Loma Linda University Behavioral Medicine Center (BMC)

All Charges

Charge

Type

Setting

Price

DEXAMETHASONE 1 MG TABLET [2324]

Facility

$0.30

Service Code	CPT J8540
Hospital Charge Code	1711366
Hospital Revenue Code	636
Min. Negotiated Rate	$0.17
Max. Negotiated Rate	$0.23
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	$0.14
Rate for Payer: Cash Price	$0.17
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	$0.17
Rate for Payer: LLUH Dept of Risk Management WC	$0.20
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$0.23
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$0.28

DEXAMETHASONE 1 MG TABLET [2324]

Facility

$0.30

Service Code	CPT J8540
Hospital Charge Code	1711366
Hospital Revenue Code	636
Min. Negotiated Rate	$0.17
Max. Negotiated Rate	$0.24
Rate for Payer: Cash Price	$0.14
Rate for Payer: Cash Price	$0.17
Rate for Payer: Cigna of CA HMO/PPO	$0.30
Rate for Payer: Cigna of CA HMO/PPO	$0.24
Rate for Payer: Health Smart Auto/Commercial	$0.22
Rate for Payer: Health Smart Auto/Commercial	$0.18
Rate for Payer: LLUH Dept of Risk Management WC	$0.17
Rate for Payer: LLUH Dept of Risk Management WC	$0.20
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$0.23
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$0.28

DEXAMETHASONE 2 MG TABLET [2326]

Facility

$0.60

Service Code	CPT J8540
Hospital Charge Code	1710159
Hospital Revenue Code	636
Min. Negotiated Rate	$0.33
Max. Negotiated Rate	$0.45
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 Government/Medicare	$0.44
Rate for Payer: Aetna of CA Government/Medicare	$0.36
Rate for Payer: Cash Price	$0.27
Rate for Payer: Cash Price	$0.33
Rate for Payer: Health Smart Auto/Commercial	$0.44
Rate for Payer: Health Smart Auto/Commercial	$0.36
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$0.36
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$0.44
Rate for Payer: LLUH Dept of Risk Management WC	$0.33
Rate for Payer: LLUH Dept of Risk Management WC	$0.41
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$0.45
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$0.56

DEXAMETHASONE 2 MG TABLET [2326]

Facility

$0.74

Service Code	CPT J8540
Hospital Charge Code	1710159
Hospital Revenue Code	636
Min. Negotiated Rate	$0.41
Max. Negotiated Rate	$0.59
Rate for Payer: Cash Price	$0.33
Rate for Payer: Cash Price	$0.27
Rate for Payer: Cigna of CA HMO/PPO	$0.59
Rate for Payer: Cigna of CA HMO/PPO	$0.48
Rate for Payer: Health Smart Auto/Commercial	$0.36
Rate for Payer: Health Smart Auto/Commercial	$0.44
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 Beech St/Commercial/PHCS	$0.45
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$0.56

DEXAMETHASONE 4 MG TABLET [2327]

Facility

$1.19

Service Code	CPT J8540
Hospital Charge Code	1710170
Hospital Revenue Code	636
Min. Negotiated Rate	$0.65
Max. Negotiated Rate	$0.95
Rate for Payer: Cash Price	$0.54
Rate for Payer: Cash Price	$0.54
Rate for Payer: Cigna of CA HMO/PPO	$0.97
Rate for Payer: Cigna of CA 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	$0.65
Rate for Payer: LLUH Dept of Risk Management WC	$0.67
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$0.91
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$0.89

DEXAMETHASONE 4 MG TABLET [2327]

Facility

$1.19

Service Code	CPT J8540
Hospital Charge Code	1710170
Hospital Revenue Code	636
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 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	$0.54
Rate for Payer: Cash Price	$0.54
Rate for Payer: Health Smart Auto/Commercial	$0.73
Rate for Payer: Health Smart Auto/Commercial	$0.71
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 Beech St/Commercial/PHCS	$0.89
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$0.91

DEXAMETHASONE 6 MG TABLET [2328]

Facility

$1.78

Service Code	CPT J8540
Hospital Charge Code	1710185
Hospital Revenue Code	636
Min. Negotiated Rate	$0.98
Max. Negotiated Rate	$1.42
Rate for Payer: Cash Price	$0.80
Rate for Payer: Cash Price	$0.86
Rate for Payer: Cigna of CA HMO/PPO	$1.42
Rate for Payer: Cigna of CA HMO/PPO	$1.52
Rate for Payer: Health Smart Auto/Commercial	$1.14
Rate for Payer: Health Smart Auto/Commercial	$1.07
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 Beech St/Commercial/PHCS	$1.34
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$1.42

DEXAMETHASONE 6 MG TABLET [2328]

Facility

$1.90

Service Code	CPT J8540
Hospital Charge Code	1710185
Hospital Revenue Code	636
Min. Negotiated Rate	$1.04
Max. Negotiated Rate	$1.42
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$1.14
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$1.07
Rate for Payer: Aetna of CA Government/Medicare	$1.07
Rate for Payer: Aetna of CA Government/Medicare	$1.14
Rate for Payer: Cash Price	$0.86
Rate for Payer: Cash Price	$0.80
Rate for Payer: Health Smart Auto/Commercial	$1.07
Rate for Payer: Health Smart Auto/Commercial	$1.14
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$1.14
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$1.07
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 Beech St/Commercial/PHCS	$1.42
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$1.34

DEXAMETHASONE INTRAVITREAL INJECTION [192081]

Facility

$3.46

Service Code	CPT J1100
Hospital Charge Code	1720127
Hospital Revenue Code	636
Min. Negotiated Rate	$1.90
Max. Negotiated Rate	$2.60
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$2.08
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$0.56
Rate for Payer: Aetna of CA Government/Medicare	$0.56
Rate for Payer: Aetna of CA Government/Medicare	$2.08
Rate for Payer: Cash Price	$0.42
Rate for Payer: Cash Price	$1.56
Rate for Payer: Health Smart Auto/Commercial	$2.08
Rate for Payer: Health Smart Auto/Commercial	$0.56
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$0.56
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$2.08
Rate for Payer: LLUH Dept of Risk Management WC	$0.51
Rate for Payer: LLUH Dept of Risk Management WC	$1.90
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$0.70
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$2.60

DEXAMETHASONE INTRAVITREAL INJECTION [192081]

Facility

$3.46

Service Code	CPT J1100
Hospital Charge Code	1720127
Hospital Revenue Code	636
Min. Negotiated Rate	$1.90
Max. Negotiated Rate	$2.77
Rate for Payer: Cash Price	$1.56
Rate for Payer: Cash Price	$0.42
Rate for Payer: Cigna of CA HMO/PPO	$2.77
Rate for Payer: Cigna of CA HMO/PPO	$0.74
Rate for Payer: Health Smart Auto/Commercial	$2.08
Rate for Payer: Health Smart Auto/Commercial	$0.56
Rate for Payer: LLUH Dept of Risk Management WC	$0.51
Rate for Payer: LLUH Dept of Risk Management WC	$1.90
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$0.70
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$2.60

DEXAMETHASONE ORAL SOLUTION (IV FORM) 4 MG/ML [4080428]

Facility

$0.62

Service Code	CPT J8540
Hospital Charge Code	1720127
Hospital Revenue Code	636
Min. Negotiated Rate	$0.34
Max. Negotiated Rate	$0.50
Rate for Payer: Cash Price	$0.28
Rate for Payer: Cigna of CA HMO/PPO	$0.50
Rate for Payer: Health Smart Auto/Commercial	$0.37
Rate for Payer: LLUH Dept of Risk Management WC	$0.34
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$0.47

DEXAMETHASONE ORAL SOLUTION (IV FORM) 4 MG/ML [4080428]

Facility

$0.62

Service Code	CPT J8540
Hospital Charge Code	1720127
Hospital Revenue Code	636
Min. Negotiated Rate	$0.34
Max. Negotiated Rate	$0.47
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$0.37
Rate for Payer: Aetna of CA Government/Medicare	$0.37
Rate for Payer: Cash Price	$0.28
Rate for Payer: Health Smart Auto/Commercial	$0.37
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$0.37
Rate for Payer: LLUH Dept of Risk Management WC	$0.34
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$0.47

DEXAMETHASONE SODIUM PHOSPHATE 10 MG/ML INJECTION SOLUTION [2331]

Facility

$1.72

Service Code	CPT J1100
Hospital Charge Code	1730171
Hospital Revenue Code	636
Min. Negotiated Rate	$0.95
Max. Negotiated Rate	$1.38
Rate for Payer: Cash Price	$0.77
Rate for Payer: Cigna of CA 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 Beech St/Commercial/PHCS	$1.29

DEXAMETHASONE SODIUM PHOSPHATE 10 MG/ML INJECTION SOLUTION [2331]

Facility

$1.86

Service Code	CPT J1100
Hospital Charge Code	1720453
Hospital Revenue Code	636
Min. Negotiated Rate	$1.02
Max. Negotiated Rate	$1.49
Rate for Payer: Cash Price	$0.84
Rate for Payer: Cash Price	$0.22
Rate for Payer: Cigna of CA HMO/PPO	$1.49
Rate for Payer: Cigna of CA HMO/PPO	$0.38
Rate for Payer: Health Smart Auto/Commercial	$0.29
Rate for Payer: Health Smart Auto/Commercial	$1.12
Rate for Payer: LLUH Dept of Risk Management WC	$0.26
Rate for Payer: LLUH Dept of Risk Management WC	$1.02
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$1.40
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$0.36

DEXAMETHASONE SODIUM PHOSPHATE 10 MG/ML INJECTION SOLUTION [2331]

Facility

$1.72

Service Code	CPT J1100
Hospital Charge Code	1730171
Hospital Revenue Code	636
Min. Negotiated Rate	$0.95
Max. Negotiated Rate	$1.29
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	$0.77
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 Beech St/Commercial/PHCS	$1.29

DEXAMETHASONE SODIUM PHOSPHATE 10 MG/ML INJECTION SOLUTION [2331]

Facility

$1.86

Service Code	CPT J1100
Hospital Charge Code	1720453
Hospital Revenue Code	636
Min. Negotiated Rate	$1.02
Max. Negotiated Rate	$1.40
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$1.12
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$0.29
Rate for Payer: Aetna of CA Government/Medicare	$0.29
Rate for Payer: Aetna of CA Government/Medicare	$1.12
Rate for Payer: Cash Price	$0.22
Rate for Payer: Cash Price	$0.84
Rate for Payer: Health Smart Auto/Commercial	$0.29
Rate for Payer: Health Smart Auto/Commercial	$1.12
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$1.12
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$0.29
Rate for Payer: LLUH Dept of Risk Management WC	$1.02
Rate for Payer: LLUH Dept of Risk Management WC	$0.26
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$0.36
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$1.40

DEXAMETHASONE SODIUM PHOSPHATE 4 MG/ML INJECTION SOLUTION [2332]

Facility

$3.46

Service Code	CPT J1100
Hospital Charge Code	1720127
Hospital Revenue Code	636
Min. Negotiated Rate	$1.90
Max. Negotiated Rate	$2.60
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$2.08
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$0.70
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$0.56
Rate for Payer: Aetna of CA Government/Medicare	$0.70
Rate for Payer: Aetna of CA Government/Medicare	$0.56
Rate for Payer: Aetna of CA Government/Medicare	$2.08
Rate for Payer: Cash Price	$0.42
Rate for Payer: Cash Price	$0.52
Rate for Payer: Cash Price	$1.56
Rate for Payer: Health Smart Auto/Commercial	$2.08
Rate for Payer: Health Smart Auto/Commercial	$0.56
Rate for Payer: Health Smart Auto/Commercial	$0.70
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$0.56
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$2.08
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$0.70
Rate for Payer: LLUH Dept of Risk Management WC	$0.64
Rate for Payer: LLUH Dept of Risk Management WC	$1.90
Rate for Payer: LLUH Dept of Risk Management WC	$0.51
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$0.70
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$2.60
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$0.87

DEXAMETHASONE SODIUM PHOSPHATE 4 MG/ML INJECTION SOLUTION [2332]

Facility

$0.26

Service Code	CPT J1100
Hospital Charge Code	1720136
Hospital Revenue Code	636
Min. Negotiated Rate	$0.14
Max. Negotiated Rate	$0.21
Rate for Payer: Cash Price	$0.12
Rate for Payer: Cigna of CA HMO/PPO	$0.21
Rate for Payer: Health Smart Auto/Commercial	$0.16
Rate for Payer: LLUH Dept of Risk Management WC	$0.14
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$0.20

DEXAMETHASONE SODIUM PHOSPHATE 4 MG/ML INJECTION SOLUTION [2332]

Facility

$0.26

Service Code	CPT J1100
Hospital Charge Code	1720136
Hospital Revenue Code	636
Min. Negotiated Rate	$0.14
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	$0.14
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$0.20

DEXAMETHASONE SODIUM PHOSPHATE 4 MG/ML INJECTION SOLUTION [2332]

Facility

$1.16

Service Code	CPT J1100
Hospital Charge Code	1720127
Hospital Revenue Code	636
Min. Negotiated Rate	$0.64
Max. Negotiated Rate	$0.93
Rate for Payer: Cash Price	$0.52
Rate for Payer: Cash Price	$0.42
Rate for Payer: Cash Price	$1.56
Rate for Payer: Cigna of CA HMO/PPO	$2.77
Rate for Payer: Cigna of CA HMO/PPO	$0.74
Rate for Payer: Cigna of CA HMO/PPO	$0.93
Rate for Payer: Health Smart Auto/Commercial	$0.70
Rate for Payer: Health Smart Auto/Commercial	$2.08
Rate for Payer: Health Smart Auto/Commercial	$0.56
Rate for Payer: LLUH Dept of Risk Management WC	$0.51
Rate for Payer: LLUH Dept of Risk Management WC	$0.64
Rate for Payer: LLUH Dept of Risk Management WC	$1.90
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$2.60
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$0.87
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$0.70

DEXAMETHASONE SODIUM PHOSPHATE 4 MG/ML INJECTION SYRINGE [114048]

Facility

$3.47

Service Code	CPT J1100
Hospital Charge Code	NDG114048
Hospital Revenue Code	636
Min. Negotiated Rate	$1.91
Max. Negotiated Rate	$2.60
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$2.08
Rate for Payer: Aetna of CA Government/Medicare	$2.08
Rate for Payer: Cash Price	$1.56
Rate for Payer: Health Smart Auto/Commercial	$2.08
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$2.08
Rate for Payer: LLUH Dept of Risk Management WC	$1.91
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$2.60

DEXAMETHASONE SODIUM PHOSPHATE 4 MG/ML INJECTION SYRINGE [114048]

Facility

$3.47

Service Code	CPT J1100
Hospital Charge Code	NDG114048
Hospital Revenue Code	636
Min. Negotiated Rate	$1.91
Max. Negotiated Rate	$2.78
Rate for Payer: Cash Price	$1.56
Rate for Payer: Cigna of CA HMO/PPO	$2.78
Rate for Payer: Health Smart Auto/Commercial	$2.08
Rate for Payer: LLUH Dept of Risk Management WC	$1.91
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$2.60

DEXAMETHASONE SODIUM PHOSPHATE (PF) 10 MG/ML INJECTION SOLUTION [118427]

Facility

$6.29

Service Code	CPT J1100
Hospital Charge Code	NDG118427
Hospital Revenue Code	636
Min. Negotiated Rate	$3.46
Max. Negotiated Rate	$5.03
Rate for Payer: Cash Price	$2.83
Rate for Payer: Cash Price	$0.95
Rate for Payer: Cash Price	$4.05
Rate for Payer: Cash Price	$2.38
Rate for Payer: Cigna of CA HMO/PPO	$7.20
Rate for Payer: Cigna of CA HMO/PPO	$1.68
Rate for Payer: Cigna of CA HMO/PPO	$4.22
Rate for Payer: Cigna of CA HMO/PPO	$5.03
Rate for Payer: Health Smart Auto/Commercial	$5.40
Rate for Payer: Health Smart Auto/Commercial	$3.17
Rate for Payer: Health Smart Auto/Commercial	$3.77
Rate for Payer: Health Smart Auto/Commercial	$1.26
Rate for Payer: LLUH Dept of Risk Management WC	$1.16
Rate for Payer: LLUH Dept of Risk Management WC	$2.90
Rate for Payer: LLUH Dept of Risk Management WC	$3.46
Rate for Payer: LLUH Dept of Risk Management WC	$4.95
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$6.75
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$1.58
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$4.72
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$3.96

DEXAMETHASONE SODIUM PHOSPHATE (PF) 10 MG/ML INJECTION SOLUTION [118427]

Facility

$5.28

Service Code	CPT J1100
Hospital Charge Code	NDG118427
Hospital Revenue Code	636
Min. Negotiated Rate	$2.90
Max. Negotiated Rate	$3.96
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$1.26
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$3.17
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$3.77
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$5.40
Rate for Payer: Aetna of CA Government/Medicare	$1.26
Rate for Payer: Aetna of CA Government/Medicare	$5.40
Rate for Payer: Aetna of CA Government/Medicare	$3.17
Rate for Payer: Aetna of CA Government/Medicare	$3.77
Rate for Payer: Cash Price	$2.83
Rate for Payer: Cash Price	$0.95
Rate for Payer: Cash Price	$4.05
Rate for Payer: Cash Price	$2.38
Rate for Payer: Health Smart Auto/Commercial	$1.26
Rate for Payer: Health Smart Auto/Commercial	$5.40
Rate for Payer: Health Smart Auto/Commercial	$3.17
Rate for Payer: Health Smart Auto/Commercial	$3.77
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$3.17
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$1.26
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$5.40
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$3.77
Rate for Payer: LLUH Dept of Risk Management WC	$2.90
Rate for Payer: LLUH Dept of Risk Management WC	$3.46
Rate for Payer: LLUH Dept of Risk Management WC	$4.95
Rate for Payer: LLUH Dept of Risk Management WC	$1.16
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$1.58
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$6.75
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$3.96
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$4.72

DEXAMETHASONE SODIUM PHOSPHATE (PF) 10 MG/ML INJECTION SYRINGE [225593]

Facility

$6.94

Service Code	CPT J1100
Hospital Charge Code	NDG225593
Hospital Revenue Code	636
Min. Negotiated Rate	$3.82
Max. Negotiated Rate	$5.55
Rate for Payer: Cash Price	$3.12
Rate for Payer: Cigna of CA HMO/PPO	$5.55
Rate for Payer: Health Smart Auto/Commercial	$4.16
Rate for Payer: LLUH Dept of Risk Management WC	$3.82
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$5.20

Know your out-of-pocket cost for care.

All Charges