Loma Linda University Behavioral Medicine Center (BMC)

All Charges

Charge

Type

Setting

Price

CALCITRIOL 0.25 MCG CAPSULE [9350]

Facility

$0.33

Service Code	NDC 69452-207-13
Hospital Charge Code	1710534
Hospital Revenue Code	259
Min. Negotiated Rate	$0.18
Max. Negotiated Rate	$0.26
Rate for Payer: Cash Price	$0.15
Rate for Payer: Cigna of CA HMO/PPO	$0.26
Rate for Payer: Health Smart Auto/Commercial	$0.20
Rate for Payer: LLUH Dept of Risk Management WC	$0.18
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$0.25

CALCITRIOL 0.25 MCG CAPSULE [9350]

Facility

$0.89

Service Code	NDC 60687-345-11
Hospital Charge Code	1710534
Hospital Revenue Code	259
Min. Negotiated Rate	$0.49
Max. Negotiated Rate	$0.71
Rate for Payer: Cash Price	$0.40
Rate for Payer: Cigna of CA HMO/PPO	$0.71
Rate for Payer: Health Smart Auto/Commercial	$0.53
Rate for Payer: LLUH Dept of Risk Management WC	$0.49
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$0.67

CALCITRIOL 0.25 MCG CAPSULE [9350]

Facility

$0.33

Service Code	NDC 64380-723-06
Hospital Charge Code	1710534
Hospital Revenue Code	259
Min. Negotiated Rate	$0.18
Max. Negotiated Rate	$0.25
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$0.20
Rate for Payer: Aetna of CA Government/Medicare	$0.20
Rate for Payer: Cash Price	$0.15
Rate for Payer: Health Smart Auto/Commercial	$0.20
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$0.20
Rate for Payer: LLUH Dept of Risk Management WC	$0.18
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$0.25

CALCITRIOL 0.25 MCG CAPSULE [9350]

Facility

$1.14

Service Code	NDC 0054-0007-25
Hospital Charge Code	1710534
Hospital Revenue Code	259
Min. Negotiated Rate	$0.63
Max. Negotiated Rate	$0.86
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$0.68
Rate for Payer: Aetna of CA Government/Medicare	$0.68
Rate for Payer: Cash Price	$0.51
Rate for Payer: Health Smart Auto/Commercial	$0.68
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$0.68
Rate for Payer: LLUH Dept of Risk Management WC	$0.63
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$0.86

CALCITRIOL 0.25 MCG CAPSULE [9350]

Facility

$0.33

Service Code	NDC 69452-207-13
Hospital Charge Code	1710534
Hospital Revenue Code	259
Min. Negotiated Rate	$0.18
Max. Negotiated Rate	$0.25
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$0.20
Rate for Payer: Aetna of CA Government/Medicare	$0.20
Rate for Payer: Cash Price	$0.15
Rate for Payer: Health Smart Auto/Commercial	$0.20
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$0.20
Rate for Payer: LLUH Dept of Risk Management WC	$0.18
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$0.25

CALCITRIOL 0.25 MCG CAPSULE [9350]

Facility

$0.33

Service Code	NDC 69452-207-20
Hospital Charge Code	1710534
Hospital Revenue Code	259
Min. Negotiated Rate	$0.18
Max. Negotiated Rate	$0.26
Rate for Payer: Cash Price	$0.15
Rate for Payer: Cigna of CA HMO/PPO	$0.26
Rate for Payer: Health Smart Auto/Commercial	$0.20
Rate for Payer: LLUH Dept of Risk Management WC	$0.18
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$0.25

CALCITRIOL 0.25 MCG CAPSULE [9350]

Facility

$0.33

Service Code	NDC 64380-723-04
Hospital Charge Code	1710534
Hospital Revenue Code	259
Min. Negotiated Rate	$0.18
Max. Negotiated Rate	$0.25
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$0.20
Rate for Payer: Aetna of CA Government/Medicare	$0.20
Rate for Payer: Cash Price	$0.15
Rate for Payer: Health Smart Auto/Commercial	$0.20
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$0.20
Rate for Payer: LLUH Dept of Risk Management WC	$0.18
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$0.25

CALCITRIOL 0.25 MCG CAPSULE [9350]

Facility

$0.33

Service Code	NDC 62756-967-88
Hospital Charge Code	1710534
Hospital Revenue Code	259
Min. Negotiated Rate	$0.18
Max. Negotiated Rate	$0.25
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$0.20
Rate for Payer: Aetna of CA Government/Medicare	$0.20
Rate for Payer: Cash Price	$0.15
Rate for Payer: Health Smart Auto/Commercial	$0.20
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$0.20
Rate for Payer: LLUH Dept of Risk Management WC	$0.18
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$0.25

CALCITRIOL 0.25 MCG CAPSULE [9350]

Facility

$0.89

Service Code	NDC 60687-345-01
Hospital Charge Code	1710534
Hospital Revenue Code	259
Min. Negotiated Rate	$0.49
Max. Negotiated Rate	$0.67
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$0.53
Rate for Payer: Aetna of CA Government/Medicare	$0.53
Rate for Payer: Cash Price	$0.40
Rate for Payer: Health Smart Auto/Commercial	$0.53
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$0.53
Rate for Payer: LLUH Dept of Risk Management WC	$0.49
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$0.67

CALCITRIOL 0.25 MCG CAPSULE [9350]

Facility

$0.89

Service Code	NDC 60687-345-01
Hospital Charge Code	1710534
Hospital Revenue Code	259
Min. Negotiated Rate	$0.49
Max. Negotiated Rate	$0.71
Rate for Payer: Cash Price	$0.40
Rate for Payer: Cigna of CA HMO/PPO	$0.71
Rate for Payer: Health Smart Auto/Commercial	$0.53
Rate for Payer: LLUH Dept of Risk Management WC	$0.49
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$0.67

CALCITRIOL 0.5 MCG CAPSULE [9351]

Facility

$0.51

Service Code	NDC 69452-208-20
Hospital Charge Code	1710571
Hospital Revenue Code	259
Min. Negotiated Rate	$0.28
Max. Negotiated Rate	$0.38
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$0.31
Rate for Payer: Aetna of CA Government/Medicare	$0.31
Rate for Payer: Cash Price	$0.23
Rate for Payer: Health Smart Auto/Commercial	$0.31
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$0.31
Rate for Payer: LLUH Dept of Risk Management WC	$0.28
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$0.38

CALCITRIOL 0.5 MCG CAPSULE [9351]

Facility

$0.51

Service Code	NDC 62756-968-88
Hospital Charge Code	1710571
Hospital Revenue Code	259
Min. Negotiated Rate	$0.28
Max. Negotiated Rate	$0.38
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$0.31
Rate for Payer: Aetna of CA Government/Medicare	$0.31
Rate for Payer: Cash Price	$0.23
Rate for Payer: Health Smart Auto/Commercial	$0.31
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$0.31
Rate for Payer: LLUH Dept of Risk Management WC	$0.28
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$0.38

CALCITRIOL 0.5 MCG CAPSULE [9351]

Facility

$1.83

Service Code	NDC 0093-7353-01
Hospital Charge Code	1710571
Hospital Revenue Code	259
Min. Negotiated Rate	$1.01
Max. Negotiated Rate	$1.37
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$1.10
Rate for Payer: Aetna of CA Government/Medicare	$1.10
Rate for Payer: Cash Price	$0.82
Rate for Payer: Health Smart Auto/Commercial	$1.10
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$1.10
Rate for Payer: LLUH Dept of Risk Management WC	$1.01
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$1.37

CALCITRIOL 0.5 MCG CAPSULE [9351]

Facility

$1.83

Service Code	NDC 0093-7353-01
Hospital Charge Code	1710571
Hospital Revenue Code	259
Min. Negotiated Rate	$1.01
Max. Negotiated Rate	$1.46
Rate for Payer: Cash Price	$0.82
Rate for Payer: Cigna of CA HMO/PPO	$1.46
Rate for Payer: Health Smart Auto/Commercial	$1.10
Rate for Payer: LLUH Dept of Risk Management WC	$1.01
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$1.37

CALCITRIOL 0.5 MCG CAPSULE [9351]

Facility

$0.51

Service Code	NDC 64380-724-06
Hospital Charge Code	1710571
Hospital Revenue Code	259
Min. Negotiated Rate	$0.28
Max. Negotiated Rate	$0.41
Rate for Payer: Cash Price	$0.23
Rate for Payer: Cigna of CA HMO/PPO	$0.41
Rate for Payer: Health Smart Auto/Commercial	$0.31
Rate for Payer: LLUH Dept of Risk Management WC	$0.28
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$0.38

CALCITRIOL 0.5 MCG CAPSULE [9351]

Facility

$0.51

Service Code	NDC 64380-724-06
Hospital Charge Code	1710571
Hospital Revenue Code	259
Min. Negotiated Rate	$0.28
Max. Negotiated Rate	$0.38
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$0.31
Rate for Payer: Aetna of CA Government/Medicare	$0.31
Rate for Payer: Cash Price	$0.23
Rate for Payer: Health Smart Auto/Commercial	$0.31
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$0.31
Rate for Payer: LLUH Dept of Risk Management WC	$0.28
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$0.38

CALCITRIOL 0.5 MCG CAPSULE [9351]

Facility

$0.51

Service Code	NDC 69452-208-20
Hospital Charge Code	1710571
Hospital Revenue Code	259
Min. Negotiated Rate	$0.28
Max. Negotiated Rate	$0.41
Rate for Payer: Cash Price	$0.23
Rate for Payer: Cigna of CA HMO/PPO	$0.41
Rate for Payer: Health Smart Auto/Commercial	$0.31
Rate for Payer: LLUH Dept of Risk Management WC	$0.28
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$0.38

CALCITRIOL 0.5 MCG CAPSULE [9351]

Facility

$1.83

Service Code	NDC 63304-240-01
Hospital Charge Code	1710571
Hospital Revenue Code	259
Min. Negotiated Rate	$1.01
Max. Negotiated Rate	$1.37
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$1.10
Rate for Payer: Aetna of CA Government/Medicare	$1.10
Rate for Payer: Cash Price	$0.82
Rate for Payer: Health Smart Auto/Commercial	$1.10
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$1.10
Rate for Payer: LLUH Dept of Risk Management WC	$1.01
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$1.37

CALCITRIOL 0.5 MCG CAPSULE [9351]

Facility

$0.51

Service Code	NDC 62756-968-88
Hospital Charge Code	1710571
Hospital Revenue Code	259
Min. Negotiated Rate	$0.28
Max. Negotiated Rate	$0.41
Rate for Payer: Cash Price	$0.23
Rate for Payer: Cigna of CA HMO/PPO	$0.41
Rate for Payer: Health Smart Auto/Commercial	$0.31
Rate for Payer: LLUH Dept of Risk Management WC	$0.28
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$0.38

CALCITRIOL 0.5 MCG CAPSULE [9351]

Facility

$1.83

Service Code	NDC 63304-240-01
Hospital Charge Code	1710571
Hospital Revenue Code	259
Min. Negotiated Rate	$1.01
Max. Negotiated Rate	$1.46
Rate for Payer: Cash Price	$0.82
Rate for Payer: Cigna of CA HMO/PPO	$1.46
Rate for Payer: Health Smart Auto/Commercial	$1.10
Rate for Payer: LLUH Dept of Risk Management WC	$1.01
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$1.37

CALCITRIOL 1 MCG/ML INTRAVENOUS SOLUTION [9348]

Facility

$7.19

Service Code	NDC 63323-731-01
Hospital Charge Code	1720636
Hospital Revenue Code	636
Min. Negotiated Rate	$3.95
Max. Negotiated Rate	$5.39
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$4.31
Rate for Payer: Aetna of CA Government/Medicare	$4.31
Rate for Payer: Cash Price	$3.24
Rate for Payer: Health Smart Auto/Commercial	$4.31
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$4.31
Rate for Payer: LLUH Dept of Risk Management WC	$3.95
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$5.39

CALCITRIOL 1 MCG/ML INTRAVENOUS SOLUTION [9348]

Facility

$9.00

Service Code	NDC 17478-931-01
Hospital Charge Code	1720636
Hospital Revenue Code	636
Min. Negotiated Rate	$4.95
Max. Negotiated Rate	$7.20
Rate for Payer: Cash Price	$4.05
Rate for Payer: Cigna of CA HMO/PPO	$7.20
Rate for Payer: Health Smart Auto/Commercial	$5.40
Rate for Payer: LLUH Dept of Risk Management WC	$4.95
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$6.75

CALCITRIOL 1 MCG/ML INTRAVENOUS SOLUTION [9348]

Facility

$7.19

Service Code	NDC 63323-731-01
Hospital Charge Code	1720636
Hospital Revenue Code	636
Min. Negotiated Rate	$3.95
Max. Negotiated Rate	$5.75
Rate for Payer: Cash Price	$3.24
Rate for Payer: Cigna of CA HMO/PPO	$5.75
Rate for Payer: Health Smart Auto/Commercial	$4.31
Rate for Payer: LLUH Dept of Risk Management WC	$3.95
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$5.39

CALCITRIOL 1 MCG/ML INTRAVENOUS SOLUTION [9348]

Facility

$9.00

Service Code	NDC 17478-931-01
Hospital Charge Code	1720636
Hospital Revenue Code	636
Min. Negotiated Rate	$4.95
Max. Negotiated Rate	$6.75
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$5.40
Rate for Payer: Aetna of CA Government/Medicare	$5.40
Rate for Payer: Cash Price	$4.05
Rate for Payer: Health Smart Auto/Commercial	$5.40
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$5.40
Rate for Payer: LLUH Dept of Risk Management WC	$4.95
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$6.75

CALCITRIOL 1 MCG/ML ORAL SOLUTION [16218]

Facility

$10.88

Service Code	NDC 63304-241-59
Hospital Charge Code	1715185
Hospital Revenue Code	259
Min. Negotiated Rate	$5.98
Max. Negotiated Rate	$8.16
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$6.53
Rate for Payer: Aetna of CA Government/Medicare	$6.53
Rate for Payer: Cash Price	$4.90
Rate for Payer: Health Smart Auto/Commercial	$6.53
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$6.53
Rate for Payer: LLUH Dept of Risk Management WC	$5.98
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$8.16

Know your out-of-pocket cost for care.

All Charges