min. Negotiated Rate	$4.00
Max. Negotiated Rate	$5.82
Rate for Payer: Cash Price	$3.27
Rate for Payer: Cigna of CA 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 Beech St/Commercial/PHCS	$5.45

PARICALCITOL 5 MCG/ML INTRAVENOUS SOLUTION [22960]

Facility

$18.18

Service Code	CPT J2501
Hospital Charge Code	1720909
Hospital Revenue Code	636
Min. Negotiated Rate	$10.00
Max. Negotiated Rate	$13.64
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	$8.18
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 Beech St/Commercial/PHCS	$13.64

PARICALCITOL 5 MCG/ML INTRAVENOUS SOLUTION [22960]

Facility

$18.18

Service Code	CPT J2501
Hospital Charge Code	1720909
Hospital Revenue Code	636
Min. Negotiated Rate	$10.00
Max. Negotiated Rate	$14.54
Rate for Payer: Cash Price	$8.18
Rate for Payer: Cigna of CA 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 Beech St/Commercial/PHCS	$13.64

PAROXETINE 10 MG/5 ML ORAL SUSPENSION [22959]

Facility

$2.13

Service Code	NDC 60505-0402-5
Hospital Charge Code	1715250
Hospital Revenue Code	259
Min. Negotiated Rate	$1.17
Max. Negotiated Rate	$1.60
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	$0.96
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 Beech St/Commercial/PHCS	$1.60

PAROXETINE 10 MG/5 ML ORAL SUSPENSION [22959]

Facility

$1.76

Service Code	NDC 70954-319-10
Hospital Charge Code	1715250
Hospital Revenue Code	259
Min. Negotiated Rate	$0.97
Max. Negotiated Rate	$1.41
Rate for Payer: Cash Price	$0.79
Rate for Payer: Cigna of CA 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 Beech St/Commercial/PHCS	$1.32

PAROXETINE 10 MG/5 ML ORAL SUSPENSION [22959]

Facility

$2.13

Service Code	NDC 60505-0402-5
Hospital Charge Code	1715250
Hospital Revenue Code	259
Min. Negotiated Rate	$1.17
Max. Negotiated Rate	$1.70
Rate for Payer: Cash Price	$0.96
Rate for Payer: Cigna of CA 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 Beech St/Commercial/PHCS	$1.60

PAROXETINE 10 MG/5 ML ORAL SUSPENSION [22959]

Facility

$1.76

Service Code	NDC 70954-319-10
Hospital Charge Code	1715250
Hospital Revenue Code	259
Min. Negotiated Rate	$0.97
Max. Negotiated Rate	$1.32
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	$0.79
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 Beech St/Commercial/PHCS	$1.32

PAROXETINE 10 MG TABLET [16632]

Facility

$1.02

Service Code	NDC 68084-044-11
Hospital Charge Code	1713121
Hospital Revenue Code	259
Min. Negotiated Rate	$0.56
Max. Negotiated Rate	$0.82
Rate for Payer: Cash Price	$0.46
Rate for Payer: Cigna of CA HMO/PPO	$0.82
Rate for Payer: Health Smart Auto/Commercial	$0.61
Rate for Payer: LLUH Dept of Risk Management WC	$0.56
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$0.77

PAROXETINE 10 MG TABLET [16632]

Facility

$0.14

Service Code	NDC 68382-097-06
Hospital Charge Code	1713121
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	$0.06
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 Beech St/Commercial/PHCS	$0.11

PAROXETINE 10 MG TABLET [16632]

Facility

$0.80

Service Code	NDC 50268-640-11
Hospital Charge Code	1713121
Hospital Revenue Code	259
Min. Negotiated Rate	$0.44
Max. Negotiated Rate	$0.60
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	$0.36
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 Beech St/Commercial/PHCS	$0.60

Know your out-of-pocket cost for care.

All Charges