Loma Linda University Behavioral Medicine Center (BMC)

All Charges

Charge

Type

Setting

Price

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

VECURONIUM BROMIDE INTRAVENOUS-NICU SPECIAL DILUTION 1MG/ML [4081284]

Facility

$10.20

Service Code	NDC 41616-931-44
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

VEDOLIZUMAB 300 MG INTRAVENOUS SOLUTION [205964]

Facility

$9,811.22

Service Code	CPT J3380
Hospital Charge Code	ERX205964
Hospital Revenue Code	636
Min. Negotiated Rate	$5,396.17
Max. Negotiated Rate	$7,358.42
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$5,886.73
Rate for Payer: Aetna of CA Government/Medicare	$5,886.73
Rate for Payer: Cash Price	$4,415.05
Rate for Payer: Health Smart Auto/Commercial	$5,886.73
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$5,886.73
Rate for Payer: LLUH Dept of Risk Management WC	$5,396.17
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$7,358.42

VEDOLIZUMAB 300 MG INTRAVENOUS SOLUTION [205964]

Facility

$9,811.22

Service Code	CPT J3380
Hospital Charge Code	ERX205964
Hospital Revenue Code	636
Min. Negotiated Rate	$5,396.17
Max. Negotiated Rate	$7,848.98
Rate for Payer: Cash Price	$4,415.05
Rate for Payer: Cigna of CA HMO/PPO	$7,848.98
Rate for Payer: Health Smart Auto/Commercial	$5,886.73
Rate for Payer: LLUH Dept of Risk Management WC	$5,396.17
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$7,358.42

VENETOCLAX 100 MG TABLET [214191]

Facility

$147.94

Service Code	NDC 0074-0576-22
Hospital Charge Code	ERX214191
Hospital Revenue Code	259
Min. Negotiated Rate	$81.37
Max. Negotiated Rate	$118.35
Rate for Payer: Cash Price	$66.57
Rate for Payer: Cigna of CA HMO/PPO	$118.35
Rate for Payer: Health Smart Auto/Commercial	$88.76
Rate for Payer: LLUH Dept of Risk Management WC	$81.37
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$110.96

VENETOCLAX 100 MG TABLET [214191]

Facility

$147.94

Service Code	NDC 0074-0576-22
Hospital Charge Code	ERX214191
Hospital Revenue Code	259
Min. Negotiated Rate	$81.37
Max. Negotiated Rate	$110.96
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$88.76
Rate for Payer: Aetna of CA Government/Medicare	$88.76
Rate for Payer: Cash Price	$66.57
Rate for Payer: Health Smart Auto/Commercial	$88.76
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$88.76
Rate for Payer: LLUH Dept of Risk Management WC	$81.37
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$110.96

VENLAFAXINE 100 MG TABLET [12205]

Facility

$0.46

Service Code	NDC 68382-101-01
Hospital Charge Code	1712185
Hospital Revenue Code	259
Min. Negotiated Rate	$0.25
Max. Negotiated Rate	$0.37
Rate for Payer: Cash Price	$0.21
Rate for Payer: Cigna of CA HMO/PPO	$0.37
Rate for Payer: Health Smart Auto/Commercial	$0.28
Rate for Payer: LLUH Dept of Risk Management WC	$0.25
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$0.35

VENLAFAXINE 100 MG TABLET [12205]

Facility

$0.46

Service Code	NDC 68382-101-01
Hospital Charge Code	1712185
Hospital Revenue Code	259
Min. Negotiated Rate	$0.25
Max. Negotiated Rate	$0.35
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$0.28
Rate for Payer: Aetna of CA Government/Medicare	$0.28
Rate for Payer: Cash Price	$0.21
Rate for Payer: Health Smart Auto/Commercial	$0.28
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$0.28
Rate for Payer: LLUH Dept of Risk Management WC	$0.25
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$0.35

VENLAFAXINE 25 MG TABLET [12203]

Facility

$1.26

Service Code	NDC 68084-896-25
Hospital Charge Code	1712239
Hospital Revenue Code	259
Min. Negotiated Rate	$0.69
Max. Negotiated Rate	$0.95
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$0.76
Rate for Payer: Aetna of CA Government/Medicare	$0.76
Rate for Payer: Cash Price	$0.57
Rate for Payer: Health Smart Auto/Commercial	$0.76
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$0.76
Rate for Payer: LLUH Dept of Risk Management WC	$0.69
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$0.95

VENLAFAXINE 25 MG TABLET [12203]

Facility

$1.26

Service Code	NDC 68084-896-95
Hospital Charge Code	1712239
Hospital Revenue Code	259
Min. Negotiated Rate	$0.69
Max. Negotiated Rate	$0.95
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$0.76
Rate for Payer: Aetna of CA Government/Medicare	$0.76
Rate for Payer: Cash Price	$0.57
Rate for Payer: Health Smart Auto/Commercial	$0.76
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$0.76
Rate for Payer: LLUH Dept of Risk Management WC	$0.69
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$0.95

VENLAFAXINE 25 MG TABLET [12203]

Facility

$1.26

Service Code	NDC 68084-896-95
Hospital Charge Code	1712239
Hospital Revenue Code	259
Min. Negotiated Rate	$0.69
Max. Negotiated Rate	$1.01
Rate for Payer: Cash Price	$0.57
Rate for Payer: Cigna of CA HMO/PPO	$1.01
Rate for Payer: Health Smart Auto/Commercial	$0.76
Rate for Payer: LLUH Dept of Risk Management WC	$0.69
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$0.95

VENLAFAXINE 25 MG TABLET [12203]

Facility

$1.26

Service Code	NDC 68084-896-25
Hospital Charge Code	1712239
Hospital Revenue Code	259
Min. Negotiated Rate	$0.69
Max. Negotiated Rate	$1.01
Rate for Payer: Cash Price	$0.57
Rate for Payer: Cigna of CA HMO/PPO	$1.01
Rate for Payer: Health Smart Auto/Commercial	$0.76
Rate for Payer: LLUH Dept of Risk Management WC	$0.69
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$0.95

VENLAFAXINE 37.5 MG TABLET [12207]

Facility

$1.03

Service Code	NDC 68084-844-11
Hospital Charge Code	1712223
Hospital Revenue Code	259
Min. Negotiated Rate	$0.57
Max. Negotiated Rate	$0.82
Rate for Payer: Cash Price	$0.46
Rate for Payer: Cigna of CA HMO/PPO	$0.82
Rate for Payer: Health Smart Auto/Commercial	$0.62
Rate for Payer: LLUH Dept of Risk Management WC	$0.57
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$0.77

VENLAFAXINE 37.5 MG TABLET [12207]

Facility

$1.03

Service Code	NDC 68084-844-11
Hospital Charge Code	1712223
Hospital Revenue Code	259
Min. Negotiated Rate	$0.57
Max. Negotiated Rate	$0.77
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$0.62
Rate for Payer: Aetna of CA Government/Medicare	$0.62
Rate for Payer: Cash Price	$0.46
Rate for Payer: Health Smart Auto/Commercial	$0.62
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$0.62
Rate for Payer: LLUH Dept of Risk Management WC	$0.57
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$0.77

VENLAFAXINE 37.5 MG TABLET [12207]

Facility

$1.03

Service Code	NDC 68084-844-01
Hospital Charge Code	1712223
Hospital Revenue Code	259
Min. Negotiated Rate	$0.57
Max. Negotiated Rate	$0.77
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$0.62
Rate for Payer: Aetna of CA Government/Medicare	$0.62
Rate for Payer: Cash Price	$0.46
Rate for Payer: Health Smart Auto/Commercial	$0.62
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$0.62
Rate for Payer: LLUH Dept of Risk Management WC	$0.57
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$0.77

VENLAFAXINE 37.5 MG TABLET [12207]

Facility

$0.40

Service Code	NDC 57664-393-88
Hospital Charge Code	1712223
Hospital Revenue Code	259
Min. Negotiated Rate	$0.22
Max. Negotiated Rate	$0.32
Rate for Payer: Cash Price	$0.18
Rate for Payer: Cigna of CA HMO/PPO	$0.32
Rate for Payer: Health Smart Auto/Commercial	$0.24
Rate for Payer: LLUH Dept of Risk Management WC	$0.22
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$0.30

VENLAFAXINE 37.5 MG TABLET [12207]

Facility

$0.40

Service Code	NDC 57664-393-88
Hospital Charge Code	1712223
Hospital Revenue Code	259
Min. Negotiated Rate	$0.22
Max. Negotiated Rate	$0.30
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$0.24
Rate for Payer: Aetna of CA Government/Medicare	$0.24
Rate for Payer: Cash Price	$0.18
Rate for Payer: Health Smart Auto/Commercial	$0.24
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$0.24
Rate for Payer: LLUH Dept of Risk Management WC	$0.22
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$0.30

VENLAFAXINE 37.5 MG TABLET [12207]

Facility

$1.03

Service Code	NDC 68084-844-01
Hospital Charge Code	1712223
Hospital Revenue Code	259
Min. Negotiated Rate	$0.57
Max. Negotiated Rate	$0.82
Rate for Payer: Cash Price	$0.46
Rate for Payer: Cigna of CA HMO/PPO	$0.82
Rate for Payer: Health Smart Auto/Commercial	$0.62
Rate for Payer: LLUH Dept of Risk Management WC	$0.57
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$0.77

VENLAFAXINE 50 MG TABLET [12204]

Facility

$0.17

Service Code	NDC 57237-174-01
Hospital Charge Code	1712639
Hospital Revenue Code	259
Min. Negotiated Rate	$0.09
Max. Negotiated Rate	$0.13
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$0.10
Rate for Payer: Aetna of CA Government/Medicare	$0.10
Rate for Payer: Cash Price	$0.08
Rate for Payer: Health Smart Auto/Commercial	$0.10
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$0.10
Rate for Payer: LLUH Dept of Risk Management WC	$0.09
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$0.13

VENLAFAXINE 50 MG TABLET [12204]

Facility

$0.41

Service Code	NDC 68001-159-00
Hospital Charge Code	1712639
Hospital Revenue Code	259
Min. Negotiated Rate	$0.23
Max. Negotiated Rate	$0.31
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$0.25
Rate for Payer: Aetna of CA Government/Medicare	$0.25
Rate for Payer: Cash Price	$0.18
Rate for Payer: Health Smart Auto/Commercial	$0.25
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$0.25
Rate for Payer: LLUH Dept of Risk Management WC	$0.23
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$0.31

VENLAFAXINE 50 MG TABLET [12204]

Facility

$0.41

Service Code	NDC 68382-020-01
Hospital Charge Code	1712639
Hospital Revenue Code	259
Min. Negotiated Rate	$0.23
Max. Negotiated Rate	$0.33
Rate for Payer: Cash Price	$0.18
Rate for Payer: Cigna of CA HMO/PPO	$0.33
Rate for Payer: Health Smart Auto/Commercial	$0.25
Rate for Payer: LLUH Dept of Risk Management WC	$0.23
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$0.31

VENLAFAXINE 50 MG TABLET [12204]

Facility

$0.41

Service Code	NDC 57664-394-88
Hospital Charge Code	1712639
Hospital Revenue Code	259
Min. Negotiated Rate	$0.23
Max. Negotiated Rate	$0.33
Rate for Payer: Cash Price	$0.18
Rate for Payer: Cigna of CA HMO/PPO	$0.33
Rate for Payer: Health Smart Auto/Commercial	$0.25
Rate for Payer: LLUH Dept of Risk Management WC	$0.23
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$0.31

VENLAFAXINE 50 MG TABLET [12204]

Facility

$0.41

Service Code	NDC 68001-159-00
Hospital Charge Code	1712639
Hospital Revenue Code	259
Min. Negotiated Rate	$0.23
Max. Negotiated Rate	$0.33
Rate for Payer: Cash Price	$0.18
Rate for Payer: Cigna of CA HMO/PPO	$0.33
Rate for Payer: Health Smart Auto/Commercial	$0.25
Rate for Payer: LLUH Dept of Risk Management WC	$0.23
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$0.31

VENLAFAXINE 50 MG TABLET [12204]

Facility

$0.41

Service Code	NDC 68382-020-01
Hospital Charge Code	1712639
Hospital Revenue Code	259
Min. Negotiated Rate	$0.23
Max. Negotiated Rate	$0.31
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$0.25
Rate for Payer: Aetna of CA Government/Medicare	$0.25
Rate for Payer: Cash Price	$0.18
Rate for Payer: Health Smart Auto/Commercial	$0.25
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$0.25
Rate for Payer: LLUH Dept of Risk Management WC	$0.23
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$0.31

VENLAFAXINE 50 MG TABLET [12204]

Facility

$0.17

Service Code	NDC 57237-174-01
Hospital Charge Code	1712639
Hospital Revenue Code	259
Min. Negotiated Rate	$0.09
Max. Negotiated Rate	$0.14
Rate for Payer: Cash Price	$0.08
Rate for Payer: Cigna of CA HMO/PPO	$0.14
Rate for Payer: Health Smart Auto/Commercial	$0.10
Rate for Payer: LLUH Dept of Risk Management WC	$0.09
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$0.13

Know your out-of-pocket cost for care.

All Charges