Loma Linda University Behavioral Medicine Center (BMC)

All Charges

Charge

Type

Setting

Price

VERAPAMIL ER (SR) 240 MG TABLET,EXTENDED RELEASE [8531]

Facility

$0.28

Service Code	NDC 75834-159-01
Hospital Charge Code	1712020
Hospital Revenue Code	259
Min. Negotiated Rate	$0.15
Max. Negotiated Rate	$0.22
Rate for Payer: Cash Price	$0.13
Rate for Payer: Cigna of CA HMO/PPO	$0.22
Rate for Payer: Health Smart Auto/Commercial	$0.17
Rate for Payer: LLUH Dept of Risk Management WC	$0.15
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$0.21

VERAPAMIL ER (SR) 240 MG TABLET,EXTENDED RELEASE [8531]

Facility

$0.37

Service Code	NDC 68462-260-01
Hospital Charge Code	1712020
Hospital Revenue Code	259
Min. Negotiated Rate	$0.20
Max. Negotiated Rate	$0.30
Rate for Payer: Cash Price	$0.17
Rate for Payer: Cigna of CA HMO/PPO	$0.30
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	$0.28

VERAPAMIL ORAL SUSPENSION COMPOUND 50 MG/ML [4080356]

Facility

$0.36

Service Code	NDC 9994-0803-56
Hospital Charge Code	1715022
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

VERAPAMIL ORAL SUSPENSION COMPOUND 50 MG/ML [4080356]

Facility

$0.36

Service Code	NDC 9994-0803-56
Hospital Charge Code	1715022
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

VILAZODONE 20 MG TABLET [109403]

Facility

$6.13

Service Code	NDC 60505-4773-3
Hospital Charge Code	1712642
Hospital Revenue Code	259
Min. Negotiated Rate	$3.37
Max. Negotiated Rate	$4.90
Rate for Payer: Cash Price	$2.76
Rate for Payer: Cigna of CA HMO/PPO	$4.90
Rate for Payer: Health Smart Auto/Commercial	$3.68
Rate for Payer: LLUH Dept of Risk Management WC	$3.37
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$4.60

VILAZODONE 20 MG TABLET [109403]

Facility

$6.13

Service Code	NDC 60505-4773-3
Hospital Charge Code	1712642
Hospital Revenue Code	259
Min. Negotiated Rate	$3.37
Max. Negotiated Rate	$4.60
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$3.68
Rate for Payer: Aetna of CA Government/Medicare	$3.68
Rate for Payer: Cash Price	$2.76
Rate for Payer: Health Smart Auto/Commercial	$3.68
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$3.68
Rate for Payer: LLUH Dept of Risk Management WC	$3.37
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$4.60

VINBLASTINE 1 MG/ML INTRAVENOUS SOLUTION [8594]

Facility

$5.66

Service Code	CPT J9360
Hospital Charge Code	NDG8594
Hospital Revenue Code	636
Min. Negotiated Rate	$3.11
Max. Negotiated Rate	$4.53
Rate for Payer: Cigna of CA HMO/PPO	$4.53
Rate for Payer: Health Smart Auto/Commercial	$3.40
Rate for Payer: Cash Price	$2.55
Rate for Payer: LLUH Dept of Risk Management WC	$3.11
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$4.24

VINBLASTINE 1 MG/ML INTRAVENOUS SOLUTION [8594]

Facility

$5.66

Service Code	CPT J9360
Hospital Charge Code	NDG8594
Hospital Revenue Code	636
Min. Negotiated Rate	$3.11
Max. Negotiated Rate	$4.24
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$3.40
Rate for Payer: Aetna of CA Government/Medicare	$3.40
Rate for Payer: Cash Price	$2.55
Rate for Payer: Health Smart Auto/Commercial	$3.40
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$3.40
Rate for Payer: LLUH Dept of Risk Management WC	$3.11
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$4.24

VINCRISTINE 1 MG/ML INTRAVENOUS SOLUTION [8597]

Facility

$19.37

Service Code	NDC 61703-309-06
Hospital Charge Code	1755769
Hospital Revenue Code	636
Min. Negotiated Rate	$10.65
Max. Negotiated Rate	$15.50
Rate for Payer: Cash Price	$8.72
Rate for Payer: Cigna of CA HMO/PPO	$15.50
Rate for Payer: Health Smart Auto/Commercial	$11.62
Rate for Payer: LLUH Dept of Risk Management WC	$10.65
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$14.53

VINCRISTINE 1 MG/ML INTRAVENOUS SOLUTION [8597]

Facility

$19.37

Service Code	NDC 61703-309-06
Hospital Charge Code	1755769
Hospital Revenue Code	636
Min. Negotiated Rate	$10.65
Max. Negotiated Rate	$14.53
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$11.62
Rate for Payer: Aetna of CA Government/Medicare	$11.62
Rate for Payer: Cash Price	$8.72
Rate for Payer: Health Smart Auto/Commercial	$11.62
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$11.62
Rate for Payer: LLUH Dept of Risk Management WC	$10.65
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$14.53

VINCRISTINE 2 MG/2 ML INTRAVENOUS SOLUTION [120009]

Facility

$8.39

Service Code	CPT J9370
Hospital Charge Code	1755094
Hospital Revenue Code	636
Min. Negotiated Rate	$4.61
Max. Negotiated Rate	$6.29
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$5.03
Rate for Payer: Aetna of CA Government/Medicare	$5.03
Rate for Payer: Cash Price	$3.78
Rate for Payer: Health Smart Auto/Commercial	$5.03
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$5.03
Rate for Payer: LLUH Dept of Risk Management WC	$4.61
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$6.29

VINCRISTINE 2 MG/2 ML INTRAVENOUS SOLUTION [120009]

Facility

$8.39

Service Code	CPT J9370
Hospital Charge Code	1755094
Hospital Revenue Code	636
Min. Negotiated Rate	$4.61
Max. Negotiated Rate	$6.71
Rate for Payer: Cash Price	$3.78
Rate for Payer: Cigna of CA HMO/PPO	$6.71
Rate for Payer: Health Smart Auto/Commercial	$5.03
Rate for Payer: LLUH Dept of Risk Management WC	$4.61
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$6.29

VINCRISTINE SULFATE LIPOSOMAL 5 MG/31 ML(0.16 MG/ML)(FINAL CONC)IV KIT [201456]

Facility

$20,636.03

Service Code	NDC 72893-008-03
Hospital Charge Code	ERX201456
Hospital Revenue Code	636
Min. Negotiated Rate	$11,349.82
Max. Negotiated Rate	$15,477.02
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$12,381.62
Rate for Payer: Aetna of CA Government/Medicare	$12,381.62
Rate for Payer: Cash Price	$9,286.21
Rate for Payer: Health Smart Auto/Commercial	$12,381.62
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$12,381.62
Rate for Payer: LLUH Dept of Risk Management WC	$11,349.82
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$15,477.02

VINCRISTINE SULFATE LIPOSOMAL 5 MG/31 ML(0.16 MG/ML)(FINAL CONC)IV KIT [201456]

Facility

$20,636.03

Service Code	NDC 72893-008-03
Hospital Charge Code	ERX201456
Hospital Revenue Code	636
Min. Negotiated Rate	$11,349.82
Max. Negotiated Rate	$16,508.82
Rate for Payer: Cash Price	$9,286.21
Rate for Payer: Cigna of CA HMO/PPO	$16,508.82
Rate for Payer: Health Smart Auto/Commercial	$12,381.62
Rate for Payer: LLUH Dept of Risk Management WC	$11,349.82
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$15,477.02

VINORELBINE 10 MG/ML INTRAVENOUS SOLUTION [14203]

Facility

$30.00

Service Code	CPT J9390
Hospital Charge Code	NDG14203
Hospital Revenue Code	636
Min. Negotiated Rate	$16.50
Max. Negotiated Rate	$22.50
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$18.00
Rate for Payer: Aetna of CA Government/Medicare	$18.00
Rate for Payer: Cash Price	$13.50
Rate for Payer: Health Smart Auto/Commercial	$18.00
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$18.00
Rate for Payer: LLUH Dept of Risk Management WC	$16.50
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$22.50

VINORELBINE 10 MG/ML INTRAVENOUS SOLUTION [14203]

Facility

$30.00

Service Code	CPT J9390
Hospital Charge Code	NDG14203
Hospital Revenue Code	636
Min. Negotiated Rate	$16.50
Max. Negotiated Rate	$24.00
Rate for Payer: Cash Price	$13.50
Rate for Payer: Cigna of CA HMO/PPO	$24.00
Rate for Payer: Health Smart Auto/Commercial	$18.00
Rate for Payer: LLUH Dept of Risk Management WC	$16.50
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$22.50

VINORELBINE 50 MG/5 ML INTRAVENOUS SOLUTION [41673]

Facility

$20.40

Service Code	CPT J9390
Hospital Charge Code	1755671
Hospital Revenue Code	636
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 EPO/HMO/POS/PPO	$12.96
Rate for Payer: Aetna of CA Government/Medicare	$12.24
Rate for Payer: Aetna of CA Government/Medicare	$12.96
Rate for Payer: Cash Price	$9.18
Rate for Payer: Cash Price	$9.72
Rate for Payer: Health Smart Auto/Commercial	$12.24
Rate for Payer: Health Smart Auto/Commercial	$12.96
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$12.24
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$12.96
Rate for Payer: LLUH Dept of Risk Management WC	$11.22
Rate for Payer: LLUH Dept of Risk Management WC	$11.88
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$16.20
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$15.30

VINORELBINE 50 MG/5 ML INTRAVENOUS SOLUTION [41673]

Facility

$21.60

Service Code	CPT J9390
Hospital Charge Code	1755671
Hospital Revenue Code	636
Min. Negotiated Rate	$11.88
Max. Negotiated Rate	$17.28
Rate for Payer: Cash Price	$9.72
Rate for Payer: Cash Price	$9.18
Rate for Payer: Cigna of CA HMO/PPO	$17.28
Rate for Payer: Cigna of CA HMO/PPO	$16.32
Rate for Payer: Health Smart Auto/Commercial	$12.96
Rate for Payer: Health Smart Auto/Commercial	$12.24
Rate for Payer: LLUH Dept of Risk Management WC	$11.88
Rate for Payer: LLUH Dept of Risk Management WC	$11.22
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$15.30
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$16.20

VITAMIN A 3,000 MCG (10,000 UNIT) CAPSULE [8639]

Facility

$0.02

Service Code	NDC 0761-0433-10
Hospital Charge Code	1712644
Hospital Revenue Code	259
Min. Negotiated Rate	$0.01
Max. Negotiated Rate	$0.02
Rate for Payer: Cash Price	$0.01
Rate for Payer: Cigna of CA HMO/PPO	$0.02
Rate for Payer: Health Smart Auto/Commercial	$0.01
Rate for Payer: LLUH Dept of Risk Management WC	$0.01
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$0.02

VITAMIN A 3,000 MCG (10,000 UNIT) CAPSULE [8639]

Facility

$0.02

Service Code	NDC 0761-0433-10
Hospital Charge Code	1712644
Hospital Revenue Code	259
Min. Negotiated Rate	$0.01
Max. Negotiated Rate	$0.02
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$0.01
Rate for Payer: Aetna of CA Government/Medicare	$0.01
Rate for Payer: Cash Price	$0.01
Rate for Payer: Health Smart Auto/Commercial	$0.01
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$0.01
Rate for Payer: LLUH Dept of Risk Management WC	$0.01
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$0.02

VITAMIN A 3,000 MCG (10,000 UNIT) CAPSULE [8639]

Facility

$0.05

Service Code	NDC 904208560
Hospital Charge Code	1712644
Hospital Revenue Code	259
Min. Negotiated Rate	$0.03
Max. Negotiated Rate	$0.04
Rate for Payer: Cash Price	$0.02
Rate for Payer: Cigna of CA HMO/PPO	$0.04
Rate for Payer: Health Smart Auto/Commercial	$0.03
Rate for Payer: LLUH Dept of Risk Management WC	$0.03
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$0.04

VITAMIN A 3,000 MCG (10,000 UNIT) CAPSULE [8639]

Facility

$0.04

Service Code	NDC 35046-001-06
Hospital Charge Code	1712644
Hospital Revenue Code	259
Min. Negotiated Rate	$0.02
Max. Negotiated Rate	$0.03
Rate for Payer: Cash Price	$0.02
Rate for Payer: Cigna of CA HMO/PPO	$0.03
Rate for Payer: Health Smart Auto/Commercial	$0.02
Rate for Payer: LLUH Dept of Risk Management WC	$0.02
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$0.03

VITAMIN A 3,000 MCG (10,000 UNIT) CAPSULE [8639]

Facility

$0.04

Service Code	NDC 35046-001-06
Hospital Charge Code	1712644
Hospital Revenue Code	259
Min. Negotiated Rate	$0.02
Max. Negotiated Rate	$0.03
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$0.02
Rate for Payer: Aetna of CA Government/Medicare	$0.02
Rate for Payer: Cash Price	$0.02
Rate for Payer: Health Smart Auto/Commercial	$0.02
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$0.02
Rate for Payer: LLUH Dept of Risk Management WC	$0.02
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$0.03

VITAMIN A 3,000 MCG (10,000 UNIT) CAPSULE [8639]

Facility

$0.05

Service Code	NDC 8770140725
Hospital Charge Code	1712644
Hospital Revenue Code	259
Min. Negotiated Rate	$0.03
Max. Negotiated Rate	$0.04
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$0.03
Rate for Payer: Aetna of CA Government/Medicare	$0.03
Rate for Payer: Cash Price	$0.02
Rate for Payer: Health Smart Auto/Commercial	$0.03
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$0.03
Rate for Payer: LLUH Dept of Risk Management WC	$0.03
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$0.04

VITAMIN A 3,000 MCG (10,000 UNIT) CAPSULE [8639]

Facility

$0.05

Service Code	NDC 8770140725
Hospital Charge Code	1712644
Hospital Revenue Code	259
Min. Negotiated Rate	$0.03
Max. Negotiated Rate	$0.04
Rate for Payer: Cash Price	$0.02
Rate for Payer: Cigna of CA HMO/PPO	$0.04
Rate for Payer: Health Smart Auto/Commercial	$0.03
Rate for Payer: LLUH Dept of Risk Management WC	$0.03
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$0.04

Know your out-of-pocket cost for care.

All Charges