Loma Linda University Behavioral Medicine Center (BMC)

All Charges

Charge

Type

Setting

Price

DEXAMETH 1 MG-MOXIFLOX 0.5 MG-KETOROLAC 0.4 MG/ML(PF) INTRAOCULAR SOLN [221697]

Facility

$38.40

Service Code	HCPCS J3490
Hospital Charge Code	901700025
Hospital Revenue Code	636
Min. Negotiated Rate	$21.12
Max. Negotiated Rate	$30.72
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$23.04
Rate for Payer: Aetna of CA Government/Medicare	$23.04
Rate for Payer: Cash Price	$21.12
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$30.72
Rate for Payer: Health Smart Auto/Commercial	$23.04
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$23.04
Rate for Payer: LLUH Dept of Risk Management WC	$21.12
Rate for Payer: Multiplan Commercial	$28.80

DEXAMETHASONE 0.1% EYE DROPS. [4082335]

Facility

$12.94

Service Code	NDC 24208-720-02
Hospital Charge Code	901700029
Hospital Revenue Code	259
Min. Negotiated Rate	$7.12
Max. Negotiated Rate	$10.35
Rate for Payer: Cash Price	$7.11
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$10.35
Rate for Payer: Health Smart Auto/Commercial	$7.76
Rate for Payer: LLUH Dept of Risk Management WC	$7.12
Rate for Payer: Multiplan Commercial	$9.71

DEXAMETHASONE 0.1% EYE DROPS. [4082335]

Facility

$12.94

Service Code	NDC 24208-720-02
Hospital Charge Code	901700029
Hospital Revenue Code	259
Min. Negotiated Rate	$7.12
Max. Negotiated Rate	$10.35
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$7.76
Rate for Payer: Aetna of CA Government/Medicare	$7.76
Rate for Payer: Cash Price	$7.11
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$10.35
Rate for Payer: Health Smart Auto/Commercial	$7.76
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$7.76
Rate for Payer: LLUH Dept of Risk Management WC	$7.12
Rate for Payer: Multiplan Commercial	$9.71

DEXAMETHASONE 0.1 % EYE DROPS,SUSPENSION [19596]

Facility

$16.56

Service Code	NDC 0078-0925-25
Hospital Charge Code	901700029
Hospital Revenue Code	259
Min. Negotiated Rate	$9.11
Max. Negotiated Rate	$13.25
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$9.94
Rate for Payer: Aetna of CA Government/Medicare	$9.94
Rate for Payer: Cash Price	$9.11
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$13.25
Rate for Payer: Health Smart Auto/Commercial	$9.94
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$9.94
Rate for Payer: LLUH Dept of Risk Management WC	$9.11
Rate for Payer: Multiplan Commercial	$12.42

DEXAMETHASONE 0.1 % EYE DROPS,SUSPENSION [19596]

Facility

$16.56

Service Code	NDC 0078-0925-25
Hospital Charge Code	901700029
Hospital Revenue Code	259
Min. Negotiated Rate	$9.11
Max. Negotiated Rate	$13.25
Rate for Payer: Cash Price	$9.11
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$13.25
Rate for Payer: Health Smart Auto/Commercial	$9.94
Rate for Payer: LLUH Dept of Risk Management WC	$9.11
Rate for Payer: Multiplan Commercial	$12.42

DEXAMETHASONE 0.5 MG/5 ML ORAL SOLUTION [2320]

Facility

$0.04

Service Code	HCPCS J8540
Hospital Charge Code	901700025
Hospital Revenue Code	636
Min. Negotiated Rate	$0.02
Max. Negotiated Rate	$0.03
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$0.02
Rate for Payer: Aetna of CA Government/Medicare	$0.02
Rate for Payer: Cash Price	$0.02
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$0.03
Rate for Payer: Health Smart Auto/Commercial	$0.02
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$0.02
Rate for Payer: LLUH Dept of Risk Management WC	$0.02
Rate for Payer: Multiplan Commercial	$0.03

DEXAMETHASONE 0.5 MG/5 ML ORAL SOLUTION [2320]

Facility

$0.04

Service Code	HCPCS J8540
Hospital Charge Code	901700025
Hospital Revenue Code	636
Min. Negotiated Rate	$0.02
Max. Negotiated Rate	$0.03
Rate for Payer: Cash Price	$0.02
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$0.03
Rate for Payer: Health Smart Auto/Commercial	$0.02
Rate for Payer: LLUH Dept of Risk Management WC	$0.02
Rate for Payer: Multiplan Commercial	$0.03

DEXAMETHASONE 0.5 MG TABLET [2322]

Facility

$0.21

Service Code	HCPCS J8540
Hospital Charge Code	901700025
Hospital Revenue Code	636
Min. Negotiated Rate	$0.12
Max. Negotiated Rate	$0.17
Rate for Payer: Cash Price	$0.11
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$0.17
Rate for Payer: Health Smart Auto/Commercial	$0.13
Rate for Payer: LLUH Dept of Risk Management WC	$0.12
Rate for Payer: Multiplan Commercial	$0.16

DEXAMETHASONE 0.5 MG TABLET [2322]

Facility

$0.21

Service Code	HCPCS J8540
Hospital Charge Code	901700025
Hospital Revenue Code	636
Min. Negotiated Rate	$0.12
Max. Negotiated Rate	$0.17
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$0.13
Rate for Payer: Aetna of CA Government/Medicare	$0.13
Rate for Payer: Cash Price	$0.11
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$0.17
Rate for Payer: Health Smart Auto/Commercial	$0.13
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$0.13
Rate for Payer: LLUH Dept of Risk Management WC	$0.12
Rate for Payer: Multiplan Commercial	$0.16

DEXAMETHASONE 10 MG/ML MED NEB SOLUTION [192189]

Facility

$1.72

Service Code	HCPCS J1100
Hospital Charge Code	901700029
Hospital Revenue Code	259
Min. Negotiated Rate	$0.95
Max. Negotiated Rate	$1.38
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$1.03
Rate for Payer: Aetna of CA Government/Medicare	$1.03
Rate for Payer: Cash Price	$0.94
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$1.38
Rate for Payer: Health Smart Auto/Commercial	$1.03
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$1.03
Rate for Payer: LLUH Dept of Risk Management WC	$0.95
Rate for Payer: Multiplan Commercial	$1.29

DEXAMETHASONE 10 MG/ML MED NEB SOLUTION [192189]

Facility

$1.72

Service Code	HCPCS J1100
Hospital Charge Code	901700029
Hospital Revenue Code	259
Min. Negotiated Rate	$0.95
Max. Negotiated Rate	$1.38
Rate for Payer: Cash Price	$0.94
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$1.38
Rate for Payer: Health Smart Auto/Commercial	$1.03
Rate for Payer: LLUH Dept of Risk Management WC	$0.95
Rate for Payer: Multiplan Commercial	$1.29

DEXAMETHASONE 10 MG/ML SUBCONJUNCTIVAL INJECTION [4081910]

Facility

$1.86

Service Code	HCPCS J1100
Hospital Charge Code	901700025
Hospital Revenue Code	636
Min. Negotiated Rate	$1.02
Max. Negotiated Rate	$1.49
Rate for Payer: Cash Price	$1.02
Rate for Payer: Cash Price	$0.94
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$1.38
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$1.49
Rate for Payer: Health Smart Auto/Commercial	$1.12
Rate for Payer: Health Smart Auto/Commercial	$1.03
Rate for Payer: LLUH Dept of Risk Management WC	$0.95
Rate for Payer: LLUH Dept of Risk Management WC	$1.02
Rate for Payer: Multiplan Commercial	$1.29
Rate for Payer: Multiplan Commercial	$1.40

DEXAMETHASONE 10 MG/ML SUBCONJUNCTIVAL INJECTION [4081910]

Facility

$1.72

Service Code	HCPCS J1100
Hospital Charge Code	901700025
Hospital Revenue Code	636
Min. Negotiated Rate	$0.95
Max. Negotiated Rate	$1.38
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$1.03
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$1.12
Rate for Payer: Aetna of CA Government/Medicare	$1.12
Rate for Payer: Aetna of CA Government/Medicare	$1.03
Rate for Payer: Cash Price	$1.02
Rate for Payer: Cash Price	$0.94
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$1.38
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$1.49
Rate for Payer: Health Smart Auto/Commercial	$1.03
Rate for Payer: Health Smart Auto/Commercial	$1.12
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$1.03
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$1.12
Rate for Payer: LLUH Dept of Risk Management WC	$0.95
Rate for Payer: LLUH Dept of Risk Management WC	$1.02
Rate for Payer: Multiplan Commercial	$1.40
Rate for Payer: Multiplan Commercial	$1.29

DEXAMETHASONE 1 MG/ML DROPS (CONCENTRATE) [110922]

Facility

$0.95

Service Code	NDC 0054-3176-44
Hospital Charge Code	901700029
Hospital Revenue Code	259
Min. Negotiated Rate	$0.52
Max. Negotiated Rate	$0.76
Rate for Payer: Cash Price	$0.52
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$0.76
Rate for Payer: Health Smart Auto/Commercial	$0.57
Rate for Payer: LLUH Dept of Risk Management WC	$0.52
Rate for Payer: Multiplan Commercial	$0.71

DEXAMETHASONE 1 MG/ML DROPS (CONCENTRATE) [110922]

Facility

$0.95

Service Code	NDC 0054-3176-44
Hospital Charge Code	901700029
Hospital Revenue Code	259
Min. Negotiated Rate	$0.52
Max. Negotiated Rate	$0.76
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$0.57
Rate for Payer: Aetna of CA Government/Medicare	$0.57
Rate for Payer: Cash Price	$0.52
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$0.76
Rate for Payer: Health Smart Auto/Commercial	$0.57
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$0.57
Rate for Payer: LLUH Dept of Risk Management WC	$0.52
Rate for Payer: Multiplan Commercial	$0.71

DEXAMETHASONE 1 MG-MOXIFLOXACIN 5 MG/ML (PF)-NACL,ISO INTRAOCULAR SOLN [221704]

Facility

$34.80

Service Code	HCPCS J3490
Hospital Charge Code	901700025
Hospital Revenue Code	636
Min. Negotiated Rate	$19.14
Max. Negotiated Rate	$27.84
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$20.88
Rate for Payer: Aetna of CA Government/Medicare	$20.88
Rate for Payer: Cash Price	$19.14
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$27.84
Rate for Payer: Health Smart Auto/Commercial	$20.88
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$20.88
Rate for Payer: LLUH Dept of Risk Management WC	$19.14
Rate for Payer: Multiplan Commercial	$26.10

DEXAMETHASONE 1 MG-MOXIFLOXACIN 5 MG/ML (PF)-NACL,ISO INTRAOCULAR SOLN [221704]

Facility

$34.80

Service Code	HCPCS J3490
Hospital Charge Code	901700025
Hospital Revenue Code	636
Min. Negotiated Rate	$19.14
Max. Negotiated Rate	$27.84
Rate for Payer: Cash Price	$19.14
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$27.84
Rate for Payer: Health Smart Auto/Commercial	$20.88
Rate for Payer: LLUH Dept of Risk Management WC	$19.14
Rate for Payer: Multiplan Commercial	$26.10

DEXAMETHASONE 1 MG TABLET [2324]

Facility

$0.30

Service Code	HCPCS J8540
Hospital Charge Code	901700025
Hospital Revenue Code	636
Min. Negotiated Rate	$0.17
Max. Negotiated Rate	$0.24
Rate for Payer: Cash Price	$0.16
Rate for Payer: Cash Price	$0.20
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$0.30
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$0.24
Rate for Payer: Health Smart Auto/Commercial	$0.18
Rate for Payer: Health Smart Auto/Commercial	$0.22
Rate for Payer: LLUH Dept of Risk Management WC	$0.20
Rate for Payer: LLUH Dept of Risk Management WC	$0.17
Rate for Payer: Multiplan Commercial	$0.23
Rate for Payer: Multiplan Commercial	$0.28

DEXAMETHASONE 1 MG TABLET [2324]

Facility

$0.30

Service Code	HCPCS J8540
Hospital Charge Code	901700025
Hospital Revenue Code	636
Min. Negotiated Rate	$0.17
Max. Negotiated Rate	$0.24
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$0.18
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$0.22
Rate for Payer: Aetna of CA Government/Medicare	$0.22
Rate for Payer: Aetna of CA Government/Medicare	$0.18
Rate for Payer: Cash Price	$0.16
Rate for Payer: Cash Price	$0.20
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$0.24
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$0.30
Rate for Payer: Health Smart Auto/Commercial	$0.18
Rate for Payer: Health Smart Auto/Commercial	$0.22
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$0.22
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$0.18
Rate for Payer: LLUH Dept of Risk Management WC	$0.20
Rate for Payer: LLUH Dept of Risk Management WC	$0.17
Rate for Payer: Multiplan Commercial	$0.28
Rate for Payer: Multiplan Commercial	$0.23

DEXAMETHASONE 2 MG TABLET [2326]

Facility

$0.58

Service Code	HCPCS J8540
Hospital Charge Code	901700025
Hospital Revenue Code	636
Min. Negotiated Rate	$0.32
Max. Negotiated Rate	$0.46
Rate for Payer: Cash Price	$0.32
Rate for Payer: Cash Price	$0.41
Rate for Payer: Cash Price	$0.47
Rate for Payer: Cash Price	$0.33
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$0.48
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$0.46
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$0.59
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$0.69
Rate for Payer: Health Smart Auto/Commercial	$0.52
Rate for Payer: Health Smart Auto/Commercial	$0.35
Rate for Payer: Health Smart Auto/Commercial	$0.44
Rate for Payer: Health Smart Auto/Commercial	$0.36
Rate for Payer: LLUH Dept of Risk Management WC	$0.33
Rate for Payer: LLUH Dept of Risk Management WC	$0.32
Rate for Payer: LLUH Dept of Risk Management WC	$0.41
Rate for Payer: LLUH Dept of Risk Management WC	$0.47
Rate for Payer: Multiplan Commercial	$0.45
Rate for Payer: Multiplan Commercial	$0.44
Rate for Payer: Multiplan Commercial	$0.65
Rate for Payer: Multiplan Commercial	$0.56

DEXAMETHASONE 2 MG TABLET [2326]

Facility

$0.58

Service Code	HCPCS J8540
Hospital Charge Code	901700025
Hospital Revenue Code	636
Min. Negotiated Rate	$0.32
Max. Negotiated Rate	$0.46
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$0.35
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$0.36
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$0.44
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$0.52
Rate for Payer: Aetna of CA Government/Medicare	$0.52
Rate for Payer: Aetna of CA Government/Medicare	$0.36
Rate for Payer: Aetna of CA Government/Medicare	$0.35
Rate for Payer: Aetna of CA Government/Medicare	$0.44
Rate for Payer: Cash Price	$0.32
Rate for Payer: Cash Price	$0.47
Rate for Payer: Cash Price	$0.33
Rate for Payer: Cash Price	$0.41
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$0.46
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$0.48
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$0.59
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$0.69
Rate for Payer: Health Smart Auto/Commercial	$0.52
Rate for Payer: Health Smart Auto/Commercial	$0.44
Rate for Payer: Health Smart Auto/Commercial	$0.36
Rate for Payer: Health Smart Auto/Commercial	$0.35
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$0.52
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$0.44
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$0.36
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$0.35
Rate for Payer: LLUH Dept of Risk Management WC	$0.47
Rate for Payer: LLUH Dept of Risk Management WC	$0.32
Rate for Payer: LLUH Dept of Risk Management WC	$0.41
Rate for Payer: LLUH Dept of Risk Management WC	$0.33
Rate for Payer: Multiplan Commercial	$0.45
Rate for Payer: Multiplan Commercial	$0.56
Rate for Payer: Multiplan Commercial	$0.65
Rate for Payer: Multiplan Commercial	$0.44

DEXAMETHASONE 4 MG TABLET [2327]

Facility

$1.19

Service Code	HCPCS J8540
Hospital Charge Code	901700025
Hospital Revenue Code	636
Min. Negotiated Rate	$0.65
Max. Negotiated Rate	$0.95
Rate for Payer: Cash Price	$0.65
Rate for Payer: Cash Price	$0.66
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$0.97
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$0.95
Rate for Payer: Health Smart Auto/Commercial	$0.71
Rate for Payer: Health Smart Auto/Commercial	$0.73
Rate for Payer: LLUH Dept of Risk Management WC	$0.67
Rate for Payer: LLUH Dept of Risk Management WC	$0.65
Rate for Payer: Multiplan Commercial	$0.89
Rate for Payer: Multiplan Commercial	$0.91

DEXAMETHASONE 4 MG TABLET [2327]

Facility

$1.19

Service Code	HCPCS J8540
Hospital Charge Code	901700025
Hospital Revenue Code	636
Min. Negotiated Rate	$0.65
Max. Negotiated Rate	$0.95
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$0.71
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$0.73
Rate for Payer: Aetna of CA Government/Medicare	$0.73
Rate for Payer: Aetna of CA Government/Medicare	$0.71
Rate for Payer: Cash Price	$0.65
Rate for Payer: Cash Price	$0.66
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$0.95
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$0.97
Rate for Payer: Health Smart Auto/Commercial	$0.71
Rate for Payer: Health Smart Auto/Commercial	$0.73
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$0.73
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: LLUH Dept of Risk Management WC	$0.67
Rate for Payer: Multiplan Commercial	$0.89
Rate for Payer: Multiplan Commercial	$0.91

DEXAMETHASONE 6 MG TABLET [2328]

Facility

$0.72

Service Code	HCPCS J8540
Hospital Charge Code	901700025
Hospital Revenue Code	636
Min. Negotiated Rate	$0.40
Max. Negotiated Rate	$0.58
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$0.43
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$0.89
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$1.07
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$1.14
Rate for Payer: Aetna of CA Government/Medicare	$0.89
Rate for Payer: Aetna of CA Government/Medicare	$1.07
Rate for Payer: Aetna of CA Government/Medicare	$0.43
Rate for Payer: Aetna of CA Government/Medicare	$1.14
Rate for Payer: Cash Price	$0.40
Rate for Payer: Cash Price	$1.04
Rate for Payer: Cash Price	$1.05
Rate for Payer: Cash Price	$0.98
Rate for Payer: Cash Price	$0.81
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$0.58
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$1.18
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$1.42
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$1.52
Rate for Payer: Health Smart Auto/Commercial	$0.89
Rate for Payer: Health Smart Auto/Commercial	$1.07
Rate for Payer: Health Smart Auto/Commercial	$1.14
Rate for Payer: Health Smart Auto/Commercial	$0.43
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$1.07
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$1.14
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$0.43
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$0.89
Rate for Payer: LLUH Dept of Risk Management WC	$1.04
Rate for Payer: LLUH Dept of Risk Management WC	$0.98
Rate for Payer: LLUH Dept of Risk Management WC	$0.40
Rate for Payer: LLUH Dept of Risk Management WC	$0.81
Rate for Payer: Multiplan Commercial	$1.33
Rate for Payer: Multiplan Commercial	$1.11
Rate for Payer: Multiplan Commercial	$0.54
Rate for Payer: Multiplan Commercial	$1.43

DEXAMETHASONE 6 MG TABLET [2328]

Facility

$1.90

Service Code	HCPCS J8540
Hospital Charge Code	901700025
Hospital Revenue Code	636
Min. Negotiated Rate	$1.04
Max. Negotiated Rate	$1.52
Rate for Payer: Cash Price	$1.05
Rate for Payer: Cash Price	$0.98
Rate for Payer: Cash Price	$0.40
Rate for Payer: Cash Price	$1.04
Rate for Payer: Cash Price	$0.81
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$1.42
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$1.18
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$1.52
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$0.58
Rate for Payer: Health Smart Auto/Commercial	$1.07
Rate for Payer: Health Smart Auto/Commercial	$0.43
Rate for Payer: Health Smart Auto/Commercial	$1.14
Rate for Payer: Health Smart Auto/Commercial	$0.89
Rate for Payer: LLUH Dept of Risk Management WC	$0.81
Rate for Payer: LLUH Dept of Risk Management WC	$0.40
Rate for Payer: LLUH Dept of Risk Management WC	$0.98
Rate for Payer: LLUH Dept of Risk Management WC	$1.04
Rate for Payer: Multiplan Commercial	$1.11
Rate for Payer: Multiplan Commercial	$0.54
Rate for Payer: Multiplan Commercial	$1.43
Rate for Payer: Multiplan Commercial	$1.33

Know your out-of-pocket cost for care.

All Charges