Loma Linda University Behavioral Medicine Center (BMC)

All Charges

Charge

Type

Setting

Price

RIMABOTULINUMTOXINB 2,500 UNIT/0.5 ML INTRAMUSCULAR SOLUTION [108078]

Facility

$762.10

Service Code	HCPCS J0587
Hospital Charge Code	901700025
Hospital Revenue Code	636
Min. Negotiated Rate	$419.15
Max. Negotiated Rate	$609.68
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$457.26
Rate for Payer: Aetna of CA Government/Medicare	$457.26
Rate for Payer: Cash Price	$419.15
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$609.68
Rate for Payer: Health Smart Auto/Commercial	$457.26
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$457.26
Rate for Payer: LLUH Dept of Risk Management WC	$419.15
Rate for Payer: Multiplan Commercial	$571.58

RINGER'S INTRAVENOUS SOLUTION [11295]

Facility

$0.01

Service Code	NDC 0264-7780-00
Hospital Charge Code	901700001
Hospital Revenue Code	250
Min. Negotiated Rate	$0.01
Max. Negotiated Rate	$0.01
Rate for Payer: Cash Price	$0.01
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$0.01
Rate for Payer: Health Smart Auto/Commercial	$0.01
Rate for Payer: LLUH Dept of Risk Management WC	$0.01
Rate for Payer: Multiplan Commercial	$0.01

RINGER'S INTRAVENOUS SOLUTION [11295]

Facility

$0.01

Service Code	NDC 0264-7780-00
Hospital Charge Code	901700001
Hospital Revenue Code	250
Min. Negotiated Rate	$0.01
Max. Negotiated Rate	$0.01
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$0.01
Rate for Payer: Aetna of CA Government/Medicare	$0.01
Rate for Payer: Cash Price	$0.01
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$0.01
Rate for Payer: Health Smart Auto/Commercial	$0.01
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$0.01
Rate for Payer: LLUH Dept of Risk Management WC	$0.01
Rate for Payer: Multiplan Commercial	$0.01

RIOCIGUAT 0.5 MG TABLET [203879]

Facility

$188.14

Service Code	NDC 50419-250-01
Hospital Charge Code	901700029
Hospital Revenue Code	259
Min. Negotiated Rate	$103.48
Max. Negotiated Rate	$150.51
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$112.88
Rate for Payer: Aetna of CA Government/Medicare	$112.88
Rate for Payer: Cash Price	$103.47
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$150.51
Rate for Payer: Health Smart Auto/Commercial	$112.88
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$112.88
Rate for Payer: LLUH Dept of Risk Management WC	$103.48
Rate for Payer: Multiplan Commercial	$141.10

RIOCIGUAT 0.5 MG TABLET [203879]

Facility

$188.14

Service Code	NDC 50419-250-91
Hospital Charge Code	901700029
Hospital Revenue Code	259
Min. Negotiated Rate	$103.48
Max. Negotiated Rate	$150.51
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$112.88
Rate for Payer: Aetna of CA Government/Medicare	$112.88
Rate for Payer: Cash Price	$103.47
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$150.51
Rate for Payer: Health Smart Auto/Commercial	$112.88
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$112.88
Rate for Payer: LLUH Dept of Risk Management WC	$103.48
Rate for Payer: Multiplan Commercial	$141.10

RIOCIGUAT 0.5 MG TABLET [203879]

Facility

$188.14

Service Code	NDC 50419-250-91
Hospital Charge Code	901700029
Hospital Revenue Code	259
Min. Negotiated Rate	$103.48
Max. Negotiated Rate	$150.51
Rate for Payer: Cash Price	$103.47
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$150.51
Rate for Payer: Health Smart Auto/Commercial	$112.88
Rate for Payer: LLUH Dept of Risk Management WC	$103.48
Rate for Payer: Multiplan Commercial	$141.10

RIOCIGUAT 0.5 MG TABLET [203879]

Facility

$188.14

Service Code	NDC 50419-250-01
Hospital Charge Code	901700029
Hospital Revenue Code	259
Min. Negotiated Rate	$103.48
Max. Negotiated Rate	$150.51
Rate for Payer: Cash Price	$103.47
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$150.51
Rate for Payer: Health Smart Auto/Commercial	$112.88
Rate for Payer: LLUH Dept of Risk Management WC	$103.48
Rate for Payer: Multiplan Commercial	$141.10

RIOCIGUAT 1 MG TABLET [203880]

Facility

$188.14

Service Code	NDC 50419-251-01
Hospital Charge Code	901700029
Hospital Revenue Code	259
Min. Negotiated Rate	$103.48
Max. Negotiated Rate	$150.51
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$112.88
Rate for Payer: Aetna of CA Government/Medicare	$112.88
Rate for Payer: Cash Price	$103.47
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$150.51
Rate for Payer: Health Smart Auto/Commercial	$112.88
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$112.88
Rate for Payer: LLUH Dept of Risk Management WC	$103.48
Rate for Payer: Multiplan Commercial	$141.10

RIOCIGUAT 1 MG TABLET [203880]

Facility

$188.14

Service Code	NDC 50419-251-91
Hospital Charge Code	901700029
Hospital Revenue Code	259
Min. Negotiated Rate	$103.48
Max. Negotiated Rate	$150.51
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$112.88
Rate for Payer: Aetna of CA Government/Medicare	$112.88
Rate for Payer: Cash Price	$103.47
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$150.51
Rate for Payer: Health Smart Auto/Commercial	$112.88
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$112.88
Rate for Payer: LLUH Dept of Risk Management WC	$103.48
Rate for Payer: Multiplan Commercial	$141.10

RIOCIGUAT 1 MG TABLET [203880]

Facility

$188.14

Service Code	NDC 50419-251-91
Hospital Charge Code	901700029
Hospital Revenue Code	259
Min. Negotiated Rate	$103.48
Max. Negotiated Rate	$150.51
Rate for Payer: Cash Price	$103.47
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$150.51
Rate for Payer: Health Smart Auto/Commercial	$112.88
Rate for Payer: LLUH Dept of Risk Management WC	$103.48
Rate for Payer: Multiplan Commercial	$141.10

RIOCIGUAT 1 MG TABLET [203880]

Facility

$188.14

Service Code	NDC 50419-251-01
Hospital Charge Code	901700029
Hospital Revenue Code	259
Min. Negotiated Rate	$103.48
Max. Negotiated Rate	$150.51
Rate for Payer: Cash Price	$103.47
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$150.51
Rate for Payer: Health Smart Auto/Commercial	$112.88
Rate for Payer: LLUH Dept of Risk Management WC	$103.48
Rate for Payer: Multiplan Commercial	$141.10

RIOCIGUAT 2.5 MG TABLET [203883]

Facility

$188.14

Service Code	NDC 50419-254-91
Hospital Charge Code	901700029
Hospital Revenue Code	259
Min. Negotiated Rate	$103.48
Max. Negotiated Rate	$150.51
Rate for Payer: Cash Price	$103.47
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$150.51
Rate for Payer: Health Smart Auto/Commercial	$112.88
Rate for Payer: LLUH Dept of Risk Management WC	$103.48
Rate for Payer: Multiplan Commercial	$141.10

RIOCIGUAT 2.5 MG TABLET [203883]

Facility

$188.14

Service Code	NDC 50419-254-01
Hospital Charge Code	901700029
Hospital Revenue Code	259
Min. Negotiated Rate	$103.48
Max. Negotiated Rate	$150.51
Rate for Payer: Cash Price	$103.47
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$150.51
Rate for Payer: Health Smart Auto/Commercial	$112.88
Rate for Payer: LLUH Dept of Risk Management WC	$103.48
Rate for Payer: Multiplan Commercial	$141.10

RIOCIGUAT 2.5 MG TABLET [203883]

Facility

$188.14

Service Code	NDC 50419-254-01
Hospital Charge Code	901700029
Hospital Revenue Code	259
Min. Negotiated Rate	$103.48
Max. Negotiated Rate	$150.51
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$112.88
Rate for Payer: Aetna of CA Government/Medicare	$112.88
Rate for Payer: Cash Price	$103.47
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$150.51
Rate for Payer: Health Smart Auto/Commercial	$112.88
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$112.88
Rate for Payer: LLUH Dept of Risk Management WC	$103.48
Rate for Payer: Multiplan Commercial	$141.10

RIOCIGUAT 2.5 MG TABLET [203883]

Facility

$188.14

Service Code	NDC 50419-254-91
Hospital Charge Code	901700029
Hospital Revenue Code	259
Min. Negotiated Rate	$103.48
Max. Negotiated Rate	$150.51
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$112.88
Rate for Payer: Aetna of CA Government/Medicare	$112.88
Rate for Payer: Cash Price	$103.47
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$150.51
Rate for Payer: Health Smart Auto/Commercial	$112.88
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$112.88
Rate for Payer: LLUH Dept of Risk Management WC	$103.48
Rate for Payer: Multiplan Commercial	$141.10

RIPRETINIB 50 MG TABLET [228115]

Facility

$591.60

Service Code	NDC 73207-101-30
Hospital Charge Code	901700029
Hospital Revenue Code	259
Min. Negotiated Rate	$325.38
Max. Negotiated Rate	$473.28
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$354.96
Rate for Payer: Aetna of CA Government/Medicare	$354.96
Rate for Payer: Cash Price	$325.38
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$473.28
Rate for Payer: Health Smart Auto/Commercial	$354.96
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$354.96
Rate for Payer: LLUH Dept of Risk Management WC	$325.38
Rate for Payer: Multiplan Commercial	$443.70

RIPRETINIB 50 MG TABLET [228115]

Facility

$591.60

Service Code	NDC 73207-101-30
Hospital Charge Code	901700029
Hospital Revenue Code	259
Min. Negotiated Rate	$325.38
Max. Negotiated Rate	$473.28
Rate for Payer: Cash Price	$325.38
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$473.28
Rate for Payer: Health Smart Auto/Commercial	$354.96
Rate for Payer: LLUH Dept of Risk Management WC	$325.38
Rate for Payer: Multiplan Commercial	$443.70

RISEDRONATE 35 MG TABLET [32895]

Facility

$102.29

Service Code	NDC 0430-0472-03
Hospital Charge Code	901700029
Hospital Revenue Code	259
Min. Negotiated Rate	$56.26
Max. Negotiated Rate	$81.83
Rate for Payer: Cash Price	$56.26
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$81.83
Rate for Payer: Health Smart Auto/Commercial	$61.37
Rate for Payer: LLUH Dept of Risk Management WC	$56.26
Rate for Payer: Multiplan Commercial	$76.72

RISEDRONATE 35 MG TABLET [32895]

Facility

$102.29

Service Code	NDC 0430-0472-03
Hospital Charge Code	901700029
Hospital Revenue Code	259
Min. Negotiated Rate	$56.26
Max. Negotiated Rate	$81.83
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$61.37
Rate for Payer: Aetna of CA Government/Medicare	$61.37
Rate for Payer: Cash Price	$56.26
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$81.83
Rate for Payer: Health Smart Auto/Commercial	$61.37
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$61.37
Rate for Payer: LLUH Dept of Risk Management WC	$56.26
Rate for Payer: Multiplan Commercial	$76.72

RISPERIDONE 0.25 MG TABLET [25519]

Facility

$0.27

Service Code	NDC 68084-270-11
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	$0.16
Rate for Payer: LLUH Dept of Risk Management WC	$0.15
Rate for Payer: Multiplan Commercial	$0.20

RISPERIDONE 0.25 MG TABLET [25519]

Facility

$0.27

Service Code	NDC 68084-270-11
Hospital Charge Code	901700029
Hospital Revenue Code	259
Min. Negotiated Rate	$0.15
Max. Negotiated Rate	$0.22
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	$0.22
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	$0.15
Rate for Payer: Multiplan Commercial	$0.20

RISPERIDONE 0.25 MG TABLET [25519]

Facility

$0.27

Service Code	NDC 68084-270-01
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	$0.16
Rate for Payer: LLUH Dept of Risk Management WC	$0.15
Rate for Payer: Multiplan Commercial	$0.20

RISPERIDONE 0.25 MG TABLET [25519]

Facility

$0.27

Service Code	NDC 68084-270-01
Hospital Charge Code	901700029
Hospital Revenue Code	259
Min. Negotiated Rate	$0.15
Max. Negotiated Rate	$0.22
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	$0.22
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	$0.15
Rate for Payer: Multiplan Commercial	$0.20

RISPERIDONE 0.5 MG DISINTEGRATING TABLET [35686]

Facility

$4.20

Service Code	NDC 49884-311-91
Hospital Charge Code	901700029
Hospital Revenue Code	259
Min. Negotiated Rate	$2.31
Max. Negotiated Rate	$3.36
Rate for Payer: Cash Price	$2.31
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$3.36
Rate for Payer: Health Smart Auto/Commercial	$2.52
Rate for Payer: LLUH Dept of Risk Management WC	$2.31
Rate for Payer: Multiplan Commercial	$3.15

RISPERIDONE 0.5 MG DISINTEGRATING TABLET [35686]

Facility

$4.20

Service Code	NDC 49884-311-52
Hospital Charge Code	901700029
Hospital Revenue Code	259
Min. Negotiated Rate	$2.31
Max. Negotiated Rate	$3.36
Rate for Payer: Cash Price	$2.31
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$3.36
Rate for Payer: Health Smart Auto/Commercial	$2.52
Rate for Payer: LLUH Dept of Risk Management WC	$2.31
Rate for Payer: Multiplan Commercial	$3.15

Know your out-of-pocket cost for care.

All Charges