Loma Linda University Behavioral Medicine Center (BMC)

All Charges

Charge

Type

Setting

Price

CINACALCET 15 MG PARTIAL TABLET [40820825]

Facility

$0.60

Service Code	NDC 16729-440-10
Hospital Charge Code	ERX40820825
Hospital Revenue Code	259
Min. Negotiated Rate	$0.33
Max. Negotiated Rate	$0.48
Rate for Payer: Cash Price	$0.27
Rate for Payer: Cigna of CA HMO/PPO	$0.48
Rate for Payer: Health Smart Auto/Commercial	$0.36
Rate for Payer: LLUH Dept of Risk Management WC	$0.33
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$0.45

CINACALCET 30 MG TABLET [38100]

Facility

$0.60

Service Code	NDC 16729-440-10
Hospital Charge Code	1710945
Hospital Revenue Code	259
Min. Negotiated Rate	$0.33
Max. Negotiated Rate	$0.45
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$0.36
Rate for Payer: Aetna of CA Government/Medicare	$0.36
Rate for Payer: Cash Price	$0.27
Rate for Payer: Health Smart Auto/Commercial	$0.36
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$0.36
Rate for Payer: LLUH Dept of Risk Management WC	$0.33
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$0.45

CINACALCET 30 MG TABLET [38100]

Facility

$0.60

Service Code	NDC 16729-440-10
Hospital Charge Code	1710945
Hospital Revenue Code	259
Min. Negotiated Rate	$0.33
Max. Negotiated Rate	$0.48
Rate for Payer: Cash Price	$0.27
Rate for Payer: Cigna of CA HMO/PPO	$0.48
Rate for Payer: Health Smart Auto/Commercial	$0.36
Rate for Payer: LLUH Dept of Risk Management WC	$0.33
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$0.45

CINACALCET 30 MG TABLET [38100]

Facility

$0.60

Service Code	NDC 69097-410-02
Hospital Charge Code	1710945
Hospital Revenue Code	259
Min. Negotiated Rate	$0.33
Max. Negotiated Rate	$0.48
Rate for Payer: Cash Price	$0.27
Rate for Payer: Cigna of CA HMO/PPO	$0.48
Rate for Payer: Health Smart Auto/Commercial	$0.36
Rate for Payer: LLUH Dept of Risk Management WC	$0.33
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$0.45

CINACALCET 30 MG TABLET [38100]

Facility

$0.59

Service Code	NDC 67877-503-30
Hospital Charge Code	1710945
Hospital Revenue Code	259
Min. Negotiated Rate	$0.32
Max. Negotiated Rate	$0.44
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$0.35
Rate for Payer: Aetna of CA Government/Medicare	$0.35
Rate for Payer: Cash Price	$0.27
Rate for Payer: Health Smart Auto/Commercial	$0.35
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$0.35
Rate for Payer: LLUH Dept of Risk Management WC	$0.32
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$0.44

CINACALCET 30 MG TABLET [38100]

Facility

$0.60

Service Code	NDC 69097-410-02
Hospital Charge Code	1710945
Hospital Revenue Code	259
Min. Negotiated Rate	$0.33
Max. Negotiated Rate	$0.45
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$0.36
Rate for Payer: Aetna of CA Government/Medicare	$0.36
Rate for Payer: Cash Price	$0.27
Rate for Payer: Health Smart Auto/Commercial	$0.36
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$0.36
Rate for Payer: LLUH Dept of Risk Management WC	$0.33
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$0.45

CINACALCET 30 MG TABLET [38100]

Facility

$0.59

Service Code	NDC 67877-503-30
Hospital Charge Code	1710945
Hospital Revenue Code	259
Min. Negotiated Rate	$0.32
Max. Negotiated Rate	$0.47
Rate for Payer: Cash Price	$0.27
Rate for Payer: Cigna of CA HMO/PPO	$0.47
Rate for Payer: Health Smart Auto/Commercial	$0.35
Rate for Payer: LLUH Dept of Risk Management WC	$0.32
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$0.44

CINACALCET 60 MG TABLET [38101]

Facility

$1.08

Service Code	NDC 16729-441-10
Hospital Charge Code	1710946
Hospital Revenue Code	259
Min. Negotiated Rate	$0.59
Max. Negotiated Rate	$0.81
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	$0.59
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$0.81

CINACALCET 60 MG TABLET [38101]

Facility

$64.54

Service Code	NDC 55513-074-30
Hospital Charge Code	1710946
Hospital Revenue Code	259
Min. Negotiated Rate	$35.50
Max. Negotiated Rate	$48.40
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	$29.04
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 Beech St/Commercial/PHCS	$48.40

CINACALCET 60 MG TABLET [38101]

Facility

$1.08

Service Code	NDC 16729-441-10
Hospital Charge Code	1710946
Hospital Revenue Code	259
Min. Negotiated Rate	$0.59
Max. Negotiated Rate	$0.86
Rate for Payer: Cash Price	$0.49
Rate for Payer: Cigna of CA 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 Beech St/Commercial/PHCS	$0.81

CINACALCET 60 MG TABLET [38101]

Facility

$64.54

Service Code	NDC 55513-074-30
Hospital Charge Code	1710946
Hospital Revenue Code	259
Min. Negotiated Rate	$35.50
Max. Negotiated Rate	$51.63
Rate for Payer: Cash Price	$29.04
Rate for Payer: Cigna of CA 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 Beech St/Commercial/PHCS	$48.40

CINACALCET 60 MG TABLET [38101]

Facility

$1.08

Service Code	NDC 65862-832-30
Hospital Charge Code	1710946
Hospital Revenue Code	259
Min. Negotiated Rate	$0.59
Max. Negotiated Rate	$0.86
Rate for Payer: Cash Price	$0.49
Rate for Payer: Cigna of CA 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 Beech St/Commercial/PHCS	$0.81

CINACALCET 60 MG TABLET [38101]

Facility

$1.08

Service Code	NDC 69097-411-02
Hospital Charge Code	1710946
Hospital Revenue Code	259
Min. Negotiated Rate	$0.59
Max. Negotiated Rate	$0.86
Rate for Payer: Cash Price	$0.49
Rate for Payer: Cigna of CA 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 Beech St/Commercial/PHCS	$0.81

CINACALCET 60 MG TABLET [38101]

Facility

$1.08

Service Code	NDC 65862-832-30
Hospital Charge Code	1710946
Hospital Revenue Code	259
Min. Negotiated Rate	$0.59
Max. Negotiated Rate	$0.81
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	$0.59
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$0.81

CINACALCET 60 MG TABLET [38101]

Facility

$1.08

Service Code	NDC 69097-411-02
Hospital Charge Code	1710946
Hospital Revenue Code	259
Min. Negotiated Rate	$0.59
Max. Negotiated Rate	$0.81
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	$0.59
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$0.81

CINACALCET 60 MG TABLET [38101]

Facility

$1.08

Service Code	NDC 67877-504-30
Hospital Charge Code	1710946
Hospital Revenue Code	259
Min. Negotiated Rate	$0.59
Max. Negotiated Rate	$0.81
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	$0.59
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$0.81

CINACALCET 60 MG TABLET [38101]

Facility

$1.08

Service Code	NDC 67877-504-30
Hospital Charge Code	1710946
Hospital Revenue Code	259
Min. Negotiated Rate	$0.59
Max. Negotiated Rate	$0.86
Rate for Payer: Cash Price	$0.49
Rate for Payer: Cigna of CA 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 Beech St/Commercial/PHCS	$0.81

CINACALCET 90 MG TABLET [38102]

Facility

$96.80

Service Code	NDC 55513-075-30
Hospital Charge Code	1712405
Hospital Revenue Code	259
Min. Negotiated Rate	$53.24
Max. Negotiated Rate	$72.60
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	$43.56
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 Beech St/Commercial/PHCS	$72.60

CINACALCET 90 MG TABLET [38102]

Facility

$96.80

Service Code	NDC 55513-075-30
Hospital Charge Code	1712405
Hospital Revenue Code	259
Min. Negotiated Rate	$53.24
Max. Negotiated Rate	$77.44
Rate for Payer: Cash Price	$43.56
Rate for Payer: Cigna of CA 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 Beech St/Commercial/PHCS	$72.60

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

Facility

$37.90

Service Code	NDC 0065-8531-10
Hospital Charge Code	1740308
Hospital Revenue Code	259
Min. Negotiated Rate	$20.84
Max. Negotiated Rate	$30.32
Rate for Payer: Cash Price	$17.06
Rate for Payer: Cigna of CA HMO/PPO	$30.32
Rate for Payer: Health Smart Auto/Commercial	$22.74
Rate for Payer: LLUH Dept of Risk Management WC	$20.84
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$28.42

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

Facility

$37.90

Service Code	NDC 0065-8531-10
Hospital Charge Code	1740308
Hospital Revenue Code	259
Min. Negotiated Rate	$20.84
Max. Negotiated Rate	$28.42
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$22.74
Rate for Payer: Aetna of CA Government/Medicare	$22.74
Rate for Payer: Cash Price	$17.06
Rate for Payer: Health Smart Auto/Commercial	$22.74
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$22.74
Rate for Payer: LLUH Dept of Risk Management WC	$20.84
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$28.42

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

Facility

$28.00

Service Code	NDC 43598-326-75
Hospital Charge Code	1740331
Hospital Revenue Code	259
Min. Negotiated Rate	$15.40
Max. Negotiated Rate	$21.00
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$16.80
Rate for Payer: Aetna of CA Government/Medicare	$16.80
Rate for Payer: Cash Price	$12.60
Rate for Payer: Health Smart Auto/Commercial	$16.80
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$16.80
Rate for Payer: LLUH Dept of Risk Management WC	$15.40
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$21.00

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

Facility

$28.00

Service Code	NDC 43598-326-75
Hospital Charge Code	1740331
Hospital Revenue Code	259
Min. Negotiated Rate	$15.40
Max. Negotiated Rate	$22.40
Rate for Payer: Cash Price	$12.60
Rate for Payer: Cigna of CA HMO/PPO	$22.40
Rate for Payer: Health Smart Auto/Commercial	$16.80
Rate for Payer: LLUH Dept of Risk Management WC	$15.40
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$21.00

CIPROFLOXACIN 0.3 % EYE DROPS [9610]

Facility

$3.36

Service Code	NDC 69315-308-05
Hospital Charge Code	1740266
Hospital Revenue Code	259
Min. Negotiated Rate	$1.85
Max. Negotiated Rate	$2.69
Rate for Payer: Cash Price	$1.51
Rate for Payer: Cigna of CA 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 Beech St/Commercial/PHCS	$2.52

CIPROFLOXACIN 0.3 % EYE DROPS [9610]

Facility

$3.36

Service Code	NDC 69315-308-05
Hospital Charge Code	1740266
Hospital Revenue Code	259
Min. Negotiated Rate	$1.85
Max. Negotiated Rate	$2.52
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	$1.51
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 Beech St/Commercial/PHCS	$2.52

Know your out-of-pocket cost for care.

All Charges