Loma Linda University Behavioral Medicine Center (BMC)

All Charges

Charge

Type

Setting

Price

RIOCIGUAT 0.5 MG TABLET [203879]

Facility

$164.16

Service Code	NDC 50419-250-91
Hospital Charge Code	ERX203879
Hospital Revenue Code	259
Min. Negotiated Rate	$90.29
Max. Negotiated Rate	$123.12
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$98.50
Rate for Payer: Aetna of CA Government/Medicare	$98.50
Rate for Payer: Cash Price	$73.87
Rate for Payer: Health Smart Auto/Commercial	$98.50
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$98.50
Rate for Payer: LLUH Dept of Risk Management WC	$90.29
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$123.12

RIOCIGUAT 0.5 MG TABLET [203879]

Facility

$164.16

Service Code	NDC 50419-250-91
Hospital Charge Code	ERX203879
Hospital Revenue Code	259
Min. Negotiated Rate	$90.29
Max. Negotiated Rate	$131.33
Rate for Payer: Cash Price	$73.87
Rate for Payer: Cigna of CA HMO/PPO	$131.33
Rate for Payer: Health Smart Auto/Commercial	$98.50
Rate for Payer: LLUH Dept of Risk Management WC	$90.29
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$123.12

RIOCIGUAT 0.5 MG TABLET [203879]

Facility

$164.16

Service Code	NDC 50419-250-01
Hospital Charge Code	ERX203879
Hospital Revenue Code	259
Min. Negotiated Rate	$90.29
Max. Negotiated Rate	$131.33
Rate for Payer: Health Smart Auto/Commercial	$98.50
Rate for Payer: Cash Price	$73.87
Rate for Payer: Cigna of CA HMO/PPO	$131.33
Rate for Payer: LLUH Dept of Risk Management WC	$90.29
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$123.12

RIOCIGUAT 0.5 MG TABLET [203879]

Facility

$164.16

Service Code	NDC 50419-250-01
Hospital Charge Code	ERX203879
Hospital Revenue Code	259
Min. Negotiated Rate	$90.29
Max. Negotiated Rate	$123.12
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$98.50
Rate for Payer: Aetna of CA Government/Medicare	$98.50
Rate for Payer: Cash Price	$73.87
Rate for Payer: Health Smart Auto/Commercial	$98.50
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$98.50
Rate for Payer: LLUH Dept of Risk Management WC	$90.29
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$123.12

RIOCIGUAT 1 MG TABLET [203880]

Facility

$164.16

Service Code	NDC 50419-251-91
Hospital Charge Code	ERX203880
Hospital Revenue Code	259
Min. Negotiated Rate	$90.29
Max. Negotiated Rate	$131.33
Rate for Payer: Cash Price	$73.87
Rate for Payer: Cigna of CA HMO/PPO	$131.33
Rate for Payer: Health Smart Auto/Commercial	$98.50
Rate for Payer: LLUH Dept of Risk Management WC	$90.29
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$123.12

RIOCIGUAT 1 MG TABLET [203880]

Facility

$164.16

Service Code	NDC 50419-251-91
Hospital Charge Code	ERX203880
Hospital Revenue Code	259
Min. Negotiated Rate	$90.29
Max. Negotiated Rate	$123.12
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$98.50
Rate for Payer: Aetna of CA Government/Medicare	$98.50
Rate for Payer: Cash Price	$73.87
Rate for Payer: Health Smart Auto/Commercial	$98.50
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$98.50
Rate for Payer: LLUH Dept of Risk Management WC	$90.29
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$123.12

RIOCIGUAT 1 MG TABLET [203880]

Facility

$164.16

Service Code	NDC 50419-251-01
Hospital Charge Code	ERX203880
Hospital Revenue Code	259
Min. Negotiated Rate	$90.29
Max. Negotiated Rate	$131.33
Rate for Payer: Cash Price	$73.87
Rate for Payer: Cigna of CA HMO/PPO	$131.33
Rate for Payer: Health Smart Auto/Commercial	$98.50
Rate for Payer: LLUH Dept of Risk Management WC	$90.29
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$123.12

RIOCIGUAT 1 MG TABLET [203880]

Facility

$164.16

Service Code	NDC 50419-251-01
Hospital Charge Code	ERX203880
Hospital Revenue Code	259
Min. Negotiated Rate	$90.29
Max. Negotiated Rate	$123.12
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$98.50
Rate for Payer: Aetna of CA Government/Medicare	$98.50
Rate for Payer: Cash Price	$73.87
Rate for Payer: Health Smart Auto/Commercial	$98.50
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$98.50
Rate for Payer: LLUH Dept of Risk Management WC	$90.29
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$123.12

RIOCIGUAT 2.5 MG TABLET [203883]

Facility

$164.16

Service Code	NDC 50419-254-01
Hospital Charge Code	ERX203883
Hospital Revenue Code	259
Min. Negotiated Rate	$90.29
Max. Negotiated Rate	$123.12
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$98.50
Rate for Payer: Aetna of CA Government/Medicare	$98.50
Rate for Payer: Cash Price	$73.87
Rate for Payer: Health Smart Auto/Commercial	$98.50
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$98.50
Rate for Payer: LLUH Dept of Risk Management WC	$90.29
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$123.12

RIOCIGUAT 2.5 MG TABLET [203883]

Facility

$164.16

Service Code	NDC 50419-254-91
Hospital Charge Code	ERX203883
Hospital Revenue Code	259
Min. Negotiated Rate	$90.29
Max. Negotiated Rate	$131.33
Rate for Payer: Cash Price	$73.87
Rate for Payer: Cigna of CA HMO/PPO	$131.33
Rate for Payer: Health Smart Auto/Commercial	$98.50
Rate for Payer: LLUH Dept of Risk Management WC	$90.29
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$123.12

RIOCIGUAT 2.5 MG TABLET [203883]

Facility

$164.16

Service Code	NDC 50419-254-91
Hospital Charge Code	ERX203883
Hospital Revenue Code	259
Min. Negotiated Rate	$90.29
Max. Negotiated Rate	$123.12
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$98.50
Rate for Payer: Aetna of CA Government/Medicare	$98.50
Rate for Payer: Cash Price	$73.87
Rate for Payer: Health Smart Auto/Commercial	$98.50
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$98.50
Rate for Payer: LLUH Dept of Risk Management WC	$90.29
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$123.12

RIOCIGUAT 2.5 MG TABLET [203883]

Facility

$164.16

Service Code	NDC 50419-254-01
Hospital Charge Code	ERX203883
Hospital Revenue Code	259
Min. Negotiated Rate	$90.29
Max. Negotiated Rate	$131.33
Rate for Payer: Cash Price	$73.87
Rate for Payer: Cigna of CA HMO/PPO	$131.33
Rate for Payer: Health Smart Auto/Commercial	$98.50
Rate for Payer: LLUH Dept of Risk Management WC	$90.29
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$123.12

RIPRETINIB 50 MG TABLET [228115]

Facility

$521.40

Service Code	NDC 73207-101-30
Hospital Charge Code	ERX228115
Hospital Revenue Code	259
Min. Negotiated Rate	$286.77
Max. Negotiated Rate	$391.05
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$312.84
Rate for Payer: Aetna of CA Government/Medicare	$312.84
Rate for Payer: Cash Price	$234.63
Rate for Payer: Health Smart Auto/Commercial	$312.84
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$312.84
Rate for Payer: LLUH Dept of Risk Management WC	$286.77
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$391.05

RIPRETINIB 50 MG TABLET [228115]

Facility

$521.40

Service Code	NDC 73207-101-30
Hospital Charge Code	ERX228115
Hospital Revenue Code	259
Min. Negotiated Rate	$286.77
Max. Negotiated Rate	$417.12
Rate for Payer: Cash Price	$234.63
Rate for Payer: Cigna of CA HMO/PPO	$417.12
Rate for Payer: Health Smart Auto/Commercial	$312.84
Rate for Payer: LLUH Dept of Risk Management WC	$286.77
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$391.05

RISANKIZUMAB-RZAA 60 MG/ML INTRAVENOUS SOLUTION [234679]

Facility

$1,140.22

Service Code	CPT J2327
Hospital Charge Code	NDG234679
Hospital Revenue Code	636
Min. Negotiated Rate	$627.12
Max. Negotiated Rate	$855.16
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$684.13
Rate for Payer: Aetna of CA Government/Medicare	$684.13
Rate for Payer: Cash Price	$513.10
Rate for Payer: Health Smart Auto/Commercial	$684.13
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$684.13
Rate for Payer: LLUH Dept of Risk Management WC	$627.12
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$855.16

RISANKIZUMAB-RZAA 60 MG/ML INTRAVENOUS SOLUTION [234679]

Facility

$1,140.22

Service Code	CPT J2327
Hospital Charge Code	NDG234679
Hospital Revenue Code	636
Min. Negotiated Rate	$627.12
Max. Negotiated Rate	$912.18
Rate for Payer: Cash Price	$513.10
Rate for Payer: Cigna of CA HMO/PPO	$912.18
Rate for Payer: Health Smart Auto/Commercial	$684.13
Rate for Payer: LLUH Dept of Risk Management WC	$627.12
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$855.16

RISEDRONATE 35 MG TABLET [32895]

Facility

$102.29

Service Code	NDC 0430-0472-03
Hospital Charge Code	1711871
Hospital Revenue Code	259
Min. Negotiated Rate	$56.26
Max. Negotiated Rate	$81.83
Rate for Payer: Cash Price	$46.03
Rate for Payer: Cigna of CA 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 Beech St/Commercial/PHCS	$76.72

RISEDRONATE 35 MG TABLET [32895]

Facility

$102.29

Service Code	NDC 0430-0472-03
Hospital Charge Code	1711871
Hospital Revenue Code	259
Min. Negotiated Rate	$56.26
Max. Negotiated Rate	$76.72
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	$46.03
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 Beech St/Commercial/PHCS	$76.72

RISPERIDONE 0.25 MG TABLET [25519]

Facility

$0.27

Service Code	NDC 68084-270-01
Hospital Charge Code	1712235
Hospital Revenue Code	259
Min. Negotiated Rate	$0.15
Max. Negotiated Rate	$0.20
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	$0.12
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 Beech St/Commercial/PHCS	$0.20

RISPERIDONE 0.25 MG TABLET [25519]

Facility

$0.27

Service Code	NDC 68084-270-11
Hospital Charge Code	1712235
Hospital Revenue Code	259
Min. Negotiated Rate	$0.15
Max. Negotiated Rate	$0.20
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	$0.12
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 Beech St/Commercial/PHCS	$0.20

RISPERIDONE 0.25 MG TABLET [25519]

Facility

$0.20

Service Code	NDC 0904-6357-61
Hospital Charge Code	1712235
Hospital Revenue Code	259
Min. Negotiated Rate	$0.11
Max. Negotiated Rate	$0.16
Rate for Payer: Cash Price	$0.09
Rate for Payer: Cigna of CA HMO/PPO	$0.16
Rate for Payer: Health Smart Auto/Commercial	$0.12
Rate for Payer: LLUH Dept of Risk Management WC	$0.11
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$0.15

RISPERIDONE 0.25 MG TABLET [25519]

Facility

$0.27

Service Code	NDC 68084-270-01
Hospital Charge Code	1712235
Hospital Revenue Code	259
Min. Negotiated Rate	$0.15
Max. Negotiated Rate	$0.22
Rate for Payer: Cash Price	$0.12
Rate for Payer: Cigna of CA 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 Beech St/Commercial/PHCS	$0.20

RISPERIDONE 0.25 MG TABLET [25519]

Facility

$0.20

Service Code	NDC 0904-6357-61
Hospital Charge Code	1712235
Hospital Revenue Code	259
Min. Negotiated Rate	$0.11
Max. Negotiated Rate	$0.15
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$0.12
Rate for Payer: Aetna of CA Government/Medicare	$0.12
Rate for Payer: Cash Price	$0.09
Rate for Payer: Health Smart Auto/Commercial	$0.12
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$0.12
Rate for Payer: LLUH Dept of Risk Management WC	$0.11
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$0.15

RISPERIDONE 0.25 MG TABLET [25519]

Facility

$0.27

Service Code	NDC 68084-270-11
Hospital Charge Code	1712235
Hospital Revenue Code	259
Min. Negotiated Rate	$0.15
Max. Negotiated Rate	$0.22
Rate for Payer: Cash Price	$0.12
Rate for Payer: Cigna of CA 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 Beech St/Commercial/PHCS	$0.20

RISPERIDONE 0.5 MG DISINTEGRATING TABLET [35686]

Facility

$3.87

Service Code	NDC 0781-5310-08
Hospital Charge Code	1713151
Hospital Revenue Code	259
Min. Negotiated Rate	$2.13
Max. Negotiated Rate	$2.90
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$2.32
Rate for Payer: Aetna of CA Government/Medicare	$2.32
Rate for Payer: Cash Price	$1.74
Rate for Payer: Health Smart Auto/Commercial	$2.32
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$2.32
Rate for Payer: LLUH Dept of Risk Management WC	$2.13
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$2.90

Know your out-of-pocket cost for care.

All Charges