Loma Linda University Behavioral Medicine Center (BMC)

All Charges

Charge

Type

Setting

Price

METOPROLOL TARTRATE 50 MG TABLET [5009]

Facility

$0.04

Service Code	NDC 62332-113-31
Hospital Charge Code	901700029
Hospital Revenue Code	259
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

METOPROLOL TARTRATE 50 MG TABLET [5009]

Facility

$0.13

Service Code	NDC 62584-266-01
Hospital Charge Code	901700029
Hospital Revenue Code	259
Min. Negotiated Rate	$0.07
Max. Negotiated Rate	$0.10
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$0.08
Rate for Payer: Aetna of CA Government/Medicare	$0.08
Rate for Payer: Cash Price	$0.07
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$0.10
Rate for Payer: Health Smart Auto/Commercial	$0.08
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$0.08
Rate for Payer: LLUH Dept of Risk Management WC	$0.07
Rate for Payer: Multiplan Commercial	$0.10

METOPROLOL TARTRATE 50 MG TABLET [5009]

Facility

$0.13

Service Code	NDC 62584-266-11
Hospital Charge Code	901700029
Hospital Revenue Code	259
Min. Negotiated Rate	$0.07
Max. Negotiated Rate	$0.10
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$0.08
Rate for Payer: Aetna of CA Government/Medicare	$0.08
Rate for Payer: Cash Price	$0.07
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$0.10
Rate for Payer: Health Smart Auto/Commercial	$0.08
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$0.08
Rate for Payer: LLUH Dept of Risk Management WC	$0.07
Rate for Payer: Multiplan Commercial	$0.10

METOPROLOL TARTRATE 50 MG TABLET [5009]

Facility

$0.13

Service Code	NDC 62584-266-11
Hospital Charge Code	901700029
Hospital Revenue Code	259
Min. Negotiated Rate	$0.07
Max. Negotiated Rate	$0.10
Rate for Payer: Cash Price	$0.07
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$0.10
Rate for Payer: Health Smart Auto/Commercial	$0.08
Rate for Payer: LLUH Dept of Risk Management WC	$0.07
Rate for Payer: Multiplan Commercial	$0.10

METOPROLOL TARTRATE 50 MG TABLET [5009]

Facility

$0.09

Service Code	NDC 51079-801-20
Hospital Charge Code	901700029
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	$0.05
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$0.07
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 Commercial	$0.07

METOPROLOL TARTRATE 50 MG TABLET [5009]

Facility

$0.13

Service Code	NDC 62584-266-01
Hospital Charge Code	901700029
Hospital Revenue Code	259
Min. Negotiated Rate	$0.07
Max. Negotiated Rate	$0.10
Rate for Payer: Cash Price	$0.07
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$0.10
Rate for Payer: Health Smart Auto/Commercial	$0.08
Rate for Payer: LLUH Dept of Risk Management WC	$0.07
Rate for Payer: Multiplan Commercial	$0.10

METOPROLOL TARTRATE 50 MG TABLET [5009]

Facility

$0.09

Service Code	NDC 51079-801-01
Hospital Charge Code	901700029
Hospital Revenue Code	259
Min. Negotiated Rate	$0.05
Max. Negotiated Rate	$0.07
Rate for Payer: Cash Price	$0.05
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$0.07
Rate for Payer: Health Smart Auto/Commercial	$0.05
Rate for Payer: LLUH Dept of Risk Management WC	$0.05
Rate for Payer: Multiplan Commercial	$0.07

METOPROLOL TARTRATE 5 MG/5 ML INTRAVENOUS SOLUTION [5007]

Facility

$0.24

Service Code	HCPCS J0616
Hospital Charge Code	901700025
Hospital Revenue Code	636
Min. Negotiated Rate	$0.13
Max. Negotiated Rate	$0.19
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$0.14
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$0.41
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$0.14
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$0.19
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$0.39
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$0.26
Rate for Payer: Aetna of CA Government/Medicare	$0.14
Rate for Payer: Aetna of CA Government/Medicare	$0.26
Rate for Payer: Aetna of CA Government/Medicare	$0.19
Rate for Payer: Aetna of CA Government/Medicare	$0.39
Rate for Payer: Aetna of CA Government/Medicare	$0.41
Rate for Payer: Aetna of CA Government/Medicare	$0.14
Rate for Payer: Cash Price	$0.13
Rate for Payer: Cash Price	$0.38
Rate for Payer: Cash Price	$0.24
Rate for Payer: Cash Price	$0.17
Rate for Payer: Cash Price	$0.36
Rate for Payer: Cash Price	$0.13
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$0.52
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$0.34
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$0.25
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$0.19
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$0.18
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$0.54
Rate for Payer: Health Smart Auto/Commercial	$0.14
Rate for Payer: Health Smart Auto/Commercial	$0.39
Rate for Payer: Health Smart Auto/Commercial	$0.14
Rate for Payer: Health Smart Auto/Commercial	$0.41
Rate for Payer: Health Smart Auto/Commercial	$0.19
Rate for Payer: Health Smart Auto/Commercial	$0.26
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$0.14
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$0.14
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$0.26
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$0.39
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$0.41
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$0.19
Rate for Payer: LLUH Dept of Risk Management WC	$0.17
Rate for Payer: LLUH Dept of Risk Management WC	$0.36
Rate for Payer: LLUH Dept of Risk Management WC	$0.13
Rate for Payer: LLUH Dept of Risk Management WC	$0.37
Rate for Payer: LLUH Dept of Risk Management WC	$0.24
Rate for Payer: LLUH Dept of Risk Management WC	$0.13
Rate for Payer: Multiplan Commercial	$0.17
Rate for Payer: Multiplan Commercial	$0.49
Rate for Payer: Multiplan Commercial	$0.51
Rate for Payer: Multiplan Commercial	$0.23
Rate for Payer: Multiplan Commercial	$0.18
Rate for Payer: Multiplan Commercial	$0.32

METOPROLOL TARTRATE 5 MG/5 ML INTRAVENOUS SOLUTION [5007]

Facility

$0.43

Service Code	HCPCS J0616
Hospital Charge Code	901700025
Hospital Revenue Code	636
Min. Negotiated Rate	$0.24
Max. Negotiated Rate	$0.34
Rate for Payer: Cash Price	$0.24
Rate for Payer: Cash Price	$0.13
Rate for Payer: Cash Price	$0.38
Rate for Payer: Cash Price	$0.36
Rate for Payer: Cash Price	$0.17
Rate for Payer: Cash Price	$0.13
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$0.25
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$0.34
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$0.54
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$0.19
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$0.52
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$0.18
Rate for Payer: Health Smart Auto/Commercial	$0.14
Rate for Payer: Health Smart Auto/Commercial	$0.14
Rate for Payer: Health Smart Auto/Commercial	$0.19
Rate for Payer: Health Smart Auto/Commercial	$0.26
Rate for Payer: Health Smart Auto/Commercial	$0.39
Rate for Payer: Health Smart Auto/Commercial	$0.41
Rate for Payer: LLUH Dept of Risk Management WC	$0.13
Rate for Payer: LLUH Dept of Risk Management WC	$0.17
Rate for Payer: LLUH Dept of Risk Management WC	$0.13
Rate for Payer: LLUH Dept of Risk Management WC	$0.24
Rate for Payer: LLUH Dept of Risk Management WC	$0.37
Rate for Payer: LLUH Dept of Risk Management WC	$0.36
Rate for Payer: Multiplan Commercial	$0.51
Rate for Payer: Multiplan Commercial	$0.32
Rate for Payer: Multiplan Commercial	$0.18
Rate for Payer: Multiplan Commercial	$0.49
Rate for Payer: Multiplan Commercial	$0.17
Rate for Payer: Multiplan Commercial	$0.23

METRONIDAZOLE 0.75 % (37.5 MG/5 GRAM) VAGINAL GEL [10592]

Facility

$2.10

Service Code	NDC 0245-0860-70
Hospital Charge Code	901700029
Hospital Revenue Code	259
Min. Negotiated Rate	$1.16
Max. Negotiated Rate	$1.68
Rate for Payer: Cash Price	$1.15
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$1.68
Rate for Payer: Health Smart Auto/Commercial	$1.26
Rate for Payer: LLUH Dept of Risk Management WC	$1.16
Rate for Payer: Multiplan Commercial	$1.57

METRONIDAZOLE 0.75 % (37.5 MG/5 GRAM) VAGINAL GEL [10592]

Facility

$0.34

Service Code	NDC 21922-039-23
Hospital Charge Code	901700029
Hospital Revenue Code	259
Min. Negotiated Rate	$0.19
Max. Negotiated Rate	$0.27
Rate for Payer: Cash Price	$0.19
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$0.27
Rate for Payer: Health Smart Auto/Commercial	$0.20
Rate for Payer: LLUH Dept of Risk Management WC	$0.19
Rate for Payer: Multiplan Commercial	$0.26

METRONIDAZOLE 0.75 % (37.5 MG/5 GRAM) VAGINAL GEL [10592]

Facility

$2.10

Service Code	NDC 0245-0860-70
Hospital Charge Code	901700029
Hospital Revenue Code	259
Min. Negotiated Rate	$1.16
Max. Negotiated Rate	$1.68
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$1.26
Rate for Payer: Aetna of CA Government/Medicare	$1.26
Rate for Payer: Cash Price	$1.15
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$1.68
Rate for Payer: Health Smart Auto/Commercial	$1.26
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$1.26
Rate for Payer: LLUH Dept of Risk Management WC	$1.16
Rate for Payer: Multiplan Commercial	$1.57

METRONIDAZOLE 0.75 % (37.5 MG/5 GRAM) VAGINAL GEL [10592]

Facility

$0.34

Service Code	NDC 21922-039-23
Hospital Charge Code	901700029
Hospital Revenue Code	259
Min. Negotiated Rate	$0.19
Max. Negotiated Rate	$0.27
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	$0.19
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$0.27
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	$0.19
Rate for Payer: Multiplan Commercial	$0.26

METRONIDAZOLE 0.75 % (37.5 MG/5 GRAM) VAGINAL GEL [10592]

Facility

$0.34

Service Code	NDC 45802-139-70
Hospital Charge Code	901700029
Hospital Revenue Code	259
Min. Negotiated Rate	$0.19
Max. Negotiated Rate	$0.27
Rate for Payer: Cash Price	$0.19
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$0.27
Rate for Payer: Health Smart Auto/Commercial	$0.20
Rate for Payer: LLUH Dept of Risk Management WC	$0.19
Rate for Payer: Multiplan Commercial	$0.26

METRONIDAZOLE 0.75 % (37.5 MG/5 GRAM) VAGINAL GEL [10592]

Facility

$0.34

Service Code	NDC 45802-139-70
Hospital Charge Code	901700029
Hospital Revenue Code	259
Min. Negotiated Rate	$0.19
Max. Negotiated Rate	$0.27
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	$0.19
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$0.27
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	$0.19
Rate for Payer: Multiplan Commercial	$0.26

METRONIDAZOLE 0.75 % TOPICAL CREAM [19805]

Facility

$1.90

Service Code	NDC 0168-0323-46
Hospital Charge Code	901700029
Hospital Revenue Code	259
Min. Negotiated Rate	$1.04
Max. Negotiated Rate	$1.52
Rate for Payer: Cash Price	$1.05
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$1.52
Rate for Payer: Health Smart Auto/Commercial	$1.14
Rate for Payer: LLUH Dept of Risk Management WC	$1.04
Rate for Payer: Multiplan Commercial	$1.43

METRONIDAZOLE 0.75 % TOPICAL CREAM [19805]

Facility

$1.90

Service Code	NDC 0168-0323-46
Hospital Charge Code	901700029
Hospital Revenue Code	259
Min. Negotiated Rate	$1.04
Max. Negotiated Rate	$1.52
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$1.14
Rate for Payer: Aetna of CA Government/Medicare	$1.14
Rate for Payer: Cash Price	$1.05
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$1.52
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: LLUH Dept of Risk Management WC	$1.04
Rate for Payer: Multiplan Commercial	$1.43

METRONIDAZOLE 1 % TOPICAL GEL [41899]

Facility

$3.10

Service Code	NDC 51672-4215-3
Hospital Charge Code	901700029
Hospital Revenue Code	259
Min. Negotiated Rate	$1.71
Max. Negotiated Rate	$2.48
Rate for Payer: Cash Price	$1.71
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$2.48
Rate for Payer: Health Smart Auto/Commercial	$1.86
Rate for Payer: LLUH Dept of Risk Management WC	$1.71
Rate for Payer: Multiplan Commercial	$2.33

METRONIDAZOLE 1 % TOPICAL GEL [41899]

Facility

$3.10

Service Code	NDC 51672-4215-3
Hospital Charge Code	901700029
Hospital Revenue Code	259
Min. Negotiated Rate	$1.71
Max. Negotiated Rate	$2.48
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$1.86
Rate for Payer: Aetna of CA Government/Medicare	$1.86
Rate for Payer: Cash Price	$1.71
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$2.48
Rate for Payer: Health Smart Auto/Commercial	$1.86
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$1.86
Rate for Payer: LLUH Dept of Risk Management WC	$1.71
Rate for Payer: Multiplan Commercial	$2.33

METRONIDAZOLE 1 % TOPICAL GEL [41899]

Facility

$3.10

Service Code	NDC 66993-936-61
Hospital Charge Code	901700029
Hospital Revenue Code	259
Min. Negotiated Rate	$1.71
Max. Negotiated Rate	$2.48
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$1.86
Rate for Payer: Aetna of CA Government/Medicare	$1.86
Rate for Payer: Cash Price	$1.71
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$2.48
Rate for Payer: Health Smart Auto/Commercial	$1.86
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$1.86
Rate for Payer: LLUH Dept of Risk Management WC	$1.71
Rate for Payer: Multiplan Commercial	$2.33

METRONIDAZOLE 1 % TOPICAL GEL [41899]

Facility

$3.10

Service Code	NDC 66993-936-61
Hospital Charge Code	901700029
Hospital Revenue Code	259
Min. Negotiated Rate	$1.71
Max. Negotiated Rate	$2.48
Rate for Payer: Cash Price	$1.71
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$2.48
Rate for Payer: Health Smart Auto/Commercial	$1.86
Rate for Payer: LLUH Dept of Risk Management WC	$1.71
Rate for Payer: Multiplan Commercial	$2.33

METRONIDAZOLE 250 MG TABLET [5015]

Facility

$0.36

Service Code	NDC 50111-333-01
Hospital Charge Code	901700029
Hospital Revenue Code	259
Min. Negotiated Rate	$0.20
Max. Negotiated Rate	$0.29
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: Cash Price	$0.20
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$0.29
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: LLUH Dept of Risk Management WC	$0.20
Rate for Payer: Multiplan Commercial	$0.27

METRONIDAZOLE 250 MG TABLET [5015]

Facility

$0.36

Service Code	NDC 50111-333-01
Hospital Charge Code	901700029
Hospital Revenue Code	259
Min. Negotiated Rate	$0.20
Max. Negotiated Rate	$0.29
Rate for Payer: Cash Price	$0.20
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$0.29
Rate for Payer: Health Smart Auto/Commercial	$0.22
Rate for Payer: LLUH Dept of Risk Management WC	$0.20
Rate for Payer: Multiplan Commercial	$0.27

METRONIDAZOLE 375 MG CAPSULE [15057]

Facility

$11.80

Service Code	NDC 62332-018-50
Hospital Charge Code	901700029
Hospital Revenue Code	259
Min. Negotiated Rate	$6.49
Max. Negotiated Rate	$9.44
Rate for Payer: Cash Price	$6.49
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$9.44
Rate for Payer: Health Smart Auto/Commercial	$7.08
Rate for Payer: LLUH Dept of Risk Management WC	$6.49
Rate for Payer: Multiplan Commercial	$8.85

METRONIDAZOLE 375 MG CAPSULE [15057]

Facility

$11.80

Service Code	NDC 62332-018-50
Hospital Charge Code	901700029
Hospital Revenue Code	259
Min. Negotiated Rate	$6.49
Max. Negotiated Rate	$9.44
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$7.08
Rate for Payer: Aetna of CA Government/Medicare	$7.08
Rate for Payer: Cash Price	$6.49
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$9.44
Rate for Payer: Health Smart Auto/Commercial	$7.08
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$7.08
Rate for Payer: LLUH Dept of Risk Management WC	$6.49
Rate for Payer: Multiplan Commercial	$8.85

Know your out-of-pocket cost for care.

All Charges