Loma Linda University Behavioral Medicine Center (BMC)

All Charges

Charge

Type

Setting

Price

CINACALCET 60 MG TABLET [38101]

Facility

$64.54

Service Code	NDC 55513-074-30
Hospital Charge Code	901700029
Hospital Revenue Code	259
Min. Negotiated Rate	$35.50
Max. Negotiated Rate	$51.63
Rate for Payer: Cash Price	$35.49
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$51.63
Rate for Payer: Health Smart Auto/Commercial	$38.72
Rate for Payer: LLUH Dept of Risk Management WC	$35.50
Rate for Payer: Multiplan Commercial	$48.41

CINACALCET 60 MG TABLET [38101]

Facility

$64.54

Service Code	NDC 55513-074-30
Hospital Charge Code	901700029
Hospital Revenue Code	259
Min. Negotiated Rate	$35.50
Max. Negotiated Rate	$51.63
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$38.72
Rate for Payer: Aetna of CA Government/Medicare	$38.72
Rate for Payer: Cash Price	$35.49
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$51.63
Rate for Payer: Health Smart Auto/Commercial	$38.72
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$38.72
Rate for Payer: LLUH Dept of Risk Management WC	$35.50
Rate for Payer: Multiplan Commercial	$48.41

CINACALCET 60 MG TABLET [38101]

Facility

$1.08

Service Code	NDC 69097-411-02
Hospital Charge Code	901700029
Hospital Revenue Code	259
Min. Negotiated Rate	$0.59
Max. Negotiated Rate	$0.86
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	$0.59
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$0.86
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	$0.59
Rate for Payer: Multiplan Commercial	$0.81

CINACALCET 60 MG TABLET [38101]

Facility

$1.08

Service Code	NDC 16729-441-10
Hospital Charge Code	901700029
Hospital Revenue Code	259
Min. Negotiated Rate	$0.59
Max. Negotiated Rate	$0.86
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	$0.59
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$0.86
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	$0.59
Rate for Payer: Multiplan Commercial	$0.81

CINACALCET 60 MG TABLET [38101]

Facility

$1.08

Service Code	NDC 16729-441-10
Hospital Charge Code	901700029
Hospital Revenue Code	259
Min. Negotiated Rate	$0.59
Max. Negotiated Rate	$0.86
Rate for Payer: Cash Price	$0.59
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$0.86
Rate for Payer: Health Smart Auto/Commercial	$0.65
Rate for Payer: LLUH Dept of Risk Management WC	$0.59
Rate for Payer: Multiplan Commercial	$0.81

CINACALCET 60 MG TABLET [38101]

Facility

$1.08

Service Code	NDC 65862-832-30
Hospital Charge Code	901700029
Hospital Revenue Code	259
Min. Negotiated Rate	$0.59
Max. Negotiated Rate	$0.86
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	$0.59
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$0.86
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	$0.59
Rate for Payer: Multiplan Commercial	$0.81

CINACALCET 60 MG TABLET [38101]

Facility

$1.08

Service Code	NDC 64380-884-04
Hospital Charge Code	901700029
Hospital Revenue Code	259
Min. Negotiated Rate	$0.59
Max. Negotiated Rate	$0.86
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	$0.59
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$0.86
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	$0.59
Rate for Payer: Multiplan Commercial	$0.81

CINACALCET 60 MG TABLET [38101]

Facility

$1.08

Service Code	NDC 70436-008-04
Hospital Charge Code	901700029
Hospital Revenue Code	259
Min. Negotiated Rate	$0.59
Max. Negotiated Rate	$0.86
Rate for Payer: Cash Price	$0.59
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$0.86
Rate for Payer: Health Smart Auto/Commercial	$0.65
Rate for Payer: LLUH Dept of Risk Management WC	$0.59
Rate for Payer: Multiplan Commercial	$0.81

CINACALCET 60 MG TABLET [38101]

Facility

$1.08

Service Code	NDC 67877-504-30
Hospital Charge Code	901700029
Hospital Revenue Code	259
Min. Negotiated Rate	$0.59
Max. Negotiated Rate	$0.86
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	$0.59
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$0.86
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	$0.59
Rate for Payer: Multiplan Commercial	$0.81

CINACALCET 60 MG TABLET [38101]

Facility

$1.08

Service Code	NDC 67877-504-30
Hospital Charge Code	901700029
Hospital Revenue Code	259
Min. Negotiated Rate	$0.59
Max. Negotiated Rate	$0.86
Rate for Payer: Cash Price	$0.59
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$0.86
Rate for Payer: Health Smart Auto/Commercial	$0.65
Rate for Payer: LLUH Dept of Risk Management WC	$0.59
Rate for Payer: Multiplan Commercial	$0.81

CINACALCET 60 MG TABLET [38101]

Facility

$1.08

Service Code	NDC 65862-832-30
Hospital Charge Code	901700029
Hospital Revenue Code	259
Min. Negotiated Rate	$0.59
Max. Negotiated Rate	$0.86
Rate for Payer: Cash Price	$0.59
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$0.86
Rate for Payer: Health Smart Auto/Commercial	$0.65
Rate for Payer: LLUH Dept of Risk Management WC	$0.59
Rate for Payer: Multiplan Commercial	$0.81

CINACALCET 60 MG TABLET [38101]

Facility

$1.08

Service Code	NDC 70436-008-04
Hospital Charge Code	901700029
Hospital Revenue Code	259
Min. Negotiated Rate	$0.59
Max. Negotiated Rate	$0.86
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	$0.59
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$0.86
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	$0.59
Rate for Payer: Multiplan Commercial	$0.81

CINACALCET 60 MG TABLET [38101]

Facility

$1.08

Service Code	NDC 69097-411-02
Hospital Charge Code	901700029
Hospital Revenue Code	259
Min. Negotiated Rate	$0.59
Max. Negotiated Rate	$0.86
Rate for Payer: Cash Price	$0.59
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$0.86
Rate for Payer: Health Smart Auto/Commercial	$0.65
Rate for Payer: LLUH Dept of Risk Management WC	$0.59
Rate for Payer: Multiplan Commercial	$0.81

CINACALCET 90 MG TABLET [38102]

Facility

$1.56

Service Code	NDC 67877-505-30
Hospital Charge Code	901700029
Hospital Revenue Code	259
Min. Negotiated Rate	$0.86
Max. Negotiated Rate	$1.25
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$0.94
Rate for Payer: Aetna of CA Government/Medicare	$0.94
Rate for Payer: Cash Price	$0.86
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$1.25
Rate for Payer: Health Smart Auto/Commercial	$0.94
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$0.94
Rate for Payer: LLUH Dept of Risk Management WC	$0.86
Rate for Payer: Multiplan Commercial	$1.17

CINACALCET 90 MG TABLET [38102]

Facility

$96.80

Service Code	NDC 55513-075-30
Hospital Charge Code	901700029
Hospital Revenue Code	259
Min. Negotiated Rate	$53.24
Max. Negotiated Rate	$77.44
Rate for Payer: Cash Price	$53.24
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$77.44
Rate for Payer: Health Smart Auto/Commercial	$58.08
Rate for Payer: LLUH Dept of Risk Management WC	$53.24
Rate for Payer: Multiplan Commercial	$72.60

CINACALCET 90 MG TABLET [38102]

Facility

$1.56

Service Code	NDC 67877-505-30
Hospital Charge Code	901700029
Hospital Revenue Code	259
Min. Negotiated Rate	$0.86
Max. Negotiated Rate	$1.25
Rate for Payer: Cash Price	$0.86
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$1.25
Rate for Payer: Health Smart Auto/Commercial	$0.94
Rate for Payer: LLUH Dept of Risk Management WC	$0.86
Rate for Payer: Multiplan Commercial	$1.17

CINACALCET 90 MG TABLET [38102]

Facility

$96.80

Service Code	NDC 55513-075-30
Hospital Charge Code	901700029
Hospital Revenue Code	259
Min. Negotiated Rate	$53.24
Max. Negotiated Rate	$77.44
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$58.08
Rate for Payer: Aetna of CA Government/Medicare	$58.08
Rate for Payer: Cash Price	$53.24
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$77.44
Rate for Payer: Health Smart Auto/Commercial	$58.08
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$58.08
Rate for Payer: LLUH Dept of Risk Management WC	$53.24
Rate for Payer: Multiplan Commercial	$72.60

CIPROFLOXACIN 0.2 %-HYDROCORTISONE 1 % EAR DROPS,SUSPENSION [22986]

Facility

$43.74

Service Code	NDC 66758-087-70
Hospital Charge Code	901700029
Hospital Revenue Code	259
Min. Negotiated Rate	$24.06
Max. Negotiated Rate	$34.99
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$26.24
Rate for Payer: Aetna of CA Government/Medicare	$26.24
Rate for Payer: Cash Price	$24.06
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$34.99
Rate for Payer: Health Smart Auto/Commercial	$26.24
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$26.24
Rate for Payer: LLUH Dept of Risk Management WC	$24.06
Rate for Payer: Multiplan Commercial	$32.80

CIPROFLOXACIN 0.2 %-HYDROCORTISONE 1 % EAR DROPS,SUSPENSION [22986]

Facility

$43.74

Service Code	NDC 66758-087-70
Hospital Charge Code	901700029
Hospital Revenue Code	259
Min. Negotiated Rate	$24.06
Max. Negotiated Rate	$34.99
Rate for Payer: Cash Price	$24.06
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$34.99
Rate for Payer: Health Smart Auto/Commercial	$26.24
Rate for Payer: LLUH Dept of Risk Management WC	$24.06
Rate for Payer: Multiplan Commercial	$32.80

CIPROFLOXACIN 0.3 %-DEXAMETHASONE 0.1 % EAR DROPS,SUSPENSION [36576]

Facility

$18.46

Service Code	NDC 43598-326-75
Hospital Charge Code	901700029
Hospital Revenue Code	259
Min. Negotiated Rate	$10.15
Max. Negotiated Rate	$14.77
Rate for Payer: Cash Price	$10.15
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$14.77
Rate for Payer: Health Smart Auto/Commercial	$11.08
Rate for Payer: LLUH Dept of Risk Management WC	$10.15
Rate for Payer: Multiplan Commercial	$13.85

CIPROFLOXACIN 0.3 %-DEXAMETHASONE 0.1 % EAR DROPS,SUSPENSION [36576]

Facility

$18.46

Service Code	NDC 43598-326-75
Hospital Charge Code	901700029
Hospital Revenue Code	259
Min. Negotiated Rate	$10.15
Max. Negotiated Rate	$14.77
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$11.08
Rate for Payer: Aetna of CA Government/Medicare	$11.08
Rate for Payer: Cash Price	$10.15
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$14.77
Rate for Payer: Health Smart Auto/Commercial	$11.08
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$11.08
Rate for Payer: LLUH Dept of Risk Management WC	$10.15
Rate for Payer: Multiplan Commercial	$13.85

CIPROFLOXACIN 0.3 % EYE DROPS [9610]

Facility

$3.36

Service Code	NDC 69315-308-05
Hospital Charge Code	901700029
Hospital Revenue Code	259
Min. Negotiated Rate	$1.85
Max. Negotiated Rate	$2.69
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$2.02
Rate for Payer: Aetna of CA Government/Medicare	$2.02
Rate for Payer: Cash Price	$1.85
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$2.69
Rate for Payer: Health Smart Auto/Commercial	$2.02
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$2.02
Rate for Payer: LLUH Dept of Risk Management WC	$1.85
Rate for Payer: Multiplan Commercial	$2.52

CIPROFLOXACIN 0.3 % EYE DROPS [9610]

Facility

$3.36

Service Code	NDC 69315-308-05
Hospital Charge Code	901700029
Hospital Revenue Code	259
Min. Negotiated Rate	$1.85
Max. Negotiated Rate	$2.69
Rate for Payer: Cash Price	$1.85
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$2.69
Rate for Payer: Health Smart Auto/Commercial	$2.02
Rate for Payer: LLUH Dept of Risk Management WC	$1.85
Rate for Payer: Multiplan Commercial	$2.52

CIPROFLOXACIN 0.3 % EYE DROPS [9610]

Facility

$3.36

Service Code	NDC 61314-656-05
Hospital Charge Code	901700029
Hospital Revenue Code	259
Min. Negotiated Rate	$1.85
Max. Negotiated Rate	$2.69
Rate for Payer: Cash Price	$1.85
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$2.69
Rate for Payer: Health Smart Auto/Commercial	$2.02
Rate for Payer: LLUH Dept of Risk Management WC	$1.85
Rate for Payer: Multiplan Commercial	$2.52

CIPROFLOXACIN 0.3 % EYE DROPS [9610]

Facility

$3.36

Service Code	NDC 61314-656-05
Hospital Charge Code	901700029
Hospital Revenue Code	259
Min. Negotiated Rate	$1.85
Max. Negotiated Rate	$2.69
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$2.02
Rate for Payer: Aetna of CA Government/Medicare	$2.02
Rate for Payer: Cash Price	$1.85
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$2.69
Rate for Payer: Health Smart Auto/Commercial	$2.02
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$2.02
Rate for Payer: LLUH Dept of Risk Management WC	$1.85
Rate for Payer: Multiplan Commercial	$2.52

Know your out-of-pocket cost for care.

All Charges