Loma Linda University Behavioral Medicine Center (BMC)

All Charges

Charge

Type

Setting

Price

VALGANCICLOVIR 50 MG/ML ORAL SOLUTION [99443]

Facility

$10.91

Service Code	NDC 70010-051-40
Hospital Charge Code	1715257
Hospital Revenue Code	259
Min. Negotiated Rate	$6.00
Max. Negotiated Rate	$8.73
Rate for Payer: Cash Price	$4.91
Rate for Payer: Cigna of CA HMO/PPO	$8.73
Rate for Payer: Health Smart Auto/Commercial	$6.55
Rate for Payer: LLUH Dept of Risk Management WC	$6.00
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$8.18

VALGANCICLOVIR 50 MG/ML ORAL SOLUTION [99443]

Facility

$10.91

Service Code	NDC 70010-051-40
Hospital Charge Code	1715257
Hospital Revenue Code	259
Min. Negotiated Rate	$6.00
Max. Negotiated Rate	$8.18
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$6.55
Rate for Payer: Aetna of CA Government/Medicare	$6.55
Rate for Payer: Cash Price	$4.91
Rate for Payer: Health Smart Auto/Commercial	$6.55
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$6.55
Rate for Payer: LLUH Dept of Risk Management WC	$6.00
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$8.18

VALGANCICLOVIR 50 MG/ML ORAL SOLUTION [99443]

Facility

$10.91

Service Code	NDC 0591-2579-20
Hospital Charge Code	1715257
Hospital Revenue Code	259
Min. Negotiated Rate	$6.00
Max. Negotiated Rate	$8.73
Rate for Payer: Cash Price	$4.91
Rate for Payer: Cigna of CA HMO/PPO	$8.73
Rate for Payer: Health Smart Auto/Commercial	$6.55
Rate for Payer: LLUH Dept of Risk Management WC	$6.00
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$8.18

VALGANCICLOVIR 50 MG/ML ORAL SOLUTION [99443]

Facility

$10.91

Service Code	NDC 0591-2579-20
Hospital Charge Code	1715257
Hospital Revenue Code	259
Min. Negotiated Rate	$6.00
Max. Negotiated Rate	$8.18
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$6.55
Rate for Payer: Aetna of CA Government/Medicare	$6.55
Rate for Payer: Cash Price	$4.91
Rate for Payer: Health Smart Auto/Commercial	$6.55
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$6.55
Rate for Payer: LLUH Dept of Risk Management WC	$6.00
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$8.18

VALPROATE SODIUM 500 MG/5 ML (100 MG/ML) INTRAVENOUS SOLUTION [20887]

Facility

$1.61

Service Code	NDC 63323-494-05
Hospital Charge Code	1721089
Hospital Revenue Code	250
Min. Negotiated Rate	$0.89
Max. Negotiated Rate	$1.21
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$0.97
Rate for Payer: Aetna of CA Government/Medicare	$0.97
Rate for Payer: Cash Price	$0.72
Rate for Payer: Health Smart Auto/Commercial	$0.97
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$0.97
Rate for Payer: LLUH Dept of Risk Management WC	$0.89
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$1.21

VALPROATE SODIUM 500 MG/5 ML (100 MG/ML) INTRAVENOUS SOLUTION [20887]

Facility

$0.49

Service Code	NDC 63323-494-41
Hospital Charge Code	1721089
Hospital Revenue Code	250
Min. Negotiated Rate	$0.27
Max. Negotiated Rate	$0.37
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$0.29
Rate for Payer: Aetna of CA Government/Medicare	$0.29
Rate for Payer: Cash Price	$0.22
Rate for Payer: Health Smart Auto/Commercial	$0.29
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$0.29
Rate for Payer: LLUH Dept of Risk Management WC	$0.27
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$0.37

VALPROATE SODIUM 500 MG/5 ML (100 MG/ML) INTRAVENOUS SOLUTION [20887]

Facility

$1.61

Service Code	NDC 63323-494-05
Hospital Charge Code	1721089
Hospital Revenue Code	250
Min. Negotiated Rate	$0.89
Max. Negotiated Rate	$1.29
Rate for Payer: Cash Price	$0.72
Rate for Payer: Cigna of CA HMO/PPO	$1.29
Rate for Payer: Health Smart Auto/Commercial	$0.97
Rate for Payer: LLUH Dept of Risk Management WC	$0.89
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$1.21

VALPROATE SODIUM 500 MG/5 ML (100 MG/ML) INTRAVENOUS SOLUTION [20887]

Facility

$4.15

Service Code	NDC 0143-9785-10
Hospital Charge Code	1721089
Hospital Revenue Code	250
Min. Negotiated Rate	$2.28
Max. Negotiated Rate	$3.11
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$2.49
Rate for Payer: Aetna of CA Government/Medicare	$2.49
Rate for Payer: Cash Price	$1.87
Rate for Payer: Health Smart Auto/Commercial	$2.49
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$2.49
Rate for Payer: LLUH Dept of Risk Management WC	$2.28
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$3.11

VALPROATE SODIUM 500 MG/5 ML (100 MG/ML) INTRAVENOUS SOLUTION [20887]

Facility

$1.61

Service Code	NDC 63323-494-01
Hospital Charge Code	1721089
Hospital Revenue Code	250
Min. Negotiated Rate	$0.89
Max. Negotiated Rate	$1.29
Rate for Payer: Cash Price	$0.72
Rate for Payer: Cigna of CA HMO/PPO	$1.29
Rate for Payer: Health Smart Auto/Commercial	$0.97
Rate for Payer: LLUH Dept of Risk Management WC	$0.89
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$1.21

VALPROATE SODIUM 500 MG/5 ML (100 MG/ML) INTRAVENOUS SOLUTION [20887]

Facility

$4.15

Service Code	NDC 0143-9785-01
Hospital Charge Code	1721089
Hospital Revenue Code	250
Min. Negotiated Rate	$2.28
Max. Negotiated Rate	$3.32
Rate for Payer: Cash Price	$1.87
Rate for Payer: Cigna of CA HMO/PPO	$3.32
Rate for Payer: Health Smart Auto/Commercial	$2.49
Rate for Payer: LLUH Dept of Risk Management WC	$2.28
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$3.11

VALPROATE SODIUM 500 MG/5 ML (100 MG/ML) INTRAVENOUS SOLUTION [20887]

Facility

$1.61

Service Code	NDC 63323-494-01
Hospital Charge Code	1721089
Hospital Revenue Code	250
Min. Negotiated Rate	$0.89
Max. Negotiated Rate	$1.21
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$0.97
Rate for Payer: Aetna of CA Government/Medicare	$0.97
Rate for Payer: Cash Price	$0.72
Rate for Payer: Health Smart Auto/Commercial	$0.97
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$0.97
Rate for Payer: LLUH Dept of Risk Management WC	$0.89
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$1.21

VALPROATE SODIUM 500 MG/5 ML (100 MG/ML) INTRAVENOUS SOLUTION [20887]

Facility

$4.15

Service Code	NDC 0143-9785-01
Hospital Charge Code	1721089
Hospital Revenue Code	250
Min. Negotiated Rate	$2.28
Max. Negotiated Rate	$3.11
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$2.49
Rate for Payer: Aetna of CA Government/Medicare	$2.49
Rate for Payer: Cash Price	$1.87
Rate for Payer: Health Smart Auto/Commercial	$2.49
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$2.49
Rate for Payer: LLUH Dept of Risk Management WC	$2.28
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$3.11

VALPROATE SODIUM 500 MG/5 ML (100 MG/ML) INTRAVENOUS SOLUTION [20887]

Facility

$0.49

Service Code	NDC 63323-494-16
Hospital Charge Code	1721089
Hospital Revenue Code	250
Min. Negotiated Rate	$0.27
Max. Negotiated Rate	$0.37
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$0.29
Rate for Payer: Aetna of CA Government/Medicare	$0.29
Rate for Payer: Cash Price	$0.22
Rate for Payer: Health Smart Auto/Commercial	$0.29
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$0.29
Rate for Payer: LLUH Dept of Risk Management WC	$0.27
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$0.37

VALPROATE SODIUM 500 MG/5 ML (100 MG/ML) INTRAVENOUS SOLUTION [20887]

Facility

$0.49

Service Code	NDC 63323-494-16
Hospital Charge Code	1721089
Hospital Revenue Code	250
Min. Negotiated Rate	$0.27
Max. Negotiated Rate	$0.39
Rate for Payer: Cash Price	$0.22
Rate for Payer: Cigna of CA HMO/PPO	$0.39
Rate for Payer: Health Smart Auto/Commercial	$0.29
Rate for Payer: LLUH Dept of Risk Management WC	$0.27
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$0.37

VALPROATE SODIUM 500 MG/5 ML (100 MG/ML) INTRAVENOUS SOLUTION [20887]

Facility

$4.15

Service Code	NDC 0143-9785-10
Hospital Charge Code	1721089
Hospital Revenue Code	250
Min. Negotiated Rate	$2.28
Max. Negotiated Rate	$3.32
Rate for Payer: Cash Price	$1.87
Rate for Payer: Cigna of CA HMO/PPO	$3.32
Rate for Payer: Health Smart Auto/Commercial	$2.49
Rate for Payer: LLUH Dept of Risk Management WC	$2.28
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$3.11

VALPROATE SODIUM 500 MG/5 ML (100 MG/ML) INTRAVENOUS SOLUTION [20887]

Facility

$0.49

Service Code	NDC 63323-494-41
Hospital Charge Code	1721089
Hospital Revenue Code	250
Min. Negotiated Rate	$0.27
Max. Negotiated Rate	$0.39
Rate for Payer: Cash Price	$0.22
Rate for Payer: Cigna of CA HMO/PPO	$0.39
Rate for Payer: Health Smart Auto/Commercial	$0.29
Rate for Payer: LLUH Dept of Risk Management WC	$0.27
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$0.37

VALPROIC ACID 250 MG CAPSULE [8429]

Facility

$0.51

Service Code	NDC 63739-086-10
Hospital Charge Code	1710034
Hospital Revenue Code	259
Min. Negotiated Rate	$0.28
Max. Negotiated Rate	$0.41
Rate for Payer: Cash Price	$0.23
Rate for Payer: Cigna of CA HMO/PPO	$0.41
Rate for Payer: Health Smart Auto/Commercial	$0.31
Rate for Payer: LLUH Dept of Risk Management WC	$0.28
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$0.38

VALPROIC ACID 250 MG CAPSULE [8429]

Facility

$0.48

Service Code	NDC 0591-4012-01
Hospital Charge Code	1710034
Hospital Revenue Code	259
Min. Negotiated Rate	$0.26
Max. Negotiated Rate	$0.36
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$0.29
Rate for Payer: Aetna of CA Government/Medicare	$0.29
Rate for Payer: Cash Price	$0.22
Rate for Payer: Health Smart Auto/Commercial	$0.29
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$0.29
Rate for Payer: LLUH Dept of Risk Management WC	$0.26
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$0.36

VALPROIC ACID 250 MG CAPSULE [8429]

Facility

$0.53

Service Code	NDC 0832-0310-11
Hospital Charge Code	1710034
Hospital Revenue Code	259
Min. Negotiated Rate	$0.29
Max. Negotiated Rate	$0.42
Rate for Payer: Cash Price	$0.24
Rate for Payer: Cigna of CA HMO/PPO	$0.42
Rate for Payer: Health Smart Auto/Commercial	$0.32
Rate for Payer: LLUH Dept of Risk Management WC	$0.29
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$0.40

VALPROIC ACID 250 MG CAPSULE [8429]

Facility

$0.53

Service Code	NDC 0832-0310-11
Hospital Charge Code	1710034
Hospital Revenue Code	259
Min. Negotiated Rate	$0.29
Max. Negotiated Rate	$0.40
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$0.32
Rate for Payer: Aetna of CA Government/Medicare	$0.32
Rate for Payer: Cash Price	$0.24
Rate for Payer: Health Smart Auto/Commercial	$0.32
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$0.32
Rate for Payer: LLUH Dept of Risk Management WC	$0.29
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$0.40

VALPROIC ACID 250 MG CAPSULE [8429]

Facility

$0.51

Service Code	NDC 63739-086-10
Hospital Charge Code	1710034
Hospital Revenue Code	259
Min. Negotiated Rate	$0.28
Max. Negotiated Rate	$0.38
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$0.31
Rate for Payer: Aetna of CA Government/Medicare	$0.31
Rate for Payer: Cash Price	$0.23
Rate for Payer: Health Smart Auto/Commercial	$0.31
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$0.31
Rate for Payer: LLUH Dept of Risk Management WC	$0.28
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$0.38

VALPROIC ACID 250 MG CAPSULE [8429]

Facility

$0.48

Service Code	NDC 0591-4012-01
Hospital Charge Code	1710034
Hospital Revenue Code	259
Min. Negotiated Rate	$0.26
Max. Negotiated Rate	$0.38
Rate for Payer: Cash Price	$0.22
Rate for Payer: Cigna of CA HMO/PPO	$0.38
Rate for Payer: Health Smart Auto/Commercial	$0.29
Rate for Payer: LLUH Dept of Risk Management WC	$0.26
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$0.36

VALPROIC ACID (AS SODIUM SALT) 250 MG/5 ML (5 ML) ORAL SOLUTION [152936]

Facility

$0.15

Service Code	NDC 68094-193-59
Hospital Charge Code	1716069
Hospital Revenue Code	259
Min. Negotiated Rate	$0.08
Max. Negotiated Rate	$0.11
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$0.09
Rate for Payer: Aetna of CA Government/Medicare	$0.09
Rate for Payer: Cash Price	$0.07
Rate for Payer: Health Smart Auto/Commercial	$0.09
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$0.09
Rate for Payer: LLUH Dept of Risk Management WC	$0.08
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$0.11

VALPROIC ACID (AS SODIUM SALT) 250 MG/5 ML (5 ML) ORAL SOLUTION [152936]

Facility

$0.21

Service Code	NDC 0121-4675-00
Hospital Charge Code	1716069
Hospital Revenue Code	259
Min. Negotiated Rate	$0.12
Max. Negotiated Rate	$0.16
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	$0.09
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	$0.16

VALPROIC ACID (AS SODIUM SALT) 250 MG/5 ML (5 ML) ORAL SOLUTION [152936]

Facility

$0.21

Service Code	NDC 0121-4675-00
Hospital Charge Code	1716069
Hospital Revenue Code	259
Min. Negotiated Rate	$0.12
Max. Negotiated Rate	$0.17
Rate for Payer: Cash Price	$0.09
Rate for Payer: Cigna of CA HMO/PPO	$0.17
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	$0.16

Know your out-of-pocket cost for care.

All Charges