Loma Linda University Behavioral Medicine Center (BMC)

All Charges

Charge

Type

Setting

Price

BENZTROPINE 1 MG TABLET [999]

Facility

$0.19

Service Code	NDC 0603-2438-21
Hospital Charge Code	1710776
Hospital Revenue Code	259
Min. Negotiated Rate	$0.10
Max. Negotiated Rate	$0.15
Rate for Payer: Cash Price	$0.09
Rate for Payer: Cigna of CA HMO/PPO	$0.15
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

BENZTROPINE 1 MG TABLET [999]

Facility

$0.19

Service Code	NDC 69315-137-01
Hospital Charge Code	1710776
Hospital Revenue Code	259
Min. Negotiated Rate	$0.10
Max. Negotiated Rate	$0.15
Rate for Payer: Cash Price	$0.09
Rate for Payer: Cigna of CA HMO/PPO	$0.15
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

BENZTROPINE 1 MG TABLET [999]

Facility

$0.19

Service Code	NDC 0603-2434-21
Hospital Charge Code	1710776
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	$0.09
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

BENZTROPINE 2 MG TABLET [1000]

Facility

$0.18

Service Code	NDC 76385-105-01
Hospital Charge Code	1710775
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

BENZTROPINE 2 MG TABLET [1000]

Facility

$0.18

Service Code	NDC 76385-105-01
Hospital Charge Code	1710775
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

BENZTROPINE 2 MG TABLET [1000]

Facility

$0.25

Service Code	NDC 0603-2439-21
Hospital Charge Code	1710775
Hospital Revenue Code	259
Min. Negotiated Rate	$0.14
Max. Negotiated Rate	$0.20
Rate for Payer: Cash Price	$0.11
Rate for Payer: Cigna of CA HMO/PPO	$0.20
Rate for Payer: Health Smart Auto/Commercial	$0.15
Rate for Payer: LLUH Dept of Risk Management WC	$0.14
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$0.19

BENZTROPINE 2 MG TABLET [1000]

Facility

$0.25

Service Code	NDC 0603-2439-21
Hospital Charge Code	1710775
Hospital Revenue Code	259
Min. Negotiated Rate	$0.14
Max. Negotiated Rate	$0.19
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$0.15
Rate for Payer: Aetna of CA Government/Medicare	$0.15
Rate for Payer: Cash Price	$0.11
Rate for Payer: Health Smart Auto/Commercial	$0.15
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$0.15
Rate for Payer: LLUH Dept of Risk Management WC	$0.14
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$0.19

BETAMETHASONE ACETATE AND SODIUM PHOS 6 MG/ML SUSPENSION FOR INJECTION [9266]

Facility

$8.98

Service Code	CPT J0702
Hospital Charge Code	1720213
Hospital Revenue Code	636
Min. Negotiated Rate	$4.94
Max. Negotiated Rate	$7.18
Rate for Payer: Cash Price	$4.04
Rate for Payer: Cash Price	$5.94
Rate for Payer: Cash Price	$4.49
Rate for Payer: Cigna of CA HMO/PPO	$10.57
Rate for Payer: Cigna of CA HMO/PPO	$7.18
Rate for Payer: Cigna of CA HMO/PPO	$7.98
Rate for Payer: Health Smart Auto/Commercial	$5.99
Rate for Payer: Health Smart Auto/Commercial	$5.39
Rate for Payer: Health Smart Auto/Commercial	$7.93
Rate for Payer: LLUH Dept of Risk Management WC	$5.49
Rate for Payer: LLUH Dept of Risk Management WC	$7.27
Rate for Payer: LLUH Dept of Risk Management WC	$4.94
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$6.74
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$7.48
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$9.91

BETAMETHASONE ACETATE AND SODIUM PHOS 6 MG/ML SUSPENSION FOR INJECTION [9266]

Facility

$9.98

Service Code	CPT J0702
Hospital Charge Code	1720213
Hospital Revenue Code	636
Min. Negotiated Rate	$5.49
Max. Negotiated Rate	$7.48
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$5.99
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$5.39
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$7.93
Rate for Payer: Aetna of CA Government/Medicare	$5.39
Rate for Payer: Aetna of CA Government/Medicare	$7.93
Rate for Payer: Aetna of CA Government/Medicare	$5.99
Rate for Payer: Cash Price	$4.49
Rate for Payer: Cash Price	$4.04
Rate for Payer: Cash Price	$5.94
Rate for Payer: Health Smart Auto/Commercial	$5.99
Rate for Payer: Health Smart Auto/Commercial	$5.39
Rate for Payer: Health Smart Auto/Commercial	$7.93
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$5.99
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$5.39
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$7.93
Rate for Payer: LLUH Dept of Risk Management WC	$7.27
Rate for Payer: LLUH Dept of Risk Management WC	$4.94
Rate for Payer: LLUH Dept of Risk Management WC	$5.49
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$7.48
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$6.74
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$9.91

BETAMETHASONE, AUGMENTED 0.05 % TOPICAL CREAM [9175]

Facility

$0.56

Service Code	NDC 68462-290-17
Hospital Charge Code	1743496
Hospital Revenue Code	259
Min. Negotiated Rate	$0.31
Max. Negotiated Rate	$0.45
Rate for Payer: Cash Price	$0.25
Rate for Payer: Cigna of CA HMO/PPO	$0.45
Rate for Payer: Health Smart Auto/Commercial	$0.34
Rate for Payer: LLUH Dept of Risk Management WC	$0.31
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$0.42

BETAMETHASONE, AUGMENTED 0.05 % TOPICAL CREAM [9175]

Facility

$0.56

Service Code	NDC 68462-290-17
Hospital Charge Code	1743496
Hospital Revenue Code	259
Min. Negotiated Rate	$0.31
Max. Negotiated Rate	$0.42
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$0.34
Rate for Payer: Aetna of CA Government/Medicare	$0.34
Rate for Payer: Cash Price	$0.25
Rate for Payer: Health Smart Auto/Commercial	$0.34
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$0.34
Rate for Payer: LLUH Dept of Risk Management WC	$0.31
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$0.42

BETAMETHASONE, AUGMENTED 0.05 % TOPICAL OINTMENT [9178]

Facility

$2.84

Service Code	NDC 0472-0382-45
Hospital Charge Code	1743379
Hospital Revenue Code	259
Min. Negotiated Rate	$1.56
Max. Negotiated Rate	$2.13
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$1.70
Rate for Payer: Aetna of CA Government/Medicare	$1.70
Rate for Payer: Cash Price	$1.28
Rate for Payer: Health Smart Auto/Commercial	$1.70
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$1.70
Rate for Payer: LLUH Dept of Risk Management WC	$1.56
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$2.13

BETAMETHASONE, AUGMENTED 0.05 % TOPICAL OINTMENT [9178]

Facility

$2.84

Service Code	NDC 0472-0382-45
Hospital Charge Code	1743379
Hospital Revenue Code	259
Min. Negotiated Rate	$1.56
Max. Negotiated Rate	$2.27
Rate for Payer: Cash Price	$1.28
Rate for Payer: Cigna of CA HMO/PPO	$2.27
Rate for Payer: Health Smart Auto/Commercial	$1.70
Rate for Payer: LLUH Dept of Risk Management WC	$1.56
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$2.13

BETAMETHASONE DIPROPIONATE 0.05 % LOTION [1028]

Facility

$0.80

Service Code	NDC 0168-0057-60
Hospital Charge Code	1743383
Hospital Revenue Code	259
Min. Negotiated Rate	$0.44
Max. Negotiated Rate	$0.60
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$0.48
Rate for Payer: Aetna of CA Government/Medicare	$0.48
Rate for Payer: Cash Price	$0.36
Rate for Payer: Health Smart Auto/Commercial	$0.48
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$0.48
Rate for Payer: LLUH Dept of Risk Management WC	$0.44
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$0.60

BETAMETHASONE DIPROPIONATE 0.05 % LOTION [1028]

Facility

$0.80

Service Code	NDC 0168-0057-60
Hospital Charge Code	1743383
Hospital Revenue Code	259
Min. Negotiated Rate	$0.44
Max. Negotiated Rate	$0.64
Rate for Payer: Cash Price	$0.36
Rate for Payer: Cigna of CA HMO/PPO	$0.64
Rate for Payer: Health Smart Auto/Commercial	$0.48
Rate for Payer: LLUH Dept of Risk Management WC	$0.44
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$0.60

BETAMETHASONE DIPROPIONATE 0.05 % TOPICAL CREAM [1027]

Facility

$2.59

Service Code	NDC 0472-0380-15
Hospital Charge Code	1743546
Hospital Revenue Code	259
Min. Negotiated Rate	$1.42
Max. Negotiated Rate	$1.94
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$1.55
Rate for Payer: Aetna of CA Government/Medicare	$1.55
Rate for Payer: Cash Price	$1.17
Rate for Payer: Health Smart Auto/Commercial	$1.55
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$1.55
Rate for Payer: LLUH Dept of Risk Management WC	$1.42
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$1.94

BETAMETHASONE DIPROPIONATE 0.05 % TOPICAL CREAM [1027]

Facility

$2.59

Service Code	NDC 0472-0380-15
Hospital Charge Code	1743546
Hospital Revenue Code	259
Min. Negotiated Rate	$1.42
Max. Negotiated Rate	$2.07
Rate for Payer: Cash Price	$1.17
Rate for Payer: Cigna of CA HMO/PPO	$2.07
Rate for Payer: Health Smart Auto/Commercial	$1.55
Rate for Payer: LLUH Dept of Risk Management WC	$1.42
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$1.94

BETAMETHASONE DIPROPIONATE 0.05 % TOPICAL OINTMENT [1029]

Facility

$3.94

Service Code	NDC 0168-0056-15
Hospital Charge Code	1743377
Hospital Revenue Code	259
Min. Negotiated Rate	$2.17
Max. Negotiated Rate	$3.15
Rate for Payer: Cash Price	$1.77
Rate for Payer: Cigna of CA HMO/PPO	$3.15
Rate for Payer: Health Smart Auto/Commercial	$2.36
Rate for Payer: LLUH Dept of Risk Management WC	$2.17
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$2.96

BETAMETHASONE DIPROPIONATE 0.05 % TOPICAL OINTMENT [1029]

Facility

$3.14

Service Code	NDC 0472-0381-15
Hospital Charge Code	1743377
Hospital Revenue Code	259
Min. Negotiated Rate	$1.73
Max. Negotiated Rate	$2.36
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$1.88
Rate for Payer: Aetna of CA Government/Medicare	$1.88
Rate for Payer: Cash Price	$1.41
Rate for Payer: Health Smart Auto/Commercial	$1.88
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$1.88
Rate for Payer: LLUH Dept of Risk Management WC	$1.73
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$2.36

BETAMETHASONE DIPROPIONATE 0.05 % TOPICAL OINTMENT [1029]

Facility

$3.14

Service Code	NDC 0472-0381-15
Hospital Charge Code	1743377
Hospital Revenue Code	259
Min. Negotiated Rate	$1.73
Max. Negotiated Rate	$2.51
Rate for Payer: Cash Price	$1.41
Rate for Payer: Cigna of CA HMO/PPO	$2.51
Rate for Payer: Health Smart Auto/Commercial	$1.88
Rate for Payer: LLUH Dept of Risk Management WC	$1.73
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$2.36

BETAMETHASONE DIPROPIONATE 0.05 % TOPICAL OINTMENT [1029]

Facility

$3.94

Service Code	NDC 0168-0056-15
Hospital Charge Code	1743377
Hospital Revenue Code	259
Min. Negotiated Rate	$2.17
Max. Negotiated Rate	$2.96
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$2.36
Rate for Payer: Aetna of CA Government/Medicare	$2.36
Rate for Payer: Cash Price	$1.77
Rate for Payer: Health Smart Auto/Commercial	$2.36
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$2.36
Rate for Payer: LLUH Dept of Risk Management WC	$2.17
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$2.96

BETAMETHASONE VALERATE 0.1 % TOPICAL CREAM [1031]

Facility

$1.43

Service Code	NDC 51672-1269-1
Hospital Charge Code	1743469
Hospital Revenue Code	259
Min. Negotiated Rate	$0.79
Max. Negotiated Rate	$1.14
Rate for Payer: Cash Price	$0.64
Rate for Payer: Cigna of CA HMO/PPO	$1.14
Rate for Payer: Health Smart Auto/Commercial	$0.86
Rate for Payer: LLUH Dept of Risk Management WC	$0.79
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$1.07

BETAMETHASONE VALERATE 0.1 % TOPICAL CREAM [1031]

Facility

$1.43

Service Code	NDC 51672-1269-1
Hospital Charge Code	1743469
Hospital Revenue Code	259
Min. Negotiated Rate	$0.79
Max. Negotiated Rate	$1.07
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$0.86
Rate for Payer: Aetna of CA Government/Medicare	$0.86
Rate for Payer: Cash Price	$0.64
Rate for Payer: Health Smart Auto/Commercial	$0.86
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$0.86
Rate for Payer: LLUH Dept of Risk Management WC	$0.79
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$1.07

BETAMETHASONE VALERATE 0.1 % TOPICAL CREAM [1031]

Facility

$1.43

Service Code	NDC 0713-0326-15
Hospital Charge Code	1743469
Hospital Revenue Code	259
Min. Negotiated Rate	$0.79
Max. Negotiated Rate	$1.14
Rate for Payer: Cash Price	$0.64
Rate for Payer: Cigna of CA HMO/PPO	$1.14
Rate for Payer: Health Smart Auto/Commercial	$0.86
Rate for Payer: LLUH Dept of Risk Management WC	$0.79
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$1.07

BETAMETHASONE VALERATE 0.1 % TOPICAL CREAM [1031]

Facility

$1.43

Service Code	NDC 0713-0326-15
Hospital Charge Code	1743469
Hospital Revenue Code	259
Min. Negotiated Rate	$0.79
Max. Negotiated Rate	$1.07
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$0.86
Rate for Payer: Aetna of CA Government/Medicare	$0.86
Rate for Payer: Cash Price	$0.64
Rate for Payer: Health Smart Auto/Commercial	$0.86
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$0.86
Rate for Payer: LLUH Dept of Risk Management WC	$0.79
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$1.07

Know your out-of-pocket cost for care.

All Charges