Loma Linda University Behavioral Medicine Center (BMC)

All Charges

Charge

Type

Setting

Price

POTASSIUM CHLORIDE ER 8 MEQ TABLET,EXTENDED RELEASE [6437]

Facility

$0.58

Service Code	NDC 66758-110-06
Hospital Charge Code	1712611
Hospital Revenue Code	259
Min. Negotiated Rate	$0.32
Max. Negotiated Rate	$0.44
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$0.35
Rate for Payer: Aetna of CA Government/Medicare	$0.35
Rate for Payer: Cash Price	$0.26
Rate for Payer: Health Smart Auto/Commercial	$0.35
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$0.35
Rate for Payer: LLUH Dept of Risk Management WC	$0.32
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$0.44

POTASSIUM CHLORIDE ER 8 MEQ TABLET,EXTENDED RELEASE [6437]

Facility

$0.58

Service Code	NDC 66758-110-13
Hospital Charge Code	1712611
Hospital Revenue Code	259
Min. Negotiated Rate	$0.32
Max. Negotiated Rate	$0.44
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$0.35
Rate for Payer: Aetna of CA Government/Medicare	$0.35
Rate for Payer: Cash Price	$0.26
Rate for Payer: Health Smart Auto/Commercial	$0.35
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$0.35
Rate for Payer: LLUH Dept of Risk Management WC	$0.32
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$0.44

POTASSIUM CHLORIDE ER 8 MEQ TABLET,EXTENDED RELEASE [6437]

Facility

$0.59

Service Code	NDC 0245-5315-89
Hospital Charge Code	1712611
Hospital Revenue Code	259
Min. Negotiated Rate	$0.32
Max. Negotiated Rate	$0.47
Rate for Payer: Cash Price	$0.27
Rate for Payer: Cigna of CA HMO/PPO	$0.47
Rate for Payer: Health Smart Auto/Commercial	$0.35
Rate for Payer: LLUH Dept of Risk Management WC	$0.32
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$0.44

POTASSIUM CHLORIDE ER 8 MEQ TABLET,EXTENDED RELEASE [6437]

Facility

$0.52

Service Code	NDC 0781-1516-10
Hospital Charge Code	1712611
Hospital Revenue Code	259
Min. Negotiated Rate	$0.29
Max. Negotiated Rate	$0.39
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$0.31
Rate for Payer: Aetna of CA Government/Medicare	$0.31
Rate for Payer: Cash Price	$0.23
Rate for Payer: Health Smart Auto/Commercial	$0.31
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$0.31
Rate for Payer: LLUH Dept of Risk Management WC	$0.29
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$0.39

POTASSIUM CHLORIDE ER 8 MEQ TABLET,EXTENDED RELEASE [6437]

Facility

$0.52

Service Code	NDC 0245-5315-11
Hospital Charge Code	1712611
Hospital Revenue Code	259
Min. Negotiated Rate	$0.29
Max. Negotiated Rate	$0.39
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$0.31
Rate for Payer: Aetna of CA Government/Medicare	$0.31
Rate for Payer: Cash Price	$0.23
Rate for Payer: Health Smart Auto/Commercial	$0.31
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$0.31
Rate for Payer: LLUH Dept of Risk Management WC	$0.29
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$0.39

POTASSIUM CHLORIDE ER 8 MEQ TABLET,EXTENDED RELEASE [6437]

Facility

$0.59

Service Code	NDC 0245-5315-89
Hospital Charge Code	1712611
Hospital Revenue Code	259
Min. Negotiated Rate	$0.32
Max. Negotiated Rate	$0.44
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$0.35
Rate for Payer: Aetna of CA Government/Medicare	$0.35
Rate for Payer: Cash Price	$0.27
Rate for Payer: Health Smart Auto/Commercial	$0.35
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$0.35
Rate for Payer: LLUH Dept of Risk Management WC	$0.32
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$0.44

POTASSIUM CHLORIDE ER 8 MEQ TABLET,EXTENDED RELEASE [6437]

Facility

$0.58

Service Code	NDC 66758-110-13
Hospital Charge Code	1712611
Hospital Revenue Code	259
Min. Negotiated Rate	$0.32
Max. Negotiated Rate	$0.46
Rate for Payer: Cash Price	$0.26
Rate for Payer: Cigna of CA HMO/PPO	$0.46
Rate for Payer: Health Smart Auto/Commercial	$0.35
Rate for Payer: LLUH Dept of Risk Management WC	$0.32
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$0.44

POTASSIUM CHLORIDE ER 8 MEQ TABLET,EXTENDED RELEASE [6437]

Facility

$0.52

Service Code	NDC 0781-1516-10
Hospital Charge Code	1712611
Hospital Revenue Code	259
Min. Negotiated Rate	$0.29
Max. Negotiated Rate	$0.42
Rate for Payer: Cash Price	$0.23
Rate for Payer: Cigna of CA HMO/PPO	$0.42
Rate for Payer: Health Smart Auto/Commercial	$0.31
Rate for Payer: LLUH Dept of Risk Management WC	$0.29
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$0.39

POTASSIUM CHLORIDE ER 8 MEQ TABLET,EXTENDED RELEASE [6437]

Facility

$0.52

Service Code	NDC 0245-5315-11
Hospital Charge Code	1712611
Hospital Revenue Code	259
Min. Negotiated Rate	$0.29
Max. Negotiated Rate	$0.42
Rate for Payer: Cash Price	$0.23
Rate for Payer: Cigna of CA HMO/PPO	$0.42
Rate for Payer: Health Smart Auto/Commercial	$0.31
Rate for Payer: LLUH Dept of Risk Management WC	$0.29
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$0.39

POTASSIUM CHLORIDE ER 8 MEQ TABLET,EXTENDED RELEASE [6437]

Facility

$0.58

Service Code	NDC 66758-110-06
Hospital Charge Code	1712611
Hospital Revenue Code	259
Min. Negotiated Rate	$0.32
Max. Negotiated Rate	$0.46
Rate for Payer: Cash Price	$0.26
Rate for Payer: Cigna of CA HMO/PPO	$0.46
Rate for Payer: Health Smart Auto/Commercial	$0.35
Rate for Payer: LLUH Dept of Risk Management WC	$0.32
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$0.44

POTASSIUM CITRATE-CITRIC ACID 1,100 MG-334 MG/5 ML ORAL SOLUTION [22646]

Facility

$0.16

Service Code	NDC 5865731216
Hospital Charge Code	1717203
Hospital Revenue Code	259
Min. Negotiated Rate	$0.09
Max. Negotiated Rate	$0.12
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	$0.07
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 Beech St/Commercial/PHCS	$0.12

POTASSIUM CITRATE-CITRIC ACID 1,100 MG-334 MG/5 ML ORAL SOLUTION [22646]

Facility

$0.09

Service Code	NDC 121067616
Hospital Charge Code	1717203
Hospital Revenue Code	259
Min. Negotiated Rate	$0.05
Max. Negotiated Rate	$0.07
Rate for Payer: Cash Price	$0.04
Rate for Payer: Cigna of CA HMO/PPO	$0.07
Rate for Payer: Health Smart Auto/Commercial	$0.05
Rate for Payer: LLUH Dept of Risk Management WC	$0.05
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$0.07

POTASSIUM CITRATE-CITRIC ACID 1,100 MG-334 MG/5 ML ORAL SOLUTION [22646]

Facility

$0.16

Service Code	NDC 6025800316
Hospital Charge Code	1717203
Hospital Revenue Code	259
Min. Negotiated Rate	$0.09
Max. Negotiated Rate	$0.12
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	$0.07
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 Beech St/Commercial/PHCS	$0.12

POTASSIUM CITRATE-CITRIC ACID 1,100 MG-334 MG/5 ML ORAL SOLUTION [22646]

Facility

$0.16

Service Code	NDC 6025800316
Hospital Charge Code	1717203
Hospital Revenue Code	259
Min. Negotiated Rate	$0.09
Max. Negotiated Rate	$0.13
Rate for Payer: Cash Price	$0.07
Rate for Payer: Cigna of CA 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 Beech St/Commercial/PHCS	$0.12

POTASSIUM CITRATE-CITRIC ACID 1,100 MG-334 MG/5 ML ORAL SOLUTION [22646]

Facility

$0.16

Service Code	NDC 5865731216
Hospital Charge Code	1717203
Hospital Revenue Code	259
Min. Negotiated Rate	$0.09
Max. Negotiated Rate	$0.13
Rate for Payer: Cash Price	$0.07
Rate for Payer: Cigna of CA 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 Beech St/Commercial/PHCS	$0.12

POTASSIUM CITRATE-CITRIC ACID 1,100 MG-334 MG/5 ML ORAL SOLUTION [22646]

Facility

$0.09

Service Code	NDC 121067616
Hospital Charge Code	1717203
Hospital Revenue Code	259
Min. Negotiated Rate	$0.05
Max. Negotiated Rate	$0.07
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	$0.05
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$0.07

POTASSIUM CITRATE ER 10 MEQ (1,080 MG) TABLET,EXTENDED RELEASE [11083]

Facility

$2.57

Service Code	NDC 0178-0610-01
Hospital Charge Code	1711951
Hospital Revenue Code	259
Min. Negotiated Rate	$1.41
Max. Negotiated Rate	$2.06
Rate for Payer: Cash Price	$1.16
Rate for Payer: Cigna of CA HMO/PPO	$2.06
Rate for Payer: Health Smart Auto/Commercial	$1.54
Rate for Payer: LLUH Dept of Risk Management WC	$1.41
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$1.93

POTASSIUM CITRATE ER 10 MEQ (1,080 MG) TABLET,EXTENDED RELEASE [11083]

Facility

$1.70

Service Code	NDC 0245-0071-11
Hospital Charge Code	1711951
Hospital Revenue Code	259
Min. Negotiated Rate	$0.94
Max. Negotiated Rate	$1.28
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$1.02
Rate for Payer: Aetna of CA Government/Medicare	$1.02
Rate for Payer: Cash Price	$0.77
Rate for Payer: Health Smart Auto/Commercial	$1.02
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$1.02
Rate for Payer: LLUH Dept of Risk Management WC	$0.94
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$1.28

POTASSIUM CITRATE ER 10 MEQ (1,080 MG) TABLET,EXTENDED RELEASE [11083]

Facility

$2.89

Service Code	NDC 68084-850-33
Hospital Charge Code	1711951
Hospital Revenue Code	259
Min. Negotiated Rate	$1.59
Max. Negotiated Rate	$2.17
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$1.73
Rate for Payer: Aetna of CA Government/Medicare	$1.73
Rate for Payer: Cash Price	$1.30
Rate for Payer: Health Smart Auto/Commercial	$1.73
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$1.73
Rate for Payer: LLUH Dept of Risk Management WC	$1.59
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$2.17

POTASSIUM CITRATE ER 10 MEQ (1,080 MG) TABLET,EXTENDED RELEASE [11083]

Facility

$1.70

Service Code	NDC 0245-0071-11
Hospital Charge Code	1711951
Hospital Revenue Code	259
Min. Negotiated Rate	$0.94
Max. Negotiated Rate	$1.36
Rate for Payer: Cash Price	$0.77
Rate for Payer: Cigna of CA HMO/PPO	$1.36
Rate for Payer: Health Smart Auto/Commercial	$1.02
Rate for Payer: LLUH Dept of Risk Management WC	$0.94
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$1.28

POTASSIUM CITRATE ER 10 MEQ (1,080 MG) TABLET,EXTENDED RELEASE [11083]

Facility

$2.89

Service Code	NDC 68084-850-32
Hospital Charge Code	1711951
Hospital Revenue Code	259
Min. Negotiated Rate	$1.59
Max. Negotiated Rate	$2.17
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$1.73
Rate for Payer: Aetna of CA Government/Medicare	$1.73
Rate for Payer: Cash Price	$1.30
Rate for Payer: Health Smart Auto/Commercial	$1.73
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$1.73
Rate for Payer: LLUH Dept of Risk Management WC	$1.59
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$2.17

POTASSIUM CITRATE ER 10 MEQ (1,080 MG) TABLET,EXTENDED RELEASE [11083]

Facility

$0.40

Service Code	NDC 0591-2729-01
Hospital Charge Code	1711951
Hospital Revenue Code	259
Min. Negotiated Rate	$0.22
Max. Negotiated Rate	$0.32
Rate for Payer: Cash Price	$0.18
Rate for Payer: Cigna of CA HMO/PPO	$0.32
Rate for Payer: Health Smart Auto/Commercial	$0.24
Rate for Payer: LLUH Dept of Risk Management WC	$0.22
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$0.30

POTASSIUM CITRATE ER 10 MEQ (1,080 MG) TABLET,EXTENDED RELEASE [11083]

Facility

$2.89

Service Code	NDC 68084-850-33
Hospital Charge Code	1711951
Hospital Revenue Code	259
Min. Negotiated Rate	$1.59
Max. Negotiated Rate	$2.31
Rate for Payer: Cash Price	$1.30
Rate for Payer: Cigna of CA HMO/PPO	$2.31
Rate for Payer: Health Smart Auto/Commercial	$1.73
Rate for Payer: LLUH Dept of Risk Management WC	$1.59
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$2.17

POTASSIUM CITRATE ER 10 MEQ (1,080 MG) TABLET,EXTENDED RELEASE [11083]

Facility

$0.40

Service Code	NDC 0591-2729-01
Hospital Charge Code	1711951
Hospital Revenue Code	259
Min. Negotiated Rate	$0.22
Max. Negotiated Rate	$0.30
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$0.24
Rate for Payer: Aetna of CA Government/Medicare	$0.24
Rate for Payer: Cash Price	$0.18
Rate for Payer: Health Smart Auto/Commercial	$0.24
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$0.24
Rate for Payer: LLUH Dept of Risk Management WC	$0.22
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$0.30

POTASSIUM CITRATE ER 10 MEQ (1,080 MG) TABLET,EXTENDED RELEASE [11083]

Facility

$2.89

Service Code	NDC 68084-850-32
Hospital Charge Code	1711951
Hospital Revenue Code	259
Min. Negotiated Rate	$1.59
Max. Negotiated Rate	$2.31
Rate for Payer: Cash Price	$1.30
Rate for Payer: Cigna of CA HMO/PPO	$2.31
Rate for Payer: Health Smart Auto/Commercial	$1.73
Rate for Payer: LLUH Dept of Risk Management WC	$1.59
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$2.17

Know your out-of-pocket cost for care.

All Charges