Loma Linda University Behavioral Medicine Center (BMC)

All Charges

Charge

Type

Setting

Price

COLCHICINE 0.6 MG CAPSULE [207785]

Facility

$8.16

Service Code	NDC 60687-358-95
Hospital Charge Code	901700029
Hospital Revenue Code	259
Min. Negotiated Rate	$4.49
Max. Negotiated Rate	$6.53
Rate for Payer: Cash Price	$4.49
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$6.53
Rate for Payer: Health Smart Auto/Commercial	$4.90
Rate for Payer: LLUH Dept of Risk Management WC	$4.49
Rate for Payer: Multiplan Commercial	$6.12

COLCHICINE 0.6 MG TABLET [1821]

Facility

$4.46

Service Code	NDC 50268-187-11
Hospital Charge Code	901700029
Hospital Revenue Code	259
Min. Negotiated Rate	$2.45
Max. Negotiated Rate	$3.57
Rate for Payer: Cash Price	$2.46
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$3.57
Rate for Payer: Health Smart Auto/Commercial	$2.68
Rate for Payer: LLUH Dept of Risk Management WC	$2.45
Rate for Payer: Multiplan Commercial	$3.35

COLCHICINE 0.6 MG TABLET [1821]

Facility

$6.74

Service Code	NDC 0254-2008-01
Hospital Charge Code	901700029
Hospital Revenue Code	259
Min. Negotiated Rate	$3.71
Max. Negotiated Rate	$5.39
Rate for Payer: Cash Price	$3.70
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$5.39
Rate for Payer: Health Smart Auto/Commercial	$4.04
Rate for Payer: LLUH Dept of Risk Management WC	$3.71
Rate for Payer: Multiplan Commercial	$5.05

COLCHICINE 0.6 MG TABLET [1821]

Facility

$1.57

Service Code	NDC 43598-372-30
Hospital Charge Code	901700029
Hospital Revenue Code	259
Min. Negotiated Rate	$0.86
Max. Negotiated Rate	$1.26
Rate for Payer: Cash Price	$0.86
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$1.26
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	$1.18

COLCHICINE 0.6 MG TABLET [1821]

Facility

$11.15

Service Code	NDC 60687-727-21
Hospital Charge Code	901700029
Hospital Revenue Code	259
Min. Negotiated Rate	$6.13
Max. Negotiated Rate	$8.92
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$6.69
Rate for Payer: Aetna of CA Government/Medicare	$6.69
Rate for Payer: Cash Price	$6.13
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$8.92
Rate for Payer: Health Smart Auto/Commercial	$6.69
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$6.69
Rate for Payer: LLUH Dept of Risk Management WC	$6.13
Rate for Payer: Multiplan Commercial	$8.36

COLCHICINE 0.6 MG TABLET [1821]

Facility

$0.98

Service Code	NDC 0591-2562-30
Hospital Charge Code	901700029
Hospital Revenue Code	259
Min. Negotiated Rate	$0.54
Max. Negotiated Rate	$0.78
Rate for Payer: Cash Price	$0.54
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$0.78
Rate for Payer: Health Smart Auto/Commercial	$0.59
Rate for Payer: LLUH Dept of Risk Management WC	$0.54
Rate for Payer: Multiplan Commercial	$0.74

COLCHICINE 0.6 MG TABLET [1821]

Facility

$1.57

Service Code	NDC 43598-372-30
Hospital Charge Code	901700029
Hospital Revenue Code	259
Min. Negotiated Rate	$0.86
Max. Negotiated Rate	$1.26
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	$1.26
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	$1.18

COLCHICINE 0.6 MG TABLET [1821]

Facility

$4.46

Service Code	NDC 50268-187-11
Hospital Charge Code	901700029
Hospital Revenue Code	259
Min. Negotiated Rate	$2.45
Max. Negotiated Rate	$3.57
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$2.68
Rate for Payer: Aetna of CA Government/Medicare	$2.68
Rate for Payer: Cash Price	$2.46
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$3.57
Rate for Payer: Health Smart Auto/Commercial	$2.68
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$2.68
Rate for Payer: LLUH Dept of Risk Management WC	$2.45
Rate for Payer: Multiplan Commercial	$3.35

COLCHICINE 0.6 MG TABLET [1821]

Facility

$0.23

Service Code	NDC 67877-589-01
Hospital Charge Code	901700029
Hospital Revenue Code	259
Min. Negotiated Rate	$0.13
Max. Negotiated Rate	$0.18
Rate for Payer: Cash Price	$0.13
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO 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 Commercial	$0.17

COLCHICINE 0.6 MG TABLET [1821]

Facility

$6.74

Service Code	NDC 0254-2008-01
Hospital Charge Code	901700029
Hospital Revenue Code	259
Min. Negotiated Rate	$3.71
Max. Negotiated Rate	$5.39
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$4.04
Rate for Payer: Aetna of CA Government/Medicare	$4.04
Rate for Payer: Cash Price	$3.70
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$5.39
Rate for Payer: Health Smart Auto/Commercial	$4.04
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$4.04
Rate for Payer: LLUH Dept of Risk Management WC	$3.71
Rate for Payer: Multiplan Commercial	$5.05

COLCHICINE 0.6 MG TABLET [1821]

Facility

$0.23

Service Code	NDC 67877-589-01
Hospital Charge Code	901700029
Hospital Revenue Code	259
Min. Negotiated Rate	$0.13
Max. Negotiated Rate	$0.18
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$0.14
Rate for Payer: Aetna of CA Government/Medicare	$0.14
Rate for Payer: Cash Price	$0.13
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$0.18
Rate for Payer: Health Smart Auto/Commercial	$0.14
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$0.14
Rate for Payer: LLUH Dept of Risk Management WC	$0.13
Rate for Payer: Multiplan Commercial	$0.17

COLCHICINE 0.6 MG TABLET [1821]

Facility

$0.74

Service Code	NDC 65162-710-03
Hospital Charge Code	901700029
Hospital Revenue Code	259
Min. Negotiated Rate	$0.41
Max. Negotiated Rate	$0.59
Rate for Payer: Cash Price	$0.41
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$0.59
Rate for Payer: Health Smart Auto/Commercial	$0.44
Rate for Payer: LLUH Dept of Risk Management WC	$0.41
Rate for Payer: Multiplan Commercial	$0.56

COLCHICINE 0.6 MG TABLET [1821]

Facility

$11.15

Service Code	NDC 60687-727-11
Hospital Charge Code	901700029
Hospital Revenue Code	259
Min. Negotiated Rate	$6.13
Max. Negotiated Rate	$8.92
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$6.69
Rate for Payer: Aetna of CA Government/Medicare	$6.69
Rate for Payer: Cash Price	$6.13
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$8.92
Rate for Payer: Health Smart Auto/Commercial	$6.69
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$6.69
Rate for Payer: LLUH Dept of Risk Management WC	$6.13
Rate for Payer: Multiplan Commercial	$8.36

COLCHICINE 0.6 MG TABLET [1821]

Facility

$11.15

Service Code	NDC 60687-727-11
Hospital Charge Code	901700029
Hospital Revenue Code	259
Min. Negotiated Rate	$6.13
Max. Negotiated Rate	$8.92
Rate for Payer: Cash Price	$6.13
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$8.92
Rate for Payer: Health Smart Auto/Commercial	$6.69
Rate for Payer: LLUH Dept of Risk Management WC	$6.13
Rate for Payer: Multiplan Commercial	$8.36

COLCHICINE 0.6 MG TABLET [1821]

Facility

$0.98

Service Code	NDC 0591-2562-30
Hospital Charge Code	901700029
Hospital Revenue Code	259
Min. Negotiated Rate	$0.54
Max. Negotiated Rate	$0.78
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$0.59
Rate for Payer: Aetna of CA Government/Medicare	$0.59
Rate for Payer: Cash Price	$0.54
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$0.78
Rate for Payer: Health Smart Auto/Commercial	$0.59
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$0.59
Rate for Payer: LLUH Dept of Risk Management WC	$0.54
Rate for Payer: Multiplan Commercial	$0.74

COLCHICINE 0.6 MG TABLET [1821]

Facility

$0.74

Service Code	NDC 65162-710-03
Hospital Charge Code	901700029
Hospital Revenue Code	259
Min. Negotiated Rate	$0.41
Max. Negotiated Rate	$0.59
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$0.44
Rate for Payer: Aetna of CA Government/Medicare	$0.44
Rate for Payer: Cash Price	$0.41
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$0.59
Rate for Payer: Health Smart Auto/Commercial	$0.44
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$0.44
Rate for Payer: LLUH Dept of Risk Management WC	$0.41
Rate for Payer: Multiplan Commercial	$0.56

COLCHICINE 0.6 MG TABLET [1821]

Facility

$11.15

Service Code	NDC 60687-727-21
Hospital Charge Code	901700029
Hospital Revenue Code	259
Min. Negotiated Rate	$6.13
Max. Negotiated Rate	$8.92
Rate for Payer: Cash Price	$6.13
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$8.92
Rate for Payer: Health Smart Auto/Commercial	$6.69
Rate for Payer: LLUH Dept of Risk Management WC	$6.13
Rate for Payer: Multiplan Commercial	$8.36

COLESTIPOL 1 GRAM TABLET [13884]

Facility

$5.00

Service Code	NDC 60687-715-21
Hospital Charge Code	901700029
Hospital Revenue Code	259
Min. Negotiated Rate	$2.75
Max. Negotiated Rate	$4.00
Rate for Payer: Cash Price	$2.75
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$4.00
Rate for Payer: Health Smart Auto/Commercial	$3.00
Rate for Payer: LLUH Dept of Risk Management WC	$2.75
Rate for Payer: Multiplan Commercial	$3.75

COLESTIPOL 1 GRAM TABLET [13884]

Facility

$5.00

Service Code	NDC 60687-715-21
Hospital Charge Code	901700029
Hospital Revenue Code	259
Min. Negotiated Rate	$2.75
Max. Negotiated Rate	$4.00
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$3.00
Rate for Payer: Aetna of CA Government/Medicare	$3.00
Rate for Payer: Cash Price	$2.75
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$4.00
Rate for Payer: Health Smart Auto/Commercial	$3.00
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$3.00
Rate for Payer: LLUH Dept of Risk Management WC	$2.75
Rate for Payer: Multiplan Commercial	$3.75

COLESTIPOL 1 GRAM TABLET [13884]

Facility

$5.00

Service Code	NDC 60687-715-11
Hospital Charge Code	901700029
Hospital Revenue Code	259
Min. Negotiated Rate	$2.75
Max. Negotiated Rate	$4.00
Rate for Payer: Cash Price	$2.75
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$4.00
Rate for Payer: Health Smart Auto/Commercial	$3.00
Rate for Payer: LLUH Dept of Risk Management WC	$2.75
Rate for Payer: Multiplan Commercial	$3.75

COLESTIPOL 1 GRAM TABLET [13884]

Facility

$5.00

Service Code	NDC 60687-715-11
Hospital Charge Code	901700029
Hospital Revenue Code	259
Min. Negotiated Rate	$2.75
Max. Negotiated Rate	$4.00
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$3.00
Rate for Payer: Aetna of CA Government/Medicare	$3.00
Rate for Payer: Cash Price	$2.75
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$4.00
Rate for Payer: Health Smart Auto/Commercial	$3.00
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$3.00
Rate for Payer: LLUH Dept of Risk Management WC	$2.75
Rate for Payer: Multiplan Commercial	$3.75

COLESTIPOL 5 GRAM ORAL PACKET [12218]

Facility

$3.77

Service Code	NDC 0115-5212-18
Hospital Charge Code	901700029
Hospital Revenue Code	259
Min. Negotiated Rate	$2.07
Max. Negotiated Rate	$3.02
Rate for Payer: Cash Price	$2.08
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$3.02
Rate for Payer: Health Smart Auto/Commercial	$2.26
Rate for Payer: LLUH Dept of Risk Management WC	$2.07
Rate for Payer: Multiplan Commercial	$2.83

COLESTIPOL 5 GRAM ORAL PACKET [12218]

Facility

$3.77

Service Code	NDC 0115-5212-18
Hospital Charge Code	901700029
Hospital Revenue Code	259
Min. Negotiated Rate	$2.07
Max. Negotiated Rate	$3.02
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$2.26
Rate for Payer: Aetna of CA Government/Medicare	$2.26
Rate for Payer: Cash Price	$2.08
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$3.02
Rate for Payer: Health Smart Auto/Commercial	$2.26
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$2.26
Rate for Payer: LLUH Dept of Risk Management WC	$2.07
Rate for Payer: Multiplan Commercial	$2.83

COLISTIN (COLISTIMETHATE) 150 MG CBA SOLUTION FOR INJECTION [9681]

Facility

$33.59

Service Code	HCPCS J0770
Hospital Charge Code	901700025
Hospital Revenue Code	636
Min. Negotiated Rate	$18.47
Max. Negotiated Rate	$26.87
Rate for Payer: Cash Price	$18.47
Rate for Payer: Cash Price	$18.48
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$26.88
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$26.87
Rate for Payer: Health Smart Auto/Commercial	$20.15
Rate for Payer: Health Smart Auto/Commercial	$20.16
Rate for Payer: LLUH Dept of Risk Management WC	$18.47
Rate for Payer: LLUH Dept of Risk Management WC	$18.48
Rate for Payer: Multiplan Commercial	$25.20
Rate for Payer: Multiplan Commercial	$25.19

COLISTIN (COLISTIMETHATE) 150 MG CBA SOLUTION FOR INJECTION [9681]

Facility

$33.59

Service Code	HCPCS J0770
Hospital Charge Code	901700025
Hospital Revenue Code	636
Min. Negotiated Rate	$18.47
Max. Negotiated Rate	$26.87
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$20.15
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$20.16
Rate for Payer: Aetna of CA Government/Medicare	$20.15
Rate for Payer: Aetna of CA Government/Medicare	$20.16
Rate for Payer: Cash Price	$18.47
Rate for Payer: Cash Price	$18.48
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$26.87
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$26.88
Rate for Payer: Health Smart Auto/Commercial	$20.15
Rate for Payer: Health Smart Auto/Commercial	$20.16
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$20.15
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$20.16
Rate for Payer: LLUH Dept of Risk Management WC	$18.48
Rate for Payer: LLUH Dept of Risk Management WC	$18.47
Rate for Payer: Multiplan Commercial	$25.19
Rate for Payer: Multiplan Commercial	$25.20

Know your out-of-pocket cost for care.

All Charges