Loma Linda University Behavioral Medicine Center (BMC)

All Charges

Charge

Type

Setting

Price

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

$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

$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 20 MG INTRAVENOUS SOLUTION [11635]

Facility

$12.00

Service Code	NDC 67457-475-00
Hospital Charge Code	1720438
Hospital Revenue Code	250
Min. Negotiated Rate	$6.60
Max. Negotiated Rate	$9.00
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$7.20
Rate for Payer: Aetna of CA Government/Medicare	$7.20
Rate for Payer: Cash Price	$5.40
Rate for Payer: Health Smart Auto/Commercial	$7.20
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$7.20
Rate for Payer: LLUH Dept of Risk Management WC	$6.60
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$9.00

VECURONIUM BROMIDE 20 MG INTRAVENOUS SOLUTION [11635]

Facility

$10.80

Service Code	NDC 55150-236-20
Hospital Charge Code	1720438
Hospital Revenue Code	250
Min. Negotiated Rate	$5.94
Max. Negotiated Rate	$8.64
Rate for Payer: Cash Price	$4.86
Rate for Payer: Cigna of CA HMO/PPO	$8.64
Rate for Payer: Health Smart Auto/Commercial	$6.48
Rate for Payer: LLUH Dept of Risk Management WC	$5.94
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$8.10

VECURONIUM BROMIDE 20 MG INTRAVENOUS SOLUTION [11635]

Facility

$20.40

Service Code	NDC 47335-932-40
Hospital Charge Code	1720438
Hospital Revenue Code	250
Min. Negotiated Rate	$11.22
Max. Negotiated Rate	$15.30
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$12.24
Rate for Payer: Aetna of CA Government/Medicare	$12.24
Rate for Payer: Cash Price	$9.18
Rate for Payer: Health Smart Auto/Commercial	$12.24
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$12.24
Rate for Payer: LLUH Dept of Risk Management WC	$11.22
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$15.30

VECURONIUM BROMIDE 20 MG INTRAVENOUS SOLUTION [11635]

Facility

$12.00

Service Code	NDC 67457-475-20
Hospital Charge Code	1720438
Hospital Revenue Code	250
Min. Negotiated Rate	$6.60
Max. Negotiated Rate	$9.00
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$7.20
Rate for Payer: Aetna of CA Government/Medicare	$7.20
Rate for Payer: Cash Price	$5.40
Rate for Payer: Health Smart Auto/Commercial	$7.20
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$7.20
Rate for Payer: LLUH Dept of Risk Management WC	$6.60
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$9.00

VECURONIUM BROMIDE 20 MG INTRAVENOUS SOLUTION [11635]

Facility

$20.40

Service Code	NDC 47335-932-40
Hospital Charge Code	1720438
Hospital Revenue Code	250
Min. Negotiated Rate	$11.22
Max. Negotiated Rate	$16.32
Rate for Payer: Cash Price	$9.18
Rate for Payer: Cigna of CA HMO/PPO	$16.32
Rate for Payer: Health Smart Auto/Commercial	$12.24
Rate for Payer: LLUH Dept of Risk Management WC	$11.22
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$15.30

VECURONIUM BROMIDE 20 MG INTRAVENOUS SOLUTION [11635]

Facility

$10.80

Service Code	NDC 55150-236-20
Hospital Charge Code	1720438
Hospital Revenue Code	250
Min. Negotiated Rate	$5.94
Max. Negotiated Rate	$8.10
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$6.48
Rate for Payer: Aetna of CA Government/Medicare	$6.48
Rate for Payer: Cash Price	$4.86
Rate for Payer: Health Smart Auto/Commercial	$6.48
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$6.48
Rate for Payer: LLUH Dept of Risk Management WC	$5.94
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$8.10

VECURONIUM BROMIDE 20 MG INTRAVENOUS SOLUTION [11635]

Facility

$10.80

Service Code	NDC 55150-236-01
Hospital Charge Code	1720438
Hospital Revenue Code	250
Min. Negotiated Rate	$5.94
Max. Negotiated Rate	$8.10
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$6.48
Rate for Payer: Aetna of CA Government/Medicare	$6.48
Rate for Payer: Cash Price	$4.86
Rate for Payer: Health Smart Auto/Commercial	$6.48
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$6.48
Rate for Payer: LLUH Dept of Risk Management WC	$5.94
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$8.10

VECURONIUM BROMIDE 20 MG INTRAVENOUS SOLUTION [11635]

Facility

$10.80

Service Code	NDC 55150-236-01
Hospital Charge Code	1720438
Hospital Revenue Code	250
Min. Negotiated Rate	$5.94
Max. Negotiated Rate	$8.64
Rate for Payer: Cash Price	$4.86
Rate for Payer: Cigna of CA HMO/PPO	$8.64
Rate for Payer: Health Smart Auto/Commercial	$6.48
Rate for Payer: LLUH Dept of Risk Management WC	$5.94
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$8.10

VECURONIUM BROMIDE 20 MG INTRAVENOUS SOLUTION [11635]

Facility

$14.46

Service Code	NDC 63323-782-23
Hospital Charge Code	1720438
Hospital Revenue Code	250
Min. Negotiated Rate	$7.95
Max. Negotiated Rate	$10.84
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$8.68
Rate for Payer: Aetna of CA Government/Medicare	$8.68
Rate for Payer: Cash Price	$6.51
Rate for Payer: Health Smart Auto/Commercial	$8.68
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$8.68
Rate for Payer: LLUH Dept of Risk Management WC	$7.95
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$10.84

VECURONIUM BROMIDE 20 MG INTRAVENOUS SOLUTION [11635]

Facility

$14.46

Service Code	NDC 63323-782-20
Hospital Charge Code	1720438
Hospital Revenue Code	250
Min. Negotiated Rate	$7.95
Max. Negotiated Rate	$10.84
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$8.68
Rate for Payer: Aetna of CA Government/Medicare	$8.68
Rate for Payer: Cash Price	$6.51
Rate for Payer: Health Smart Auto/Commercial	$8.68
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$8.68
Rate for Payer: LLUH Dept of Risk Management WC	$7.95
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$10.84

VECURONIUM BROMIDE 20 MG INTRAVENOUS SOLUTION [11635]

Facility

$12.00

Service Code	NDC 67457-475-00
Hospital Charge Code	1720438
Hospital Revenue Code	250
Min. Negotiated Rate	$6.60
Max. Negotiated Rate	$9.60
Rate for Payer: Cash Price	$5.40
Rate for Payer: Cigna of CA HMO/PPO	$9.60
Rate for Payer: Health Smart Auto/Commercial	$7.20
Rate for Payer: LLUH Dept of Risk Management WC	$6.60
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$9.00

VECURONIUM BROMIDE 20 MG INTRAVENOUS SOLUTION [11635]

Facility

$12.00

Service Code	NDC 67457-475-20
Hospital Charge Code	1720438
Hospital Revenue Code	250
Min. Negotiated Rate	$6.60
Max. Negotiated Rate	$9.60
Rate for Payer: Cash Price	$5.40
Rate for Payer: Cigna of CA HMO/PPO	$9.60
Rate for Payer: Health Smart Auto/Commercial	$7.20
Rate for Payer: LLUH Dept of Risk Management WC	$6.60
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$9.00

VECURONIUM BROMIDE 20 MG INTRAVENOUS SOLUTION [11635]

Facility

$14.46

Service Code	NDC 63323-782-23
Hospital Charge Code	1720438
Hospital Revenue Code	250
Min. Negotiated Rate	$7.95
Max. Negotiated Rate	$11.57
Rate for Payer: Cash Price	$6.51
Rate for Payer: Cigna of CA HMO/PPO	$11.57
Rate for Payer: Health Smart Auto/Commercial	$8.68
Rate for Payer: LLUH Dept of Risk Management WC	$7.95
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$10.84

VECURONIUM BROMIDE 20 MG INTRAVENOUS SOLUTION [11635]

Facility

$20.40

Service Code	NDC 47335-932-44
Hospital Charge Code	1720438
Hospital Revenue Code	250
Min. Negotiated Rate	$11.22
Max. Negotiated Rate	$15.30
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$12.24
Rate for Payer: Aetna of CA Government/Medicare	$12.24
Rate for Payer: Cash Price	$9.18
Rate for Payer: Health Smart Auto/Commercial	$12.24
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$12.24
Rate for Payer: LLUH Dept of Risk Management WC	$11.22
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$15.30

VECURONIUM BROMIDE 20 MG INTRAVENOUS SOLUTION [11635]

Facility

$14.46

Service Code	NDC 63323-782-20
Hospital Charge Code	1720438
Hospital Revenue Code	250
Min. Negotiated Rate	$7.95
Max. Negotiated Rate	$11.57
Rate for Payer: Cash Price	$6.51
Rate for Payer: Cigna of CA HMO/PPO	$11.57
Rate for Payer: Health Smart Auto/Commercial	$8.68
Rate for Payer: LLUH Dept of Risk Management WC	$7.95
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$10.84

VECURONIUM BROMIDE 20 MG INTRAVENOUS SOLUTION [11635]

Facility

$20.40

Service Code	NDC 47335-932-44
Hospital Charge Code	1720438
Hospital Revenue Code	250
Min. Negotiated Rate	$11.22
Max. Negotiated Rate	$16.32
Rate for Payer: Cash Price	$9.18
Rate for Payer: Cigna of CA HMO/PPO	$16.32
Rate for Payer: Health Smart Auto/Commercial	$12.24
Rate for Payer: LLUH Dept of Risk Management WC	$11.22
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$15.30

VECURONIUM BROMIDE INTRAVENOUS-NICU SPECIAL DILUTION 0.5 MG/ML [4081455]

Facility

$10.20

Service Code	NDC 41616-931-44
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 INTRAVENOUS-NICU SPECIAL DILUTION 0.5 MG/ML [4081455]

Facility

$10.20

Service Code	NDC 41616-931-40
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 INTRAVENOUS-NICU SPECIAL DILUTION 0.5 MG/ML [4081455]

Facility

$10.20

Service Code	NDC 41616-931-44
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 INTRAVENOUS-NICU SPECIAL DILUTION 0.5 MG/ML [4081455]

Facility

$10.20

Service Code	NDC 41616-931-40
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 INTRAVENOUS-NICU SPECIAL DILUTION 1MG/ML [4081284]

Facility

$10.20

Service Code	NDC 41616-931-40
Hospital Charge Code	ERX4081284
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 INTRAVENOUS-NICU SPECIAL DILUTION 1MG/ML [4081284]

Facility

$10.20

Service Code	NDC 41616-931-40
Hospital Charge Code	ERX4081284
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