Loma Linda University Behavioral Medicine Center (BMC)

All Charges

Charge

Type

Setting

Price

RISPERIDONE 0.5 MG DISINTEGRATING TABLET [35686]

Facility

$1.99

Service Code	NDC 59746-010-32
Hospital Charge Code	901700029
Hospital Revenue Code	259
Min. Negotiated Rate	$1.09
Max. Negotiated Rate	$1.59
Rate for Payer: Cash Price	$1.10
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$1.59
Rate for Payer: Health Smart Auto/Commercial	$1.19
Rate for Payer: LLUH Dept of Risk Management WC	$1.09
Rate for Payer: Multiplan Commercial	$1.49

RISPERIDONE 0.5 MG DISINTEGRATING TABLET [35686]

Facility

$1.99

Service Code	NDC 59746-010-32
Hospital Charge Code	901700029
Hospital Revenue Code	259
Min. Negotiated Rate	$1.09
Max. Negotiated Rate	$1.59
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$1.19
Rate for Payer: Aetna of CA Government/Medicare	$1.19
Rate for Payer: Cash Price	$1.10
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$1.59
Rate for Payer: Health Smart Auto/Commercial	$1.19
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$1.19
Rate for Payer: LLUH Dept of Risk Management WC	$1.09
Rate for Payer: Multiplan Commercial	$1.49

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: Aetna of CA EPO/HMO/POS/PPO	$2.52
Rate for Payer: Aetna of CA Government/Medicare	$2.52
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: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$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: Aetna of CA EPO/HMO/POS/PPO	$2.52
Rate for Payer: Aetna of CA Government/Medicare	$2.52
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: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$2.52
Rate for Payer: LLUH Dept of Risk Management WC	$2.31
Rate for Payer: Multiplan Commercial	$3.15

RISPERIDONE 0.5 MG TABLET [25520]

Facility

$0.22

Service Code	NDC 43547-340-06
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

RISPERIDONE 0.5 MG TABLET [25520]

Facility

$0.15

Service Code	NDC 68382-113-14
Hospital Charge Code	901700029
Hospital Revenue Code	259
Min. Negotiated Rate	$0.08
Max. Negotiated Rate	$0.12
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$0.09
Rate for Payer: Aetna of CA Government/Medicare	$0.09
Rate for Payer: Cash Price	$0.08
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$0.12
Rate for Payer: Health Smart Auto/Commercial	$0.09
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$0.09
Rate for Payer: LLUH Dept of Risk Management WC	$0.08
Rate for Payer: Multiplan Commercial	$0.11

RISPERIDONE 0.5 MG TABLET [25520]

Facility

$0.15

Service Code	NDC 68382-113-14
Hospital Charge Code	901700029
Hospital Revenue Code	259
Min. Negotiated Rate	$0.08
Max. Negotiated Rate	$0.12
Rate for Payer: Cash Price	$0.08
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$0.12
Rate for Payer: Health Smart Auto/Commercial	$0.09
Rate for Payer: LLUH Dept of Risk Management WC	$0.08
Rate for Payer: Multiplan Commercial	$0.11

RISPERIDONE 0.5 MG TABLET [25520]

Facility

$0.22

Service Code	NDC 43547-340-06
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

RISPERIDONE 1 MG DISINTEGRATING TABLET [35687]

Facility

$4.90

Service Code	NDC 49884-315-52
Hospital Charge Code	901700029
Hospital Revenue Code	259
Min. Negotiated Rate	$2.69
Max. Negotiated Rate	$3.92
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$2.94
Rate for Payer: Aetna of CA Government/Medicare	$2.94
Rate for Payer: Cash Price	$2.70
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$3.92
Rate for Payer: Health Smart Auto/Commercial	$2.94
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$2.94
Rate for Payer: LLUH Dept of Risk Management WC	$2.69
Rate for Payer: Multiplan Commercial	$3.67

RISPERIDONE 1 MG DISINTEGRATING TABLET [35687]

Facility

$4.90

Service Code	NDC 49884-315-55
Hospital Charge Code	901700029
Hospital Revenue Code	259
Min. Negotiated Rate	$2.69
Max. Negotiated Rate	$3.92
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$2.94
Rate for Payer: Aetna of CA Government/Medicare	$2.94
Rate for Payer: Cash Price	$2.70
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$3.92
Rate for Payer: Health Smart Auto/Commercial	$2.94
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$2.94
Rate for Payer: LLUH Dept of Risk Management WC	$2.69
Rate for Payer: Multiplan Commercial	$3.67

RISPERIDONE 1 MG DISINTEGRATING TABLET [35687]

Facility

$4.90

Service Code	NDC 49884-315-55
Hospital Charge Code	901700029
Hospital Revenue Code	259
Min. Negotiated Rate	$2.69
Max. Negotiated Rate	$3.92
Rate for Payer: Cash Price	$2.70
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$3.92
Rate for Payer: Health Smart Auto/Commercial	$2.94
Rate for Payer: LLUH Dept of Risk Management WC	$2.69
Rate for Payer: Multiplan Commercial	$3.67

RISPERIDONE 1 MG DISINTEGRATING TABLET [35687]

Facility

$4.90

Service Code	NDC 49884-315-52
Hospital Charge Code	901700029
Hospital Revenue Code	259
Min. Negotiated Rate	$2.69
Max. Negotiated Rate	$3.92
Rate for Payer: Cash Price	$2.70
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$3.92
Rate for Payer: Health Smart Auto/Commercial	$2.94
Rate for Payer: LLUH Dept of Risk Management WC	$2.69
Rate for Payer: Multiplan Commercial	$3.67

RISPERIDONE 1 MG DISINTEGRATING TABLET [35687]

Facility

$2.61

Service Code	NDC 59746-020-22
Hospital Charge Code	901700029
Hospital Revenue Code	259
Min. Negotiated Rate	$1.44
Max. Negotiated Rate	$2.09
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$1.57
Rate for Payer: Aetna of CA Government/Medicare	$1.57
Rate for Payer: Cash Price	$1.44
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$2.09
Rate for Payer: Health Smart Auto/Commercial	$1.57
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$1.57
Rate for Payer: LLUH Dept of Risk Management WC	$1.44
Rate for Payer: Multiplan Commercial	$1.96

RISPERIDONE 1 MG DISINTEGRATING TABLET [35687]

Facility

$2.61

Service Code	NDC 59746-020-22
Hospital Charge Code	901700029
Hospital Revenue Code	259
Min. Negotiated Rate	$1.44
Max. Negotiated Rate	$2.09
Rate for Payer: Cash Price	$1.44
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$2.09
Rate for Payer: Health Smart Auto/Commercial	$1.57
Rate for Payer: LLUH Dept of Risk Management WC	$1.44
Rate for Payer: Multiplan Commercial	$1.96

RISPERIDONE 1 MG/ML ORAL SOLUTION [17377]

Facility

$4.87

Service Code	NDC 50458-596-01
Hospital Charge Code	901700029
Hospital Revenue Code	259
Min. Negotiated Rate	$2.68
Max. Negotiated Rate	$3.90
Rate for Payer: Cash Price	$2.68
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$3.90
Rate for Payer: Health Smart Auto/Commercial	$2.92
Rate for Payer: LLUH Dept of Risk Management WC	$2.68
Rate for Payer: Multiplan Commercial	$3.65

RISPERIDONE 1 MG/ML ORAL SOLUTION [17377]

Facility

$0.80

Service Code	NDC 27808-002-01
Hospital Charge Code	901700029
Hospital Revenue Code	259
Min. Negotiated Rate	$0.44
Max. Negotiated Rate	$0.64
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$0.48
Rate for Payer: Aetna of CA Government/Medicare	$0.48
Rate for Payer: Cash Price	$0.44
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$0.64
Rate for Payer: Health Smart Auto/Commercial	$0.48
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$0.48
Rate for Payer: LLUH Dept of Risk Management WC	$0.44
Rate for Payer: Multiplan Commercial	$0.60

RISPERIDONE 1 MG/ML ORAL SOLUTION [17377]

Facility

$0.84

Service Code	NDC 65162-673-84
Hospital Charge Code	901700029
Hospital Revenue Code	259
Min. Negotiated Rate	$0.46
Max. Negotiated Rate	$0.67
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$0.50
Rate for Payer: Aetna of CA Government/Medicare	$0.50
Rate for Payer: Cash Price	$0.46
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$0.67
Rate for Payer: Health Smart Auto/Commercial	$0.50
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$0.50
Rate for Payer: LLUH Dept of Risk Management WC	$0.46
Rate for Payer: Multiplan Commercial	$0.63

RISPERIDONE 1 MG/ML ORAL SOLUTION [17377]

Facility

$0.80

Service Code	NDC 27808-002-01
Hospital Charge Code	901700029
Hospital Revenue Code	259
Min. Negotiated Rate	$0.44
Max. Negotiated Rate	$0.64
Rate for Payer: Cash Price	$0.44
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$0.64
Rate for Payer: Health Smart Auto/Commercial	$0.48
Rate for Payer: LLUH Dept of Risk Management WC	$0.44
Rate for Payer: Multiplan Commercial	$0.60

RISPERIDONE 1 MG/ML ORAL SOLUTION [17377]

Facility

$4.87

Service Code	NDC 50458-596-01
Hospital Charge Code	901700029
Hospital Revenue Code	259
Min. Negotiated Rate	$2.68
Max. Negotiated Rate	$3.90
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$2.92
Rate for Payer: Aetna of CA Government/Medicare	$2.92
Rate for Payer: Cash Price	$2.68
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$3.90
Rate for Payer: Health Smart Auto/Commercial	$2.92
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$2.92
Rate for Payer: LLUH Dept of Risk Management WC	$2.68
Rate for Payer: Multiplan Commercial	$3.65

RISPERIDONE 1 MG/ML ORAL SOLUTION [17377]

Facility

$0.84

Service Code	NDC 65162-673-84
Hospital Charge Code	901700029
Hospital Revenue Code	259
Min. Negotiated Rate	$0.46
Max. Negotiated Rate	$0.67
Rate for Payer: Cash Price	$0.46
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$0.67
Rate for Payer: Health Smart Auto/Commercial	$0.50
Rate for Payer: LLUH Dept of Risk Management WC	$0.46
Rate for Payer: Multiplan Commercial	$0.63

RISPERIDONE 1 MG TABLET [18313]

Facility

$0.24

Service Code	NDC 43547-341-06
Hospital Charge Code	901700029
Hospital Revenue Code	259
Min. Negotiated Rate	$0.13
Max. Negotiated Rate	$0.19
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	$0.19
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	$0.18

RISPERIDONE 1 MG TABLET [18313]

Facility

$0.50

Service Code	NDC 68084-272-01
Hospital Charge Code	901700029
Hospital Revenue Code	259
Min. Negotiated Rate	$0.28
Max. Negotiated Rate	$0.40
Rate for Payer: Cash Price	$0.28
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$0.40
Rate for Payer: Health Smart Auto/Commercial	$0.30
Rate for Payer: LLUH Dept of Risk Management WC	$0.28
Rate for Payer: Multiplan Commercial	$0.38

RISPERIDONE 1 MG TABLET [18313]

Facility

$0.50

Service Code	NDC 68084-272-11
Hospital Charge Code	901700029
Hospital Revenue Code	259
Min. Negotiated Rate	$0.28
Max. Negotiated Rate	$0.40
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$0.30
Rate for Payer: Aetna of CA Government/Medicare	$0.30
Rate for Payer: Cash Price	$0.28
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$0.40
Rate for Payer: Health Smart Auto/Commercial	$0.30
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$0.30
Rate for Payer: LLUH Dept of Risk Management WC	$0.28
Rate for Payer: Multiplan Commercial	$0.38

RISPERIDONE 1 MG TABLET [18313]

Facility

$0.50

Service Code	NDC 68084-272-11
Hospital Charge Code	901700029
Hospital Revenue Code	259
Min. Negotiated Rate	$0.28
Max. Negotiated Rate	$0.40
Rate for Payer: Cash Price	$0.28
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$0.40
Rate for Payer: Health Smart Auto/Commercial	$0.30
Rate for Payer: LLUH Dept of Risk Management WC	$0.28
Rate for Payer: Multiplan Commercial	$0.38

RISPERIDONE 1 MG TABLET [18313]

Facility

$0.50

Service Code	NDC 68084-272-01
Hospital Charge Code	901700029
Hospital Revenue Code	259
Min. Negotiated Rate	$0.28
Max. Negotiated Rate	$0.40
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$0.30
Rate for Payer: Aetna of CA Government/Medicare	$0.30
Rate for Payer: Cash Price	$0.28
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$0.40
Rate for Payer: Health Smart Auto/Commercial	$0.30
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$0.30
Rate for Payer: LLUH Dept of Risk Management WC	$0.28
Rate for Payer: Multiplan Commercial	$0.38

Know your out-of-pocket cost for care.

All Charges