Loma Linda University Behavioral Medicine Center (BMC)

All Charges

Charge

Type

Setting

Price

RABIES IMMUNE GLOBULIN (PF) 300 UNIT/ML INTRAMUSCULAR SOLUTION [221392]

Facility

$816.60

Service Code	CPT 90375
Hospital Charge Code	NDG221392
Hospital Revenue Code	636
Min. Negotiated Rate	$449.13
Max. Negotiated Rate	$612.45
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$489.96
Rate for Payer: Aetna of CA Government/Medicare	$489.96
Rate for Payer: Cash Price	$367.47
Rate for Payer: Health Smart Auto/Commercial	$489.96
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$489.96
Rate for Payer: LLUH Dept of Risk Management WC	$449.13
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$612.45

RABIES IMMUNE GLOBULIN (PF) 300 UNIT/ML INTRAMUSCULAR SOLUTION [221392]

Facility

$816.60

Service Code	CPT 90375
Hospital Charge Code	NDG221392
Hospital Revenue Code	636
Min. Negotiated Rate	$449.13
Max. Negotiated Rate	$653.28
Rate for Payer: Cash Price	$367.47
Rate for Payer: Cigna of CA HMO/PPO	$653.28
Rate for Payer: Health Smart Auto/Commercial	$489.96
Rate for Payer: LLUH Dept of Risk Management WC	$449.13
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$612.45

RABIES VACCINE,HUMAN DIPLOID (PF) 2.5 UNIT INTRAMUSCULAR SOLUTION [11257]

Facility

$486.20

Service Code	CPT 90675
Hospital Charge Code	ERX11257
Hospital Revenue Code	636
Min. Negotiated Rate	$267.41
Max. Negotiated Rate	$364.65
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$291.72
Rate for Payer: Aetna of CA Government/Medicare	$291.72
Rate for Payer: Cash Price	$218.79
Rate for Payer: Health Smart Auto/Commercial	$291.72
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$291.72
Rate for Payer: LLUH Dept of Risk Management WC	$267.41
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$364.65

RABIES VACCINE,HUMAN DIPLOID (PF) 2.5 UNIT INTRAMUSCULAR SOLUTION [11257]

Facility

$486.20

Service Code	CPT 90675
Hospital Charge Code	ERX11257
Hospital Revenue Code	636
Min. Negotiated Rate	$267.41
Max. Negotiated Rate	$388.96
Rate for Payer: Cash Price	$218.79
Rate for Payer: Cigna of CA HMO/PPO	$388.96
Rate for Payer: Health Smart Auto/Commercial	$291.72
Rate for Payer: LLUH Dept of Risk Management WC	$267.41
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$364.65

RABIES VACCINE, PURIFIED CHICKEN EMBRYO CELL (PF) 2.5 UNIT IM SUSP [22120]

Facility

$477.59

Service Code	CPT 90675
Hospital Charge Code	1720343
Hospital Revenue Code	636
Min. Negotiated Rate	$262.67
Max. Negotiated Rate	$382.07
Rate for Payer: Cash Price	$214.92
Rate for Payer: Cigna of CA HMO/PPO	$382.07
Rate for Payer: Health Smart Auto/Commercial	$286.55
Rate for Payer: LLUH Dept of Risk Management WC	$262.67
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$358.19

RABIES VACCINE, PURIFIED CHICKEN EMBRYO CELL (PF) 2.5 UNIT IM SUSP [22120]

Facility

$477.59

Service Code	CPT 90675
Hospital Charge Code	1720343
Hospital Revenue Code	636
Min. Negotiated Rate	$262.67
Max. Negotiated Rate	$358.19
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$286.55
Rate for Payer: Aetna of CA Government/Medicare	$286.55
Rate for Payer: Cash Price	$214.92
Rate for Payer: Health Smart Auto/Commercial	$286.55
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$286.55
Rate for Payer: LLUH Dept of Risk Management WC	$262.67
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$358.19

RACEPINEPHRINE 2.25 % SOLUTION FOR NEBULIZATION [2851]

Facility

$1.68

Service Code	NDC 0487-5901-99
Hospital Charge Code	1781099
Hospital Revenue Code	259
Min. Negotiated Rate	$0.92
Max. Negotiated Rate	$1.34
Rate for Payer: Cash Price	$0.76
Rate for Payer: Cigna of CA HMO/PPO	$1.34
Rate for Payer: Health Smart Auto/Commercial	$1.01
Rate for Payer: LLUH Dept of Risk Management WC	$0.92
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$1.26

RACEPINEPHRINE 2.25 % SOLUTION FOR NEBULIZATION [2851]

Facility

$1.68

Service Code	NDC 0487-5901-99
Hospital Charge Code	1781099
Hospital Revenue Code	259
Min. Negotiated Rate	$0.92
Max. Negotiated Rate	$1.26
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$1.01
Rate for Payer: Aetna of CA Government/Medicare	$1.01
Rate for Payer: Cash Price	$0.76
Rate for Payer: Health Smart Auto/Commercial	$1.01
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$1.01
Rate for Payer: LLUH Dept of Risk Management WC	$0.92
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$1.26

RADIUM RA 223 DICHLOR 1,100 KBQ/ML (30 MICROCURIE/ML) INTRAVENOUS SOLN [202157]

Facility

$60,372.00

Service Code	CPT A9606
Hospital Charge Code	ERX202157
Hospital Revenue Code	344
Min. Negotiated Rate	$33,204.60
Max. Negotiated Rate	$48,297.60
Rate for Payer: Cash Price	$27,167.40
Rate for Payer: Cigna of CA HMO/PPO	$48,297.60
Rate for Payer: Health Smart Auto/Commercial	$36,223.20
Rate for Payer: LLUH Dept of Risk Management WC	$33,204.60
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$45,279.00

RADIUM RA 223 DICHLOR 1,100 KBQ/ML (30 MICROCURIE/ML) INTRAVENOUS SOLN [202157]

Facility

$60,372.00

Service Code	CPT A9606
Hospital Charge Code	ERX202157
Hospital Revenue Code	344
Min. Negotiated Rate	$33,204.60
Max. Negotiated Rate	$45,279.00
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$36,223.20
Rate for Payer: Aetna of CA Government/Medicare	$36,223.20
Rate for Payer: Cash Price	$27,167.40
Rate for Payer: Health Smart Auto/Commercial	$36,223.20
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$36,223.20
Rate for Payer: LLUH Dept of Risk Management WC	$33,204.60
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$45,279.00

RALOXIFENE 60 MG TABLET [22143]

Facility

$2.77

Service Code	NDC 43598-505-30
Hospital Charge Code	1710918
Hospital Revenue Code	259
Min. Negotiated Rate	$1.52
Max. Negotiated Rate	$2.08
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$1.66
Rate for Payer: Aetna of CA Government/Medicare	$1.66
Rate for Payer: Cash Price	$1.25
Rate for Payer: Health Smart Auto/Commercial	$1.66
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$1.66
Rate for Payer: LLUH Dept of Risk Management WC	$1.52
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$2.08

RALOXIFENE 60 MG TABLET [22143]

Facility

$2.77

Service Code	NDC 43598-505-30
Hospital Charge Code	1710918
Hospital Revenue Code	259
Min. Negotiated Rate	$1.52
Max. Negotiated Rate	$2.22
Rate for Payer: Cash Price	$1.25
Rate for Payer: Cigna of CA HMO/PPO	$2.22
Rate for Payer: Health Smart Auto/Commercial	$1.66
Rate for Payer: LLUH Dept of Risk Management WC	$1.52
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$2.08

RALTEGRAVIR 400 MG TABLET [88608]

Facility

$38.21

Service Code	NDC 0006-0227-61
Hospital Charge Code	1711979
Hospital Revenue Code	259
Min. Negotiated Rate	$21.02
Max. Negotiated Rate	$28.66
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$22.93
Rate for Payer: Aetna of CA Government/Medicare	$22.93
Rate for Payer: Cash Price	$17.19
Rate for Payer: Health Smart Auto/Commercial	$22.93
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$22.93
Rate for Payer: LLUH Dept of Risk Management WC	$21.02
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$28.66

RALTEGRAVIR 400 MG TABLET [88608]

Facility

$38.21

Service Code	NDC 0006-0227-61
Hospital Charge Code	1711979
Hospital Revenue Code	259
Min. Negotiated Rate	$21.02
Max. Negotiated Rate	$30.57
Rate for Payer: Cash Price	$17.19
Rate for Payer: Cigna of CA HMO/PPO	$30.57
Rate for Payer: Health Smart Auto/Commercial	$22.93
Rate for Payer: LLUH Dept of Risk Management WC	$21.02
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$28.66

RAMIPRIL 5 MG CAPSULE [11261]

Facility

$0.24

Service Code	NDC 65862-476-01
Hospital Charge Code	1712231
Hospital Revenue Code	259
Min. Negotiated Rate	$0.13
Max. Negotiated Rate	$0.18
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$0.14
Rate for Payer: Aetna of CA Government/Medicare	$0.14
Rate for Payer: Cash Price	$0.11
Rate for Payer: Health Smart Auto/Commercial	$0.14
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$0.14
Rate for Payer: LLUH Dept of Risk Management WC	$0.13
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$0.18

RAMIPRIL 5 MG CAPSULE [11261]

Facility

$0.24

Service Code	NDC 65862-476-01
Hospital Charge Code	1712231
Hospital Revenue Code	259
Min. Negotiated Rate	$0.13
Max. Negotiated Rate	$0.19
Rate for Payer: Cash Price	$0.11
Rate for Payer: Cigna of CA HMO/PPO	$0.19
Rate for Payer: Health Smart Auto/Commercial	$0.14
Rate for Payer: LLUH Dept of Risk Management WC	$0.13
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$0.18

RAMUCIRUMAB 10 MG/ML INTRAVENOUS SOLUTION [205590]

Facility

$166.40

Service Code	NDC 0002-7669-01
Hospital Charge Code	NDG2205
Hospital Revenue Code	636
Min. Negotiated Rate	$91.52
Max. Negotiated Rate	$124.80
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$99.84
Rate for Payer: Aetna of CA Government/Medicare	$99.84
Rate for Payer: Cash Price	$74.88
Rate for Payer: Health Smart Auto/Commercial	$99.84
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$99.84
Rate for Payer: LLUH Dept of Risk Management WC	$91.52
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$124.80

RAMUCIRUMAB 10 MG/ML INTRAVENOUS SOLUTION [205590]

Facility

$166.40

Service Code	NDC 0002-7678-01
Hospital Charge Code	NDG2206
Hospital Revenue Code	636
Min. Negotiated Rate	$91.52
Max. Negotiated Rate	$133.12
Rate for Payer: Cash Price	$74.88
Rate for Payer: Cigna of CA HMO/PPO	$133.12
Rate for Payer: Health Smart Auto/Commercial	$99.84
Rate for Payer: LLUH Dept of Risk Management WC	$91.52
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$124.80

RAMUCIRUMAB 10 MG/ML INTRAVENOUS SOLUTION [205590]

Facility

$166.40

Service Code	NDC 0002-7678-01
Hospital Charge Code	NDG2206
Hospital Revenue Code	636
Min. Negotiated Rate	$91.52
Max. Negotiated Rate	$124.80
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$99.84
Rate for Payer: Aetna of CA Government/Medicare	$99.84
Rate for Payer: Cash Price	$74.88
Rate for Payer: Health Smart Auto/Commercial	$99.84
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$99.84
Rate for Payer: LLUH Dept of Risk Management WC	$91.52
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$124.80

RAMUCIRUMAB 10 MG/ML INTRAVENOUS SOLUTION [205590]

Facility

$166.40

Service Code	NDC 0002-7669-01
Hospital Charge Code	NDG2205
Hospital Revenue Code	636
Min. Negotiated Rate	$91.52
Max. Negotiated Rate	$133.12
Rate for Payer: Cash Price	$74.88
Rate for Payer: Cigna of CA HMO/PPO	$133.12
Rate for Payer: Health Smart Auto/Commercial	$99.84
Rate for Payer: LLUH Dept of Risk Management WC	$91.52
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$124.80

RANIBIZUMAB 0.3 MG/0.05 ML INTRAVITREAL SOLUTION FOR INJECTION [197046]

Facility

$28,080.00

Service Code	NDC 50242-082-02
Hospital Charge Code	NDG197046
Hospital Revenue Code	636
Min. Negotiated Rate	$15,444.00
Max. Negotiated Rate	$22,464.00
Rate for Payer: Cash Price	$12,636.00
Rate for Payer: Cigna of CA HMO/PPO	$22,464.00
Rate for Payer: Health Smart Auto/Commercial	$16,848.00
Rate for Payer: LLUH Dept of Risk Management WC	$15,444.00
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$21,060.00

RANIBIZUMAB 0.3 MG/0.05 ML INTRAVITREAL SOLUTION FOR INJECTION [197046]

Facility

$28,080.00

Service Code	NDC 50242-082-02
Hospital Charge Code	NDG197046
Hospital Revenue Code	636
Min. Negotiated Rate	$15,444.00
Max. Negotiated Rate	$21,060.00
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$16,848.00
Rate for Payer: Aetna of CA Government/Medicare	$16,848.00
Rate for Payer: Cash Price	$12,636.00
Rate for Payer: Health Smart Auto/Commercial	$16,848.00
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$16,848.00
Rate for Payer: LLUH Dept of Risk Management WC	$15,444.00
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$21,060.00

RANIBIZUMAB 0.5 MG/0.05 ML INTRAVITREAL SOLUTION FOR INJECTION [76790]

Facility

$46,800.00

Service Code	CPT J2778
Hospital Charge Code	NDG76790
Hospital Revenue Code	636
Min. Negotiated Rate	$25,740.00
Max. Negotiated Rate	$37,440.00
Rate for Payer: Cash Price	$21,060.00
Rate for Payer: Cigna of CA HMO/PPO	$37,440.00
Rate for Payer: Health Smart Auto/Commercial	$28,080.00
Rate for Payer: LLUH Dept of Risk Management WC	$25,740.00
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$35,100.00

RANIBIZUMAB 0.5 MG/0.05 ML INTRAVITREAL SOLUTION FOR INJECTION [76790]

Facility

$46,800.00

Service Code	CPT J2778
Hospital Charge Code	NDG76790
Hospital Revenue Code	636
Min. Negotiated Rate	$25,740.00
Max. Negotiated Rate	$35,100.00
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$28,080.00
Rate for Payer: Aetna of CA Government/Medicare	$28,080.00
Rate for Payer: Cash Price	$21,060.00
Rate for Payer: Health Smart Auto/Commercial	$28,080.00
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$28,080.00
Rate for Payer: LLUH Dept of Risk Management WC	$25,740.00
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$35,100.00

RANOLAZINE ER 1,000 MG TABLET,EXTENDED RELEASE,12 HR [88007]

Facility

$0.34

Service Code	NDC 42291-774-60
Hospital Charge Code	1711990
Hospital Revenue Code	259
Min. Negotiated Rate	$0.19
Max. Negotiated Rate	$0.26
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$0.20
Rate for Payer: Aetna of CA Government/Medicare	$0.20
Rate for Payer: Cash Price	$0.15
Rate for Payer: Health Smart Auto/Commercial	$0.20
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$0.20
Rate for Payer: LLUH Dept of Risk Management WC	$0.19
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$0.26

Know your out-of-pocket cost for care.

All Charges