Loma Linda University Behavioral Medicine Center (BMC)

All Charges

Charge

Type

Setting

Price

ROCURONIUM 50 MG/5 ML VIAL- CODE [40895812]

Facility

$1.16

Service Code	NDC 67457-228-05
Hospital Charge Code	1722005
Hospital Revenue Code	250
Min. Negotiated Rate	$0.64
Max. Negotiated Rate	$0.87
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$0.70
Rate for Payer: Aetna of CA Government/Medicare	$0.70
Rate for Payer: Cash Price	$0.52
Rate for Payer: Health Smart Auto/Commercial	$0.70
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$0.70
Rate for Payer: LLUH Dept of Risk Management WC	$0.64
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$0.87

ROCURONIUM 50 MG/5 ML VIAL- CODE [40895812]

Facility

$1.16

Service Code	NDC 67457-228-05
Hospital Charge Code	1722005
Hospital Revenue Code	250
Min. Negotiated Rate	$0.64
Max. Negotiated Rate	$0.93
Rate for Payer: Cash Price	$0.52
Rate for Payer: Cigna of CA HMO/PPO	$0.93
Rate for Payer: Health Smart Auto/Commercial	$0.70
Rate for Payer: LLUH Dept of Risk Management WC	$0.64
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$0.87

ROFLUMILAST 500 MCG TABLET [109401]

Facility

$0.72

Service Code	NDC 72205-200-30
Hospital Charge Code	ERX109401
Hospital Revenue Code	259
Min. Negotiated Rate	$0.40
Max. Negotiated Rate	$0.54
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$0.43
Rate for Payer: Aetna of CA Government/Medicare	$0.43
Rate for Payer: Cash Price	$0.32
Rate for Payer: Health Smart Auto/Commercial	$0.43
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$0.43
Rate for Payer: LLUH Dept of Risk Management WC	$0.40
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$0.54

ROFLUMILAST 500 MCG TABLET [109401]

Facility

$0.72

Service Code	NDC 72205-200-30
Hospital Charge Code	ERX109401
Hospital Revenue Code	259
Min. Negotiated Rate	$0.40
Max. Negotiated Rate	$0.58
Rate for Payer: Cash Price	$0.32
Rate for Payer: Cigna of CA HMO/PPO	$0.58
Rate for Payer: Health Smart Auto/Commercial	$0.43
Rate for Payer: LLUH Dept of Risk Management WC	$0.40
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$0.54

ROFLUMILAST 500 MCG TABLET [109401]

Facility

$17.24

Service Code	NDC 0310-0095-30
Hospital Charge Code	ERX109401
Hospital Revenue Code	259
Min. Negotiated Rate	$9.48
Max. Negotiated Rate	$13.79
Rate for Payer: Cash Price	$7.76
Rate for Payer: Cigna of CA HMO/PPO	$13.79
Rate for Payer: Health Smart Auto/Commercial	$10.34
Rate for Payer: LLUH Dept of Risk Management WC	$9.48
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$12.93

ROFLUMILAST 500 MCG TABLET [109401]

Facility

$17.24

Service Code	NDC 0310-0095-30
Hospital Charge Code	ERX109401
Hospital Revenue Code	259
Min. Negotiated Rate	$9.48
Max. Negotiated Rate	$12.93
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$10.34
Rate for Payer: Aetna of CA Government/Medicare	$10.34
Rate for Payer: Cash Price	$7.76
Rate for Payer: Health Smart Auto/Commercial	$10.34
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$10.34
Rate for Payer: LLUH Dept of Risk Management WC	$9.48
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$12.93

ROMIDEPSIN 10 MG/2 ML INTRAVENOUS POWDER FOR SOLUTION [100344]

Facility

$3,838.38

Service Code	CPT J9319
Hospital Charge Code	ERX100344
Hospital Revenue Code	636
Min. Negotiated Rate	$2,111.11
Max. Negotiated Rate	$2,878.78
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$2,303.03
Rate for Payer: Aetna of CA Government/Medicare	$2,303.03
Rate for Payer: Cash Price	$1,727.27
Rate for Payer: Health Smart Auto/Commercial	$2,303.03
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$2,303.03
Rate for Payer: LLUH Dept of Risk Management WC	$2,111.11
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$2,878.78

ROMIDEPSIN 10 MG/2 ML INTRAVENOUS POWDER FOR SOLUTION [100344]

Facility

$3,838.38

Service Code	CPT J9319
Hospital Charge Code	ERX100344
Hospital Revenue Code	636
Min. Negotiated Rate	$2,111.11
Max. Negotiated Rate	$3,070.70
Rate for Payer: Cash Price	$1,727.27
Rate for Payer: Cigna of CA HMO/PPO	$3,070.70
Rate for Payer: Health Smart Auto/Commercial	$2,303.03
Rate for Payer: LLUH Dept of Risk Management WC	$2,111.11
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$2,878.78

ROMIPLOSTIM 125 MCG SUBCUTANEOUS SOLUTION [226462]

Facility

$1,431.00

Service Code	CPT J2796
Hospital Charge Code	ERX226462
Hospital Revenue Code	636
Min. Negotiated Rate	$787.05
Max. Negotiated Rate	$1,073.25
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$858.60
Rate for Payer: Aetna of CA Government/Medicare	$858.60
Rate for Payer: Cash Price	$643.95
Rate for Payer: Health Smart Auto/Commercial	$858.60
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$858.60
Rate for Payer: LLUH Dept of Risk Management WC	$787.05
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$1,073.25

ROMIPLOSTIM 125 MCG SUBCUTANEOUS SOLUTION [226462]

Facility

$1,431.00

Service Code	CPT J2796
Hospital Charge Code	ERX226462
Hospital Revenue Code	636
Min. Negotiated Rate	$787.05
Max. Negotiated Rate	$1,144.80
Rate for Payer: Cash Price	$643.95
Rate for Payer: Cigna of CA HMO/PPO	$1,144.80
Rate for Payer: Health Smart Auto/Commercial	$858.60
Rate for Payer: LLUH Dept of Risk Management WC	$787.05
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$1,073.25

ROMIPLOSTIM 250 MCG SUBCUTANEOUS SOLUTION [93566]

Facility

$2,861.96

Service Code	CPT J2796
Hospital Charge Code	1721175
Hospital Revenue Code	636
Min. Negotiated Rate	$1,574.08
Max. Negotiated Rate	$2,289.57
Rate for Payer: Cash Price	$1,287.88
Rate for Payer: Cigna of CA HMO/PPO	$2,289.57
Rate for Payer: Health Smart Auto/Commercial	$1,717.18
Rate for Payer: LLUH Dept of Risk Management WC	$1,574.08
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$2,146.47

ROMIPLOSTIM 250 MCG SUBCUTANEOUS SOLUTION [93566]

Facility

$2,861.96

Service Code	CPT J2796
Hospital Charge Code	1721175
Hospital Revenue Code	636
Min. Negotiated Rate	$1,574.08
Max. Negotiated Rate	$2,146.47
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$1,717.18
Rate for Payer: Aetna of CA Government/Medicare	$1,717.18
Rate for Payer: Cash Price	$1,287.88
Rate for Payer: Health Smart Auto/Commercial	$1,717.18
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$1,717.18
Rate for Payer: LLUH Dept of Risk Management WC	$1,574.08
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$2,146.47

ROMIPLOSTIM 500 MCG SUBCUTANEOUS SOLUTION [93567]

Facility

$5,723.92

Service Code	CPT J2796
Hospital Charge Code	1721176
Hospital Revenue Code	636
Min. Negotiated Rate	$3,148.16
Max. Negotiated Rate	$4,579.14
Rate for Payer: Cash Price	$2,575.76
Rate for Payer: Cigna of CA HMO/PPO	$4,579.14
Rate for Payer: Health Smart Auto/Commercial	$3,434.35
Rate for Payer: LLUH Dept of Risk Management WC	$3,148.16
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$4,292.94

ROMIPLOSTIM 500 MCG SUBCUTANEOUS SOLUTION [93567]

Facility

$5,723.92

Service Code	CPT J2796
Hospital Charge Code	1721176
Hospital Revenue Code	636
Min. Negotiated Rate	$3,148.16
Max. Negotiated Rate	$4,292.94
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$3,434.35
Rate for Payer: Aetna of CA Government/Medicare	$3,434.35
Rate for Payer: Cash Price	$2,575.76
Rate for Payer: Health Smart Auto/Commercial	$3,434.35
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$3,434.35
Rate for Payer: LLUH Dept of Risk Management WC	$3,148.16
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$4,292.94

ROPINIROLE 0.25 MG TABLET [21688]

Facility

$0.36

Service Code	NDC 62332-030-31
Hospital Charge Code	1711813
Hospital Revenue Code	259
Min. Negotiated Rate	$0.20
Max. Negotiated Rate	$0.27
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$0.22
Rate for Payer: Aetna of CA Government/Medicare	$0.22
Rate for Payer: Cash Price	$0.16
Rate for Payer: Health Smart Auto/Commercial	$0.22
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$0.22
Rate for Payer: LLUH Dept of Risk Management WC	$0.20
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$0.27

ROPINIROLE 0.25 MG TABLET [21688]

Facility

$0.66

Service Code	NDC 60687-577-01
Hospital Charge Code	1711813
Hospital Revenue Code	259
Min. Negotiated Rate	$0.36
Max. Negotiated Rate	$0.53
Rate for Payer: Cash Price	$0.30
Rate for Payer: Cigna of CA HMO/PPO	$0.53
Rate for Payer: Health Smart Auto/Commercial	$0.40
Rate for Payer: LLUH Dept of Risk Management WC	$0.36
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$0.50

ROPINIROLE 0.25 MG TABLET [21688]

Facility

$0.36

Service Code	NDC 62332-030-31
Hospital Charge Code	1711813
Hospital Revenue Code	259
Min. Negotiated Rate	$0.20
Max. Negotiated Rate	$0.29
Rate for Payer: Cash Price	$0.16
Rate for Payer: Cigna of CA HMO/PPO	$0.29
Rate for Payer: Health Smart Auto/Commercial	$0.22
Rate for Payer: LLUH Dept of Risk Management WC	$0.20
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$0.27

ROPINIROLE 0.25 MG TABLET [21688]

Facility

$0.59

Service Code	NDC 0904-6373-61
Hospital Charge Code	1711813
Hospital Revenue Code	259
Min. Negotiated Rate	$0.32
Max. Negotiated Rate	$0.44
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$0.35
Rate for Payer: Aetna of CA Government/Medicare	$0.35
Rate for Payer: Cash Price	$0.27
Rate for Payer: Health Smart Auto/Commercial	$0.35
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$0.35
Rate for Payer: LLUH Dept of Risk Management WC	$0.32
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$0.44

ROPINIROLE 0.25 MG TABLET [21688]

Facility

$0.66

Service Code	NDC 60687-577-11
Hospital Charge Code	1711813
Hospital Revenue Code	259
Min. Negotiated Rate	$0.36
Max. Negotiated Rate	$0.53
Rate for Payer: Cash Price	$0.30
Rate for Payer: Cigna of CA HMO/PPO	$0.53
Rate for Payer: Health Smart Auto/Commercial	$0.40
Rate for Payer: LLUH Dept of Risk Management WC	$0.36
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$0.50

ROPINIROLE 0.25 MG TABLET [21688]

Facility

$0.66

Service Code	NDC 60687-577-11
Hospital Charge Code	1711813
Hospital Revenue Code	259
Min. Negotiated Rate	$0.36
Max. Negotiated Rate	$0.50
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$0.40
Rate for Payer: Aetna of CA Government/Medicare	$0.40
Rate for Payer: Cash Price	$0.30
Rate for Payer: Health Smart Auto/Commercial	$0.40
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$0.40
Rate for Payer: LLUH Dept of Risk Management WC	$0.36
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$0.50

ROPINIROLE 0.25 MG TABLET [21688]

Facility

$0.66

Service Code	NDC 60687-577-01
Hospital Charge Code	1711813
Hospital Revenue Code	259
Min. Negotiated Rate	$0.36
Max. Negotiated Rate	$0.50
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$0.40
Rate for Payer: Aetna of CA Government/Medicare	$0.40
Rate for Payer: Cash Price	$0.30
Rate for Payer: Health Smart Auto/Commercial	$0.40
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$0.40
Rate for Payer: LLUH Dept of Risk Management WC	$0.36
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$0.50

ROPINIROLE 0.25 MG TABLET [21688]

Facility

$0.59

Service Code	NDC 0904-6373-61
Hospital Charge Code	1711813
Hospital Revenue Code	259
Min. Negotiated Rate	$0.32
Max. Negotiated Rate	$0.47
Rate for Payer: Cash Price	$0.27
Rate for Payer: Cigna of CA HMO/PPO	$0.47
Rate for Payer: Health Smart Auto/Commercial	$0.35
Rate for Payer: LLUH Dept of Risk Management WC	$0.32
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$0.44

ROPINIROLE 0.5 MG TABLET [21800]

Facility

$0.36

Service Code	NDC 62332-031-31
Hospital Charge Code	1711816
Hospital Revenue Code	259
Min. Negotiated Rate	$0.20
Max. Negotiated Rate	$0.29
Rate for Payer: Cash Price	$0.16
Rate for Payer: Cigna of CA HMO/PPO	$0.29
Rate for Payer: Health Smart Auto/Commercial	$0.22
Rate for Payer: LLUH Dept of Risk Management WC	$0.20
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$0.27

ROPINIROLE 0.5 MG TABLET [21800]

Facility

$0.14

Service Code	NDC 68462-254-01
Hospital Charge Code	1711816
Hospital Revenue Code	259
Min. Negotiated Rate	$0.08
Max. Negotiated Rate	$0.11
Rate for Payer: Cash Price	$0.06
Rate for Payer: Cigna of CA HMO/PPO	$0.11
Rate for Payer: Health Smart Auto/Commercial	$0.08
Rate for Payer: LLUH Dept of Risk Management WC	$0.08
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$0.11

ROPINIROLE 0.5 MG TABLET [21800]

Facility

$0.14

Service Code	NDC 68462-254-01
Hospital Charge Code	1711816
Hospital Revenue Code	259
Min. Negotiated Rate	$0.08
Max. Negotiated Rate	$0.11
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$0.08
Rate for Payer: Aetna of CA Government/Medicare	$0.08
Rate for Payer: Cash Price	$0.06
Rate for Payer: Health Smart Auto/Commercial	$0.08
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$0.08
Rate for Payer: LLUH Dept of Risk Management WC	$0.08
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$0.11

Know your out-of-pocket cost for care.

All Charges