Loma Linda University Behavioral Medicine Center (BMC)

All Charges

Charge

Type

Setting

Price

VASOPRESSIN 20 UNIT/ML INTRAVENOUS SOLUTION [207969]

Facility

$126.13

Service Code	HCPCS J2598
Hospital Charge Code	901700025
Hospital Revenue Code	636
Min. Negotiated Rate	$69.37
Max. Negotiated Rate	$100.90
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$75.68
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$36.00
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$16.56
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$14.40
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$12.97
Rate for Payer: Aetna of CA Government/Medicare	$12.97
Rate for Payer: Aetna of CA Government/Medicare	$16.56
Rate for Payer: Aetna of CA Government/Medicare	$36.00
Rate for Payer: Aetna of CA Government/Medicare	$14.40
Rate for Payer: Aetna of CA Government/Medicare	$75.68
Rate for Payer: Cash Price	$11.89
Rate for Payer: Cash Price	$33.00
Rate for Payer: Cash Price	$69.37
Rate for Payer: Cash Price	$15.18
Rate for Payer: Cash Price	$13.20
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$19.20
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$48.00
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$100.90
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$17.29
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$22.08
Rate for Payer: Health Smart Auto/Commercial	$14.40
Rate for Payer: Health Smart Auto/Commercial	$75.68
Rate for Payer: Health Smart Auto/Commercial	$12.97
Rate for Payer: Health Smart Auto/Commercial	$16.56
Rate for Payer: Health Smart Auto/Commercial	$36.00
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$14.40
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$16.56
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$12.97
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$75.68
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$36.00
Rate for Payer: LLUH Dept of Risk Management WC	$13.20
Rate for Payer: LLUH Dept of Risk Management WC	$69.37
Rate for Payer: LLUH Dept of Risk Management WC	$11.89
Rate for Payer: LLUH Dept of Risk Management WC	$33.00
Rate for Payer: LLUH Dept of Risk Management WC	$15.18
Rate for Payer: Multiplan Commercial	$45.00
Rate for Payer: Multiplan Commercial	$20.70
Rate for Payer: Multiplan Commercial	$94.60
Rate for Payer: Multiplan Commercial	$18.00
Rate for Payer: Multiplan Commercial	$16.21

VASOPRESSIN 20 UNIT/ML INTRAVENOUS SOLUTION [207969]

Facility

$27.60

Service Code	HCPCS J2598
Hospital Charge Code	901700025
Hospital Revenue Code	636
Min. Negotiated Rate	$15.18
Max. Negotiated Rate	$22.08
Rate for Payer: Cash Price	$15.18
Rate for Payer: Cash Price	$69.37
Rate for Payer: Cash Price	$33.00
Rate for Payer: Cash Price	$11.89
Rate for Payer: Cash Price	$13.20
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$22.08
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$17.29
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$100.90
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$48.00
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$19.20
Rate for Payer: Health Smart Auto/Commercial	$12.97
Rate for Payer: Health Smart Auto/Commercial	$75.68
Rate for Payer: Health Smart Auto/Commercial	$14.40
Rate for Payer: Health Smart Auto/Commercial	$16.56
Rate for Payer: Health Smart Auto/Commercial	$36.00
Rate for Payer: LLUH Dept of Risk Management WC	$33.00
Rate for Payer: LLUH Dept of Risk Management WC	$69.37
Rate for Payer: LLUH Dept of Risk Management WC	$15.18
Rate for Payer: LLUH Dept of Risk Management WC	$13.20
Rate for Payer: LLUH Dept of Risk Management WC	$11.89
Rate for Payer: Multiplan Commercial	$18.00
Rate for Payer: Multiplan Commercial	$20.70
Rate for Payer: Multiplan Commercial	$94.60
Rate for Payer: Multiplan Commercial	$45.00
Rate for Payer: Multiplan Commercial	$16.21

VASOPRESSIN 20 UNITS/ML 1 ML VIAL - CODE [4080573]

Facility

$24.00

Service Code	HCPCS J2598
Hospital Charge Code	901700025
Hospital Revenue Code	636
Min. Negotiated Rate	$13.20
Max. Negotiated Rate	$19.20
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$14.40
Rate for Payer: Aetna of CA Government/Medicare	$14.40
Rate for Payer: Cash Price	$13.20
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$19.20
Rate for Payer: Health Smart Auto/Commercial	$14.40
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$14.40
Rate for Payer: LLUH Dept of Risk Management WC	$13.20
Rate for Payer: Multiplan Commercial	$18.00

VASOPRESSIN 20 UNITS/ML 1 ML VIAL - CODE [4080573]

Facility

$24.00

Service Code	HCPCS J2598
Hospital Charge Code	901700025
Hospital Revenue Code	636
Min. Negotiated Rate	$13.20
Max. Negotiated Rate	$19.20
Rate for Payer: Cash Price	$13.20
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$19.20
Rate for Payer: Health Smart Auto/Commercial	$14.40
Rate for Payer: LLUH Dept of Risk Management WC	$13.20
Rate for Payer: Multiplan Commercial	$18.00

VASOPRESSIN SPEC DIL 2 UNITS/ML [4081064]

Facility

$1.09

Service Code	NDC 9994-0810-64
Hospital Charge Code	901700004
Hospital Revenue Code	250
Min. Negotiated Rate	$0.60
Max. Negotiated Rate	$0.87
Rate for Payer: Cash Price	$0.60
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$0.87
Rate for Payer: Health Smart Auto/Commercial	$0.65
Rate for Payer: LLUH Dept of Risk Management WC	$0.60
Rate for Payer: Multiplan Commercial	$0.82

VASOPRESSIN SPEC DIL 2 UNITS/ML [4081064]

Facility

$1.09

Service Code	NDC 9994-0810-64
Hospital Charge Code	901700004
Hospital Revenue Code	250
Min. Negotiated Rate	$0.60
Max. Negotiated Rate	$0.87
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$0.65
Rate for Payer: Aetna of CA Government/Medicare	$0.65
Rate for Payer: Cash Price	$0.60
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$0.87
Rate for Payer: Health Smart Auto/Commercial	$0.65
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$0.65
Rate for Payer: LLUH Dept of Risk Management WC	$0.60
Rate for Payer: Multiplan Commercial	$0.82

VECURONIUM 10 MG IV BOLUS - CODE [4080584]

Facility

$6.84

Service Code	NDC 67457-438-10
Hospital Charge Code	901700004
Hospital Revenue Code	250
Min. Negotiated Rate	$3.76
Max. Negotiated Rate	$5.47
Rate for Payer: Cash Price	$3.76
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$5.47
Rate for Payer: Health Smart Auto/Commercial	$4.10
Rate for Payer: LLUH Dept of Risk Management WC	$3.76
Rate for Payer: Multiplan Commercial	$5.13

VECURONIUM 10 MG IV BOLUS - CODE [4080584]

Facility

$10.20

Service Code	NDC 47335-931-44
Hospital Charge Code	901700004
Hospital Revenue Code	250
Min. Negotiated Rate	$5.61
Max. Negotiated Rate	$8.16
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$6.12
Rate for Payer: Aetna of CA Government/Medicare	$6.12
Rate for Payer: Cash Price	$5.61
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$8.16
Rate for Payer: Health Smart Auto/Commercial	$6.12
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$6.12
Rate for Payer: LLUH Dept of Risk Management WC	$5.61
Rate for Payer: Multiplan Commercial	$7.65

VECURONIUM 10 MG IV BOLUS - CODE [4080584]

Facility

$10.20

Service Code	NDC 47335-931-40
Hospital Charge Code	901700004
Hospital Revenue Code	250
Min. Negotiated Rate	$5.61
Max. Negotiated Rate	$8.16
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$6.12
Rate for Payer: Aetna of CA Government/Medicare	$6.12
Rate for Payer: Cash Price	$5.61
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$8.16
Rate for Payer: Health Smart Auto/Commercial	$6.12
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$6.12
Rate for Payer: LLUH Dept of Risk Management WC	$5.61
Rate for Payer: Multiplan Commercial	$7.65

VECURONIUM 10 MG IV BOLUS - CODE [4080584]

Facility

$10.20

Service Code	NDC 47335-931-44
Hospital Charge Code	901700004
Hospital Revenue Code	250
Min. Negotiated Rate	$5.61
Max. Negotiated Rate	$8.16
Rate for Payer: Cash Price	$5.61
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$8.16
Rate for Payer: Health Smart Auto/Commercial	$6.12
Rate for Payer: LLUH Dept of Risk Management WC	$5.61
Rate for Payer: Multiplan Commercial	$7.65

VECURONIUM 10 MG IV BOLUS - CODE [4080584]

Facility

$10.20

Service Code	NDC 47335-931-40
Hospital Charge Code	901700004
Hospital Revenue Code	250
Min. Negotiated Rate	$5.61
Max. Negotiated Rate	$8.16
Rate for Payer: Cash Price	$5.61
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$8.16
Rate for Payer: Health Smart Auto/Commercial	$6.12
Rate for Payer: LLUH Dept of Risk Management WC	$5.61
Rate for Payer: Multiplan Commercial	$7.65

VECURONIUM 10 MG IV BOLUS - CODE [4080584]

Facility

$6.84

Service Code	NDC 67457-438-10
Hospital Charge Code	901700004
Hospital Revenue Code	250
Min. Negotiated Rate	$3.76
Max. Negotiated Rate	$5.47
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$4.10
Rate for Payer: Aetna of CA Government/Medicare	$4.10
Rate for Payer: Cash Price	$3.76
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$5.47
Rate for Payer: Health Smart Auto/Commercial	$4.10
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$4.10
Rate for Payer: LLUH Dept of Risk Management WC	$3.76
Rate for Payer: Multiplan Commercial	$5.13

VECURONIUM BROMIDE 10 MG INTRAVENOUS SOLUTION [11634]

Facility

$8.81

Service Code	NDC 0409-1632-01
Hospital Charge Code	901700004
Hospital Revenue Code	250
Min. Negotiated Rate	$4.85
Max. Negotiated Rate	$7.05
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$5.29
Rate for Payer: Aetna of CA Government/Medicare	$5.29
Rate for Payer: Cash Price	$4.84
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$7.05
Rate for Payer: Health Smart Auto/Commercial	$5.29
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$5.29
Rate for Payer: LLUH Dept of Risk Management WC	$4.85
Rate for Payer: Multiplan Commercial	$6.61

VECURONIUM BROMIDE 10 MG INTRAVENOUS SOLUTION [11634]

Facility

$8.81

Service Code	NDC 0409-1632-21
Hospital Charge Code	901700004
Hospital Revenue Code	250
Min. Negotiated Rate	$4.85
Max. Negotiated Rate	$7.05
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$5.29
Rate for Payer: Aetna of CA Government/Medicare	$5.29
Rate for Payer: Cash Price	$4.84
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$7.05
Rate for Payer: Health Smart Auto/Commercial	$5.29
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$5.29
Rate for Payer: LLUH Dept of Risk Management WC	$4.85
Rate for Payer: Multiplan Commercial	$6.61

VECURONIUM BROMIDE 10 MG INTRAVENOUS SOLUTION [11634]

Facility

$5.28

Service Code	NDC 55150-235-01
Hospital Charge Code	901700004
Hospital Revenue Code	250
Min. Negotiated Rate	$2.90
Max. Negotiated Rate	$4.22
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$3.17
Rate for Payer: Aetna of CA Government/Medicare	$3.17
Rate for Payer: Cash Price	$2.90
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$4.22
Rate for Payer: Health Smart Auto/Commercial	$3.17
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$3.17
Rate for Payer: LLUH Dept of Risk Management WC	$2.90
Rate for Payer: Multiplan Commercial	$3.96

VECURONIUM BROMIDE 10 MG INTRAVENOUS SOLUTION [11634]

Facility

$8.81

Service Code	NDC 0409-1632-01
Hospital Charge Code	901700004
Hospital Revenue Code	250
Min. Negotiated Rate	$4.85
Max. Negotiated Rate	$7.05
Rate for Payer: Cash Price	$4.84
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$7.05
Rate for Payer: Health Smart Auto/Commercial	$5.29
Rate for Payer: LLUH Dept of Risk Management WC	$4.85
Rate for Payer: Multiplan Commercial	$6.61

VECURONIUM BROMIDE 10 MG INTRAVENOUS SOLUTION [11634]

Facility

$5.28

Service Code	NDC 55150-235-01
Hospital Charge Code	901700004
Hospital Revenue Code	250
Min. Negotiated Rate	$2.90
Max. Negotiated Rate	$4.22
Rate for Payer: Cash Price	$2.90
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$4.22
Rate for Payer: Health Smart Auto/Commercial	$3.17
Rate for Payer: LLUH Dept of Risk Management WC	$2.90
Rate for Payer: Multiplan Commercial	$3.96

VECURONIUM BROMIDE 10 MG INTRAVENOUS SOLUTION [11634]

Facility

$5.28

Service Code	NDC 55150-235-10
Hospital Charge Code	901700004
Hospital Revenue Code	250
Min. Negotiated Rate	$2.90
Max. Negotiated Rate	$4.22
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$3.17
Rate for Payer: Aetna of CA Government/Medicare	$3.17
Rate for Payer: Cash Price	$2.90
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$4.22
Rate for Payer: Health Smart Auto/Commercial	$3.17
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$3.17
Rate for Payer: LLUH Dept of Risk Management WC	$2.90
Rate for Payer: Multiplan Commercial	$3.96

VECURONIUM BROMIDE 10 MG INTRAVENOUS SOLUTION [11634]

Facility

$8.81

Service Code	NDC 0409-1632-21
Hospital Charge Code	901700004
Hospital Revenue Code	250
Min. Negotiated Rate	$4.85
Max. Negotiated Rate	$7.05
Rate for Payer: Cash Price	$4.84
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$7.05
Rate for Payer: Health Smart Auto/Commercial	$5.29
Rate for Payer: LLUH Dept of Risk Management WC	$4.85
Rate for Payer: Multiplan Commercial	$6.61

VECURONIUM BROMIDE 10 MG INTRAVENOUS SOLUTION [11634]

Facility

$5.28

Service Code	NDC 55150-235-10
Hospital Charge Code	901700004
Hospital Revenue Code	250
Min. Negotiated Rate	$2.90
Max. Negotiated Rate	$4.22
Rate for Payer: Cash Price	$2.90
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$4.22
Rate for Payer: Health Smart Auto/Commercial	$3.17
Rate for Payer: LLUH Dept of Risk Management WC	$2.90
Rate for Payer: Multiplan Commercial	$3.96

VECURONIUM BROMIDE 20 MG INTRAVENOUS SOLUTION [11635]

Facility

$10.80

Service Code	NDC 55150-236-01
Hospital Charge Code	901700004
Hospital Revenue Code	250
Min. Negotiated Rate	$5.94
Max. Negotiated Rate	$8.64
Rate for Payer: Cash Price	$5.94
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$8.64
Rate for Payer: Health Smart Auto/Commercial	$6.48
Rate for Payer: LLUH Dept of Risk Management WC	$5.94
Rate for Payer: Multiplan Commercial	$8.10

VECURONIUM BROMIDE 20 MG INTRAVENOUS SOLUTION [11635]

Facility

$14.46

Service Code	NDC 63323-782-23
Hospital Charge Code	901700004
Hospital Revenue Code	250
Min. Negotiated Rate	$7.95
Max. Negotiated Rate	$11.57
Rate for Payer: Cash Price	$7.95
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$11.57
Rate for Payer: Health Smart Auto/Commercial	$8.68
Rate for Payer: LLUH Dept of Risk Management WC	$7.95
Rate for Payer: Multiplan Commercial	$10.85

VECURONIUM BROMIDE 20 MG INTRAVENOUS SOLUTION [11635]

Facility

$20.40

Service Code	NDC 47335-932-40
Hospital Charge Code	901700004
Hospital Revenue Code	250
Min. Negotiated Rate	$11.22
Max. Negotiated Rate	$16.32
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$12.24
Rate for Payer: Aetna of CA Government/Medicare	$12.24
Rate for Payer: Cash Price	$11.22
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$16.32
Rate for Payer: Health Smart Auto/Commercial	$12.24
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$12.24
Rate for Payer: LLUH Dept of Risk Management WC	$11.22
Rate for Payer: Multiplan Commercial	$15.30

VECURONIUM BROMIDE 20 MG INTRAVENOUS SOLUTION [11635]

Facility

$13.68

Service Code	NDC 67457-475-00
Hospital Charge Code	901700004
Hospital Revenue Code	250
Min. Negotiated Rate	$7.52
Max. Negotiated Rate	$10.94
Rate for Payer: Cash Price	$7.52
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$10.94
Rate for Payer: Health Smart Auto/Commercial	$8.21
Rate for Payer: LLUH Dept of Risk Management WC	$7.52
Rate for Payer: Multiplan Commercial	$10.26

VECURONIUM BROMIDE 20 MG INTRAVENOUS SOLUTION [11635]

Facility

$14.46

Service Code	NDC 63323-782-20
Hospital Charge Code	901700004
Hospital Revenue Code	250
Min. Negotiated Rate	$7.95
Max. Negotiated Rate	$11.57
Rate for Payer: Cash Price	$7.95
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$11.57
Rate for Payer: Health Smart Auto/Commercial	$8.68
Rate for Payer: LLUH Dept of Risk Management WC	$7.95
Rate for Payer: Multiplan Commercial	$10.85

Know your out-of-pocket cost for care.

All Charges