Loma Linda University Behavioral Medicine Center (BMC)

All Charges

Charge

Type

Setting

Price

CIPROFLOXACIN 500 MG TABLET [25119]

Facility

$0.23

Service Code	NDC 55111-127-01
Hospital Charge Code	1711159
Hospital Revenue Code	259
Min. Negotiated Rate	$0.13
Max. Negotiated Rate	$0.18
Rate for Payer: Cash Price	$0.10
Rate for Payer: Cigna of CA HMO/PPO	$0.18
Rate for Payer: Health Smart Auto/Commercial	$0.14
Rate for Payer: LLUH Dept of Risk Management WC	$0.13
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$0.17

CIPROFLOXACIN 750 MG TABLET [25120]

Facility

$0.65

Service Code	NDC 65862-078-50
Hospital Charge Code	1711176
Hospital Revenue Code	259
Min. Negotiated Rate	$0.36
Max. Negotiated Rate	$0.49
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$0.39
Rate for Payer: Aetna of CA Government/Medicare	$0.39
Rate for Payer: Cash Price	$0.29
Rate for Payer: Health Smart Auto/Commercial	$0.39
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$0.39
Rate for Payer: LLUH Dept of Risk Management WC	$0.36
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$0.49

CIPROFLOXACIN 750 MG TABLET [25120]

Facility

$0.38

Service Code	NDC 55111-128-50
Hospital Charge Code	1711176
Hospital Revenue Code	259
Min. Negotiated Rate	$0.21
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	$0.23
Rate for Payer: LLUH Dept of Risk Management WC	$0.21
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$0.29

CIPROFLOXACIN 750 MG TABLET [25120]

Facility

$0.65

Service Code	NDC 65862-078-50
Hospital Charge Code	1711176
Hospital Revenue Code	259
Min. Negotiated Rate	$0.36
Max. Negotiated Rate	$0.52
Rate for Payer: Cash Price	$0.29
Rate for Payer: Cigna of CA HMO/PPO	$0.52
Rate for Payer: Health Smart Auto/Commercial	$0.39
Rate for Payer: LLUH Dept of Risk Management WC	$0.36
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$0.49

CIPROFLOXACIN 750 MG TABLET [25120]

Facility

$0.38

Service Code	NDC 55111-128-50
Hospital Charge Code	1711176
Hospital Revenue Code	259
Min. Negotiated Rate	$0.21
Max. Negotiated Rate	$0.29
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$0.23
Rate for Payer: Aetna of CA Government/Medicare	$0.23
Rate for Payer: Cash Price	$0.17
Rate for Payer: Health Smart Auto/Commercial	$0.23
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$0.23
Rate for Payer: LLUH Dept of Risk Management WC	$0.21
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$0.29

CISATRACURIUM 2 MG/ML INTRAVENOUS SOLUTION [16168]

Facility

$2.79

Service Code	NDC 0409-1208-11
Hospital Charge Code	1721072
Hospital Revenue Code	250
Min. Negotiated Rate	$1.53
Max. Negotiated Rate	$2.09
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$1.67
Rate for Payer: Aetna of CA Government/Medicare	$1.67
Rate for Payer: Cash Price	$1.26
Rate for Payer: Health Smart Auto/Commercial	$1.67
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$1.67
Rate for Payer: LLUH Dept of Risk Management WC	$1.53
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$2.09

CISATRACURIUM 2 MG/ML INTRAVENOUS SOLUTION [16168]

Facility

$2.76

Service Code	NDC 0703-2056-01
Hospital Charge Code	1721072
Hospital Revenue Code	250
Min. Negotiated Rate	$1.52
Max. Negotiated Rate	$2.07
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$1.66
Rate for Payer: Aetna of CA Government/Medicare	$1.66
Rate for Payer: Cash Price	$1.24
Rate for Payer: Health Smart Auto/Commercial	$1.66
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$1.66
Rate for Payer: LLUH Dept of Risk Management WC	$1.52
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$2.07

CISATRACURIUM 2 MG/ML INTRAVENOUS SOLUTION [16168]

Facility

$2.79

Service Code	NDC 0409-1208-11
Hospital Charge Code	1721072
Hospital Revenue Code	250
Min. Negotiated Rate	$1.53
Max. Negotiated Rate	$2.23
Rate for Payer: Cash Price	$1.26
Rate for Payer: Cigna of CA HMO/PPO	$2.23
Rate for Payer: Health Smart Auto/Commercial	$1.67
Rate for Payer: LLUH Dept of Risk Management WC	$1.53
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$2.09

CISATRACURIUM 2 MG/ML INTRAVENOUS SOLUTION [16168]

Facility

$1.09

Service Code	NDC 70069-161-10
Hospital Charge Code	1721072
Hospital Revenue Code	250
Min. Negotiated Rate	$0.60
Max. Negotiated Rate	$0.87
Rate for Payer: Cash Price	$0.49
Rate for Payer: Cigna of CA HMO/PPO	$0.87
Rate for Payer: Health Smart Auto/Commercial	$0.65
Rate for Payer: LLUH Dept of Risk Management WC	$0.60
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$0.82

CISATRACURIUM 2 MG/ML INTRAVENOUS SOLUTION [16168]

Facility

$2.76

Service Code	NDC 0703-2056-03
Hospital Charge Code	1721072
Hospital Revenue Code	250
Min. Negotiated Rate	$1.52
Max. Negotiated Rate	$2.07
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$1.66
Rate for Payer: Aetna of CA Government/Medicare	$1.66
Rate for Payer: Cash Price	$1.24
Rate for Payer: Health Smart Auto/Commercial	$1.66
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$1.66
Rate for Payer: LLUH Dept of Risk Management WC	$1.52
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$2.07

CISATRACURIUM 2 MG/ML INTRAVENOUS SOLUTION [16168]

Facility

$1.99

Service Code	NDC 25021-670-10
Hospital Charge Code	1721072
Hospital Revenue Code	250
Min. Negotiated Rate	$1.09
Max. Negotiated Rate	$1.59
Rate for Payer: Cash Price	$0.90
Rate for Payer: Cigna of CA HMO/PPO	$1.59
Rate for Payer: Health Smart Auto/Commercial	$1.19
Rate for Payer: LLUH Dept of Risk Management WC	$1.09
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$1.49

CISATRACURIUM 2 MG/ML INTRAVENOUS SOLUTION [16168]

Facility

$2.79

Service Code	NDC 0409-7083-10
Hospital Charge Code	1721072
Hospital Revenue Code	250
Min. Negotiated Rate	$1.53
Max. Negotiated Rate	$2.23
Rate for Payer: Cash Price	$1.26
Rate for Payer: Cigna of CA HMO/PPO	$2.23
Rate for Payer: Health Smart Auto/Commercial	$1.67
Rate for Payer: LLUH Dept of Risk Management WC	$1.53
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$2.09

CISATRACURIUM 2 MG/ML INTRAVENOUS SOLUTION [16168]

Facility

$1.09

Service Code	NDC 70069-161-10
Hospital Charge Code	1721072
Hospital Revenue Code	250
Min. Negotiated Rate	$0.60
Max. Negotiated Rate	$0.82
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	$0.60
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$0.82

CISATRACURIUM 2 MG/ML INTRAVENOUS SOLUTION [16168]

Facility

$2.28

Service Code	NDC 0781-3152-70
Hospital Charge Code	1721072
Hospital Revenue Code	250
Min. Negotiated Rate	$1.25
Max. Negotiated Rate	$1.71
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$1.37
Rate for Payer: Aetna of CA Government/Medicare	$1.37
Rate for Payer: Cash Price	$1.03
Rate for Payer: Health Smart Auto/Commercial	$1.37
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$1.37
Rate for Payer: LLUH Dept of Risk Management WC	$1.25
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$1.71

CISATRACURIUM 2 MG/ML INTRAVENOUS SOLUTION [16168]

Facility

$2.28

Service Code	NDC 0781-3152-95
Hospital Charge Code	1721072
Hospital Revenue Code	250
Min. Negotiated Rate	$1.25
Max. Negotiated Rate	$1.71
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$1.37
Rate for Payer: Aetna of CA Government/Medicare	$1.37
Rate for Payer: Cash Price	$1.03
Rate for Payer: Health Smart Auto/Commercial	$1.37
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$1.37
Rate for Payer: LLUH Dept of Risk Management WC	$1.25
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$1.71

CISATRACURIUM 2 MG/ML INTRAVENOUS SOLUTION [16168]

Facility

$2.79

Service Code	NDC 0409-1208-01
Hospital Charge Code	1721072
Hospital Revenue Code	250
Min. Negotiated Rate	$1.53
Max. Negotiated Rate	$2.09
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$1.67
Rate for Payer: Aetna of CA Government/Medicare	$1.67
Rate for Payer: Cash Price	$1.26
Rate for Payer: Health Smart Auto/Commercial	$1.67
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$1.67
Rate for Payer: LLUH Dept of Risk Management WC	$1.53
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$2.09

CISATRACURIUM 2 MG/ML INTRAVENOUS SOLUTION [16168]

Facility

$2.79

Service Code	NDC 0409-7083-01
Hospital Charge Code	1721072
Hospital Revenue Code	250
Min. Negotiated Rate	$1.53
Max. Negotiated Rate	$2.09
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$1.67
Rate for Payer: Aetna of CA Government/Medicare	$1.67
Rate for Payer: Cash Price	$1.26
Rate for Payer: Health Smart Auto/Commercial	$1.67
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$1.67
Rate for Payer: LLUH Dept of Risk Management WC	$1.53
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$2.09

CISATRACURIUM 2 MG/ML INTRAVENOUS SOLUTION [16168]

Facility

$1.99

Service Code	NDC 25021-670-10
Hospital Charge Code	1721072
Hospital Revenue Code	250
Min. Negotiated Rate	$1.09
Max. Negotiated Rate	$1.49
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$1.19
Rate for Payer: Aetna of CA Government/Medicare	$1.19
Rate for Payer: Cash Price	$0.90
Rate for Payer: Health Smart Auto/Commercial	$1.19
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$1.19
Rate for Payer: LLUH Dept of Risk Management WC	$1.09
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$1.49

CISATRACURIUM 2 MG/ML INTRAVENOUS SOLUTION [16168]

Facility

$1.68

Service Code	NDC 71288-712-05
Hospital Charge Code	NDG16168
Hospital Revenue Code	250
Min. Negotiated Rate	$0.92
Max. Negotiated Rate	$1.26
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$1.01
Rate for Payer: Aetna of CA Government/Medicare	$1.01
Rate for Payer: Cash Price	$0.76
Rate for Payer: Health Smart Auto/Commercial	$1.01
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$1.01
Rate for Payer: LLUH Dept of Risk Management WC	$0.92
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$1.26

CISATRACURIUM 2 MG/ML INTRAVENOUS SOLUTION [16168]

Facility

$2.76

Service Code	NDC 0703-2056-03
Hospital Charge Code	1721072
Hospital Revenue Code	250
Min. Negotiated Rate	$1.52
Max. Negotiated Rate	$2.21
Rate for Payer: Cash Price	$1.24
Rate for Payer: Cigna of CA HMO/PPO	$2.21
Rate for Payer: Health Smart Auto/Commercial	$1.66
Rate for Payer: LLUH Dept of Risk Management WC	$1.52
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$2.07

CISATRACURIUM 2 MG/ML INTRAVENOUS SOLUTION [16168]

Facility

$2.79

Service Code	NDC 0409-7083-10
Hospital Charge Code	1721072
Hospital Revenue Code	250
Min. Negotiated Rate	$1.53
Max. Negotiated Rate	$2.09
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$1.67
Rate for Payer: Aetna of CA Government/Medicare	$1.67
Rate for Payer: Cash Price	$1.26
Rate for Payer: Health Smart Auto/Commercial	$1.67
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$1.67
Rate for Payer: LLUH Dept of Risk Management WC	$1.53
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$2.09

CISATRACURIUM 2 MG/ML INTRAVENOUS SOLUTION [16168]

Facility

$2.28

Service Code	NDC 0781-3152-70
Hospital Charge Code	1721072
Hospital Revenue Code	250
Min. Negotiated Rate	$1.25
Max. Negotiated Rate	$1.82
Rate for Payer: Cash Price	$1.03
Rate for Payer: Cigna of CA HMO/PPO	$1.82
Rate for Payer: Health Smart Auto/Commercial	$1.37
Rate for Payer: LLUH Dept of Risk Management WC	$1.25
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$1.71

CISATRACURIUM 2 MG/ML INTRAVENOUS SOLUTION [16168]

Facility

$2.79

Service Code	NDC 0409-1208-01
Hospital Charge Code	1721072
Hospital Revenue Code	250
Min. Negotiated Rate	$1.53
Max. Negotiated Rate	$2.23
Rate for Payer: Cash Price	$1.26
Rate for Payer: Cigna of CA HMO/PPO	$2.23
Rate for Payer: Health Smart Auto/Commercial	$1.67
Rate for Payer: LLUH Dept of Risk Management WC	$1.53
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$2.09

CISATRACURIUM 2 MG/ML INTRAVENOUS SOLUTION [16168]

Facility

$2.76

Service Code	NDC 0703-2056-01
Hospital Charge Code	1721072
Hospital Revenue Code	250
Min. Negotiated Rate	$1.52
Max. Negotiated Rate	$2.21
Rate for Payer: Cash Price	$1.24
Rate for Payer: Cigna of CA HMO/PPO	$2.21
Rate for Payer: Health Smart Auto/Commercial	$1.66
Rate for Payer: LLUH Dept of Risk Management WC	$1.52
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$2.07

CISATRACURIUM 2 MG/ML INTRAVENOUS SOLUTION [16168]

Facility

$1.68

Service Code	NDC 71288-712-06
Hospital Charge Code	NDG16168
Hospital Revenue Code	250
Min. Negotiated Rate	$0.92
Max. Negotiated Rate	$1.26
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$1.01
Rate for Payer: Aetna of CA Government/Medicare	$1.01
Rate for Payer: Cash Price	$0.76
Rate for Payer: Health Smart Auto/Commercial	$1.01
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$1.01
Rate for Payer: LLUH Dept of Risk Management WC	$0.92
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$1.26

Know your out-of-pocket cost for care.

All Charges