Loma Linda University Behavioral Medicine Center (BMC)

All Charges

Charge

Type

Setting

Price

PYRAZINAMIDE 500 MG TABLET [6738]

Facility

$6.03

Service Code	NDC 61748-012-09
Hospital Charge Code	1712086
Hospital Revenue Code	259
Min. Negotiated Rate	$3.32
Max. Negotiated Rate	$4.52
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$3.62
Rate for Payer: Aetna of CA Government/Medicare	$3.62
Rate for Payer: Cash Price	$2.71
Rate for Payer: Health Smart Auto/Commercial	$3.62
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$3.62
Rate for Payer: LLUH Dept of Risk Management WC	$3.32
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$4.52

PYRAZINAMIDE 500 MG TABLET [6738]

Facility

$4.40

Service Code	NDC 10135-735-60
Hospital Charge Code	1712086
Hospital Revenue Code	259
Min. Negotiated Rate	$2.42
Max. Negotiated Rate	$3.30
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$2.64
Rate for Payer: Aetna of CA Government/Medicare	$2.64
Rate for Payer: Cash Price	$1.98
Rate for Payer: Health Smart Auto/Commercial	$2.64
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$2.64
Rate for Payer: LLUH Dept of Risk Management WC	$2.42
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$3.30

PYRAZINAMIDE 500 MG TABLET [6738]

Facility

$5.32

Service Code	NDC 33342-447-11
Hospital Charge Code	1712086
Hospital Revenue Code	259
Min. Negotiated Rate	$2.93
Max. Negotiated Rate	$4.26
Rate for Payer: Cash Price	$2.39
Rate for Payer: Cigna of CA HMO/PPO	$4.26
Rate for Payer: Health Smart Auto/Commercial	$3.19
Rate for Payer: LLUH Dept of Risk Management WC	$2.93
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$3.99

PYRAZINAMIDE 500 MG TABLET [6738]

Facility

$5.46

Service Code	NDC 70954-484-10
Hospital Charge Code	1712086
Hospital Revenue Code	259
Min. Negotiated Rate	$3.00
Max. Negotiated Rate	$4.10
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$3.28
Rate for Payer: Aetna of CA Government/Medicare	$3.28
Rate for Payer: Cash Price	$2.46
Rate for Payer: Health Smart Auto/Commercial	$3.28
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$3.28
Rate for Payer: LLUH Dept of Risk Management WC	$3.00
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$4.10

PYRAZINAMIDE 500 MG TABLET [6738]

Facility

$5.46

Service Code	NDC 70954-484-10
Hospital Charge Code	1712086
Hospital Revenue Code	259
Min. Negotiated Rate	$3.00
Max. Negotiated Rate	$4.37
Rate for Payer: Cash Price	$2.46
Rate for Payer: Cigna of CA HMO/PPO	$4.37
Rate for Payer: Health Smart Auto/Commercial	$3.28
Rate for Payer: LLUH Dept of Risk Management WC	$3.00
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$4.10

PYRAZINAMIDE 500 MG TABLET [6738]

Facility

$4.40

Service Code	NDC 10135-735-60
Hospital Charge Code	1712086
Hospital Revenue Code	259
Min. Negotiated Rate	$2.42
Max. Negotiated Rate	$3.52
Rate for Payer: Cash Price	$1.98
Rate for Payer: Cigna of CA HMO/PPO	$3.52
Rate for Payer: Health Smart Auto/Commercial	$2.64
Rate for Payer: LLUH Dept of Risk Management WC	$2.42
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$3.30

PYRAZINAMIDE 500 MG TABLET [6738]

Facility

$6.03

Service Code	NDC 61748-012-09
Hospital Charge Code	1712086
Hospital Revenue Code	259
Min. Negotiated Rate	$3.32
Max. Negotiated Rate	$4.82
Rate for Payer: Cash Price	$2.71
Rate for Payer: Cigna of CA HMO/PPO	$4.82
Rate for Payer: Health Smart Auto/Commercial	$3.62
Rate for Payer: LLUH Dept of Risk Management WC	$3.32
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$4.52

PYRAZINAMIDE ORAL SUSPENSION COMPOUND 100 MG/ML [4080326]

Facility

$6.32

Service Code	NDC 9994-0803-26
Hospital Charge Code	1715093
Hospital Revenue Code	259
Min. Negotiated Rate	$3.48
Max. Negotiated Rate	$5.06
Rate for Payer: Cash Price	$2.84
Rate for Payer: Cigna of CA HMO/PPO	$5.06
Rate for Payer: Health Smart Auto/Commercial	$3.79
Rate for Payer: LLUH Dept of Risk Management WC	$3.48
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$4.74

PYRAZINAMIDE ORAL SUSPENSION COMPOUND 100 MG/ML [4080326]

Facility

$6.32

Service Code	NDC 9994-0803-26
Hospital Charge Code	1715093
Hospital Revenue Code	259
Min. Negotiated Rate	$3.48
Max. Negotiated Rate	$4.74
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$3.79
Rate for Payer: Aetna of CA Government/Medicare	$3.79
Rate for Payer: Cash Price	$2.84
Rate for Payer: Health Smart Auto/Commercial	$3.79
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$3.79
Rate for Payer: LLUH Dept of Risk Management WC	$3.48
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$4.74

PYRIDOSTIGMINE BROMIDE 5 MG/ML INJECTION SOLUTION [11237]

Facility

$18.43

Service Code	NDC 0781-3040-72
Hospital Charge Code	1721076
Hospital Revenue Code	250
Min. Negotiated Rate	$10.14
Max. Negotiated Rate	$13.82
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$11.06
Rate for Payer: Aetna of CA Government/Medicare	$11.06
Rate for Payer: Cash Price	$8.29
Rate for Payer: Health Smart Auto/Commercial	$11.06
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$11.06
Rate for Payer: LLUH Dept of Risk Management WC	$10.14
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$13.82

PYRIDOSTIGMINE BROMIDE 5 MG/ML INJECTION SOLUTION [11237]

Facility

$18.43

Service Code	NDC 0781-3040-95
Hospital Charge Code	1721076
Hospital Revenue Code	250
Min. Negotiated Rate	$10.14
Max. Negotiated Rate	$13.82
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$11.06
Rate for Payer: Aetna of CA Government/Medicare	$11.06
Rate for Payer: Cash Price	$8.29
Rate for Payer: Health Smart Auto/Commercial	$11.06
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$11.06
Rate for Payer: LLUH Dept of Risk Management WC	$10.14
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$13.82

PYRIDOSTIGMINE BROMIDE 5 MG/ML INJECTION SOLUTION [11237]

Facility

$18.43

Service Code	NDC 0781-3040-95
Hospital Charge Code	1721076
Hospital Revenue Code	250
Min. Negotiated Rate	$10.14
Max. Negotiated Rate	$14.74
Rate for Payer: Cash Price	$8.29
Rate for Payer: Cigna of CA HMO/PPO	$14.74
Rate for Payer: Health Smart Auto/Commercial	$11.06
Rate for Payer: LLUH Dept of Risk Management WC	$10.14
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$13.82

PYRIDOSTIGMINE BROMIDE 5 MG/ML INJECTION SOLUTION [11237]

Facility

$18.43

Service Code	NDC 0781-3040-72
Hospital Charge Code	1721076
Hospital Revenue Code	250
Min. Negotiated Rate	$10.14
Max. Negotiated Rate	$14.74
Rate for Payer: Cash Price	$8.29
Rate for Payer: Cigna of CA HMO/PPO	$14.74
Rate for Payer: Health Smart Auto/Commercial	$11.06
Rate for Payer: LLUH Dept of Risk Management WC	$10.14
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$13.82

PYRIDOSTIGMINE BROMIDE 60 MG/5 ML ORAL SYRUP [11238]

Facility

$4.06

Service Code	NDC 0187-3012-20
Hospital Charge Code	1715939
Hospital Revenue Code	259
Min. Negotiated Rate	$2.23
Max. Negotiated Rate	$3.04
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$2.44
Rate for Payer: Aetna of CA Government/Medicare	$2.44
Rate for Payer: Cash Price	$1.83
Rate for Payer: Health Smart Auto/Commercial	$2.44
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$2.44
Rate for Payer: LLUH Dept of Risk Management WC	$2.23
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$3.04

PYRIDOSTIGMINE BROMIDE 60 MG/5 ML ORAL SYRUP [11238]

Facility

$4.06

Service Code	NDC 0187-3012-20
Hospital Charge Code	1715939
Hospital Revenue Code	259
Min. Negotiated Rate	$2.23
Max. Negotiated Rate	$3.25
Rate for Payer: Cash Price	$1.83
Rate for Payer: Cigna of CA HMO/PPO	$3.25
Rate for Payer: Health Smart Auto/Commercial	$2.44
Rate for Payer: LLUH Dept of Risk Management WC	$2.23
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$3.04

PYRIDOSTIGMINE BROMIDE 60 MG TABLET [11239]

Facility

$1.22

Service Code	NDC 68382-659-06
Hospital Charge Code	1710447
Hospital Revenue Code	259
Min. Negotiated Rate	$0.67
Max. Negotiated Rate	$0.98
Rate for Payer: Cash Price	$0.55
Rate for Payer: Cigna of CA HMO/PPO	$0.98
Rate for Payer: Health Smart Auto/Commercial	$0.73
Rate for Payer: LLUH Dept of Risk Management WC	$0.67
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$0.92

PYRIDOSTIGMINE BROMIDE 60 MG TABLET [11239]

Facility

$1.22

Service Code	NDC 68682-302-10
Hospital Charge Code	1710447
Hospital Revenue Code	259
Min. Negotiated Rate	$0.67
Max. Negotiated Rate	$0.98
Rate for Payer: Cash Price	$0.55
Rate for Payer: Cigna of CA HMO/PPO	$0.98
Rate for Payer: Health Smart Auto/Commercial	$0.73
Rate for Payer: LLUH Dept of Risk Management WC	$0.67
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$0.92

PYRIDOSTIGMINE BROMIDE 60 MG TABLET [11239]

Facility

$1.22

Service Code	NDC 71930-028-90
Hospital Charge Code	1710447
Hospital Revenue Code	259
Min. Negotiated Rate	$0.67
Max. Negotiated Rate	$0.98
Rate for Payer: Cash Price	$0.55
Rate for Payer: Cigna of CA HMO/PPO	$0.98
Rate for Payer: Health Smart Auto/Commercial	$0.73
Rate for Payer: LLUH Dept of Risk Management WC	$0.67
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$0.92

PYRIDOSTIGMINE BROMIDE 60 MG TABLET [11239]

Facility

$1.22

Service Code	NDC 68682-302-10
Hospital Charge Code	1710447
Hospital Revenue Code	259
Min. Negotiated Rate	$0.67
Max. Negotiated Rate	$0.92
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$0.73
Rate for Payer: Aetna of CA Government/Medicare	$0.73
Rate for Payer: Cash Price	$0.55
Rate for Payer: Health Smart Auto/Commercial	$0.73
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$0.73
Rate for Payer: LLUH Dept of Risk Management WC	$0.67
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$0.92

PYRIDOSTIGMINE BROMIDE 60 MG TABLET [11239]

Facility

$1.22

Service Code	NDC 71930-028-90
Hospital Charge Code	1710447
Hospital Revenue Code	259
Min. Negotiated Rate	$0.67
Max. Negotiated Rate	$0.92
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$0.73
Rate for Payer: Aetna of CA Government/Medicare	$0.73
Rate for Payer: Cash Price	$0.55
Rate for Payer: Health Smart Auto/Commercial	$0.73
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$0.73
Rate for Payer: LLUH Dept of Risk Management WC	$0.67
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$0.92

PYRIDOSTIGMINE BROMIDE 60 MG TABLET [11239]

Facility

$1.22

Service Code	NDC 68382-659-06
Hospital Charge Code	1710447
Hospital Revenue Code	259
Min. Negotiated Rate	$0.67
Max. Negotiated Rate	$0.92
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$0.73
Rate for Payer: Aetna of CA Government/Medicare	$0.73
Rate for Payer: Cash Price	$0.55
Rate for Payer: Health Smart Auto/Commercial	$0.73
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$0.73
Rate for Payer: LLUH Dept of Risk Management WC	$0.67
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$0.92

PYRIDOSTIGMINE BROMIDE ER 180 MG TABLET,EXTENDED RELEASE [11240]

Facility

$24.83

Service Code	NDC 68682-301-30
Hospital Charge Code	1710454
Hospital Revenue Code	259
Min. Negotiated Rate	$13.66
Max. Negotiated Rate	$18.62
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$14.90
Rate for Payer: Aetna of CA Government/Medicare	$14.90
Rate for Payer: Cash Price	$11.17
Rate for Payer: Health Smart Auto/Commercial	$14.90
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$14.90
Rate for Payer: LLUH Dept of Risk Management WC	$13.66
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$18.62

PYRIDOSTIGMINE BROMIDE ER 180 MG TABLET,EXTENDED RELEASE [11240]

Facility

$24.83

Service Code	NDC 68682-301-30
Hospital Charge Code	1710454
Hospital Revenue Code	259
Min. Negotiated Rate	$13.66
Max. Negotiated Rate	$19.86
Rate for Payer: Cash Price	$11.17
Rate for Payer: Cigna of CA HMO/PPO	$19.86
Rate for Payer: Health Smart Auto/Commercial	$14.90
Rate for Payer: LLUH Dept of Risk Management WC	$13.66
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$18.62

PYRIDOXINE ORAL SOLUTION (IV FORM) 100 MG/ML [4080441]

Facility

$10.79

Service Code	NDC 9994-0804-41
Hospital Charge Code	1715004
Hospital Revenue Code	259
Min. Negotiated Rate	$5.93
Max. Negotiated Rate	$8.63
Rate for Payer: Cash Price	$4.86
Rate for Payer: Cigna of CA HMO/PPO	$8.63
Rate for Payer: Health Smart Auto/Commercial	$6.47
Rate for Payer: LLUH Dept of Risk Management WC	$5.93
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$8.09

PYRIDOXINE ORAL SOLUTION (IV FORM) 100 MG/ML [4080441]

Facility

$10.79

Service Code	NDC 9994-0804-41
Hospital Charge Code	1715004
Hospital Revenue Code	259
Min. Negotiated Rate	$5.93
Max. Negotiated Rate	$8.09
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$6.47
Rate for Payer: Aetna of CA Government/Medicare	$6.47
Rate for Payer: Cash Price	$4.86
Rate for Payer: Health Smart Auto/Commercial	$6.47
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$6.47
Rate for Payer: LLUH Dept of Risk Management WC	$5.93
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$8.09

Know your out-of-pocket cost for care.

All Charges