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

$10.79

Service Code	NDC 24338-230-12
Hospital Charge Code	NDG40820772A
Hospital Revenue Code	259
Min. Negotiated Rate	$5.93
Max. Negotiated Rate	$8.09
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$6.47
Rate for Payer: Aetna of CA Government/Medicare	$6.47
Rate for Payer: Cash Price	$4.86
Rate for Payer: Health Smart Auto/Commercial	$6.47
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$6.47
Rate for Payer: LLUH Dept of Risk Management WC	$5.93
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$8.09

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

Facility

$10.79

Service Code	NDC 24338-230-05
Hospital Charge Code	NDG40820772A
Hospital Revenue Code	259
Min. Negotiated Rate	$5.93
Max. Negotiated Rate	$8.09
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$6.47
Rate for Payer: Aetna of CA Government/Medicare	$6.47
Rate for Payer: Cash Price	$4.86
Rate for Payer: Health Smart Auto/Commercial	$6.47
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$6.47
Rate for Payer: LLUH Dept of Risk Management WC	$5.93
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$8.09

NIMODIPINE 30 MG CAPSULE [10722]

Facility

$3.45

Service Code	NDC 69452-209-20
Hospital Charge Code	1711278
Hospital Revenue Code	259
Min. Negotiated Rate	$1.90
Max. Negotiated Rate	$2.59
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	$1.55
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 Beech St/Commercial/PHCS	$2.59

NIMODIPINE 30 MG CAPSULE [10722]

Facility

$2.53

Service Code	NDC 68084-912-33
Hospital Charge Code	1711278
Hospital Revenue Code	259
Min. Negotiated Rate	$1.39
Max. Negotiated Rate	$1.90
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$1.52
Rate for Payer: Aetna of CA Government/Medicare	$1.52
Rate for Payer: Cash Price	$1.14
Rate for Payer: Health Smart Auto/Commercial	$1.52
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$1.52
Rate for Payer: LLUH Dept of Risk Management WC	$1.39
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$1.90

NIMODIPINE 30 MG CAPSULE [10722]

Facility

$3.45

Service Code	NDC 69452-209-07
Hospital Charge Code	1711278
Hospital Revenue Code	259
Min. Negotiated Rate	$1.90
Max. Negotiated Rate	$2.76
Rate for Payer: Cash Price	$1.55
Rate for Payer: Cigna of CA 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 Beech St/Commercial/PHCS	$2.59

NIMODIPINE 30 MG CAPSULE [10722]

Facility

$2.53

Service Code	NDC 68084-912-31
Hospital Charge Code	1711278
Hospital Revenue Code	259
Min. Negotiated Rate	$1.39
Max. Negotiated Rate	$1.90
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$1.52
Rate for Payer: Aetna of CA Government/Medicare	$1.52
Rate for Payer: Cash Price	$1.14
Rate for Payer: Health Smart Auto/Commercial	$1.52
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$1.52
Rate for Payer: LLUH Dept of Risk Management WC	$1.39
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$1.90

NIMODIPINE 30 MG CAPSULE [10722]

Facility

$3.45

Service Code	NDC 69452-209-13
Hospital Charge Code	1711278
Hospital Revenue Code	259
Min. Negotiated Rate	$1.90
Max. Negotiated Rate	$2.59
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	$1.55
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 Beech St/Commercial/PHCS	$2.59

NIMODIPINE 30 MG CAPSULE [10722]

Facility

$3.45

Service Code	NDC 69452-209-07
Hospital Charge Code	1711278
Hospital Revenue Code	259
Min. Negotiated Rate	$1.90
Max. Negotiated Rate	$2.59
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	$1.55
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 Beech St/Commercial/PHCS	$2.59

NIMODIPINE 30 MG CAPSULE [10722]

Facility

$2.53

Service Code	NDC 68084-912-31
Hospital Charge Code	1711278
Hospital Revenue Code	259
Min. Negotiated Rate	$1.39
Max. Negotiated Rate	$2.02
Rate for Payer: Cash Price	$1.14
Rate for Payer: Cigna of CA HMO/PPO	$2.02
Rate for Payer: Health Smart Auto/Commercial	$1.52
Rate for Payer: LLUH Dept of Risk Management WC	$1.39
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$1.90

NIMODIPINE 30 MG CAPSULE [10722]

Facility

$1.44

Service Code	NDC 23155-512-00
Hospital Charge Code	1711278
Hospital Revenue Code	259
Min. Negotiated Rate	$0.79
Max. Negotiated Rate	$1.15
Rate for Payer: Cash Price	$0.65
Rate for Payer: Cigna of CA 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 Beech St/Commercial/PHCS	$1.08

NIMODIPINE 30 MG CAPSULE [10722]

Facility

$1.44

Service Code	NDC 23155-512-30
Hospital Charge Code	1711278
Hospital Revenue Code	259
Min. Negotiated Rate	$0.79
Max. Negotiated Rate	$1.15
Rate for Payer: Cash Price	$0.65
Rate for Payer: Cigna of CA 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 Beech St/Commercial/PHCS	$1.08

NIMODIPINE 30 MG CAPSULE [10722]

Facility

$6.00

Service Code	NDC 57664-135-60
Hospital Charge Code	1711278
Hospital Revenue Code	259
Min. Negotiated Rate	$3.30
Max. Negotiated Rate	$4.80
Rate for Payer: Cash Price	$2.70
Rate for Payer: Cigna of CA 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 Beech St/Commercial/PHCS	$4.50

NIMODIPINE 30 MG CAPSULE [10722]

Facility

$6.00

Service Code	NDC 57664-135-60
Hospital Charge Code	1711278
Hospital Revenue Code	259
Min. Negotiated Rate	$3.30
Max. Negotiated Rate	$4.50
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	$2.70
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 Beech St/Commercial/PHCS	$4.50

NIMODIPINE 30 MG CAPSULE [10722]

Facility

$3.45

Service Code	NDC 69452-209-20
Hospital Charge Code	1711278
Hospital Revenue Code	259
Min. Negotiated Rate	$1.90
Max. Negotiated Rate	$2.76
Rate for Payer: Cash Price	$1.55
Rate for Payer: Cigna of CA 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 Beech St/Commercial/PHCS	$2.59

NIMODIPINE 30 MG CAPSULE [10722]

Facility

$1.44

Service Code	NDC 23155-512-00
Hospital Charge Code	1711278
Hospital Revenue Code	259
Min. Negotiated Rate	$0.79
Max. Negotiated Rate	$1.08
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	$0.65
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 Beech St/Commercial/PHCS	$1.08

NIMODIPINE 30 MG CAPSULE [10722]

Facility

$2.53

Service Code	NDC 68084-912-33
Hospital Charge Code	1711278
Hospital Revenue Code	259
Min. Negotiated Rate	$1.39
Max. Negotiated Rate	$2.02
Rate for Payer: Cash Price	$1.14
Rate for Payer: Cigna of CA HMO/PPO	$2.02
Rate for Payer: Health Smart Auto/Commercial	$1.52
Rate for Payer: LLUH Dept of Risk Management WC	$1.39
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$1.90

NIMODIPINE 30 MG CAPSULE [10722]

Facility

$1.44

Service Code	NDC 23155-512-11
Hospital Charge Code	1711278
Hospital Revenue Code	259
Min. Negotiated Rate	$0.79
Max. Negotiated Rate	$1.08
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	$0.65
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 Beech St/Commercial/PHCS	$1.08

NIMODIPINE 30 MG CAPSULE [10722]

Facility

$1.44

Service Code	NDC 23155-512-30
Hospital Charge Code	1711278
Hospital Revenue Code	259
Min. Negotiated Rate	$0.79
Max. Negotiated Rate	$1.08
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	$0.65
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 Beech St/Commercial/PHCS	$1.08

NIMODIPINE 30 MG CAPSULE [10722]

Facility

$3.45

Service Code	NDC 69452-209-13
Hospital Charge Code	1711278
Hospital Revenue Code	259
Min. Negotiated Rate	$1.90
Max. Negotiated Rate	$2.76
Rate for Payer: Cash Price	$1.55
Rate for Payer: Cigna of CA 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 Beech St/Commercial/PHCS	$2.59

NIMODIPINE 30 MG CAPSULE [10722]

Facility

$1.44

Service Code	NDC 23155-512-11
Hospital Charge Code	1711278
Hospital Revenue Code	259
Min. Negotiated Rate	$0.79
Max. Negotiated Rate	$1.15
Rate for Payer: Cash Price	$0.65
Rate for Payer: Cigna of CA 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 Beech St/Commercial/PHCS	$1.08

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

Facility

$10.79

Service Code	NDC 24338-260-10
Hospital Charge Code	NDG40820772B
Hospital Revenue Code	259
Min. Negotiated Rate	$5.93
Max. Negotiated Rate	$8.09
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$6.47
Rate for Payer: Aetna of CA Government/Medicare	$6.47
Rate for Payer: Cash Price	$4.86
Rate for Payer: Health Smart Auto/Commercial	$6.47
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$6.47
Rate for Payer: LLUH Dept of Risk Management WC	$5.93
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$8.09

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

Facility

$10.79

Service Code	NDC 24338-260-12
Hospital Charge Code	NDG40820772B
Hospital Revenue Code	259
Min. Negotiated Rate	$5.93
Max. Negotiated Rate	$8.09
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$6.47
Rate for Payer: Aetna of CA Government/Medicare	$6.47
Rate for Payer: Cash Price	$4.86
Rate for Payer: Health Smart Auto/Commercial	$6.47
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$6.47
Rate for Payer: LLUH Dept of Risk Management WC	$5.93
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$8.09

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

Facility

$10.79

Service Code	NDC 24338-260-12
Hospital Charge Code	NDG40820772B
Hospital Revenue Code	259
Min. Negotiated Rate	$5.93
Max. Negotiated Rate	$8.63
Rate for Payer: Cash Price	$4.86
Rate for Payer: Cigna of CA HMO/PPO	$8.63
Rate for Payer: Health Smart Auto/Commercial	$6.47
Rate for Payer: LLUH Dept of Risk Management WC	$5.93
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$8.09

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

Facility

$10.79

Service Code	NDC 24338-260-10
Hospital Charge Code	NDG40820772B
Hospital Revenue Code	259
Min. Negotiated Rate	$5.93
Max. Negotiated Rate	$8.63
Rate for Payer: Health Smart Auto/Commercial	$6.47
Rate for Payer: Cash Price	$4.86
Rate for Payer: Cigna of CA HMO/PPO	$8.63
Rate for Payer: LLUH Dept of Risk Management WC	$5.93
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$8.09

NIMODIPINE ORAL SUSPENSION COMPOUND 30 MG/ML [4080312]

Facility

$9.15

Service Code	NDC 9994-0803-12
Hospital Charge Code	1715266
Hospital Revenue Code	259
Min. Negotiated Rate	$5.03
Max. Negotiated Rate	$6.86
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$5.49
Rate for Payer: Aetna of CA Government/Medicare	$5.49
Rate for Payer: Cash Price	$4.12
Rate for Payer: Health Smart Auto/Commercial	$5.49
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$5.49
Rate for Payer: LLUH Dept of Risk Management WC	$5.03
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$6.86

Know your out-of-pocket cost for care.

All Charges