Loma Linda University Behavioral Medicine Center (BMC)

All Charges

Charge

Type

Setting

Price

METOLAZONE 2.5 MG TABLET [10587]

Facility

$3.29

Service Code	NDC 51079-023-20
Hospital Charge Code	1711248
Hospital Revenue Code	259
Min. Negotiated Rate	$1.81
Max. Negotiated Rate	$2.63
Rate for Payer: Cash Price	$1.48
Rate for Payer: Cigna of CA HMO/PPO	$2.63
Rate for Payer: Health Smart Auto/Commercial	$1.97
Rate for Payer: LLUH Dept of Risk Management WC	$1.81
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$2.47

METOLAZONE 2.5 MG TABLET [10587]

Facility

$3.29

Service Code	NDC 51079-023-01
Hospital Charge Code	1711248
Hospital Revenue Code	259
Min. Negotiated Rate	$1.81
Max. Negotiated Rate	$2.63
Rate for Payer: Cash Price	$1.48
Rate for Payer: Cigna of CA HMO/PPO	$2.63
Rate for Payer: Health Smart Auto/Commercial	$1.97
Rate for Payer: LLUH Dept of Risk Management WC	$1.81
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$2.47

METOLAZONE 2.5 MG TABLET [10587]

Facility

$3.29

Service Code	NDC 51079-023-01
Hospital Charge Code	1711248
Hospital Revenue Code	259
Min. Negotiated Rate	$1.81
Max. Negotiated Rate	$2.47
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$1.97
Rate for Payer: Aetna of CA Government/Medicare	$1.97
Rate for Payer: Cash Price	$1.48
Rate for Payer: Health Smart Auto/Commercial	$1.97
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$1.97
Rate for Payer: LLUH Dept of Risk Management WC	$1.81
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$2.47

METOLAZONE 2.5 MG TABLET [10587]

Facility

$2.17

Service Code	NDC 0378-6172-01
Hospital Charge Code	1711248
Hospital Revenue Code	259
Min. Negotiated Rate	$1.19
Max. Negotiated Rate	$1.74
Rate for Payer: Cash Price	$0.98
Rate for Payer: Cigna of CA HMO/PPO	$1.74
Rate for Payer: Health Smart Auto/Commercial	$1.30
Rate for Payer: LLUH Dept of Risk Management WC	$1.19
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$1.63

METOLAZONE 2.5 MG TABLET [10587]

Facility

$0.70

Service Code	NDC 0185-5050-01
Hospital Charge Code	1711248
Hospital Revenue Code	259
Min. Negotiated Rate	$0.39
Max. Negotiated Rate	$0.53
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$0.42
Rate for Payer: Aetna of CA Government/Medicare	$0.42
Rate for Payer: Cash Price	$0.32
Rate for Payer: Health Smart Auto/Commercial	$0.42
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$0.42
Rate for Payer: LLUH Dept of Risk Management WC	$0.39
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$0.53

METOLAZONE 2.5 MG TABLET [10587]

Facility

$2.17

Service Code	NDC 0378-6172-01
Hospital Charge Code	1711248
Hospital Revenue Code	259
Min. Negotiated Rate	$1.19
Max. Negotiated Rate	$1.63
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$1.30
Rate for Payer: Aetna of CA Government/Medicare	$1.30
Rate for Payer: Cash Price	$0.98
Rate for Payer: Health Smart Auto/Commercial	$1.30
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$1.30
Rate for Payer: LLUH Dept of Risk Management WC	$1.19
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$1.63

METOLAZONE 2.5 MG TABLET [10587]

Facility

$3.30

Service Code	NDC 60687-536-11
Hospital Charge Code	1711248
Hospital Revenue Code	259
Min. Negotiated Rate	$1.82
Max. Negotiated Rate	$2.64
Rate for Payer: Cash Price	$1.49
Rate for Payer: Cigna of CA HMO/PPO	$2.64
Rate for Payer: Health Smart Auto/Commercial	$1.98
Rate for Payer: LLUH Dept of Risk Management WC	$1.82
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$2.48

METOLAZONE 2.5 MG TABLET [10587]

Facility

$0.78

Service Code	NDC 76385-136-01
Hospital Charge Code	1711248
Hospital Revenue Code	259
Min. Negotiated Rate	$0.43
Max. Negotiated Rate	$0.59
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$0.47
Rate for Payer: Aetna of CA Government/Medicare	$0.47
Rate for Payer: Cash Price	$0.35
Rate for Payer: Health Smart Auto/Commercial	$0.47
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$0.47
Rate for Payer: LLUH Dept of Risk Management WC	$0.43
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$0.59

METOLAZONE 2.5 MG TABLET [10587]

Facility

$3.29

Service Code	NDC 51079-023-20
Hospital Charge Code	1711248
Hospital Revenue Code	259
Min. Negotiated Rate	$1.81
Max. Negotiated Rate	$2.47
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$1.97
Rate for Payer: Aetna of CA Government/Medicare	$1.97
Rate for Payer: Cash Price	$1.48
Rate for Payer: Health Smart Auto/Commercial	$1.97
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$1.97
Rate for Payer: LLUH Dept of Risk Management WC	$1.81
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$2.47

METOLAZONE 2.5 MG TABLET [10587]

Facility

$0.78

Service Code	NDC 76385-136-01
Hospital Charge Code	1711248
Hospital Revenue Code	259
Min. Negotiated Rate	$0.43
Max. Negotiated Rate	$0.62
Rate for Payer: Cash Price	$0.35
Rate for Payer: Cigna of CA HMO/PPO	$0.62
Rate for Payer: Health Smart Auto/Commercial	$0.47
Rate for Payer: LLUH Dept of Risk Management WC	$0.43
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$0.59

METOLAZONE 5 MG TABLET [10588]

Facility

$2.46

Service Code	NDC 0378-6173-01
Hospital Charge Code	1711255
Hospital Revenue Code	259
Min. Negotiated Rate	$1.35
Max. Negotiated Rate	$1.97
Rate for Payer: Cash Price	$1.11
Rate for Payer: Cigna of CA HMO/PPO	$1.97
Rate for Payer: Health Smart Auto/Commercial	$1.48
Rate for Payer: LLUH Dept of Risk Management WC	$1.35
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$1.84

METOLAZONE 5 MG TABLET [10588]

Facility

$0.36

Service Code	NDC 72888-053-01
Hospital Charge Code	1711255
Hospital Revenue Code	259
Min. Negotiated Rate	$0.20
Max. Negotiated Rate	$0.27
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	$0.16
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 Beech St/Commercial/PHCS	$0.27

METOLAZONE 5 MG TABLET [10588]

Facility

$3.73

Service Code	NDC 51079-024-20
Hospital Charge Code	1711255
Hospital Revenue Code	259
Min. Negotiated Rate	$2.05
Max. Negotiated Rate	$2.80
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$2.24
Rate for Payer: Aetna of CA Government/Medicare	$2.24
Rate for Payer: Cash Price	$1.68
Rate for Payer: Health Smart Auto/Commercial	$2.24
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$2.24
Rate for Payer: LLUH Dept of Risk Management WC	$2.05
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$2.80

METOLAZONE 5 MG TABLET [10588]

Facility

$3.73

Service Code	NDC 51079-024-20
Hospital Charge Code	1711255
Hospital Revenue Code	259
Min. Negotiated Rate	$2.05
Max. Negotiated Rate	$2.98
Rate for Payer: Cash Price	$1.68
Rate for Payer: Cigna of CA HMO/PPO	$2.98
Rate for Payer: Health Smart Auto/Commercial	$2.24
Rate for Payer: LLUH Dept of Risk Management WC	$2.05
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$2.80

METOLAZONE 5 MG TABLET [10588]

Facility

$3.73

Service Code	NDC 51079-024-01
Hospital Charge Code	1711255
Hospital Revenue Code	259
Min. Negotiated Rate	$2.05
Max. Negotiated Rate	$2.98
Rate for Payer: Cash Price	$1.68
Rate for Payer: Cigna of CA HMO/PPO	$2.98
Rate for Payer: Health Smart Auto/Commercial	$2.24
Rate for Payer: LLUH Dept of Risk Management WC	$2.05
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$2.80

METOLAZONE 5 MG TABLET [10588]

Facility

$0.36

Service Code	NDC 72888-053-01
Hospital Charge Code	1711255
Hospital Revenue Code	259
Min. Negotiated Rate	$0.20
Max. Negotiated Rate	$0.29
Rate for Payer: Cash Price	$0.16
Rate for Payer: Cigna of CA 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 Beech St/Commercial/PHCS	$0.27

METOLAZONE 5 MG TABLET [10588]

Facility

$0.90

Service Code	NDC 76385-137-01
Hospital Charge Code	1711255
Hospital Revenue Code	259
Min. Negotiated Rate	$0.50
Max. Negotiated Rate	$0.72
Rate for Payer: Cash Price	$0.41
Rate for Payer: Cigna of CA HMO/PPO	$0.72
Rate for Payer: Health Smart Auto/Commercial	$0.54
Rate for Payer: LLUH Dept of Risk Management WC	$0.50
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$0.68

METOLAZONE 5 MG TABLET [10588]

Facility

$2.46

Service Code	NDC 0378-6173-01
Hospital Charge Code	1711255
Hospital Revenue Code	259
Min. Negotiated Rate	$1.35
Max. Negotiated Rate	$1.84
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$1.48
Rate for Payer: Aetna of CA Government/Medicare	$1.48
Rate for Payer: Cash Price	$1.11
Rate for Payer: Health Smart Auto/Commercial	$1.48
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$1.48
Rate for Payer: LLUH Dept of Risk Management WC	$1.35
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$1.84

METOLAZONE 5 MG TABLET [10588]

Facility

$3.73

Service Code	NDC 51079-024-01
Hospital Charge Code	1711255
Hospital Revenue Code	259
Min. Negotiated Rate	$2.05
Max. Negotiated Rate	$2.80
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$2.24
Rate for Payer: Aetna of CA Government/Medicare	$2.24
Rate for Payer: Cash Price	$1.68
Rate for Payer: Health Smart Auto/Commercial	$2.24
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$2.24
Rate for Payer: LLUH Dept of Risk Management WC	$2.05
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$2.80

METOLAZONE 5 MG TABLET [10588]

Facility

$0.90

Service Code	NDC 76385-137-01
Hospital Charge Code	1711255
Hospital Revenue Code	259
Min. Negotiated Rate	$0.50
Max. Negotiated Rate	$0.68
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$0.54
Rate for Payer: Aetna of CA Government/Medicare	$0.54
Rate for Payer: Cash Price	$0.41
Rate for Payer: Health Smart Auto/Commercial	$0.54
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$0.54
Rate for Payer: LLUH Dept of Risk Management WC	$0.50
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$0.68

METOLAZONE 5 MG TABLET [10588]

Facility

$0.81

Service Code	NDC 0185-0055-01
Hospital Charge Code	1711255
Hospital Revenue Code	259
Min. Negotiated Rate	$0.45
Max. Negotiated Rate	$0.61
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$0.49
Rate for Payer: Aetna of CA Government/Medicare	$0.49
Rate for Payer: Cash Price	$0.36
Rate for Payer: Health Smart Auto/Commercial	$0.49
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$0.49
Rate for Payer: LLUH Dept of Risk Management WC	$0.45
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$0.61

METOLAZONE 5 MG TABLET [10588]

Facility

$0.81

Service Code	NDC 0185-0055-01
Hospital Charge Code	1711255
Hospital Revenue Code	259
Min. Negotiated Rate	$0.45
Max. Negotiated Rate	$0.65
Rate for Payer: Cash Price	$0.36
Rate for Payer: Cigna of CA HMO/PPO	$0.65
Rate for Payer: Health Smart Auto/Commercial	$0.49
Rate for Payer: LLUH Dept of Risk Management WC	$0.45
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$0.61

METOLAZONE ORAL SUSPENSION COMPOUND 1 MG/ML [4080301]

Facility

$0.18

Service Code	NDC 9994-0803-01
Hospital Charge Code	1715932
Hospital Revenue Code	259
Min. Negotiated Rate	$0.10
Max. Negotiated Rate	$0.14
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$0.11
Rate for Payer: Aetna of CA Government/Medicare	$0.11
Rate for Payer: Cash Price	$0.08
Rate for Payer: Health Smart Auto/Commercial	$0.11
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$0.11
Rate for Payer: LLUH Dept of Risk Management WC	$0.10
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$0.14

METOLAZONE ORAL SUSPENSION COMPOUND 1 MG/ML [4080301]

Facility

$0.18

Service Code	NDC 9994-0803-01
Hospital Charge Code	1715932
Hospital Revenue Code	259
Min. Negotiated Rate	$0.10
Max. Negotiated Rate	$0.14
Rate for Payer: Cash Price	$0.08
Rate for Payer: Cigna of CA HMO/PPO	$0.14
Rate for Payer: Health Smart Auto/Commercial	$0.11
Rate for Payer: LLUH Dept of Risk Management WC	$0.10
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$0.14

METOPROLOL ORAL SUSPENSION COMPOUND 10 MG/ML [4080302]

Facility

$0.01

Service Code	NDC 9994-0803-02
Hospital Charge Code	1715242
Hospital Revenue Code	259
Min. Negotiated Rate	$0.01
Max. Negotiated Rate	$0.01
Rate for Payer: Cigna of CA HMO/PPO	$0.01
Rate for Payer: Health Smart Auto/Commercial	$0.01
Rate for Payer: LLUH Dept of Risk Management WC	$0.01
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$0.01

Know your out-of-pocket cost for care.

All Charges