Loma Linda University Behavioral Medicine Center (BMC)

All Charges

Charge

Type

Setting

Price

QUETIAPINE (SEROQUEL) CRUSHED TABLET IN WATER 2.5 MG/ML [40821823]

Facility

$0.39

Service Code	NDC 60687-327-11
Hospital Charge Code	ERX40821823
Hospital Revenue Code	259
Min. Negotiated Rate	$0.21
Max. Negotiated Rate	$0.31
Rate for Payer: Cigna of CA HMO/PPO	$0.31
Rate for Payer: Health Smart Auto/Commercial	$0.23
Rate for Payer: Cash Price	$0.18
Rate for Payer: LLUH Dept of Risk Management WC	$0.21
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$0.29

QUETIAPINE (SEROQUEL) CRUSHED TABLET IN WATER 2.5 MG/ML [40821823]

Facility

$0.06

Service Code	NDC 68180-445-01
Hospital Charge Code	ERX40821823
Hospital Revenue Code	259
Min. Negotiated Rate	$0.03
Max. Negotiated Rate	$0.05
Rate for Payer: Cash Price	$0.03
Rate for Payer: Cigna of CA 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 Beech St/Commercial/PHCS	$0.05

QUETIAPINE (SEROQUEL) CRUSHED TABLET IN WATER 2.5 MG/ML [40821823]

Facility

$0.22

Service Code	NDC 47335-902-88
Hospital Charge Code	ERX40821823
Hospital Revenue Code	259
Min. Negotiated Rate	$0.12
Max. Negotiated Rate	$0.17
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$0.13
Rate for Payer: Aetna of CA Government/Medicare	$0.13
Rate for Payer: Cash Price	$0.10
Rate for Payer: Health Smart Auto/Commercial	$0.13
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$0.13
Rate for Payer: LLUH Dept of Risk Management WC	$0.12
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$0.17

QUETIAPINE (SEROQUEL) CRUSHED TABLET IN WATER 2.5 MG/ML [40821823]

Facility

$0.39

Service Code	NDC 60687-327-01
Hospital Charge Code	ERX40821823
Hospital Revenue Code	259
Min. Negotiated Rate	$0.21
Max. Negotiated Rate	$0.29
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$0.23
Rate for Payer: Aetna of CA Government/Medicare	$0.23
Rate for Payer: Cash Price	$0.18
Rate for Payer: Health Smart Auto/Commercial	$0.23
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$0.23
Rate for Payer: LLUH Dept of Risk Management WC	$0.21
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$0.29

QUETIAPINE (SEROQUEL) CRUSHED TABLET IN WATER 2.5 MG/ML [40821823]

Facility

$0.39

Service Code	NDC 60687-327-01
Hospital Charge Code	ERX40821823
Hospital Revenue Code	259
Min. Negotiated Rate	$0.21
Max. Negotiated Rate	$0.31
Rate for Payer: Cash Price	$0.18
Rate for Payer: Cigna of CA HMO/PPO	$0.31
Rate for Payer: Health Smart Auto/Commercial	$0.23
Rate for Payer: LLUH Dept of Risk Management WC	$0.21
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$0.29

QUETIAPINE (SEROQUEL) CRUSHED TABLET IN WATER 2.5 MG/ML [40821823]

Facility

$0.11

Service Code	NDC 29300-147-01
Hospital Charge Code	ERX40821823
Hospital Revenue Code	259
Min. Negotiated Rate	$0.06
Max. Negotiated Rate	$0.08
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$0.07
Rate for Payer: Aetna of CA Government/Medicare	$0.07
Rate for Payer: Cash Price	$0.05
Rate for Payer: Health Smart Auto/Commercial	$0.07
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$0.07
Rate for Payer: LLUH Dept of Risk Management WC	$0.06
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$0.08

QUETIAPINE (SEROQUEL) CRUSHED TABLET IN WATER 2.5 MG/ML [40821823]

Facility

$0.22

Service Code	NDC 47335-902-88
Hospital Charge Code	ERX40821823
Hospital Revenue Code	259
Min. Negotiated Rate	$0.12
Max. Negotiated Rate	$0.18
Rate for Payer: Cash Price	$0.10
Rate for Payer: Cigna of CA HMO/PPO	$0.18
Rate for Payer: Health Smart Auto/Commercial	$0.13
Rate for Payer: LLUH Dept of Risk Management WC	$0.12
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$0.17

QUETIAPINE (SEROQUEL) CRUSHED TABLET IN WATER 2.5 MG/ML [40821823]

Facility

$0.06

Service Code	NDC 68180-445-01
Hospital Charge Code	ERX40821823
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: 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 Beech St/Commercial/PHCS	$0.05

QUETIAPINE (SEROQUEL) CRUSHED TABLET IN WATER 2.5 MG/ML [40821823]

Facility

$0.06

Service Code	NDC 16729-145-01
Hospital Charge Code	ERX40821823
Hospital Revenue Code	259
Min. Negotiated Rate	$0.03
Max. Negotiated Rate	$0.05
Rate for Payer: Cash Price	$0.03
Rate for Payer: Cigna of CA 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 Beech St/Commercial/PHCS	$0.05

QUETIAPINE (SEROQUEL) CRUSHED TABLET IN WATER 2.5 MG/ML [40821823]

Facility

$0.11

Service Code	NDC 29300-147-01
Hospital Charge Code	ERX40821823
Hospital Revenue Code	259
Min. Negotiated Rate	$0.06
Max. Negotiated Rate	$0.09
Rate for Payer: Cash Price	$0.05
Rate for Payer: Cigna of CA HMO/PPO	$0.09
Rate for Payer: Health Smart Auto/Commercial	$0.07
Rate for Payer: LLUH Dept of Risk Management WC	$0.06
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$0.08

QUETIAPINE (SEROQUEL) CRUSHED TABLET IN WATER 2.5 MG/ML [40821823]

Facility

$0.04

Service Code	NDC 67877-242-01
Hospital Charge Code	ERX40821823
Hospital Revenue Code	259
Min. Negotiated Rate	$0.02
Max. Negotiated Rate	$0.03
Rate for Payer: Cash Price	$0.02
Rate for Payer: Cigna of CA HMO/PPO	$0.03
Rate for Payer: Health Smart Auto/Commercial	$0.02
Rate for Payer: LLUH Dept of Risk Management WC	$0.02
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$0.03

QUETIAPINE (SEROQUEL) CRUSHED TABLET IN WATER 2.5 MG/ML [40821823]

Facility

$0.39

Service Code	NDC 60687-327-11
Hospital Charge Code	ERX40821823
Hospital Revenue Code	259
Min. Negotiated Rate	$0.21
Max. Negotiated Rate	$0.29
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$0.23
Rate for Payer: Aetna of CA Government/Medicare	$0.23
Rate for Payer: Cash Price	$0.18
Rate for Payer: Health Smart Auto/Commercial	$0.23
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$0.23
Rate for Payer: LLUH Dept of Risk Management WC	$0.21
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$0.29

QUETIAPINE (SEROQUEL) CRUSHED TABLET IN WATER 2.5 MG/ML [40821823]

Facility

$0.06

Service Code	NDC 16729-145-01
Hospital Charge Code	ERX40821823
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: 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 Beech St/Commercial/PHCS	$0.05

QUETIAPINE (SEROQUEL) CRUSHED TABLET IN WATER 2.5 MG/ML [40821823]

Facility

$0.35

Service Code	NDC 0904-6638-61
Hospital Charge Code	ERX40821823
Hospital Revenue Code	259
Min. Negotiated Rate	$0.19
Max. Negotiated Rate	$0.26
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$0.21
Rate for Payer: Aetna of CA Government/Medicare	$0.21
Rate for Payer: Cash Price	$0.16
Rate for Payer: Health Smart Auto/Commercial	$0.21
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$0.21
Rate for Payer: LLUH Dept of Risk Management WC	$0.19
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$0.26

QUETIAPINE (SEROQUEL) CRUSHED TABLET IN WATER 2.5 MG/ML [40821823]

Facility

$0.35

Service Code	NDC 0904-6638-61
Hospital Charge Code	ERX40821823
Hospital Revenue Code	259
Min. Negotiated Rate	$0.19
Max. Negotiated Rate	$0.28
Rate for Payer: Cash Price	$0.16
Rate for Payer: Cigna of CA HMO/PPO	$0.28
Rate for Payer: Health Smart Auto/Commercial	$0.21
Rate for Payer: LLUH Dept of Risk Management WC	$0.19
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$0.26

QUINIDINE GLUCONATE ER 324 MG TABLET,EXTENDED RELEASE [12197]

Facility

$8.70

Service Code	NDC 53489-141-01
Hospital Charge Code	1710542
Hospital Revenue Code	259
Min. Negotiated Rate	$4.78
Max. Negotiated Rate	$6.52
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$5.22
Rate for Payer: Aetna of CA Government/Medicare	$5.22
Rate for Payer: Cash Price	$3.92
Rate for Payer: Health Smart Auto/Commercial	$5.22
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$5.22
Rate for Payer: LLUH Dept of Risk Management WC	$4.78
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$6.52

QUINIDINE GLUCONATE ER 324 MG TABLET,EXTENDED RELEASE [12197]

Facility

$8.70

Service Code	NDC 53489-141-01
Hospital Charge Code	1710542
Hospital Revenue Code	259
Min. Negotiated Rate	$4.78
Max. Negotiated Rate	$6.96
Rate for Payer: Cash Price	$3.92
Rate for Payer: Cigna of CA HMO/PPO	$6.96
Rate for Payer: Health Smart Auto/Commercial	$5.22
Rate for Payer: LLUH Dept of Risk Management WC	$4.78
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$6.52

QUINIDINE SULFATE 200 MG TABLET [6777]

Facility

$0.30

Service Code	NDC 0185-4346-01
Hospital Charge Code	1710761
Hospital Revenue Code	259
Min. Negotiated Rate	$0.17
Max. Negotiated Rate	$0.24
Rate for Payer: Cash Price	$0.14
Rate for Payer: Cigna of CA HMO/PPO	$0.24
Rate for Payer: Health Smart Auto/Commercial	$0.18
Rate for Payer: LLUH Dept of Risk Management WC	$0.17
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$0.23

QUINIDINE SULFATE 200 MG TABLET [6777]

Facility

$0.30

Service Code	NDC 0185-4346-01
Hospital Charge Code	1710761
Hospital Revenue Code	259
Min. Negotiated Rate	$0.17
Max. Negotiated Rate	$0.23
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$0.18
Rate for Payer: Aetna of CA Government/Medicare	$0.18
Rate for Payer: Cash Price	$0.14
Rate for Payer: Health Smart Auto/Commercial	$0.18
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$0.18
Rate for Payer: LLUH Dept of Risk Management WC	$0.17
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$0.23

QUININE 324 MG CAPSULE [117183]

Facility

$7.86

Service Code	NDC 13310-153-07
Hospital Charge Code	1711954
Hospital Revenue Code	259
Min. Negotiated Rate	$4.32
Max. Negotiated Rate	$5.90
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$4.72
Rate for Payer: Aetna of CA Government/Medicare	$4.72
Rate for Payer: Cash Price	$3.54
Rate for Payer: Health Smart Auto/Commercial	$4.72
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$4.72
Rate for Payer: LLUH Dept of Risk Management WC	$4.32
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$5.90

QUININE 324 MG CAPSULE [117183]

Facility

$7.86

Service Code	NDC 13310-153-07
Hospital Charge Code	1711954
Hospital Revenue Code	259
Min. Negotiated Rate	$4.32
Max. Negotiated Rate	$6.29
Rate for Payer: Cash Price	$3.54
Rate for Payer: Cigna of CA HMO/PPO	$6.29
Rate for Payer: Health Smart Auto/Commercial	$4.72
Rate for Payer: LLUH Dept of Risk Management WC	$4.32
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$5.90

QUINUPRISTIN-DALFOPRISTIN 500 MG INTRAVENOUS SOLUTION [26335]

Facility

$559.21

Service Code	CPT J2770
Hospital Charge Code	1753511
Hospital Revenue Code	636
Min. Negotiated Rate	$307.57
Max. Negotiated Rate	$419.41
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$335.53
Rate for Payer: Aetna of CA Government/Medicare	$335.53
Rate for Payer: Cash Price	$251.64
Rate for Payer: Health Smart Auto/Commercial	$335.53
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$335.53
Rate for Payer: LLUH Dept of Risk Management WC	$307.57
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$419.41

QUINUPRISTIN-DALFOPRISTIN 500 MG INTRAVENOUS SOLUTION [26335]

Facility

$559.21

Service Code	CPT J2770
Hospital Charge Code	1753511
Hospital Revenue Code	636
Min. Negotiated Rate	$307.57
Max. Negotiated Rate	$447.37
Rate for Payer: Cash Price	$251.64
Rate for Payer: Cigna of CA HMO/PPO	$447.37
Rate for Payer: Health Smart Auto/Commercial	$335.53
Rate for Payer: LLUH Dept of Risk Management WC	$307.57
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$419.41

RABIES IMMUNE GLOBULIN (PF) 150 UNIT/ML INTRAMUSCULAR SOLUTION [111036]

Facility

$447.37

Service Code	CPT 90377
Hospital Charge Code	NDG111036
Hospital Revenue Code	636
Min. Negotiated Rate	$246.05
Max. Negotiated Rate	$335.53
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$268.42
Rate for Payer: Aetna of CA Government/Medicare	$268.42
Rate for Payer: Cash Price	$201.32
Rate for Payer: Health Smart Auto/Commercial	$268.42
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$268.42
Rate for Payer: LLUH Dept of Risk Management WC	$246.05
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$335.53

RABIES IMMUNE GLOBULIN (PF) 150 UNIT/ML INTRAMUSCULAR SOLUTION [111036]

Facility

$447.37

Service Code	CPT 90377
Hospital Charge Code	NDG111036
Hospital Revenue Code	636
Min. Negotiated Rate	$246.05
Max. Negotiated Rate	$357.90
Rate for Payer: Cash Price	$201.32
Rate for Payer: Cigna of CA HMO/PPO	$357.90
Rate for Payer: Health Smart Auto/Commercial	$268.42
Rate for Payer: LLUH Dept of Risk Management WC	$246.05
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$335.53

Know your out-of-pocket cost for care.

All Charges