Loma Linda University Behavioral Medicine Center (BMC)

All Charges

Charge

Type

Setting

Price

NIMODIPINE 30 MG/5 ML ORAL SYRINGE (FOR ORAL USE ONLY) [228034]

Facility

$12.82

Service Code	NDC 24338-230-05
Hospital Charge Code	901700029
Hospital Revenue Code	259
Min. Negotiated Rate	$7.05
Max. Negotiated Rate	$10.26
Rate for Payer: Cash Price	$7.05
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$10.26
Rate for Payer: Health Smart Auto/Commercial	$7.69
Rate for Payer: LLUH Dept of Risk Management WC	$7.05
Rate for Payer: Multiplan Commercial	$9.62

NIMODIPINE 30 MG/5 ML ORAL SYRINGE (FOR ORAL USE ONLY) [228034]

Facility

$12.82

Service Code	NDC 24338-230-15
Hospital Charge Code	901700029
Hospital Revenue Code	259
Min. Negotiated Rate	$7.05
Max. Negotiated Rate	$10.26
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$7.69
Rate for Payer: Aetna of CA Government/Medicare	$7.69
Rate for Payer: Cash Price	$7.05
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$10.26
Rate for Payer: Health Smart Auto/Commercial	$7.69
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$7.69
Rate for Payer: LLUH Dept of Risk Management WC	$7.05
Rate for Payer: Multiplan Commercial	$9.62

NIMODIPINE 30 MG/5 ML ORAL SYRINGE (FOR ORAL USE ONLY) [228034]

Facility

$12.82

Service Code	NDC 24338-230-30
Hospital Charge Code	901700029
Hospital Revenue Code	259
Min. Negotiated Rate	$7.05
Max. Negotiated Rate	$10.26
Rate for Payer: Cash Price	$7.05
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$10.26
Rate for Payer: Health Smart Auto/Commercial	$7.69
Rate for Payer: LLUH Dept of Risk Management WC	$7.05
Rate for Payer: Multiplan Commercial	$9.62

NIMODIPINE 30 MG/5 ML ORAL SYRINGE (FOR ORAL USE ONLY) [228034]

Facility

$12.82

Service Code	NDC 24338-230-30
Hospital Charge Code	901700029
Hospital Revenue Code	259
Min. Negotiated Rate	$7.05
Max. Negotiated Rate	$10.26
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$7.69
Rate for Payer: Aetna of CA Government/Medicare	$7.69
Rate for Payer: Cash Price	$7.05
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$10.26
Rate for Payer: Health Smart Auto/Commercial	$7.69
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$7.69
Rate for Payer: LLUH Dept of Risk Management WC	$7.05
Rate for Payer: Multiplan Commercial	$9.62

NIMODIPINE 30 MG/5 ML ORAL SYRINGE (FOR ORAL USE ONLY) [228034]

Facility

$12.82

Service Code	NDC 24338-230-12
Hospital Charge Code	901700029
Hospital Revenue Code	259
Min. Negotiated Rate	$7.05
Max. Negotiated Rate	$10.26
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$7.69
Rate for Payer: Aetna of CA Government/Medicare	$7.69
Rate for Payer: Cash Price	$7.05
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$10.26
Rate for Payer: Health Smart Auto/Commercial	$7.69
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$7.69
Rate for Payer: LLUH Dept of Risk Management WC	$7.05
Rate for Payer: Multiplan Commercial	$9.62

NIMODIPINE 30 MG CAPSULE [10722]

Facility

$3.45

Service Code	NDC 69452-209-13
Hospital Charge Code	901700029
Hospital Revenue Code	259
Min. Negotiated Rate	$1.90
Max. Negotiated Rate	$2.76
Rate for Payer: Cash Price	$1.90
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$2.76
Rate for Payer: Health Smart Auto/Commercial	$2.07
Rate for Payer: LLUH Dept of Risk Management WC	$1.90
Rate for Payer: Multiplan Commercial	$2.59

NIMODIPINE 30 MG CAPSULE [10722]

Facility

$3.45

Service Code	NDC 69452-209-07
Hospital Charge Code	901700029
Hospital Revenue Code	259
Min. Negotiated Rate	$1.90
Max. Negotiated Rate	$2.76
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$2.07
Rate for Payer: Aetna of CA Government/Medicare	$2.07
Rate for Payer: Cash Price	$1.90
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$2.76
Rate for Payer: Health Smart Auto/Commercial	$2.07
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$2.07
Rate for Payer: LLUH Dept of Risk Management WC	$1.90
Rate for Payer: Multiplan Commercial	$2.59

NIMODIPINE 30 MG CAPSULE [10722]

Facility

$1.44

Service Code	NDC 23155-512-00
Hospital Charge Code	901700029
Hospital Revenue Code	259
Min. Negotiated Rate	$0.79
Max. Negotiated Rate	$1.15
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$0.86
Rate for Payer: Aetna of CA Government/Medicare	$0.86
Rate for Payer: Cash Price	$0.79
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$1.15
Rate for Payer: Health Smart Auto/Commercial	$0.86
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$0.86
Rate for Payer: LLUH Dept of Risk Management WC	$0.79
Rate for Payer: Multiplan Commercial	$1.08

NIMODIPINE 30 MG CAPSULE [10722]

Facility

$3.45

Service Code	NDC 69452-209-07
Hospital Charge Code	901700029
Hospital Revenue Code	259
Min. Negotiated Rate	$1.90
Max. Negotiated Rate	$2.76
Rate for Payer: Cash Price	$1.90
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$2.76
Rate for Payer: Health Smart Auto/Commercial	$2.07
Rate for Payer: LLUH Dept of Risk Management WC	$1.90
Rate for Payer: Multiplan Commercial	$2.59

NIMODIPINE 30 MG CAPSULE [10722]

Facility

$3.45

Service Code	NDC 69452-209-20
Hospital Charge Code	901700029
Hospital Revenue Code	259
Min. Negotiated Rate	$1.90
Max. Negotiated Rate	$2.76
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$2.07
Rate for Payer: Aetna of CA Government/Medicare	$2.07
Rate for Payer: Cash Price	$1.90
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$2.76
Rate for Payer: Health Smart Auto/Commercial	$2.07
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$2.07
Rate for Payer: LLUH Dept of Risk Management WC	$1.90
Rate for Payer: Multiplan Commercial	$2.59

NIMODIPINE 30 MG CAPSULE [10722]

Facility

$1.44

Service Code	NDC 23155-512-30
Hospital Charge Code	901700029
Hospital Revenue Code	259
Min. Negotiated Rate	$0.79
Max. Negotiated Rate	$1.15
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$0.86
Rate for Payer: Aetna of CA Government/Medicare	$0.86
Rate for Payer: Cash Price	$0.79
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$1.15
Rate for Payer: Health Smart Auto/Commercial	$0.86
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$0.86
Rate for Payer: LLUH Dept of Risk Management WC	$0.79
Rate for Payer: Multiplan Commercial	$1.08

NIMODIPINE 30 MG CAPSULE [10722]

Facility

$1.44

Service Code	NDC 23155-512-30
Hospital Charge Code	901700029
Hospital Revenue Code	259
Min. Negotiated Rate	$0.79
Max. Negotiated Rate	$1.15
Rate for Payer: Cash Price	$0.79
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$1.15
Rate for Payer: Health Smart Auto/Commercial	$0.86
Rate for Payer: LLUH Dept of Risk Management WC	$0.79
Rate for Payer: Multiplan Commercial	$1.08

NIMODIPINE 30 MG CAPSULE [10722]

Facility

$6.00

Service Code	NDC 57664-135-60
Hospital Charge Code	901700029
Hospital Revenue Code	259
Min. Negotiated Rate	$3.30
Max. Negotiated Rate	$4.80
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$3.60
Rate for Payer: Aetna of CA Government/Medicare	$3.60
Rate for Payer: Cash Price	$3.30
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$4.80
Rate for Payer: Health Smart Auto/Commercial	$3.60
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$3.60
Rate for Payer: LLUH Dept of Risk Management WC	$3.30
Rate for Payer: Multiplan Commercial	$4.50

NIMODIPINE 30 MG CAPSULE [10722]

Facility

$1.44

Service Code	NDC 23155-512-00
Hospital Charge Code	901700029
Hospital Revenue Code	259
Min. Negotiated Rate	$0.79
Max. Negotiated Rate	$1.15
Rate for Payer: Cash Price	$0.79
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$1.15
Rate for Payer: Health Smart Auto/Commercial	$0.86
Rate for Payer: LLUH Dept of Risk Management WC	$0.79
Rate for Payer: Multiplan Commercial	$1.08

NIMODIPINE 30 MG CAPSULE [10722]

Facility

$6.00

Service Code	NDC 57664-135-60
Hospital Charge Code	901700029
Hospital Revenue Code	259
Min. Negotiated Rate	$3.30
Max. Negotiated Rate	$4.80
Rate for Payer: Cash Price	$3.30
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$4.80
Rate for Payer: Health Smart Auto/Commercial	$3.60
Rate for Payer: LLUH Dept of Risk Management WC	$3.30
Rate for Payer: Multiplan Commercial	$4.50

NIMODIPINE 30 MG CAPSULE [10722]

Facility

$1.44

Service Code	NDC 23155-512-11
Hospital Charge Code	901700029
Hospital Revenue Code	259
Min. Negotiated Rate	$0.79
Max. Negotiated Rate	$1.15
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$0.86
Rate for Payer: Aetna of CA Government/Medicare	$0.86
Rate for Payer: Cash Price	$0.79
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$1.15
Rate for Payer: Health Smart Auto/Commercial	$0.86
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$0.86
Rate for Payer: LLUH Dept of Risk Management WC	$0.79
Rate for Payer: Multiplan Commercial	$1.08

NIMODIPINE 30 MG CAPSULE [10722]

Facility

$3.45

Service Code	NDC 69452-209-13
Hospital Charge Code	901700029
Hospital Revenue Code	259
Min. Negotiated Rate	$1.90
Max. Negotiated Rate	$2.76
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$2.07
Rate for Payer: Aetna of CA Government/Medicare	$2.07
Rate for Payer: Cash Price	$1.90
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$2.76
Rate for Payer: Health Smart Auto/Commercial	$2.07
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$2.07
Rate for Payer: LLUH Dept of Risk Management WC	$1.90
Rate for Payer: Multiplan Commercial	$2.59

NIMODIPINE 30 MG CAPSULE [10722]

Facility

$1.44

Service Code	NDC 23155-512-11
Hospital Charge Code	901700029
Hospital Revenue Code	259
Min. Negotiated Rate	$0.79
Max. Negotiated Rate	$1.15
Rate for Payer: Cash Price	$0.79
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$1.15
Rate for Payer: Health Smart Auto/Commercial	$0.86
Rate for Payer: LLUH Dept of Risk Management WC	$0.79
Rate for Payer: Multiplan Commercial	$1.08

NIMODIPINE 30 MG CAPSULE [10722]

Facility

$3.45

Service Code	NDC 69452-209-20
Hospital Charge Code	901700029
Hospital Revenue Code	259
Min. Negotiated Rate	$1.90
Max. Negotiated Rate	$2.76
Rate for Payer: Cash Price	$1.90
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$2.76
Rate for Payer: Health Smart Auto/Commercial	$2.07
Rate for Payer: LLUH Dept of Risk Management WC	$1.90
Rate for Payer: Multiplan Commercial	$2.59

NIMODIPINE 60 MG/10 ML ORAL SOLUTION [232032]

Facility

$13.16

Service Code	NDC 24338-260-08
Hospital Charge Code	901700029
Hospital Revenue Code	259
Min. Negotiated Rate	$7.24
Max. Negotiated Rate	$10.53
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$7.90
Rate for Payer: Aetna of CA Government/Medicare	$7.90
Rate for Payer: Cash Price	$7.24
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$10.53
Rate for Payer: Health Smart Auto/Commercial	$7.90
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$7.90
Rate for Payer: LLUH Dept of Risk Management WC	$7.24
Rate for Payer: Multiplan Commercial	$9.87

NIMODIPINE 60 MG/10 ML ORAL SOLUTION [232032]

Facility

$13.16

Service Code	NDC 24338-260-08
Hospital Charge Code	901700029
Hospital Revenue Code	259
Min. Negotiated Rate	$7.24
Max. Negotiated Rate	$10.53
Rate for Payer: Cash Price	$7.24
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$10.53
Rate for Payer: Health Smart Auto/Commercial	$7.90
Rate for Payer: LLUH Dept of Risk Management WC	$7.24
Rate for Payer: Multiplan Commercial	$9.87

NIMODIPINE 60 MG/10 ML ORAL SYRINGE (FOR ORAL USE ONLY) [228035]

Facility

$12.82

Service Code	NDC 24338-260-12
Hospital Charge Code	901700029
Hospital Revenue Code	259
Min. Negotiated Rate	$7.05
Max. Negotiated Rate	$10.26
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$7.69
Rate for Payer: Aetna of CA Government/Medicare	$7.69
Rate for Payer: Cash Price	$7.05
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$10.26
Rate for Payer: Health Smart Auto/Commercial	$7.69
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$7.69
Rate for Payer: LLUH Dept of Risk Management WC	$7.05
Rate for Payer: Multiplan Commercial	$9.62

NIMODIPINE 60 MG/10 ML ORAL SYRINGE (FOR ORAL USE ONLY) [228035]

Facility

$12.82

Service Code	NDC 24338-260-10
Hospital Charge Code	901700029
Hospital Revenue Code	259
Min. Negotiated Rate	$7.05
Max. Negotiated Rate	$10.26
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$7.69
Rate for Payer: Aetna of CA Government/Medicare	$7.69
Rate for Payer: Cash Price	$7.05
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$10.26
Rate for Payer: Health Smart Auto/Commercial	$7.69
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$7.69
Rate for Payer: LLUH Dept of Risk Management WC	$7.05
Rate for Payer: Multiplan Commercial	$9.62

NIMODIPINE 60 MG/10 ML ORAL SYRINGE (FOR ORAL USE ONLY) [228035]

Facility

$12.82

Service Code	NDC 24338-260-12
Hospital Charge Code	901700029
Hospital Revenue Code	259
Min. Negotiated Rate	$7.05
Max. Negotiated Rate	$10.26
Rate for Payer: Cash Price	$7.05
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$10.26
Rate for Payer: Health Smart Auto/Commercial	$7.69
Rate for Payer: LLUH Dept of Risk Management WC	$7.05
Rate for Payer: Multiplan Commercial	$9.62

NIMODIPINE 60 MG/10 ML ORAL SYRINGE (FOR ORAL USE ONLY) [228035]

Facility

$12.82

Service Code	NDC 24338-260-10
Hospital Charge Code	901700029
Hospital Revenue Code	259
Min. Negotiated Rate	$7.05
Max. Negotiated Rate	$10.26
Rate for Payer: Cash Price	$7.05
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$10.26
Rate for Payer: Health Smart Auto/Commercial	$7.69
Rate for Payer: LLUH Dept of Risk Management WC	$7.05
Rate for Payer: Multiplan Commercial	$9.62

Know your out-of-pocket cost for care.

All Charges