Loma Linda University Behavioral Medicine Center (BMC)

All Charges

Charge

Type

Setting

Price

PRAZIQUANTEL 600 MG TABLET [11113]

Facility

$79.72

Service Code	NDC 49884-231-83
Hospital Charge Code	901700029
Hospital Revenue Code	259
Min. Negotiated Rate	$43.85
Max. Negotiated Rate	$63.78
Rate for Payer: Cash Price	$43.84
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$63.78
Rate for Payer: Health Smart Auto/Commercial	$47.83
Rate for Payer: LLUH Dept of Risk Management WC	$43.85
Rate for Payer: Multiplan Commercial	$59.79

PRAZIQUANTEL 600 MG TABLET [11113]

Facility

$79.72

Service Code	NDC 49884-231-83
Hospital Charge Code	901700029
Hospital Revenue Code	259
Min. Negotiated Rate	$43.85
Max. Negotiated Rate	$63.78
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$47.83
Rate for Payer: Aetna of CA Government/Medicare	$47.83
Rate for Payer: Cash Price	$43.84
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$63.78
Rate for Payer: Health Smart Auto/Commercial	$47.83
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$47.83
Rate for Payer: LLUH Dept of Risk Management WC	$43.85
Rate for Payer: Multiplan Commercial	$59.79

PRAZIQUANTEL (BULK) 98.5 %-101 % POWDER [23284]

Facility

$30.69

Service Code	NDC 38779-0090-4
Hospital Charge Code	901700029
Hospital Revenue Code	259
Min. Negotiated Rate	$16.88
Max. Negotiated Rate	$24.55
Rate for Payer: Cash Price	$16.88
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$24.55
Rate for Payer: Health Smart Auto/Commercial	$18.41
Rate for Payer: LLUH Dept of Risk Management WC	$16.88
Rate for Payer: Multiplan Commercial	$23.02

PRAZIQUANTEL (BULK) 98.5 %-101 % POWDER [23284]

Facility

$30.69

Service Code	NDC 38779-0090-4
Hospital Charge Code	901700029
Hospital Revenue Code	259
Min. Negotiated Rate	$16.88
Max. Negotiated Rate	$24.55
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$18.41
Rate for Payer: Aetna of CA Government/Medicare	$18.41
Rate for Payer: Cash Price	$16.88
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$24.55
Rate for Payer: Health Smart Auto/Commercial	$18.41
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$18.41
Rate for Payer: LLUH Dept of Risk Management WC	$16.88
Rate for Payer: Multiplan Commercial	$23.02

PRAZOSIN 1 MG CAPSULE [6468]

Facility

$0.22

Service Code	NDC 70010-084-01
Hospital Charge Code	901700029
Hospital Revenue Code	259
Min. Negotiated Rate	$0.12
Max. Negotiated Rate	$0.18
Rate for Payer: Cash Price	$0.12
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$0.18
Rate for Payer: Health Smart Auto/Commercial	$0.13
Rate for Payer: LLUH Dept of Risk Management WC	$0.12
Rate for Payer: Multiplan Commercial	$0.17

PRAZOSIN 1 MG CAPSULE [6468]

Facility

$1.81

Service Code	NDC 51079-630-01
Hospital Charge Code	901700029
Hospital Revenue Code	259
Min. Negotiated Rate	$1.00
Max. Negotiated Rate	$1.45
Rate for Payer: Cash Price	$1.00
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$1.45
Rate for Payer: Health Smart Auto/Commercial	$1.09
Rate for Payer: LLUH Dept of Risk Management WC	$1.00
Rate for Payer: Multiplan Commercial	$1.36

PRAZOSIN 1 MG CAPSULE [6468]

Facility

$1.78

Service Code	NDC 68084-996-11
Hospital Charge Code	901700029
Hospital Revenue Code	259
Min. Negotiated Rate	$0.98
Max. Negotiated Rate	$1.42
Rate for Payer: Cash Price	$0.98
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$1.42
Rate for Payer: Health Smart Auto/Commercial	$1.07
Rate for Payer: LLUH Dept of Risk Management WC	$0.98
Rate for Payer: Multiplan Commercial	$1.33

PRAZOSIN 1 MG CAPSULE [6468]

Facility

$1.81

Service Code	NDC 51079-630-20
Hospital Charge Code	901700029
Hospital Revenue Code	259
Min. Negotiated Rate	$1.00
Max. Negotiated Rate	$1.45
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$1.09
Rate for Payer: Aetna of CA Government/Medicare	$1.09
Rate for Payer: Cash Price	$1.00
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$1.45
Rate for Payer: Health Smart Auto/Commercial	$1.09
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$1.09
Rate for Payer: LLUH Dept of Risk Management WC	$1.00
Rate for Payer: Multiplan Commercial	$1.36

PRAZOSIN 1 MG CAPSULE [6468]

Facility

$1.81

Service Code	NDC 51079-630-20
Hospital Charge Code	901700029
Hospital Revenue Code	259
Min. Negotiated Rate	$1.00
Max. Negotiated Rate	$1.45
Rate for Payer: Cash Price	$1.00
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$1.45
Rate for Payer: Health Smart Auto/Commercial	$1.09
Rate for Payer: LLUH Dept of Risk Management WC	$1.00
Rate for Payer: Multiplan Commercial	$1.36

PRAZOSIN 1 MG CAPSULE [6468]

Facility

$1.62

Service Code	NDC 0904-7020-61
Hospital Charge Code	901700029
Hospital Revenue Code	259
Min. Negotiated Rate	$0.89
Max. Negotiated Rate	$1.30
Rate for Payer: Cash Price	$0.89
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$1.30
Rate for Payer: Health Smart Auto/Commercial	$0.97
Rate for Payer: LLUH Dept of Risk Management WC	$0.89
Rate for Payer: Multiplan Commercial	$1.22

PRAZOSIN 1 MG CAPSULE [6468]

Facility

$1.81

Service Code	NDC 51079-630-01
Hospital Charge Code	901700029
Hospital Revenue Code	259
Min. Negotiated Rate	$1.00
Max. Negotiated Rate	$1.45
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$1.09
Rate for Payer: Aetna of CA Government/Medicare	$1.09
Rate for Payer: Cash Price	$1.00
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$1.45
Rate for Payer: Health Smart Auto/Commercial	$1.09
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$1.09
Rate for Payer: LLUH Dept of Risk Management WC	$1.00
Rate for Payer: Multiplan Commercial	$1.36

PRAZOSIN 1 MG CAPSULE [6468]

Facility

$1.78

Service Code	NDC 68084-996-01
Hospital Charge Code	901700029
Hospital Revenue Code	259
Min. Negotiated Rate	$0.98
Max. Negotiated Rate	$1.42
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$1.07
Rate for Payer: Aetna of CA Government/Medicare	$1.07
Rate for Payer: Cash Price	$0.98
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$1.42
Rate for Payer: Health Smart Auto/Commercial	$1.07
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$1.07
Rate for Payer: LLUH Dept of Risk Management WC	$0.98
Rate for Payer: Multiplan Commercial	$1.33

PRAZOSIN 1 MG CAPSULE [6468]

Facility

$1.78

Service Code	NDC 68084-996-01
Hospital Charge Code	901700029
Hospital Revenue Code	259
Min. Negotiated Rate	$0.98
Max. Negotiated Rate	$1.42
Rate for Payer: Cash Price	$0.98
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$1.42
Rate for Payer: Health Smart Auto/Commercial	$1.07
Rate for Payer: LLUH Dept of Risk Management WC	$0.98
Rate for Payer: Multiplan Commercial	$1.33

PRAZOSIN 1 MG CAPSULE [6468]

Facility

$1.78

Service Code	NDC 68084-996-11
Hospital Charge Code	901700029
Hospital Revenue Code	259
Min. Negotiated Rate	$0.98
Max. Negotiated Rate	$1.42
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$1.07
Rate for Payer: Aetna of CA Government/Medicare	$1.07
Rate for Payer: Cash Price	$0.98
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$1.42
Rate for Payer: Health Smart Auto/Commercial	$1.07
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$1.07
Rate for Payer: LLUH Dept of Risk Management WC	$0.98
Rate for Payer: Multiplan Commercial	$1.33

PRAZOSIN 1 MG CAPSULE [6468]

Facility

$0.22

Service Code	NDC 70010-084-01
Hospital Charge Code	901700029
Hospital Revenue Code	259
Min. Negotiated Rate	$0.12
Max. Negotiated Rate	$0.18
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$0.13
Rate for Payer: Aetna of CA Government/Medicare	$0.13
Rate for Payer: Cash Price	$0.12
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$0.18
Rate for Payer: Health Smart Auto/Commercial	$0.13
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$0.13
Rate for Payer: LLUH Dept of Risk Management WC	$0.12
Rate for Payer: Multiplan Commercial	$0.17

PRAZOSIN 1 MG CAPSULE [6468]

Facility

$1.62

Service Code	NDC 0904-7020-61
Hospital Charge Code	901700029
Hospital Revenue Code	259
Min. Negotiated Rate	$0.89
Max. Negotiated Rate	$1.30
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$0.97
Rate for Payer: Aetna of CA Government/Medicare	$0.97
Rate for Payer: Cash Price	$0.89
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$1.30
Rate for Payer: Health Smart Auto/Commercial	$0.97
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$0.97
Rate for Payer: LLUH Dept of Risk Management WC	$0.89
Rate for Payer: Multiplan Commercial	$1.22

PRAZOSIN 2 MG CAPSULE [6469]

Facility

$0.26

Service Code	NDC 70010-085-01
Hospital Charge Code	901700029
Hospital Revenue Code	259
Min. Negotiated Rate	$0.14
Max. Negotiated Rate	$0.21
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$0.16
Rate for Payer: Aetna of CA Government/Medicare	$0.16
Rate for Payer: Cash Price	$0.15
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$0.21
Rate for Payer: Health Smart Auto/Commercial	$0.16
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$0.16
Rate for Payer: LLUH Dept of Risk Management WC	$0.14
Rate for Payer: Multiplan Commercial	$0.20

PRAZOSIN 2 MG CAPSULE [6469]

Facility

$0.23

Service Code	NDC 70954-020-10
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

PRAZOSIN 2 MG CAPSULE [6469]

Facility

$0.26

Service Code	NDC 70010-085-01
Hospital Charge Code	901700029
Hospital Revenue Code	259
Min. Negotiated Rate	$0.14
Max. Negotiated Rate	$0.21
Rate for Payer: Cash Price	$0.15
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$0.21
Rate for Payer: Health Smart Auto/Commercial	$0.16
Rate for Payer: LLUH Dept of Risk Management WC	$0.14
Rate for Payer: Multiplan Commercial	$0.20

PRAZOSIN 2 MG CAPSULE [6469]

Facility

$0.23

Service Code	NDC 70954-020-10
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

PRAZOSIN 5 MG CAPSULE [6470]

Facility

$4.31

Service Code	NDC 51079-632-20
Hospital Charge Code	901700029
Hospital Revenue Code	259
Min. Negotiated Rate	$2.37
Max. Negotiated Rate	$3.45
Rate for Payer: Cash Price	$2.37
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$3.45
Rate for Payer: Health Smart Auto/Commercial	$2.59
Rate for Payer: LLUH Dept of Risk Management WC	$2.37
Rate for Payer: Multiplan Commercial	$3.23

PRAZOSIN 5 MG CAPSULE [6470]

Facility

$0.33

Service Code	NDC 70954-021-10
Hospital Charge Code	901700029
Hospital Revenue Code	259
Min. Negotiated Rate	$0.18
Max. Negotiated Rate	$0.26
Rate for Payer: Cash Price	$0.18
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$0.26
Rate for Payer: Health Smart Auto/Commercial	$0.20
Rate for Payer: LLUH Dept of Risk Management WC	$0.18
Rate for Payer: Multiplan Commercial	$0.25

PRAZOSIN 5 MG CAPSULE [6470]

Facility

$4.11

Service Code	NDC 60687-572-33
Hospital Charge Code	901700029
Hospital Revenue Code	259
Min. Negotiated Rate	$2.26
Max. Negotiated Rate	$3.29
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$2.47
Rate for Payer: Aetna of CA Government/Medicare	$2.47
Rate for Payer: Cash Price	$2.26
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$3.29
Rate for Payer: Health Smart Auto/Commercial	$2.47
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$2.47
Rate for Payer: LLUH Dept of Risk Management WC	$2.26
Rate for Payer: Multiplan Commercial	$3.08

PRAZOSIN 5 MG CAPSULE [6470]

Facility

$0.28

Service Code	NDC 70756-440-11
Hospital Charge Code	901700029
Hospital Revenue Code	259
Min. Negotiated Rate	$0.15
Max. Negotiated Rate	$0.22
Rate for Payer: Cash Price	$0.15
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$0.22
Rate for Payer: Health Smart Auto/Commercial	$0.17
Rate for Payer: LLUH Dept of Risk Management WC	$0.15
Rate for Payer: Multiplan Commercial	$0.21

PRAZOSIN 5 MG CAPSULE [6470]

Facility

$4.31

Service Code	NDC 51079-632-20
Hospital Charge Code	901700029
Hospital Revenue Code	259
Min. Negotiated Rate	$2.37
Max. Negotiated Rate	$3.45
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$2.59
Rate for Payer: Aetna of CA Government/Medicare	$2.59
Rate for Payer: Cash Price	$2.37
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$3.45
Rate for Payer: Health Smart Auto/Commercial	$2.59
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$2.59
Rate for Payer: LLUH Dept of Risk Management WC	$2.37
Rate for Payer: Multiplan Commercial	$3.23

Know your out-of-pocket cost for care.

All Charges