Loma Linda University Behavioral Medicine Center (BMC)

All Charges

Charge

Type

Setting

Price

COLCHICINE 0.6 MG TABLET [1821]

Facility

$6.74

Service Code	NDC 0254-2008-11
Hospital Charge Code	1710835
Hospital Revenue Code	259
Min. Negotiated Rate	$3.71
Max. Negotiated Rate	$5.39
Rate for Payer: Cash Price	$3.03
Rate for Payer: Cigna of CA 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 Beech St/Commercial/PHCS	$5.06

COLCHICINE 0.6 MG TABLET [1821]

Facility

$7.20

Service Code	NDC 50268-187-11
Hospital Charge Code	1710835
Hospital Revenue Code	259
Min. Negotiated Rate	$3.96
Max. Negotiated Rate	$5.40
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$4.32
Rate for Payer: Aetna of CA Government/Medicare	$4.32
Rate for Payer: Cash Price	$3.24
Rate for Payer: Health Smart Auto/Commercial	$4.32
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$4.32
Rate for Payer: LLUH Dept of Risk Management WC	$3.96
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$5.40

COLCHICINE 0.6 MG TABLET [1821]

Facility

$6.74

Service Code	NDC 0254-2008-01
Hospital Charge Code	1710835
Hospital Revenue Code	259
Min. Negotiated Rate	$3.71
Max. Negotiated Rate	$5.06
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	$3.03
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 Beech St/Commercial/PHCS	$5.06

COLCHICINE 0.6 MG TABLET [1821]

Facility

$0.23

Service Code	NDC 67877-589-01
Hospital Charge Code	1710835
Hospital Revenue Code	259
Min. Negotiated Rate	$0.13
Max. Negotiated Rate	$0.17
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	$0.10
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 Beech St/Commercial/PHCS	$0.17

COLCHICINE 0.6 MG TABLET [1821]

Facility

$6.74

Service Code	NDC 0254-2008-11
Hospital Charge Code	1710835
Hospital Revenue Code	259
Min. Negotiated Rate	$3.71
Max. Negotiated Rate	$5.06
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	$3.03
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 Beech St/Commercial/PHCS	$5.06

COLCHICINE 0.6 MG TABLET [1821]

Facility

$11.15

Service Code	NDC 60687-389-21
Hospital Charge Code	1710835
Hospital Revenue Code	259
Min. Negotiated Rate	$6.13
Max. Negotiated Rate	$8.36
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	$5.02
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 Beech St/Commercial/PHCS	$8.36

COLCHICINE 0.6 MG TABLET [1821]

Facility

$2.43

Service Code	NDC 0378-1086-93
Hospital Charge Code	1710835
Hospital Revenue Code	259
Min. Negotiated Rate	$1.34
Max. Negotiated Rate	$1.82
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$1.46
Rate for Payer: Aetna of CA Government/Medicare	$1.46
Rate for Payer: Cash Price	$1.09
Rate for Payer: Health Smart Auto/Commercial	$1.46
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$1.46
Rate for Payer: LLUH Dept of Risk Management WC	$1.34
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$1.82

COLCHICINE 0.6 MG TABLET [1821]

Facility

$0.23

Service Code	NDC 67877-589-01
Hospital Charge Code	1710835
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

COLCHICINE 0.6 MG TABLET [1821]

Facility

$0.98

Service Code	NDC 0591-2562-30
Hospital Charge Code	1710835
Hospital Revenue Code	259
Min. Negotiated Rate	$0.54
Max. Negotiated Rate	$0.78
Rate for Payer: Cash Price	$0.44
Rate for Payer: Cigna of CA 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 Beech St/Commercial/PHCS	$0.74

COLCHICINE 0.6 MG TABLET [1821]

Facility

$11.15

Service Code	NDC 60687-389-11
Hospital Charge Code	1710835
Hospital Revenue Code	259
Min. Negotiated Rate	$6.13
Max. Negotiated Rate	$8.36
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	$5.02
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 Beech St/Commercial/PHCS	$8.36

COLCHICINE 0.6 MG TABLET [1821]

Facility

$0.74

Service Code	NDC 65162-710-03
Hospital Charge Code	1710835
Hospital Revenue Code	259
Min. Negotiated Rate	$0.41
Max. Negotiated Rate	$0.56
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	$0.33
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 Beech St/Commercial/PHCS	$0.56

COLCHICINE 0.6 MG TABLET [1821]

Facility

$1.57

Service Code	NDC 43598-372-30
Hospital Charge Code	1710835
Hospital Revenue Code	259
Min. Negotiated Rate	$0.86
Max. Negotiated Rate	$1.26
Rate for Payer: Cash Price	$0.71
Rate for Payer: Cigna of CA 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 Beech St/Commercial/PHCS	$1.18

COLCHICINE 0.6 MG TABLET [1821]

Facility

$7.20

Service Code	NDC 50268-187-11
Hospital Charge Code	1710835
Hospital Revenue Code	259
Min. Negotiated Rate	$3.96
Max. Negotiated Rate	$5.76
Rate for Payer: Cash Price	$3.24
Rate for Payer: Cigna of CA HMO/PPO	$5.76
Rate for Payer: Health Smart Auto/Commercial	$4.32
Rate for Payer: LLUH Dept of Risk Management WC	$3.96
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$5.40

COLCHICINE 0.6 MG TABLET [1821]

Facility

$11.15

Service Code	NDC 60687-389-11
Hospital Charge Code	1710835
Hospital Revenue Code	259
Min. Negotiated Rate	$6.13
Max. Negotiated Rate	$8.92
Rate for Payer: Cash Price	$5.02
Rate for Payer: Cigna of CA 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 Beech St/Commercial/PHCS	$8.36

COLCHICINE 0.6 MG TABLET [1821]

Facility

$0.74

Service Code	NDC 65162-710-03
Hospital Charge Code	1710835
Hospital Revenue Code	259
Min. Negotiated Rate	$0.41
Max. Negotiated Rate	$0.59
Rate for Payer: Cash Price	$0.33
Rate for Payer: Cigna of CA 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 Beech St/Commercial/PHCS	$0.56

COLCHICINE 0.6 MG TABLET [1821]

Facility

$11.15

Service Code	NDC 60687-389-21
Hospital Charge Code	1710835
Hospital Revenue Code	259
Min. Negotiated Rate	$6.13
Max. Negotiated Rate	$8.92
Rate for Payer: Cash Price	$5.02
Rate for Payer: Cigna of CA 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 Beech St/Commercial/PHCS	$8.36

COLCHICINE 0.6 MG TABLET [1821]

Facility

$0.98

Service Code	NDC 0591-2562-30
Hospital Charge Code	1710835
Hospital Revenue Code	259
Min. Negotiated Rate	$0.54
Max. Negotiated Rate	$0.74
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	$0.44
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 Beech St/Commercial/PHCS	$0.74

COLCHICINE 0.6 MG TABLET [1821]

Facility

$1.57

Service Code	NDC 43598-372-30
Hospital Charge Code	1710835
Hospital Revenue Code	259
Min. Negotiated Rate	$0.86
Max. Negotiated Rate	$1.18
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	$0.71
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 Beech St/Commercial/PHCS	$1.18

COLCHICINE 0.6 MG TABLET [1821]

Facility

$2.43

Service Code	NDC 0378-1086-93
Hospital Charge Code	1710835
Hospital Revenue Code	259
Min. Negotiated Rate	$1.34
Max. Negotiated Rate	$1.94
Rate for Payer: Cash Price	$1.09
Rate for Payer: Cigna of CA HMO/PPO	$1.94
Rate for Payer: Health Smart Auto/Commercial	$1.46
Rate for Payer: LLUH Dept of Risk Management WC	$1.34
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$1.82

COLESEVELAM 625 MG TABLET [28372]

Facility

$4.46

Service Code	NDC 65597-701-18
Hospital Charge Code	1711885
Hospital Revenue Code	259
Min. Negotiated Rate	$2.45
Max. Negotiated Rate	$3.57
Rate for Payer: Cash Price	$2.01
Rate for Payer: Cigna of CA 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 Beech St/Commercial/PHCS	$3.34

COLESEVELAM 625 MG TABLET [28372]

Facility

$4.46

Service Code	NDC 65597-701-18
Hospital Charge Code	1711885
Hospital Revenue Code	259
Min. Negotiated Rate	$2.45
Max. Negotiated Rate	$3.34
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	$2.01
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 Beech St/Commercial/PHCS	$3.34

COLESTIPOL 1 GRAM TABLET [13884]

Facility

$1.26

Service Code	NDC 59762-0450-1
Hospital Charge Code	1711918
Hospital Revenue Code	259
Min. Negotiated Rate	$0.69
Max. Negotiated Rate	$0.95
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$0.76
Rate for Payer: Aetna of CA Government/Medicare	$0.76
Rate for Payer: Cash Price	$0.57
Rate for Payer: Health Smart Auto/Commercial	$0.76
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$0.76
Rate for Payer: LLUH Dept of Risk Management WC	$0.69
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$0.95

COLESTIPOL 1 GRAM TABLET [13884]

Facility

$1.24

Service Code	NDC 0115-5211-16
Hospital Charge Code	1711918
Hospital Revenue Code	259
Min. Negotiated Rate	$0.68
Max. Negotiated Rate	$0.93
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$0.74
Rate for Payer: Aetna of CA Government/Medicare	$0.74
Rate for Payer: Cash Price	$0.56
Rate for Payer: Health Smart Auto/Commercial	$0.74
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$0.74
Rate for Payer: LLUH Dept of Risk Management WC	$0.68
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$0.93

COLESTIPOL 1 GRAM TABLET [13884]

Facility

$1.26

Service Code	NDC 59762-0450-1
Hospital Charge Code	1711918
Hospital Revenue Code	259
Min. Negotiated Rate	$0.69
Max. Negotiated Rate	$1.01
Rate for Payer: Cash Price	$0.57
Rate for Payer: Cigna of CA HMO/PPO	$1.01
Rate for Payer: Health Smart Auto/Commercial	$0.76
Rate for Payer: LLUH Dept of Risk Management WC	$0.69
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$0.95

COLESTIPOL 1 GRAM TABLET [13884]

Facility

$1.24

Service Code	NDC 0115-5211-16
Hospital Charge Code	1711918
Hospital Revenue Code	259
Min. Negotiated Rate	$0.68
Max. Negotiated Rate	$0.99
Rate for Payer: Cash Price	$0.56
Rate for Payer: Cigna of CA HMO/PPO	$0.99
Rate for Payer: Health Smart Auto/Commercial	$0.74
Rate for Payer: LLUH Dept of Risk Management WC	$0.68
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$0.93

Know your out-of-pocket cost for care.

All Charges