Loma Linda University Behavioral Medicine Center (BMC)

All Charges

Charge

Type

Setting

Price

TRAZODONE 150 MG TABLET [8084]

Facility

$0.69

Service Code	NDC 60687-432-11
Hospital Charge Code	901700029
Hospital Revenue Code	259
Min. Negotiated Rate	$0.38
Max. Negotiated Rate	$0.55
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	$0.38
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$0.55
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 Commercial	$0.52

TRAZODONE 150 MG TABLET [8084]

Facility

$0.43

Service Code	NDC 53489-517-01
Hospital Charge Code	901700029
Hospital Revenue Code	259
Min. Negotiated Rate	$0.24
Max. Negotiated Rate	$0.34
Rate for Payer: Cash Price	$0.24
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$0.34
Rate for Payer: Health Smart Auto/Commercial	$0.26
Rate for Payer: LLUH Dept of Risk Management WC	$0.24
Rate for Payer: Multiplan Commercial	$0.32

TRAZODONE 150 MG TABLET [8084]

Facility

$0.43

Service Code	NDC 53489-517-01
Hospital Charge Code	901700029
Hospital Revenue Code	259
Min. Negotiated Rate	$0.24
Max. Negotiated Rate	$0.34
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$0.26
Rate for Payer: Aetna of CA Government/Medicare	$0.26
Rate for Payer: Cash Price	$0.24
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$0.34
Rate for Payer: Health Smart Auto/Commercial	$0.26
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$0.26
Rate for Payer: LLUH Dept of Risk Management WC	$0.24
Rate for Payer: Multiplan Commercial	$0.32

TRAZODONE 50 MG TABLET [8085]

Facility

$0.06

Service Code	NDC 68382-805-01
Hospital Charge Code	901700029
Hospital Revenue Code	259
Min. Negotiated Rate	$0.03
Max. Negotiated Rate	$0.05
Rate for Payer: Cash Price	$0.03
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$0.05
Rate for Payer: Health Smart Auto/Commercial	$0.04
Rate for Payer: LLUH Dept of Risk Management WC	$0.03
Rate for Payer: Multiplan Commercial	$0.05

TRAZODONE 50 MG TABLET [8085]

Facility

$0.05

Service Code	NDC 42291-868-90
Hospital Charge Code	901700029
Hospital Revenue Code	259
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

TRAZODONE 50 MG TABLET [8085]

Facility

$0.08

Service Code	NDC 50111-560-01
Hospital Charge Code	901700029
Hospital Revenue Code	259
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: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$0.06
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 Commercial	$0.06

TRAZODONE 50 MG TABLET [8085]

Facility

$0.16

Service Code	NDC 60687-443-11
Hospital Charge Code	901700029
Hospital Revenue Code	259
Min. Negotiated Rate	$0.09
Max. Negotiated Rate	$0.13
Rate for Payer: Cash Price	$0.09
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$0.13
Rate for Payer: Health Smart Auto/Commercial	$0.10
Rate for Payer: LLUH Dept of Risk Management WC	$0.09
Rate for Payer: Multiplan Commercial	$0.12

TRAZODONE 50 MG TABLET [8085]

Facility

$0.08

Service Code	NDC 50111-560-01
Hospital Charge Code	901700029
Hospital Revenue Code	259
Min. Negotiated Rate	$0.04
Max. Negotiated Rate	$0.06
Rate for Payer: Cash Price	$0.04
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO 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 Commercial	$0.06

TRAZODONE 50 MG TABLET [8085]

Facility

$0.16

Service Code	NDC 60687-443-01
Hospital Charge Code	901700029
Hospital Revenue Code	259
Min. Negotiated Rate	$0.09
Max. Negotiated Rate	$0.13
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$0.10
Rate for Payer: Aetna of CA Government/Medicare	$0.10
Rate for Payer: Cash Price	$0.09
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$0.13
Rate for Payer: Health Smart Auto/Commercial	$0.10
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$0.10
Rate for Payer: LLUH Dept of Risk Management WC	$0.09
Rate for Payer: Multiplan Commercial	$0.12

TRAZODONE 50 MG TABLET [8085]

Facility

$0.16

Service Code	NDC 60687-443-01
Hospital Charge Code	901700029
Hospital Revenue Code	259
Min. Negotiated Rate	$0.09
Max. Negotiated Rate	$0.13
Rate for Payer: Cash Price	$0.09
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$0.13
Rate for Payer: Health Smart Auto/Commercial	$0.10
Rate for Payer: LLUH Dept of Risk Management WC	$0.09
Rate for Payer: Multiplan Commercial	$0.12

TRAZODONE 50 MG TABLET [8085]

Facility

$0.07

Service Code	NDC 70010-231-01
Hospital Charge Code	901700029
Hospital Revenue Code	259
Min. Negotiated Rate	$0.04
Max. Negotiated Rate	$0.06
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$0.04
Rate for Payer: Aetna of CA Government/Medicare	$0.04
Rate for Payer: Cash Price	$0.04
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$0.06
Rate for Payer: Health Smart Auto/Commercial	$0.04
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$0.04
Rate for Payer: LLUH Dept of Risk Management WC	$0.04
Rate for Payer: Multiplan Commercial	$0.05

TRAZODONE 50 MG TABLET [8085]

Facility

$0.16

Service Code	NDC 60687-443-11
Hospital Charge Code	901700029
Hospital Revenue Code	259
Min. Negotiated Rate	$0.09
Max. Negotiated Rate	$0.13
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$0.10
Rate for Payer: Aetna of CA Government/Medicare	$0.10
Rate for Payer: Cash Price	$0.09
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$0.13
Rate for Payer: Health Smart Auto/Commercial	$0.10
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$0.10
Rate for Payer: LLUH Dept of Risk Management WC	$0.09
Rate for Payer: Multiplan Commercial	$0.12

TRAZODONE 50 MG TABLET [8085]

Facility

$0.05

Service Code	NDC 42291-868-90
Hospital Charge Code	901700029
Hospital Revenue Code	259
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	$0.03
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: 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 Commercial	$0.04

TRAZODONE 50 MG TABLET [8085]

Facility

$0.06

Service Code	NDC 68382-805-01
Hospital Charge Code	901700029
Hospital Revenue Code	259
Min. Negotiated Rate	$0.03
Max. Negotiated Rate	$0.05
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$0.04
Rate for Payer: Aetna of CA Government/Medicare	$0.04
Rate for Payer: Cash Price	$0.03
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$0.05
Rate for Payer: Health Smart Auto/Commercial	$0.04
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$0.04
Rate for Payer: LLUH Dept of Risk Management WC	$0.03
Rate for Payer: Multiplan Commercial	$0.05

TRAZODONE 50 MG TABLET [8085]

Facility

$0.07

Service Code	NDC 70010-231-01
Hospital Charge Code	901700029
Hospital Revenue Code	259
Min. Negotiated Rate	$0.04
Max. Negotiated Rate	$0.06
Rate for Payer: Cash Price	$0.04
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$0.06
Rate for Payer: Health Smart Auto/Commercial	$0.04
Rate for Payer: LLUH Dept of Risk Management WC	$0.04
Rate for Payer: Multiplan Commercial	$0.05

TRAZODONE ORAL SUSPENSION COMPOUND 10 MG/ML [4080353]

Facility

$0.15

Service Code	NDC 9994-0803-53
Hospital Charge Code	901700029
Hospital Revenue Code	259
Min. Negotiated Rate	$0.08
Max. Negotiated Rate	$0.12
Rate for Payer: Cash Price	$0.08
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$0.12
Rate for Payer: Health Smart Auto/Commercial	$0.09
Rate for Payer: LLUH Dept of Risk Management WC	$0.08
Rate for Payer: Multiplan Commercial	$0.11

TRAZODONE ORAL SUSPENSION COMPOUND 10 MG/ML [4080353]

Facility

$0.15

Service Code	NDC 9994-0803-53
Hospital Charge Code	901700029
Hospital Revenue Code	259
Min. Negotiated Rate	$0.08
Max. Negotiated Rate	$0.12
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$0.09
Rate for Payer: Aetna of CA Government/Medicare	$0.09
Rate for Payer: Cash Price	$0.08
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$0.12
Rate for Payer: Health Smart Auto/Commercial	$0.09
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$0.09
Rate for Payer: LLUH Dept of Risk Management WC	$0.08
Rate for Payer: Multiplan Commercial	$0.11

TREPROSTINIL 1.74 MG/2.9 ML (0.6 MG/ML) SOLUTION FOR NEBULIZATION [120688]

Facility

$353.43

Service Code	NDC 66302-206-03
Hospital Charge Code	901700029
Hospital Revenue Code	259
Min. Negotiated Rate	$194.39
Max. Negotiated Rate	$282.74
Rate for Payer: Cash Price	$194.39
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$282.74
Rate for Payer: Health Smart Auto/Commercial	$212.06
Rate for Payer: LLUH Dept of Risk Management WC	$194.39
Rate for Payer: Multiplan Commercial	$265.07

TREPROSTINIL 1.74 MG/2.9 ML (0.6 MG/ML) SOLUTION FOR NEBULIZATION [120688]

Facility

$353.43

Service Code	NDC 66302-206-03
Hospital Charge Code	901700029
Hospital Revenue Code	259
Min. Negotiated Rate	$194.39
Max. Negotiated Rate	$282.74
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$212.06
Rate for Payer: Aetna of CA Government/Medicare	$212.06
Rate for Payer: Cash Price	$194.39
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$282.74
Rate for Payer: Health Smart Auto/Commercial	$212.06
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$212.06
Rate for Payer: LLUH Dept of Risk Management WC	$194.39
Rate for Payer: Multiplan Commercial	$265.07

TREPROSTINIL DIOLAMINE ER 0.125 MG TABLET,EXTENDED RELEASE [205150]

Facility

$8.91

Service Code	NDC 66302-300-02
Hospital Charge Code	901700029
Hospital Revenue Code	259
Min. Negotiated Rate	$4.90
Max. Negotiated Rate	$7.13
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$5.35
Rate for Payer: Aetna of CA Government/Medicare	$5.35
Rate for Payer: Cash Price	$4.90
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$7.13
Rate for Payer: Health Smart Auto/Commercial	$5.35
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$5.35
Rate for Payer: LLUH Dept of Risk Management WC	$4.90
Rate for Payer: Multiplan Commercial	$6.68

TREPROSTINIL DIOLAMINE ER 0.125 MG TABLET,EXTENDED RELEASE [205150]

Facility

$8.91

Service Code	NDC 66302-300-01
Hospital Charge Code	901700029
Hospital Revenue Code	259
Min. Negotiated Rate	$4.90
Max. Negotiated Rate	$7.13
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$5.35
Rate for Payer: Aetna of CA Government/Medicare	$5.35
Rate for Payer: Cash Price	$4.90
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$7.13
Rate for Payer: Health Smart Auto/Commercial	$5.35
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$5.35
Rate for Payer: LLUH Dept of Risk Management WC	$4.90
Rate for Payer: Multiplan Commercial	$6.68

TREPROSTINIL DIOLAMINE ER 0.125 MG TABLET,EXTENDED RELEASE [205150]

Facility

$8.91

Service Code	NDC 66302-300-02
Hospital Charge Code	901700029
Hospital Revenue Code	259
Min. Negotiated Rate	$4.90
Max. Negotiated Rate	$7.13
Rate for Payer: Cash Price	$4.90
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$7.13
Rate for Payer: Health Smart Auto/Commercial	$5.35
Rate for Payer: LLUH Dept of Risk Management WC	$4.90
Rate for Payer: Multiplan Commercial	$6.68

TREPROSTINIL DIOLAMINE ER 0.125 MG TABLET,EXTENDED RELEASE [205150]

Facility

$8.91

Service Code	NDC 66302-300-01
Hospital Charge Code	901700029
Hospital Revenue Code	259
Min. Negotiated Rate	$4.90
Max. Negotiated Rate	$7.13
Rate for Payer: Cash Price	$4.90
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$7.13
Rate for Payer: Health Smart Auto/Commercial	$5.35
Rate for Payer: LLUH Dept of Risk Management WC	$4.90
Rate for Payer: Multiplan Commercial	$6.68

TREPROSTINIL DIOLAMINE ER 1 MG TABLET,EXTENDED RELEASE [205151]

Facility

$71.26

Service Code	NDC 66302-310-01
Hospital Charge Code	901700029
Hospital Revenue Code	259
Min. Negotiated Rate	$39.19
Max. Negotiated Rate	$57.01
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$42.76
Rate for Payer: Aetna of CA Government/Medicare	$42.76
Rate for Payer: Cash Price	$39.19
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$57.01
Rate for Payer: Health Smart Auto/Commercial	$42.76
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$42.76
Rate for Payer: LLUH Dept of Risk Management WC	$39.19
Rate for Payer: Multiplan Commercial	$53.45

TREPROSTINIL DIOLAMINE ER 1 MG TABLET,EXTENDED RELEASE [205151]

Facility

$71.26

Service Code	NDC 66302-310-01
Hospital Charge Code	901700029
Hospital Revenue Code	259
Min. Negotiated Rate	$39.19
Max. Negotiated Rate	$57.01
Rate for Payer: Cash Price	$39.19
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$57.01
Rate for Payer: Health Smart Auto/Commercial	$42.76
Rate for Payer: LLUH Dept of Risk Management WC	$39.19
Rate for Payer: Multiplan Commercial	$53.45

Know your out-of-pocket cost for care.

All Charges