Loma Linda University Behavioral Medicine Center (BMC)

All Charges

Charge

Type

Setting

Price

ESTRADIOL 0.01% (0.1 MG/GRAM) VAGINAL CREAM [9969]

Facility

$9.74

Service Code	NDC 0430-3754-14
Hospital Charge Code	1743763
Hospital Revenue Code	259
Min. Negotiated Rate	$5.36
Max. Negotiated Rate	$7.79
Rate for Payer: Cash Price	$4.38
Rate for Payer: Cigna of CA HMO/PPO	$7.79
Rate for Payer: Health Smart Auto/Commercial	$5.84
Rate for Payer: LLUH Dept of Risk Management WC	$5.36
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$7.30

ESTRADIOL 0.025 MG/24 HR SEMIWEEKLY TRANSDERMAL PATCH [27457]

Facility

$13.04

Service Code	NDC 0781-7129-58
Hospital Charge Code	1743733
Hospital Revenue Code	259
Min. Negotiated Rate	$7.17
Max. Negotiated Rate	$10.43
Rate for Payer: Cash Price	$5.87
Rate for Payer: Cigna of CA HMO/PPO	$10.43
Rate for Payer: Health Smart Auto/Commercial	$7.82
Rate for Payer: LLUH Dept of Risk Management WC	$7.17
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$9.78

ESTRADIOL 0.025 MG/24 HR SEMIWEEKLY TRANSDERMAL PATCH [27457]

Facility

$13.04

Service Code	NDC 0781-7129-83
Hospital Charge Code	1743733
Hospital Revenue Code	259
Min. Negotiated Rate	$7.17
Max. Negotiated Rate	$9.78
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$7.82
Rate for Payer: Aetna of CA Government/Medicare	$7.82
Rate for Payer: Cash Price	$5.87
Rate for Payer: Health Smart Auto/Commercial	$7.82
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$7.82
Rate for Payer: LLUH Dept of Risk Management WC	$7.17
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$9.78

ESTRADIOL 0.025 MG/24 HR SEMIWEEKLY TRANSDERMAL PATCH [27457]

Facility

$13.04

Service Code	NDC 0781-7129-83
Hospital Charge Code	1743733
Hospital Revenue Code	259
Min. Negotiated Rate	$7.17
Max. Negotiated Rate	$10.43
Rate for Payer: Cash Price	$5.87
Rate for Payer: Cigna of CA HMO/PPO	$10.43
Rate for Payer: Health Smart Auto/Commercial	$7.82
Rate for Payer: LLUH Dept of Risk Management WC	$7.17
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$9.78

ESTRADIOL 0.025 MG/24 HR SEMIWEEKLY TRANSDERMAL PATCH [27457]

Facility

$13.04

Service Code	NDC 0781-7129-58
Hospital Charge Code	1743733
Hospital Revenue Code	259
Min. Negotiated Rate	$7.17
Max. Negotiated Rate	$9.78
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$7.82
Rate for Payer: Aetna of CA Government/Medicare	$7.82
Rate for Payer: Cash Price	$5.87
Rate for Payer: Health Smart Auto/Commercial	$7.82
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$7.82
Rate for Payer: LLUH Dept of Risk Management WC	$7.17
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$9.78

ESTRADIOL 0.045 MG-LEVONORGESTREL 0.015 MG/24HR WEEKLY TRANSDERM PATCH [37533]

Facility

$72.73

Service Code	NDC 50419-491-04
Hospital Charge Code	ERX37533
Hospital Revenue Code	259
Min. Negotiated Rate	$40.00
Max. Negotiated Rate	$58.18
Rate for Payer: Cash Price	$32.73
Rate for Payer: Cigna of CA HMO/PPO	$58.18
Rate for Payer: Health Smart Auto/Commercial	$43.64
Rate for Payer: LLUH Dept of Risk Management WC	$40.00
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$54.55

ESTRADIOL 0.045 MG-LEVONORGESTREL 0.015 MG/24HR WEEKLY TRANSDERM PATCH [37533]

Facility

$72.73

Service Code	NDC 50419-491-04
Hospital Charge Code	ERX37533
Hospital Revenue Code	259
Min. Negotiated Rate	$40.00
Max. Negotiated Rate	$54.55
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$43.64
Rate for Payer: Aetna of CA Government/Medicare	$43.64
Rate for Payer: Cash Price	$32.73
Rate for Payer: Health Smart Auto/Commercial	$43.64
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$43.64
Rate for Payer: LLUH Dept of Risk Management WC	$40.00
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$54.55

ESTRADIOL 0.05 MG/24 HR SEMIWEEKLY TRANSDERMAL PATCH [27459]

Facility

$13.05

Service Code	NDC 0781-7144-58
Hospital Charge Code	1712109
Hospital Revenue Code	259
Min. Negotiated Rate	$7.18
Max. Negotiated Rate	$10.44
Rate for Payer: Cash Price	$5.87
Rate for Payer: Cigna of CA HMO/PPO	$10.44
Rate for Payer: Health Smart Auto/Commercial	$7.83
Rate for Payer: LLUH Dept of Risk Management WC	$7.18
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$9.79

ESTRADIOL 0.05 MG/24 HR SEMIWEEKLY TRANSDERMAL PATCH [27459]

Facility

$13.05

Service Code	NDC 0781-7144-83
Hospital Charge Code	1712109
Hospital Revenue Code	259
Min. Negotiated Rate	$7.18
Max. Negotiated Rate	$9.79
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$7.83
Rate for Payer: Aetna of CA Government/Medicare	$7.83
Rate for Payer: Cash Price	$5.87
Rate for Payer: Health Smart Auto/Commercial	$7.83
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$7.83
Rate for Payer: LLUH Dept of Risk Management WC	$7.18
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$9.79

ESTRADIOL 0.05 MG/24 HR SEMIWEEKLY TRANSDERMAL PATCH [27459]

Facility

$13.05

Service Code	NDC 0781-7144-83
Hospital Charge Code	1712109
Hospital Revenue Code	259
Min. Negotiated Rate	$7.18
Max. Negotiated Rate	$10.44
Rate for Payer: Cash Price	$5.87
Rate for Payer: Cigna of CA HMO/PPO	$10.44
Rate for Payer: Health Smart Auto/Commercial	$7.83
Rate for Payer: LLUH Dept of Risk Management WC	$7.18
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$9.79

ESTRADIOL 0.05 MG/24 HR SEMIWEEKLY TRANSDERMAL PATCH [27459]

Facility

$13.05

Service Code	NDC 0781-7144-58
Hospital Charge Code	1712109
Hospital Revenue Code	259
Min. Negotiated Rate	$7.18
Max. Negotiated Rate	$9.79
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$7.83
Rate for Payer: Aetna of CA Government/Medicare	$7.83
Rate for Payer: Cash Price	$5.87
Rate for Payer: Health Smart Auto/Commercial	$7.83
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$7.83
Rate for Payer: LLUH Dept of Risk Management WC	$7.18
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$9.79

ESTRADIOL 0.05 MG/24 HR WEEKLY TRANSDERMAL PATCH [110634]

Facility

$22.28

Service Code	NDC 0781-7133-54
Hospital Charge Code	1712268
Hospital Revenue Code	259
Min. Negotiated Rate	$12.25
Max. Negotiated Rate	$17.82
Rate for Payer: Cash Price	$10.03
Rate for Payer: Cigna of CA HMO/PPO	$17.82
Rate for Payer: Health Smart Auto/Commercial	$13.37
Rate for Payer: LLUH Dept of Risk Management WC	$12.25
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$16.71

ESTRADIOL 0.05 MG/24 HR WEEKLY TRANSDERMAL PATCH [110634]

Facility

$22.28

Service Code	NDC 0781-7133-58
Hospital Charge Code	1712268
Hospital Revenue Code	259
Min. Negotiated Rate	$12.25
Max. Negotiated Rate	$16.71
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$13.37
Rate for Payer: Aetna of CA Government/Medicare	$13.37
Rate for Payer: Cash Price	$10.03
Rate for Payer: Health Smart Auto/Commercial	$13.37
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$13.37
Rate for Payer: LLUH Dept of Risk Management WC	$12.25
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$16.71

ESTRADIOL 0.05 MG/24 HR WEEKLY TRANSDERMAL PATCH [110634]

Facility

$22.28

Service Code	NDC 0781-7133-54
Hospital Charge Code	1712268
Hospital Revenue Code	259
Min. Negotiated Rate	$12.25
Max. Negotiated Rate	$16.71
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$13.37
Rate for Payer: Aetna of CA Government/Medicare	$13.37
Rate for Payer: Cash Price	$10.03
Rate for Payer: Health Smart Auto/Commercial	$13.37
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$13.37
Rate for Payer: LLUH Dept of Risk Management WC	$12.25
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$16.71

ESTRADIOL 0.05 MG/24 HR WEEKLY TRANSDERMAL PATCH [110634]

Facility

$22.28

Service Code	NDC 0781-7133-58
Hospital Charge Code	1712268
Hospital Revenue Code	259
Min. Negotiated Rate	$12.25
Max. Negotiated Rate	$17.82
Rate for Payer: Cash Price	$10.03
Rate for Payer: Cigna of CA HMO/PPO	$17.82
Rate for Payer: Health Smart Auto/Commercial	$13.37
Rate for Payer: LLUH Dept of Risk Management WC	$12.25
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$16.71

ESTRADIOL 0.1 MG/24 HR SEMIWEEKLY TRANSDERMAL PATCH [27461]

Facility

$19.57

Service Code	NDC 65162-228-04
Hospital Charge Code	1712110
Hospital Revenue Code	259
Min. Negotiated Rate	$10.76
Max. Negotiated Rate	$14.68
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$11.74
Rate for Payer: Aetna of CA Government/Medicare	$11.74
Rate for Payer: Cash Price	$8.81
Rate for Payer: Health Smart Auto/Commercial	$11.74
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$11.74
Rate for Payer: LLUH Dept of Risk Management WC	$10.76
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$14.68

ESTRADIOL 0.1 MG/24 HR SEMIWEEKLY TRANSDERMAL PATCH [27461]

Facility

$19.57

Service Code	NDC 65162-228-08
Hospital Charge Code	1712110
Hospital Revenue Code	259
Min. Negotiated Rate	$10.76
Max. Negotiated Rate	$14.68
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$11.74
Rate for Payer: Aetna of CA Government/Medicare	$11.74
Rate for Payer: Cash Price	$8.81
Rate for Payer: Health Smart Auto/Commercial	$11.74
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$11.74
Rate for Payer: LLUH Dept of Risk Management WC	$10.76
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$14.68

ESTRADIOL 0.1 MG/24 HR SEMIWEEKLY TRANSDERMAL PATCH [27461]

Facility

$19.57

Service Code	NDC 65162-228-04
Hospital Charge Code	1712110
Hospital Revenue Code	259
Min. Negotiated Rate	$10.76
Max. Negotiated Rate	$15.66
Rate for Payer: Cash Price	$8.81
Rate for Payer: Cigna of CA HMO/PPO	$15.66
Rate for Payer: Health Smart Auto/Commercial	$11.74
Rate for Payer: LLUH Dept of Risk Management WC	$10.76
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$14.68

ESTRADIOL 0.1 MG/24 HR SEMIWEEKLY TRANSDERMAL PATCH [27461]

Facility

$19.57

Service Code	NDC 65162-228-08
Hospital Charge Code	1712110
Hospital Revenue Code	259
Min. Negotiated Rate	$10.76
Max. Negotiated Rate	$15.66
Rate for Payer: Cash Price	$8.81
Rate for Payer: Cigna of CA HMO/PPO	$15.66
Rate for Payer: Health Smart Auto/Commercial	$11.74
Rate for Payer: LLUH Dept of Risk Management WC	$10.76
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$14.68

ESTRADIOL 0.1 MG/24 HR WEEKLY TRANSDERMAL PATCH [112051]

Facility

$22.28

Service Code	NDC 0378-3352-99
Hospital Charge Code	1712226
Hospital Revenue Code	259
Min. Negotiated Rate	$12.25
Max. Negotiated Rate	$16.71
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$13.37
Rate for Payer: Aetna of CA Government/Medicare	$13.37
Rate for Payer: Cash Price	$10.03
Rate for Payer: Health Smart Auto/Commercial	$13.37
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$13.37
Rate for Payer: LLUH Dept of Risk Management WC	$12.25
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$16.71

ESTRADIOL 0.1 MG/24 HR WEEKLY TRANSDERMAL PATCH [112051]

Facility

$22.28

Service Code	NDC 0378-3352-16
Hospital Charge Code	1712226
Hospital Revenue Code	259
Min. Negotiated Rate	$12.25
Max. Negotiated Rate	$17.82
Rate for Payer: Cash Price	$10.03
Rate for Payer: Cigna of CA HMO/PPO	$17.82
Rate for Payer: Health Smart Auto/Commercial	$13.37
Rate for Payer: LLUH Dept of Risk Management WC	$12.25
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$16.71

ESTRADIOL 0.1 MG/24 HR WEEKLY TRANSDERMAL PATCH [112051]

Facility

$22.28

Service Code	NDC 0378-3352-16
Hospital Charge Code	1712226
Hospital Revenue Code	259
Min. Negotiated Rate	$12.25
Max. Negotiated Rate	$16.71
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$13.37
Rate for Payer: Aetna of CA Government/Medicare	$13.37
Rate for Payer: Cash Price	$10.03
Rate for Payer: Health Smart Auto/Commercial	$13.37
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$13.37
Rate for Payer: LLUH Dept of Risk Management WC	$12.25
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$16.71

ESTRADIOL 0.1 MG/24 HR WEEKLY TRANSDERMAL PATCH [112051]

Facility

$22.28

Service Code	NDC 0378-3352-99
Hospital Charge Code	1712226
Hospital Revenue Code	259
Min. Negotiated Rate	$12.25
Max. Negotiated Rate	$17.82
Rate for Payer: Cash Price	$10.03
Rate for Payer: Cigna of CA HMO/PPO	$17.82
Rate for Payer: Health Smart Auto/Commercial	$13.37
Rate for Payer: LLUH Dept of Risk Management WC	$12.25
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$16.71

ESTRADIOL 0.5 MG TABLET [12491]

Facility

$0.32

Service Code	NDC 51862-332-01
Hospital Charge Code	1712562
Hospital Revenue Code	259
Min. Negotiated Rate	$0.18
Max. Negotiated Rate	$0.24
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$0.19
Rate for Payer: Aetna of CA Government/Medicare	$0.19
Rate for Payer: Cash Price	$0.14
Rate for Payer: Health Smart Auto/Commercial	$0.19
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$0.19
Rate for Payer: LLUH Dept of Risk Management WC	$0.18
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$0.24

ESTRADIOL 0.5 MG TABLET [12491]

Facility

$0.09

Service Code	NDC 42806-087-01
Hospital Charge Code	1712562
Hospital Revenue Code	259
Min. Negotiated Rate	$0.05
Max. Negotiated Rate	$0.07
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$0.05
Rate for Payer: Aetna of CA Government/Medicare	$0.05
Rate for Payer: Cash Price	$0.04
Rate for Payer: Health Smart Auto/Commercial	$0.05
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$0.05
Rate for Payer: LLUH Dept of Risk Management WC	$0.05
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$0.07

Know your out-of-pocket cost for care.

All Charges