Loma Linda University Behavioral Medicine Center (BMC)

All Charges

Charge

Type

Setting

Price

VASOPRESSIN SPEC DIL 2 UNITS/ML [4081064]

Facility

$1.09

Service Code	NDC 9994-0810-64
Hospital Charge Code	NDC4081064
Hospital Revenue Code	250
Min. Negotiated Rate	$0.60
Max. Negotiated Rate	$0.82
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$0.65
Rate for Payer: Aetna of CA Government/Medicare	$0.65
Rate for Payer: Cash Price	$0.49
Rate for Payer: Health Smart Auto/Commercial	$0.65
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$0.65
Rate for Payer: LLUH Dept of Risk Management WC	$0.60
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$0.82

VASOPRESSIN SPEC DIL 2 UNITS/ML [4081064]

Facility

$1.09

Service Code	NDC 9994-0810-64
Hospital Charge Code	NDC4081064
Hospital Revenue Code	250
Min. Negotiated Rate	$0.60
Max. Negotiated Rate	$0.87
Rate for Payer: Cash Price	$0.49
Rate for Payer: Cigna of CA HMO/PPO	$0.87
Rate for Payer: Health Smart Auto/Commercial	$0.65
Rate for Payer: LLUH Dept of Risk Management WC	$0.60
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$0.82

VECURONIUM 10 MG IV BOLUS - CODE [4080584]

Facility

$10.20

Service Code	NDC 47335-931-44
Hospital Charge Code	ERX4080584
Hospital Revenue Code	250
Min. Negotiated Rate	$5.61
Max. Negotiated Rate	$8.16
Rate for Payer: Cash Price	$4.59
Rate for Payer: Cigna of CA HMO/PPO	$8.16
Rate for Payer: Health Smart Auto/Commercial	$6.12
Rate for Payer: LLUH Dept of Risk Management WC	$5.61
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$7.65

VECURONIUM 10 MG IV BOLUS - CODE [4080584]

Facility

$10.20

Service Code	NDC 47335-931-44
Hospital Charge Code	ERX4080584
Hospital Revenue Code	250
Min. Negotiated Rate	$5.61
Max. Negotiated Rate	$7.65
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$6.12
Rate for Payer: Aetna of CA Government/Medicare	$6.12
Rate for Payer: Cash Price	$4.59
Rate for Payer: Health Smart Auto/Commercial	$6.12
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$6.12
Rate for Payer: LLUH Dept of Risk Management WC	$5.61
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$7.65

VECURONIUM 10 MG IV BOLUS - CODE [4080584]

Facility

$6.00

Service Code	NDC 67457-438-10
Hospital Charge Code	ERX4080584
Hospital Revenue Code	250
Min. Negotiated Rate	$3.30
Max. Negotiated Rate	$4.80
Rate for Payer: Cash Price	$2.70
Rate for Payer: Cigna of CA HMO/PPO	$4.80
Rate for Payer: Health Smart Auto/Commercial	$3.60
Rate for Payer: LLUH Dept of Risk Management WC	$3.30
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$4.50

VECURONIUM 10 MG IV BOLUS - CODE [4080584]

Facility

$10.20

Service Code	NDC 47335-931-40
Hospital Charge Code	ERX4080584
Hospital Revenue Code	250
Min. Negotiated Rate	$5.61
Max. Negotiated Rate	$7.65
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$6.12
Rate for Payer: Aetna of CA Government/Medicare	$6.12
Rate for Payer: Cash Price	$4.59
Rate for Payer: Health Smart Auto/Commercial	$6.12
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$6.12
Rate for Payer: LLUH Dept of Risk Management WC	$5.61
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$7.65

VECURONIUM 10 MG IV BOLUS - CODE [4080584]

Facility

$10.20

Service Code	NDC 47335-931-40
Hospital Charge Code	ERX4080584
Hospital Revenue Code	250
Min. Negotiated Rate	$5.61
Max. Negotiated Rate	$8.16
Rate for Payer: Cash Price	$4.59
Rate for Payer: Cigna of CA HMO/PPO	$8.16
Rate for Payer: Health Smart Auto/Commercial	$6.12
Rate for Payer: LLUH Dept of Risk Management WC	$5.61
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$7.65

VECURONIUM 10 MG IV BOLUS - CODE [4080584]

Facility

$6.00

Service Code	NDC 67457-438-10
Hospital Charge Code	ERX4080584
Hospital Revenue Code	250
Min. Negotiated Rate	$3.30
Max. Negotiated Rate	$4.50
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$3.60
Rate for Payer: Aetna of CA Government/Medicare	$3.60
Rate for Payer: Cash Price	$2.70
Rate for Payer: Health Smart Auto/Commercial	$3.60
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$3.60
Rate for Payer: LLUH Dept of Risk Management WC	$3.30
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$4.50

VECURONIUM BROMIDE 10 MG INTRAVENOUS SOLUTION [11634]

Facility

$10.20

Service Code	NDC 41616-931-40
Hospital Charge Code	1720230
Hospital Revenue Code	250
Min. Negotiated Rate	$5.61
Max. Negotiated Rate	$7.65
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$6.12
Rate for Payer: Aetna of CA Government/Medicare	$6.12
Rate for Payer: Cash Price	$4.59
Rate for Payer: Health Smart Auto/Commercial	$6.12
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$6.12
Rate for Payer: LLUH Dept of Risk Management WC	$5.61
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$7.65

VECURONIUM BROMIDE 10 MG INTRAVENOUS SOLUTION [11634]

Facility

$6.00

Service Code	NDC 67457-438-00
Hospital Charge Code	1720230
Hospital Revenue Code	250
Min. Negotiated Rate	$3.30
Max. Negotiated Rate	$4.50
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$3.60
Rate for Payer: Aetna of CA Government/Medicare	$3.60
Rate for Payer: Cash Price	$2.70
Rate for Payer: Health Smart Auto/Commercial	$3.60
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$3.60
Rate for Payer: LLUH Dept of Risk Management WC	$3.30
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$4.50

VECURONIUM BROMIDE 10 MG INTRAVENOUS SOLUTION [11634]

Facility

$8.81

Service Code	NDC 0409-1632-01
Hospital Charge Code	1720230
Hospital Revenue Code	250
Min. Negotiated Rate	$4.85
Max. Negotiated Rate	$7.05
Rate for Payer: Cash Price	$3.96
Rate for Payer: Cigna of CA HMO/PPO	$7.05
Rate for Payer: Health Smart Auto/Commercial	$5.29
Rate for Payer: LLUH Dept of Risk Management WC	$4.85
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$6.61

VECURONIUM BROMIDE 10 MG INTRAVENOUS SOLUTION [11634]

Facility

$6.00

Service Code	NDC 67457-438-10
Hospital Charge Code	1720230
Hospital Revenue Code	250
Min. Negotiated Rate	$3.30
Max. Negotiated Rate	$4.80
Rate for Payer: Cash Price	$2.70
Rate for Payer: Cigna of CA HMO/PPO	$4.80
Rate for Payer: Health Smart Auto/Commercial	$3.60
Rate for Payer: LLUH Dept of Risk Management WC	$3.30
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$4.50

VECURONIUM BROMIDE 10 MG INTRAVENOUS SOLUTION [11634]

Facility

$6.83

Service Code	NDC 63323-781-10
Hospital Charge Code	1720230
Hospital Revenue Code	250
Min. Negotiated Rate	$3.76
Max. Negotiated Rate	$5.12
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$4.10
Rate for Payer: Aetna of CA Government/Medicare	$4.10
Rate for Payer: Cash Price	$3.07
Rate for Payer: Health Smart Auto/Commercial	$4.10
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$4.10
Rate for Payer: LLUH Dept of Risk Management WC	$3.76
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$5.12

VECURONIUM BROMIDE 10 MG INTRAVENOUS SOLUTION [11634]

Facility

$6.24

Service Code	NDC 63323-781-44
Hospital Charge Code	1720230
Hospital Revenue Code	250
Min. Negotiated Rate	$3.43
Max. Negotiated Rate	$4.68
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$3.74
Rate for Payer: Aetna of CA Government/Medicare	$3.74
Rate for Payer: Cash Price	$2.81
Rate for Payer: Health Smart Auto/Commercial	$3.74
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$3.74
Rate for Payer: LLUH Dept of Risk Management WC	$3.43
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$4.68

VECURONIUM BROMIDE 10 MG INTRAVENOUS SOLUTION [11634]

Facility

$10.20

Service Code	NDC 41616-931-44
Hospital Charge Code	1720230
Hospital Revenue Code	250
Min. Negotiated Rate	$5.61
Max. Negotiated Rate	$7.65
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$6.12
Rate for Payer: Aetna of CA Government/Medicare	$6.12
Rate for Payer: Cash Price	$4.59
Rate for Payer: Health Smart Auto/Commercial	$6.12
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$6.12
Rate for Payer: LLUH Dept of Risk Management WC	$5.61
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$7.65

VECURONIUM BROMIDE 10 MG INTRAVENOUS SOLUTION [11634]

Facility

$10.20

Service Code	NDC 41616-931-44
Hospital Charge Code	1720230
Hospital Revenue Code	250
Min. Negotiated Rate	$5.61
Max. Negotiated Rate	$8.16
Rate for Payer: Cash Price	$4.59
Rate for Payer: Cigna of CA HMO/PPO	$8.16
Rate for Payer: Health Smart Auto/Commercial	$6.12
Rate for Payer: LLUH Dept of Risk Management WC	$5.61
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$7.65

VECURONIUM BROMIDE 10 MG INTRAVENOUS SOLUTION [11634]

Facility

$10.20

Service Code	NDC 41616-931-40
Hospital Charge Code	1720230
Hospital Revenue Code	250
Min. Negotiated Rate	$5.61
Max. Negotiated Rate	$8.16
Rate for Payer: Cash Price	$4.59
Rate for Payer: Cigna of CA HMO/PPO	$8.16
Rate for Payer: Health Smart Auto/Commercial	$6.12
Rate for Payer: LLUH Dept of Risk Management WC	$5.61
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$7.65

VECURONIUM BROMIDE 10 MG INTRAVENOUS SOLUTION [11634]

Facility

$6.24

Service Code	NDC 63323-781-41
Hospital Charge Code	1720230
Hospital Revenue Code	250
Min. Negotiated Rate	$3.43
Max. Negotiated Rate	$4.99
Rate for Payer: Cash Price	$2.81
Rate for Payer: Cigna of CA HMO/PPO	$4.99
Rate for Payer: Health Smart Auto/Commercial	$3.74
Rate for Payer: LLUH Dept of Risk Management WC	$3.43
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$4.68

VECURONIUM BROMIDE 10 MG INTRAVENOUS SOLUTION [11634]

Facility

$5.28

Service Code	NDC 55150-235-10
Hospital Charge Code	1720230
Hospital Revenue Code	250
Min. Negotiated Rate	$2.90
Max. Negotiated Rate	$4.22
Rate for Payer: Cash Price	$2.38
Rate for Payer: Cigna of CA HMO/PPO	$4.22
Rate for Payer: Health Smart Auto/Commercial	$3.17
Rate for Payer: LLUH Dept of Risk Management WC	$2.90
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$3.96

VECURONIUM BROMIDE 10 MG INTRAVENOUS SOLUTION [11634]

Facility

$6.00

Service Code	NDC 67457-438-00
Hospital Charge Code	1720230
Hospital Revenue Code	250
Min. Negotiated Rate	$3.30
Max. Negotiated Rate	$4.80
Rate for Payer: Cash Price	$2.70
Rate for Payer: Cigna of CA HMO/PPO	$4.80
Rate for Payer: Health Smart Auto/Commercial	$3.60
Rate for Payer: LLUH Dept of Risk Management WC	$3.30
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$4.50

VECURONIUM BROMIDE 10 MG INTRAVENOUS SOLUTION [11634]

Facility

$5.28

Service Code	NDC 55150-235-10
Hospital Charge Code	1720230
Hospital Revenue Code	250
Min. Negotiated Rate	$2.90
Max. Negotiated Rate	$3.96
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$3.17
Rate for Payer: Aetna of CA Government/Medicare	$3.17
Rate for Payer: Cash Price	$2.38
Rate for Payer: Health Smart Auto/Commercial	$3.17
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$3.17
Rate for Payer: LLUH Dept of Risk Management WC	$2.90
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$3.96

VECURONIUM BROMIDE 10 MG INTRAVENOUS SOLUTION [11634]

Facility

$8.81

Service Code	NDC 0409-1632-01
Hospital Charge Code	1720230
Hospital Revenue Code	250
Min. Negotiated Rate	$4.85
Max. Negotiated Rate	$6.61
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$5.29
Rate for Payer: Aetna of CA Government/Medicare	$5.29
Rate for Payer: Cash Price	$3.96
Rate for Payer: Health Smart Auto/Commercial	$5.29
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$5.29
Rate for Payer: LLUH Dept of Risk Management WC	$4.85
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$6.61

VECURONIUM BROMIDE 10 MG INTRAVENOUS SOLUTION [11634]

Facility

$6.83

Service Code	NDC 63323-781-10
Hospital Charge Code	1720230
Hospital Revenue Code	250
Min. Negotiated Rate	$3.76
Max. Negotiated Rate	$5.46
Rate for Payer: Cash Price	$3.07
Rate for Payer: Cigna of CA HMO/PPO	$5.46
Rate for Payer: Health Smart Auto/Commercial	$4.10
Rate for Payer: LLUH Dept of Risk Management WC	$3.76
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$5.12

VECURONIUM BROMIDE 10 MG INTRAVENOUS SOLUTION [11634]

Facility

$6.00

Service Code	NDC 67457-438-10
Hospital Charge Code	1720230
Hospital Revenue Code	250
Min. Negotiated Rate	$3.30
Max. Negotiated Rate	$4.50
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$3.60
Rate for Payer: Aetna of CA Government/Medicare	$3.60
Rate for Payer: Cash Price	$2.70
Rate for Payer: Health Smart Auto/Commercial	$3.60
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$3.60
Rate for Payer: LLUH Dept of Risk Management WC	$3.30
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$4.50

VECURONIUM BROMIDE 10 MG INTRAVENOUS SOLUTION [11634]

Facility

$10.20

Service Code	NDC 47335-931-44
Hospital Charge Code	1720230
Hospital Revenue Code	250
Min. Negotiated Rate	$5.61
Max. Negotiated Rate	$8.16
Rate for Payer: Cash Price	$4.59
Rate for Payer: Cigna of CA HMO/PPO	$8.16
Rate for Payer: Health Smart Auto/Commercial	$6.12
Rate for Payer: LLUH Dept of Risk Management WC	$5.61
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$7.65

Know your out-of-pocket cost for care.

All Charges