Loma Linda University Behavioral Medicine Center (BMC)

All Charges

Charge

Type

Setting

Price

RITUXIMAB 10 MG/ML CONCENTRATE,INTRAVENOUS NON-ONCOLOGY [4081336]

Facility

$112.74

Service Code	NDC 50242-051-21
Hospital Charge Code	1755659
Hospital Revenue Code	636
Min. Negotiated Rate	$62.01
Max. Negotiated Rate	$84.56
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$67.64
Rate for Payer: Aetna of CA Government/Medicare	$67.64
Rate for Payer: Cash Price	$50.73
Rate for Payer: Health Smart Auto/Commercial	$67.64
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$67.64
Rate for Payer: LLUH Dept of Risk Management WC	$62.01
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$84.56

RITUXIMAB 10 MG/ML CONCENTRATE,INTRAVENOUS NON-ONCOLOGY [4081336]

Facility

$112.74

Service Code	NDC 50242-053-06
Hospital Charge Code	1755782
Hospital Revenue Code	636
Min. Negotiated Rate	$62.01
Max. Negotiated Rate	$90.19
Rate for Payer: Cash Price	$50.73
Rate for Payer: Cigna of CA HMO/PPO	$90.19
Rate for Payer: Health Smart Auto/Commercial	$67.64
Rate for Payer: LLUH Dept of Risk Management WC	$62.01
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$84.56

RITUXIMAB 10 MG/ML CONCENTRATE,INTRAVENOUS NON-ONCOLOGY [4081336]

Facility

$112.74

Service Code	NDC 50242-051-21
Hospital Charge Code	1755659
Hospital Revenue Code	636
Min. Negotiated Rate	$62.01
Max. Negotiated Rate	$90.19
Rate for Payer: Cash Price	$50.73
Rate for Payer: Cigna of CA HMO/PPO	$90.19
Rate for Payer: Health Smart Auto/Commercial	$67.64
Rate for Payer: LLUH Dept of Risk Management WC	$62.01
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$84.56

RITUXIMAB 10 MG/ML CONCENTRATE,INTRAVENOUS NON-ONCOLOGY [4081336]

Facility

$112.74

Service Code	NDC 50242-053-06
Hospital Charge Code	1755782
Hospital Revenue Code	636
Min. Negotiated Rate	$62.01
Max. Negotiated Rate	$84.56
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$67.64
Rate for Payer: Aetna of CA Government/Medicare	$67.64
Rate for Payer: Cash Price	$50.73
Rate for Payer: Health Smart Auto/Commercial	$67.64
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$67.64
Rate for Payer: LLUH Dept of Risk Management WC	$62.01
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$84.56

RITUXIMAB 1,400 MG/11.7 ML (120 MG/ML)-HYALURONIDASE SUBCUTANEOUS SOLN [218742]

Facility

$674.52

Service Code	CPT J9311
Hospital Charge Code	NDG218742
Hospital Revenue Code	636
Min. Negotiated Rate	$370.99
Max. Negotiated Rate	$539.62
Rate for Payer: Cash Price	$303.53
Rate for Payer: Cigna of CA HMO/PPO	$539.62
Rate for Payer: Health Smart Auto/Commercial	$404.71
Rate for Payer: LLUH Dept of Risk Management WC	$370.99
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$505.89

RITUXIMAB 1,400 MG/11.7 ML (120 MG/ML)-HYALURONIDASE SUBCUTANEOUS SOLN [218742]

Facility

$674.52

Service Code	CPT J9311
Hospital Charge Code	NDG218742
Hospital Revenue Code	636
Min. Negotiated Rate	$370.99
Max. Negotiated Rate	$505.89
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$404.71
Rate for Payer: Aetna of CA Government/Medicare	$404.71
Rate for Payer: Cash Price	$303.53
Rate for Payer: Health Smart Auto/Commercial	$404.71
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$404.71
Rate for Payer: LLUH Dept of Risk Management WC	$370.99
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$505.89

RITUXIMAB 1,600 MG/13.4 ML (120 MG/ML)-HYALURONIDASE SUBCUTANEOUS SOLN [218821]

Facility

$673.08

Service Code	CPT J9311
Hospital Charge Code	NDG218821
Hospital Revenue Code	636
Min. Negotiated Rate	$370.19
Max. Negotiated Rate	$504.81
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$403.85
Rate for Payer: Aetna of CA Government/Medicare	$403.85
Rate for Payer: Cash Price	$302.89
Rate for Payer: Health Smart Auto/Commercial	$403.85
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$403.85
Rate for Payer: LLUH Dept of Risk Management WC	$370.19
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$504.81

RITUXIMAB 1,600 MG/13.4 ML (120 MG/ML)-HYALURONIDASE SUBCUTANEOUS SOLN [218821]

Facility

$673.08

Service Code	CPT J9311
Hospital Charge Code	NDG218821
Hospital Revenue Code	636
Min. Negotiated Rate	$370.19
Max. Negotiated Rate	$538.46
Rate for Payer: Cash Price	$302.89
Rate for Payer: Cigna of CA HMO/PPO	$538.46
Rate for Payer: Health Smart Auto/Commercial	$403.85
Rate for Payer: LLUH Dept of Risk Management WC	$370.19
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$504.81

RITUXIMAB-ARRX 10 MG/ML INTRAVENOUS SOLUTION [229898]

Facility

$86.02

Service Code	CPT Q5123
Hospital Charge Code	NDG229898
Hospital Revenue Code	636
Min. Negotiated Rate	$47.31
Max. Negotiated Rate	$68.82
Rate for Payer: Cash Price	$38.71
Rate for Payer: Cigna of CA HMO/PPO	$68.82
Rate for Payer: Health Smart Auto/Commercial	$51.61
Rate for Payer: LLUH Dept of Risk Management WC	$47.31
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$64.52

RITUXIMAB-ARRX 10 MG/ML INTRAVENOUS SOLUTION [229898]

Facility

$86.02

Service Code	CPT Q5123
Hospital Charge Code	NDG229898
Hospital Revenue Code	636
Min. Negotiated Rate	$47.31
Max. Negotiated Rate	$64.52
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$51.61
Rate for Payer: Aetna of CA Government/Medicare	$51.61
Rate for Payer: Cash Price	$38.71
Rate for Payer: Health Smart Auto/Commercial	$51.61
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$51.61
Rate for Payer: LLUH Dept of Risk Management WC	$47.31
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$64.52

RITUXIMAB-PVVR 10 MG/ML INTRAVENOUS SOLUTION [226878]

Facility

$86.02

Service Code	CPT Q5119
Hospital Charge Code	NDG22687A
Hospital Revenue Code	636
Min. Negotiated Rate	$47.31
Max. Negotiated Rate	$68.82
Rate for Payer: Health Smart Auto/Commercial	$51.61
Rate for Payer: Cash Price	$38.71
Rate for Payer: Cigna of CA HMO/PPO	$68.82
Rate for Payer: LLUH Dept of Risk Management WC	$47.31
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$64.52

RITUXIMAB-PVVR 10 MG/ML INTRAVENOUS SOLUTION [226878]

Facility

$86.02

Service Code	CPT Q5119
Hospital Charge Code	NDG22687A
Hospital Revenue Code	636
Min. Negotiated Rate	$47.31
Max. Negotiated Rate	$64.52
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$51.61
Rate for Payer: Aetna of CA Government/Medicare	$51.61
Rate for Payer: Cash Price	$38.71
Rate for Payer: Health Smart Auto/Commercial	$51.61
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$51.61
Rate for Payer: LLUH Dept of Risk Management WC	$47.31
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$64.52

RITUXIMAB-PVVR 10 MG/ML INTRAVENOUS SOLUTION [226878]

Facility

$86.02

Service Code	CPT Q5119
Hospital Charge Code	NDG226878
Hospital Revenue Code	636
Min. Negotiated Rate	$47.31
Max. Negotiated Rate	$68.82
Rate for Payer: Cash Price	$38.71
Rate for Payer: Cigna of CA HMO/PPO	$68.82
Rate for Payer: Health Smart Auto/Commercial	$51.61
Rate for Payer: LLUH Dept of Risk Management WC	$47.31
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$64.52

RITUXIMAB-PVVR 10 MG/ML INTRAVENOUS SOLUTION [226878]

Facility

$86.02

Service Code	CPT Q5119
Hospital Charge Code	NDG226878
Hospital Revenue Code	636
Min. Negotiated Rate	$47.31
Max. Negotiated Rate	$64.52
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$51.61
Rate for Payer: Aetna of CA Government/Medicare	$51.61
Rate for Payer: Cash Price	$38.71
Rate for Payer: Health Smart Auto/Commercial	$51.61
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$51.61
Rate for Payer: LLUH Dept of Risk Management WC	$47.31
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$64.52

RIVAROXABAN 10 MG TABLET [153876]

Facility

$21.70

Service Code	NDC 50458-580-30
Hospital Charge Code	1712514
Hospital Revenue Code	259
Min. Negotiated Rate	$11.94
Max. Negotiated Rate	$16.28
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$13.02
Rate for Payer: Aetna of CA Government/Medicare	$13.02
Rate for Payer: Cash Price	$9.77
Rate for Payer: Health Smart Auto/Commercial	$13.02
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$13.02
Rate for Payer: LLUH Dept of Risk Management WC	$11.94
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$16.28

RIVAROXABAN 10 MG TABLET [153876]

Facility

$21.70

Service Code	NDC 50458-580-30
Hospital Charge Code	1712514
Hospital Revenue Code	259
Min. Negotiated Rate	$11.94
Max. Negotiated Rate	$17.36
Rate for Payer: Cash Price	$9.77
Rate for Payer: Cigna of CA HMO/PPO	$17.36
Rate for Payer: Health Smart Auto/Commercial	$13.02
Rate for Payer: LLUH Dept of Risk Management WC	$11.94
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$16.28

RIVAROXABAN 15 MG TABLET [153877]

Facility

$21.70

Service Code	NDC 50458-578-01
Hospital Charge Code	1712515
Hospital Revenue Code	259
Min. Negotiated Rate	$11.94
Max. Negotiated Rate	$17.36
Rate for Payer: Cash Price	$9.77
Rate for Payer: Cigna of CA HMO/PPO	$17.36
Rate for Payer: Health Smart Auto/Commercial	$13.02
Rate for Payer: LLUH Dept of Risk Management WC	$11.94
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$16.28

RIVAROXABAN 15 MG TABLET [153877]

Facility

$21.70

Service Code	NDC 50458-578-10
Hospital Charge Code	1712515
Hospital Revenue Code	259
Min. Negotiated Rate	$11.94
Max. Negotiated Rate	$17.36
Rate for Payer: Cash Price	$9.77
Rate for Payer: Cigna of CA HMO/PPO	$17.36
Rate for Payer: Health Smart Auto/Commercial	$13.02
Rate for Payer: LLUH Dept of Risk Management WC	$11.94
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$16.28

RIVAROXABAN 15 MG TABLET [153877]

Facility

$21.70

Service Code	NDC 50458-578-10
Hospital Charge Code	1712515
Hospital Revenue Code	259
Min. Negotiated Rate	$11.94
Max. Negotiated Rate	$16.28
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$13.02
Rate for Payer: Aetna of CA Government/Medicare	$13.02
Rate for Payer: Cash Price	$9.77
Rate for Payer: Health Smart Auto/Commercial	$13.02
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$13.02
Rate for Payer: LLUH Dept of Risk Management WC	$11.94
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$16.28

RIVAROXABAN 15 MG TABLET [153877]

Facility

$21.70

Service Code	NDC 50458-578-01
Hospital Charge Code	1712515
Hospital Revenue Code	259
Min. Negotiated Rate	$11.94
Max. Negotiated Rate	$16.28
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$13.02
Rate for Payer: Aetna of CA Government/Medicare	$13.02
Rate for Payer: Cash Price	$9.77
Rate for Payer: Health Smart Auto/Commercial	$13.02
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$13.02
Rate for Payer: LLUH Dept of Risk Management WC	$11.94
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$16.28

RIVAROXABAN 20 MG TABLET [153878]

Facility

$21.70

Service Code	NDC 50458-579-10
Hospital Charge Code	1712516
Hospital Revenue Code	259
Min. Negotiated Rate	$11.94
Max. Negotiated Rate	$16.28
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$13.02
Rate for Payer: Aetna of CA Government/Medicare	$13.02
Rate for Payer: Cash Price	$9.77
Rate for Payer: Health Smart Auto/Commercial	$13.02
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$13.02
Rate for Payer: LLUH Dept of Risk Management WC	$11.94
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$16.28

RIVAROXABAN 20 MG TABLET [153878]

Facility

$21.70

Service Code	NDC 50458-579-10
Hospital Charge Code	1712516
Hospital Revenue Code	259
Min. Negotiated Rate	$11.94
Max. Negotiated Rate	$17.36
Rate for Payer: Cash Price	$9.77
Rate for Payer: Cigna of CA HMO/PPO	$17.36
Rate for Payer: Health Smart Auto/Commercial	$13.02
Rate for Payer: LLUH Dept of Risk Management WC	$11.94
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$16.28

RIVAROXABAN 20 MG TABLET [153878]

Facility

$21.70

Service Code	NDC 50458-579-30
Hospital Charge Code	1712516
Hospital Revenue Code	259
Min. Negotiated Rate	$11.94
Max. Negotiated Rate	$16.28
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$13.02
Rate for Payer: Aetna of CA Government/Medicare	$13.02
Rate for Payer: Cash Price	$9.77
Rate for Payer: Health Smart Auto/Commercial	$13.02
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$13.02
Rate for Payer: LLUH Dept of Risk Management WC	$11.94
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$16.28

RIVAROXABAN 20 MG TABLET [153878]

Facility

$21.70

Service Code	NDC 50458-579-30
Hospital Charge Code	1712516
Hospital Revenue Code	259
Min. Negotiated Rate	$11.94
Max. Negotiated Rate	$17.36
Rate for Payer: Cash Price	$9.77
Rate for Payer: Cigna of CA HMO/PPO	$17.36
Rate for Payer: Health Smart Auto/Commercial	$13.02
Rate for Payer: LLUH Dept of Risk Management WC	$11.94
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$16.28

RIVAROXABAN 2.5 MG TABLET [222768]

Facility

$10.85

Service Code	NDC 50458-577-60
Hospital Charge Code	ERX222768
Hospital Revenue Code	259
Min. Negotiated Rate	$5.97
Max. Negotiated Rate	$8.68
Rate for Payer: Cash Price	$4.88
Rate for Payer: Cigna of CA HMO/PPO	$8.68
Rate for Payer: Health Smart Auto/Commercial	$6.51
Rate for Payer: LLUH Dept of Risk Management WC	$5.97
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$8.14

Know your out-of-pocket cost for care.

All Charges