Loma Linda University Behavioral Medicine Center (BMC)

All Charges

Charge

Type

Setting

Price

PRAVASTATIN 20 MG TABLET [11111]

Facility

$0.68

Service Code	NDC 0904-5892-61
Hospital Charge Code	1711539
Hospital Revenue Code	259
Min. Negotiated Rate	$0.37
Max. Negotiated Rate	$0.51
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	$0.37
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$0.51

PRAVASTATIN 20 MG TABLET [11111]

Facility

$0.84

Service Code	NDC 60687-178-11
Hospital Charge Code	1711539
Hospital Revenue Code	259
Min. Negotiated Rate	$0.46
Max. Negotiated Rate	$0.67
Rate for Payer: Cash Price	$0.38
Rate for Payer: Cigna of CA HMO/PPO	$0.67
Rate for Payer: Health Smart Auto/Commercial	$0.50
Rate for Payer: LLUH Dept of Risk Management WC	$0.46
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$0.63

PRAVASTATIN 40 MG TABLET [11112]

Facility

$1.00

Service Code	NDC 60687-190-11
Hospital Charge Code	1712509
Hospital Revenue Code	259
Min. Negotiated Rate	$0.55
Max. Negotiated Rate	$0.80
Rate for Payer: Cash Price	$0.45
Rate for Payer: Cigna of CA HMO/PPO	$0.80
Rate for Payer: Health Smart Auto/Commercial	$0.60
Rate for Payer: LLUH Dept of Risk Management WC	$0.55
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$0.75

PRAVASTATIN 40 MG TABLET [11112]

Facility

$0.86

Service Code	NDC 68180-487-09
Hospital Charge Code	1712509
Hospital Revenue Code	259
Min. Negotiated Rate	$0.47
Max. Negotiated Rate	$0.69
Rate for Payer: Cash Price	$0.39
Rate for Payer: Cigna of CA HMO/PPO	$0.69
Rate for Payer: Health Smart Auto/Commercial	$0.52
Rate for Payer: LLUH Dept of Risk Management WC	$0.47
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$0.65

PRAVASTATIN 40 MG TABLET [11112]

Facility

$0.98

Service Code	NDC 51079-782-20
Hospital Charge Code	1712509
Hospital Revenue Code	259
Min. Negotiated Rate	$0.54
Max. Negotiated Rate	$0.74
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$0.59
Rate for Payer: Aetna of CA Government/Medicare	$0.59
Rate for Payer: Cash Price	$0.44
Rate for Payer: Health Smart Auto/Commercial	$0.59
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$0.59
Rate for Payer: LLUH Dept of Risk Management WC	$0.54
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$0.74

PRAVASTATIN 40 MG TABLET [11112]

Facility

$0.85

Service Code	NDC 0904-5893-61
Hospital Charge Code	1712509
Hospital Revenue Code	259
Min. Negotiated Rate	$0.47
Max. Negotiated Rate	$0.68
Rate for Payer: Cash Price	$0.38
Rate for Payer: Cigna of CA HMO/PPO	$0.68
Rate for Payer: Health Smart Auto/Commercial	$0.51
Rate for Payer: LLUH Dept of Risk Management WC	$0.47
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$0.64

PRAVASTATIN 40 MG TABLET [11112]

Facility

$0.45

Service Code	NDC 68462-197-90
Hospital Charge Code	1712509
Hospital Revenue Code	259
Min. Negotiated Rate	$0.25
Max. Negotiated Rate	$0.36
Rate for Payer: Cash Price	$0.20
Rate for Payer: Cigna of CA HMO/PPO	$0.36
Rate for Payer: Health Smart Auto/Commercial	$0.27
Rate for Payer: LLUH Dept of Risk Management WC	$0.25
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$0.34

PRAVASTATIN 40 MG TABLET [11112]

Facility

$0.45

Service Code	NDC 68462-197-90
Hospital Charge Code	1712509
Hospital Revenue Code	259
Min. Negotiated Rate	$0.25
Max. Negotiated Rate	$0.34
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$0.27
Rate for Payer: Aetna of CA Government/Medicare	$0.27
Rate for Payer: Cash Price	$0.20
Rate for Payer: Health Smart Auto/Commercial	$0.27
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$0.27
Rate for Payer: LLUH Dept of Risk Management WC	$0.25
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$0.34

PRAVASTATIN 40 MG TABLET [11112]

Facility

$1.00

Service Code	NDC 60687-190-11
Hospital Charge Code	1712509
Hospital Revenue Code	259
Min. Negotiated Rate	$0.55
Max. Negotiated Rate	$0.75
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$0.60
Rate for Payer: Aetna of CA Government/Medicare	$0.60
Rate for Payer: Cash Price	$0.45
Rate for Payer: Health Smart Auto/Commercial	$0.60
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$0.60
Rate for Payer: LLUH Dept of Risk Management WC	$0.55
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$0.75

PRAVASTATIN 40 MG TABLET [11112]

Facility

$0.98

Service Code	NDC 51079-782-01
Hospital Charge Code	1712509
Hospital Revenue Code	259
Min. Negotiated Rate	$0.54
Max. Negotiated Rate	$0.78
Rate for Payer: Cash Price	$0.44
Rate for Payer: Cigna of CA HMO/PPO	$0.78
Rate for Payer: Health Smart Auto/Commercial	$0.59
Rate for Payer: LLUH Dept of Risk Management WC	$0.54
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$0.74

PRAVASTATIN 40 MG TABLET [11112]

Facility

$0.46

Service Code	NDC 60505-0170-9
Hospital Charge Code	1712509
Hospital Revenue Code	259
Min. Negotiated Rate	$0.25
Max. Negotiated Rate	$0.35
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$0.28
Rate for Payer: Aetna of CA Government/Medicare	$0.28
Rate for Payer: Cash Price	$0.21
Rate for Payer: Health Smart Auto/Commercial	$0.28
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$0.28
Rate for Payer: LLUH Dept of Risk Management WC	$0.25
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$0.35

PRAVASTATIN 40 MG TABLET [11112]

Facility

$0.86

Service Code	NDC 68180-487-09
Hospital Charge Code	1712509
Hospital Revenue Code	259
Min. Negotiated Rate	$0.47
Max. Negotiated Rate	$0.65
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$0.52
Rate for Payer: Aetna of CA Government/Medicare	$0.52
Rate for Payer: Cash Price	$0.39
Rate for Payer: Health Smart Auto/Commercial	$0.52
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$0.52
Rate for Payer: LLUH Dept of Risk Management WC	$0.47
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$0.65

PRAVASTATIN 40 MG TABLET [11112]

Facility

$0.98

Service Code	NDC 51079-782-01
Hospital Charge Code	1712509
Hospital Revenue Code	259
Min. Negotiated Rate	$0.54
Max. Negotiated Rate	$0.74
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$0.59
Rate for Payer: Aetna of CA Government/Medicare	$0.59
Rate for Payer: Cash Price	$0.44
Rate for Payer: Health Smart Auto/Commercial	$0.59
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$0.59
Rate for Payer: LLUH Dept of Risk Management WC	$0.54
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$0.74

PRAVASTATIN 40 MG TABLET [11112]

Facility

$0.85

Service Code	NDC 0904-5893-61
Hospital Charge Code	1712509
Hospital Revenue Code	259
Min. Negotiated Rate	$0.47
Max. Negotiated Rate	$0.64
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$0.51
Rate for Payer: Aetna of CA Government/Medicare	$0.51
Rate for Payer: Cash Price	$0.38
Rate for Payer: Health Smart Auto/Commercial	$0.51
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$0.51
Rate for Payer: LLUH Dept of Risk Management WC	$0.47
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$0.64

PRAVASTATIN 40 MG TABLET [11112]

Facility

$0.46

Service Code	NDC 60505-0170-9
Hospital Charge Code	1712509
Hospital Revenue Code	259
Min. Negotiated Rate	$0.25
Max. Negotiated Rate	$0.37
Rate for Payer: Cash Price	$0.21
Rate for Payer: Cigna of CA HMO/PPO	$0.37
Rate for Payer: Health Smart Auto/Commercial	$0.28
Rate for Payer: LLUH Dept of Risk Management WC	$0.25
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$0.35

PRAVASTATIN 40 MG TABLET [11112]

Facility

$0.98

Service Code	NDC 51079-782-20
Hospital Charge Code	1712509
Hospital Revenue Code	259
Min. Negotiated Rate	$0.54
Max. Negotiated Rate	$0.78
Rate for Payer: Cash Price	$0.44
Rate for Payer: Cigna of CA HMO/PPO	$0.78
Rate for Payer: Health Smart Auto/Commercial	$0.59
Rate for Payer: LLUH Dept of Risk Management WC	$0.54
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$0.74

PRAZIQUANTEL 600 MG TABLET [11113]

Facility

$79.72

Service Code	NDC 49884-231-83
Hospital Charge Code	1712212
Hospital Revenue Code	259
Min. Negotiated Rate	$43.85
Max. Negotiated Rate	$63.78
Rate for Payer: Cash Price	$35.87
Rate for Payer: Cigna of CA HMO/PPO	$63.78
Rate for Payer: Health Smart Auto/Commercial	$47.83
Rate for Payer: LLUH Dept of Risk Management WC	$43.85
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$59.79

PRAZIQUANTEL 600 MG TABLET [11113]

Facility

$79.72

Service Code	NDC 49884-231-83
Hospital Charge Code	1712212
Hospital Revenue Code	259
Min. Negotiated Rate	$43.85
Max. Negotiated Rate	$59.79
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$47.83
Rate for Payer: Aetna of CA Government/Medicare	$47.83
Rate for Payer: Cash Price	$35.87
Rate for Payer: Health Smart Auto/Commercial	$47.83
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$47.83
Rate for Payer: LLUH Dept of Risk Management WC	$43.85
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$59.79

PRAZIQUANTEL (BULK) 98.5 %-101 % POWDER [23284]

Facility

$30.69

Service Code	NDC 38779-0090-4
Hospital Charge Code	NDG23284B
Hospital Revenue Code	259
Min. Negotiated Rate	$16.88
Max. Negotiated Rate	$24.55
Rate for Payer: Cash Price	$13.81
Rate for Payer: Cigna of CA HMO/PPO	$24.55
Rate for Payer: Health Smart Auto/Commercial	$18.41
Rate for Payer: LLUH Dept of Risk Management WC	$16.88
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$23.02

PRAZIQUANTEL (BULK) 98.5 %-101 % POWDER [23284]

Facility

$30.69

Service Code	NDC 38779-0090-4
Hospital Charge Code	NDG23284B
Hospital Revenue Code	259
Min. Negotiated Rate	$16.88
Max. Negotiated Rate	$23.02
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$18.41
Rate for Payer: Aetna of CA Government/Medicare	$18.41
Rate for Payer: Cash Price	$13.81
Rate for Payer: Health Smart Auto/Commercial	$18.41
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$18.41
Rate for Payer: LLUH Dept of Risk Management WC	$16.88
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$23.02

PRAZOSIN 1 MG CAPSULE [6468]

Facility

$1.79

Service Code	NDC 68084-996-01
Hospital Charge Code	1710580
Hospital Revenue Code	259
Min. Negotiated Rate	$0.98
Max. Negotiated Rate	$1.43
Rate for Payer: Cash Price	$0.81
Rate for Payer: Cigna of CA HMO/PPO	$1.43
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

PRAZOSIN 1 MG CAPSULE [6468]

Facility

$1.81

Service Code	NDC 51079-630-20
Hospital Charge Code	1710580
Hospital Revenue Code	259
Min. Negotiated Rate	$1.00
Max. Negotiated Rate	$1.36
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$1.09
Rate for Payer: Aetna of CA Government/Medicare	$1.09
Rate for Payer: Cash Price	$0.81
Rate for Payer: Health Smart Auto/Commercial	$1.09
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$1.09
Rate for Payer: LLUH Dept of Risk Management WC	$1.00
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$1.36

PRAZOSIN 1 MG CAPSULE [6468]

Facility

$1.81

Service Code	NDC 51079-630-01
Hospital Charge Code	1710580
Hospital Revenue Code	259
Min. Negotiated Rate	$1.00
Max. Negotiated Rate	$1.36
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$1.09
Rate for Payer: Aetna of CA Government/Medicare	$1.09
Rate for Payer: Cash Price	$0.81
Rate for Payer: Health Smart Auto/Commercial	$1.09
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$1.09
Rate for Payer: LLUH Dept of Risk Management WC	$1.00
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$1.36

PRAZOSIN 1 MG CAPSULE [6468]

Facility

$1.81

Service Code	NDC 51079-630-20
Hospital Charge Code	1710580
Hospital Revenue Code	259
Min. Negotiated Rate	$1.00
Max. Negotiated Rate	$1.45
Rate for Payer: Cash Price	$0.81
Rate for Payer: Cigna of CA HMO/PPO	$1.45
Rate for Payer: Health Smart Auto/Commercial	$1.09
Rate for Payer: LLUH Dept of Risk Management WC	$1.00
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$1.36

PRAZOSIN 1 MG CAPSULE [6468]

Facility

$1.81

Service Code	NDC 51079-630-01
Hospital Charge Code	1710580
Hospital Revenue Code	259
Min. Negotiated Rate	$1.00
Max. Negotiated Rate	$1.45
Rate for Payer: Cash Price	$0.81
Rate for Payer: Cigna of CA HMO/PPO	$1.45
Rate for Payer: Health Smart Auto/Commercial	$1.09
Rate for Payer: LLUH Dept of Risk Management WC	$1.00
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$1.36

Know your out-of-pocket cost for care.

All Charges