Loma Linda University Behavioral Medicine Center (BMC)

All Charges

Charge

Type

Setting

Price

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

RIVASTIGMINE 1.5 MG CAPSULE [28278]

Facility

$1.25

Service Code	NDC 51991-793-06
Hospital Charge Code	1711861
Hospital Revenue Code	259
Min. Negotiated Rate	$0.69
Max. Negotiated Rate	$0.94
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$0.75
Rate for Payer: Aetna of CA Government/Medicare	$0.75
Rate for Payer: Cash Price	$0.56
Rate for Payer: Health Smart Auto/Commercial	$0.75
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$0.75
Rate for Payer: LLUH Dept of Risk Management WC	$0.69
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$0.94

RIVASTIGMINE 1.5 MG CAPSULE [28278]

Facility

$1.25

Service Code	NDC 51991-793-06
Hospital Charge Code	1711861
Hospital Revenue Code	259
Min. Negotiated Rate	$0.69
Max. Negotiated Rate	$1.00
Rate for Payer: Cash Price	$0.56
Rate for Payer: Cigna of CA HMO/PPO	$1.00
Rate for Payer: Health Smart Auto/Commercial	$0.75
Rate for Payer: LLUH Dept of Risk Management WC	$0.69
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$0.94

RIVASTIGMINE 4.6 MG/24 HOUR TRANSDERMAL PATCH [82504]

Facility

$16.22

Service Code	NDC 0781-7304-31
Hospital Charge Code	1712347
Hospital Revenue Code	259
Min. Negotiated Rate	$8.92
Max. Negotiated Rate	$12.98
Rate for Payer: Cash Price	$7.30
Rate for Payer: Cigna of CA HMO/PPO	$12.98
Rate for Payer: Health Smart Auto/Commercial	$9.73
Rate for Payer: LLUH Dept of Risk Management WC	$8.92
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$12.16

RIVASTIGMINE 4.6 MG/24 HOUR TRANSDERMAL PATCH [82504]

Facility

$5.10

Service Code	NDC 70710-1196-1
Hospital Charge Code	1712347
Hospital Revenue Code	259
Min. Negotiated Rate	$2.80
Max. Negotiated Rate	$3.82
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$3.06
Rate for Payer: Aetna of CA Government/Medicare	$3.06
Rate for Payer: Cash Price	$2.30
Rate for Payer: Health Smart Auto/Commercial	$3.06
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$3.06
Rate for Payer: LLUH Dept of Risk Management WC	$2.80
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$3.82

RIVASTIGMINE 4.6 MG/24 HOUR TRANSDERMAL PATCH [82504]

Facility

$5.10

Service Code	NDC 70710-1196-7
Hospital Charge Code	1712347
Hospital Revenue Code	259
Min. Negotiated Rate	$2.80
Max. Negotiated Rate	$4.08
Rate for Payer: Cash Price	$2.30
Rate for Payer: Cigna of CA HMO/PPO	$4.08
Rate for Payer: Health Smart Auto/Commercial	$3.06
Rate for Payer: LLUH Dept of Risk Management WC	$2.80
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$3.82

RIVASTIGMINE 4.6 MG/24 HOUR TRANSDERMAL PATCH [82504]

Facility

$2.00

Service Code	NDC 0378-9070-93
Hospital Charge Code	1712347
Hospital Revenue Code	259
Min. Negotiated Rate	$1.10
Max. Negotiated Rate	$1.50
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$1.20
Rate for Payer: Aetna of CA Government/Medicare	$1.20
Rate for Payer: Cash Price	$0.90
Rate for Payer: Health Smart Auto/Commercial	$1.20
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$1.20
Rate for Payer: LLUH Dept of Risk Management WC	$1.10
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$1.50

RIVASTIGMINE 4.6 MG/24 HOUR TRANSDERMAL PATCH [82504]

Facility

$2.00

Service Code	NDC 0378-9070-93
Hospital Charge Code	1712347
Hospital Revenue Code	259
Min. Negotiated Rate	$1.10
Max. Negotiated Rate	$1.60
Rate for Payer: Cash Price	$0.90
Rate for Payer: Cigna of CA HMO/PPO	$1.60
Rate for Payer: Health Smart Auto/Commercial	$1.20
Rate for Payer: LLUH Dept of Risk Management WC	$1.10
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$1.50

RIVASTIGMINE 4.6 MG/24 HOUR TRANSDERMAL PATCH [82504]

Facility

$2.00

Service Code	NDC 0378-9070-16
Hospital Charge Code	1712347
Hospital Revenue Code	259
Min. Negotiated Rate	$1.10
Max. Negotiated Rate	$1.50
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$1.20
Rate for Payer: Aetna of CA Government/Medicare	$1.20
Rate for Payer: Cash Price	$0.90
Rate for Payer: Health Smart Auto/Commercial	$1.20
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$1.20
Rate for Payer: LLUH Dept of Risk Management WC	$1.10
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$1.50

RIVASTIGMINE 4.6 MG/24 HOUR TRANSDERMAL PATCH [82504]

Facility

$16.22

Service Code	NDC 0781-7304-58
Hospital Charge Code	1712347
Hospital Revenue Code	259
Min. Negotiated Rate	$8.92
Max. Negotiated Rate	$12.16
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$9.73
Rate for Payer: Aetna of CA Government/Medicare	$9.73
Rate for Payer: Cash Price	$7.30
Rate for Payer: Health Smart Auto/Commercial	$9.73
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$9.73
Rate for Payer: LLUH Dept of Risk Management WC	$8.92
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$12.16

RIVASTIGMINE 4.6 MG/24 HOUR TRANSDERMAL PATCH [82504]

Facility

$16.22

Service Code	NDC 0781-7304-31
Hospital Charge Code	1712347
Hospital Revenue Code	259
Min. Negotiated Rate	$8.92
Max. Negotiated Rate	$12.16
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$9.73
Rate for Payer: Aetna of CA Government/Medicare	$9.73
Rate for Payer: Cash Price	$7.30
Rate for Payer: Health Smart Auto/Commercial	$9.73
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$9.73
Rate for Payer: LLUH Dept of Risk Management WC	$8.92
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$12.16

RIVASTIGMINE 4.6 MG/24 HOUR TRANSDERMAL PATCH [82504]

Facility

$2.00

Service Code	NDC 0378-9070-16
Hospital Charge Code	1712347
Hospital Revenue Code	259
Min. Negotiated Rate	$1.10
Max. Negotiated Rate	$1.60
Rate for Payer: Cash Price	$0.90
Rate for Payer: Cigna of CA HMO/PPO	$1.60
Rate for Payer: Health Smart Auto/Commercial	$1.20
Rate for Payer: LLUH Dept of Risk Management WC	$1.10
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$1.50

RIVASTIGMINE 4.6 MG/24 HOUR TRANSDERMAL PATCH [82504]

Facility

$5.10

Service Code	NDC 70710-1196-7
Hospital Charge Code	1712347
Hospital Revenue Code	259
Min. Negotiated Rate	$2.80
Max. Negotiated Rate	$3.82
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$3.06
Rate for Payer: Aetna of CA Government/Medicare	$3.06
Rate for Payer: Cash Price	$2.30
Rate for Payer: Health Smart Auto/Commercial	$3.06
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$3.06
Rate for Payer: LLUH Dept of Risk Management WC	$2.80
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$3.82

RIVASTIGMINE 4.6 MG/24 HOUR TRANSDERMAL PATCH [82504]

Facility

$16.22

Service Code	NDC 0781-7304-58
Hospital Charge Code	1712347
Hospital Revenue Code	259
Min. Negotiated Rate	$8.92
Max. Negotiated Rate	$12.98
Rate for Payer: Cash Price	$7.30
Rate for Payer: Cigna of CA HMO/PPO	$12.98
Rate for Payer: Health Smart Auto/Commercial	$9.73
Rate for Payer: LLUH Dept of Risk Management WC	$8.92
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$12.16

RIVASTIGMINE 4.6 MG/24 HOUR TRANSDERMAL PATCH [82504]

Facility

$5.10

Service Code	NDC 70710-1196-1
Hospital Charge Code	1712347
Hospital Revenue Code	259
Min. Negotiated Rate	$2.80
Max. Negotiated Rate	$4.08
Rate for Payer: Cash Price	$2.30
Rate for Payer: Cigna of CA HMO/PPO	$4.08
Rate for Payer: Health Smart Auto/Commercial	$3.06
Rate for Payer: LLUH Dept of Risk Management WC	$2.80
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$3.82

RIZATRIPTAN 10 MG DISINTEGRATING TABLET [27630]

Facility

$1.95

Service Code	NDC 68462-468-06
Hospital Charge Code	ERX27630
Hospital Revenue Code	259
Min. Negotiated Rate	$1.07
Max. Negotiated Rate	$1.56
Rate for Payer: Cash Price	$0.88
Rate for Payer: Cigna of CA HMO/PPO	$1.56
Rate for Payer: Health Smart Auto/Commercial	$1.17
Rate for Payer: LLUH Dept of Risk Management WC	$1.07
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$1.46

RIZATRIPTAN 10 MG DISINTEGRATING TABLET [27630]

Facility

$1.95

Service Code	NDC 68462-468-06
Hospital Charge Code	ERX27630
Hospital Revenue Code	259
Min. Negotiated Rate	$1.07
Max. Negotiated Rate	$1.46
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$1.17
Rate for Payer: Aetna of CA Government/Medicare	$1.17
Rate for Payer: Cash Price	$0.88
Rate for Payer: Health Smart Auto/Commercial	$1.17
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$1.17
Rate for Payer: LLUH Dept of Risk Management WC	$1.07
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$1.46

RIZATRIPTAN 10 MG TABLET [23377]

Facility

$1.80

Service Code	NDC 0093-7472-19
Hospital Charge Code	1712228
Hospital Revenue Code	259
Min. Negotiated Rate	$0.99
Max. Negotiated Rate	$1.35
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$1.08
Rate for Payer: Aetna of CA Government/Medicare	$1.08
Rate for Payer: Cash Price	$0.81
Rate for Payer: Health Smart Auto/Commercial	$1.08
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$1.08
Rate for Payer: LLUH Dept of Risk Management WC	$0.99
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$1.35

RIZATRIPTAN 10 MG TABLET [23377]

Facility

$1.19

Service Code	NDC 57237-088-63
Hospital Charge Code	1712228
Hospital Revenue Code	259
Min. Negotiated Rate	$0.65
Max. Negotiated Rate	$0.95
Rate for Payer: Cash Price	$0.54
Rate for Payer: Cigna of CA HMO/PPO	$0.95
Rate for Payer: Health Smart Auto/Commercial	$0.71
Rate for Payer: LLUH Dept of Risk Management WC	$0.65
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$0.89

RIZATRIPTAN 10 MG TABLET [23377]

Facility

$1.80

Service Code	NDC 0093-7472-19
Hospital Charge Code	1712228
Hospital Revenue Code	259
Min. Negotiated Rate	$0.99
Max. Negotiated Rate	$1.44
Rate for Payer: Cash Price	$0.81
Rate for Payer: Cigna of CA HMO/PPO	$1.44
Rate for Payer: Health Smart Auto/Commercial	$1.08
Rate for Payer: LLUH Dept of Risk Management WC	$0.99
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$1.35

RIZATRIPTAN 10 MG TABLET [23377]

Facility

$1.19

Service Code	NDC 57237-088-63
Hospital Charge Code	1712228
Hospital Revenue Code	259
Min. Negotiated Rate	$0.65
Max. Negotiated Rate	$0.89
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$0.71
Rate for Payer: Aetna of CA Government/Medicare	$0.71
Rate for Payer: Cash Price	$0.54
Rate for Payer: Health Smart Auto/Commercial	$0.71
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$0.71
Rate for Payer: LLUH Dept of Risk Management WC	$0.65
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$0.89

RIZATRIPTAN 5 MG TABLET [23376]

Facility

$1.44

Service Code	NDC 68462-465-99
Hospital Charge Code	1712622
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

RIZATRIPTAN 5 MG TABLET [23376]

Facility

$1.44

Service Code	NDC 68462-465-40
Hospital Charge Code	1712622
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

RIZATRIPTAN 5 MG TABLET [23376]

Facility

$1.44

Service Code	NDC 68462-465-40
Hospital Charge Code	1712622
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

RIZATRIPTAN 5 MG TABLET [23376]

Facility

$1.44

Service Code	NDC 68462-465-99
Hospital Charge Code	1712622
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

Know your out-of-pocket cost for care.

All Charges