Loma Linda University Behavioral Medicine Center (BMC)

All Charges

Charge

Type

Setting

Price

BETAMETHASONE VALERATE 0.1 % TOPICAL OINTMENT [1033]

Facility

$1.30

Service Code	NDC 0472-0371-15
Hospital Charge Code	NDG1033
Hospital Revenue Code	259
Min. Negotiated Rate	$0.72
Max. Negotiated Rate	$1.04
Rate for Payer: Health Smart Auto/Commercial	$0.78
Rate for Payer: Cash Price	$0.59
Rate for Payer: Cigna of CA HMO/PPO	$1.04
Rate for Payer: LLUH Dept of Risk Management WC	$0.72
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$0.98

BETAMETHASONE VALERATE 0.1 % TOPICAL OINTMENT [1033]

Facility

$1.30

Service Code	NDC 0168-0033-15
Hospital Charge Code	NDG1033
Hospital Revenue Code	259
Min. Negotiated Rate	$0.72
Max. Negotiated Rate	$1.04
Rate for Payer: Cash Price	$0.59
Rate for Payer: Cigna of CA HMO/PPO	$1.04
Rate for Payer: Health Smart Auto/Commercial	$0.78
Rate for Payer: LLUH Dept of Risk Management WC	$0.72
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$0.98

BETAMETHASONE VALERATE 0.1 % TOPICAL OINTMENT [1033]

Facility

$1.30

Service Code	NDC 0472-0371-15
Hospital Charge Code	NDG1033
Hospital Revenue Code	259
Min. Negotiated Rate	$0.72
Max. Negotiated Rate	$0.98
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$0.78
Rate for Payer: Aetna of CA Government/Medicare	$0.78
Rate for Payer: Cash Price	$0.59
Rate for Payer: Health Smart Auto/Commercial	$0.78
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$0.78
Rate for Payer: LLUH Dept of Risk Management WC	$0.72
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$0.98

BETAMETHASONE VALERATE 0.1 % TOPICAL OINTMENT [1033]

Facility

$1.30

Service Code	NDC 0168-0033-15
Hospital Charge Code	NDG1033
Hospital Revenue Code	259
Min. Negotiated Rate	$0.72
Max. Negotiated Rate	$0.98
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$0.78
Rate for Payer: Aetna of CA Government/Medicare	$0.78
Rate for Payer: Cash Price	$0.59
Rate for Payer: Health Smart Auto/Commercial	$0.78
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$0.78
Rate for Payer: LLUH Dept of Risk Management WC	$0.72
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$0.98

BETAMETHASONE VALERATE 0.1 % TOPICAL OINTMENT [1033]

Facility

$0.89

Service Code	NDC 0168-0033-46
Hospital Charge Code	1743276
Hospital Revenue Code	259
Min. Negotiated Rate	$0.49
Max. Negotiated Rate	$0.71
Rate for Payer: Health Smart Auto/Commercial	$0.53
Rate for Payer: Cash Price	$0.40
Rate for Payer: Cigna of CA HMO/PPO	$0.71
Rate for Payer: LLUH Dept of Risk Management WC	$0.49
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$0.67

BETAMETHASONE VALERATE 0.1 % TOPICAL OINTMENT [1033]

Facility

$0.89

Service Code	NDC 0168-0033-46
Hospital Charge Code	1743276
Hospital Revenue Code	259
Min. Negotiated Rate	$0.49
Max. Negotiated Rate	$0.67
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$0.53
Rate for Payer: Aetna of CA Government/Medicare	$0.53
Rate for Payer: Cash Price	$0.40
Rate for Payer: Health Smart Auto/Commercial	$0.53
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$0.53
Rate for Payer: LLUH Dept of Risk Management WC	$0.49
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$0.67

BETAXOLOL 0.25 % EYE DROPS,SUSPENSION [19703]

Facility

$39.13

Service Code	NDC 0065-0246-10
Hospital Charge Code	NDG19703
Hospital Revenue Code	259
Min. Negotiated Rate	$21.52
Max. Negotiated Rate	$31.30
Rate for Payer: Cash Price	$17.61
Rate for Payer: Cigna of CA HMO/PPO	$31.30
Rate for Payer: Health Smart Auto/Commercial	$23.48
Rate for Payer: LLUH Dept of Risk Management WC	$21.52
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$29.35

BETAXOLOL 0.25 % EYE DROPS,SUSPENSION [19703]

Facility

$39.13

Service Code	NDC 0065-0246-10
Hospital Charge Code	NDG19703
Hospital Revenue Code	259
Min. Negotiated Rate	$21.52
Max. Negotiated Rate	$29.35
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$23.48
Rate for Payer: Aetna of CA Government/Medicare	$23.48
Rate for Payer: Cash Price	$17.61
Rate for Payer: Health Smart Auto/Commercial	$23.48
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$23.48
Rate for Payer: LLUH Dept of Risk Management WC	$21.52
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$29.35

BETAXOLOL 0.5 % EYE DROPS [9268]

Facility

$12.18

Service Code	NDC 17478-705-10
Hospital Charge Code	1740210
Hospital Revenue Code	259
Min. Negotiated Rate	$6.70
Max. Negotiated Rate	$9.14
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$7.31
Rate for Payer: Aetna of CA Government/Medicare	$7.31
Rate for Payer: Cash Price	$5.48
Rate for Payer: Health Smart Auto/Commercial	$7.31
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$7.31
Rate for Payer: LLUH Dept of Risk Management WC	$6.70
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$9.14

BETAXOLOL 0.5 % EYE DROPS [9268]

Facility

$11.32

Service Code	NDC 17478-705-11
Hospital Charge Code	1740211
Hospital Revenue Code	259
Min. Negotiated Rate	$6.23
Max. Negotiated Rate	$9.06
Rate for Payer: Cash Price	$5.09
Rate for Payer: Cigna of CA HMO/PPO	$9.06
Rate for Payer: Health Smart Auto/Commercial	$6.79
Rate for Payer: LLUH Dept of Risk Management WC	$6.23
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$8.49

BETAXOLOL 0.5 % EYE DROPS [9268]

Facility

$11.38

Service Code	NDC 61314-245-03
Hospital Charge Code	1740211
Hospital Revenue Code	259
Min. Negotiated Rate	$6.26
Max. Negotiated Rate	$8.54
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$6.83
Rate for Payer: Aetna of CA Government/Medicare	$6.83
Rate for Payer: Cash Price	$5.12
Rate for Payer: Health Smart Auto/Commercial	$6.83
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$6.83
Rate for Payer: LLUH Dept of Risk Management WC	$6.26
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$8.54

BETAXOLOL 0.5 % EYE DROPS [9268]

Facility

$12.24

Service Code	NDC 61314-245-01
Hospital Charge Code	1740210
Hospital Revenue Code	259
Min. Negotiated Rate	$6.73
Max. Negotiated Rate	$9.18
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$7.34
Rate for Payer: Aetna of CA Government/Medicare	$7.34
Rate for Payer: Cash Price	$5.51
Rate for Payer: Health Smart Auto/Commercial	$7.34
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$7.34
Rate for Payer: LLUH Dept of Risk Management WC	$6.73
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$9.18

BETAXOLOL 0.5 % EYE DROPS [9268]

Facility

$11.32

Service Code	NDC 17478-705-11
Hospital Charge Code	1740211
Hospital Revenue Code	259
Min. Negotiated Rate	$6.23
Max. Negotiated Rate	$8.49
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$6.79
Rate for Payer: Aetna of CA Government/Medicare	$6.79
Rate for Payer: Cash Price	$5.09
Rate for Payer: Health Smart Auto/Commercial	$6.79
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$6.79
Rate for Payer: LLUH Dept of Risk Management WC	$6.23
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$8.49

BETAXOLOL 0.5 % EYE DROPS [9268]

Facility

$12.18

Service Code	NDC 17478-705-10
Hospital Charge Code	1740210
Hospital Revenue Code	259
Min. Negotiated Rate	$6.70
Max. Negotiated Rate	$9.74
Rate for Payer: Cash Price	$5.48
Rate for Payer: Cigna of CA HMO/PPO	$9.74
Rate for Payer: Health Smart Auto/Commercial	$7.31
Rate for Payer: LLUH Dept of Risk Management WC	$6.70
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$9.14

BETAXOLOL 0.5 % EYE DROPS [9268]

Facility

$12.24

Service Code	NDC 61314-245-01
Hospital Charge Code	1740210
Hospital Revenue Code	259
Min. Negotiated Rate	$6.73
Max. Negotiated Rate	$9.79
Rate for Payer: Cash Price	$5.51
Rate for Payer: Cigna of CA HMO/PPO	$9.79
Rate for Payer: Health Smart Auto/Commercial	$7.34
Rate for Payer: LLUH Dept of Risk Management WC	$6.73
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$9.18

BETAXOLOL 0.5 % EYE DROPS [9268]

Facility

$11.38

Service Code	NDC 61314-245-03
Hospital Charge Code	1740211
Hospital Revenue Code	259
Min. Negotiated Rate	$6.26
Max. Negotiated Rate	$9.10
Rate for Payer: Cash Price	$5.12
Rate for Payer: Cigna of CA HMO/PPO	$9.10
Rate for Payer: Health Smart Auto/Commercial	$6.83
Rate for Payer: LLUH Dept of Risk Management WC	$6.26
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$8.54

BETHANECHOL CHLORIDE 10 MG TABLET [1043]

Facility

$0.76

Service Code	NDC 0832-0511-01
Hospital Charge Code	1711218
Hospital Revenue Code	259
Min. Negotiated Rate	$0.42
Max. Negotiated Rate	$0.61
Rate for Payer: Cash Price	$0.34
Rate for Payer: Cigna of CA HMO/PPO	$0.61
Rate for Payer: Health Smart Auto/Commercial	$0.46
Rate for Payer: LLUH Dept of Risk Management WC	$0.42
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$0.57

BETHANECHOL CHLORIDE 10 MG TABLET [1043]

Facility

$0.76

Service Code	NDC 0832-0511-01
Hospital Charge Code	1711218
Hospital Revenue Code	259
Min. Negotiated Rate	$0.42
Max. Negotiated Rate	$0.57
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$0.46
Rate for Payer: Aetna of CA Government/Medicare	$0.46
Rate for Payer: Cash Price	$0.34
Rate for Payer: Health Smart Auto/Commercial	$0.46
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$0.46
Rate for Payer: LLUH Dept of Risk Management WC	$0.42
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$0.57

BETHANECHOL CHLORIDE 10 MG TABLET [1043]

Facility

$0.38

Service Code	NDC 0832-0511-00
Hospital Charge Code	1711218
Hospital Revenue Code	259
Min. Negotiated Rate	$0.21
Max. Negotiated Rate	$0.29
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$0.23
Rate for Payer: Aetna of CA Government/Medicare	$0.23
Rate for Payer: Cash Price	$0.17
Rate for Payer: Health Smart Auto/Commercial	$0.23
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$0.23
Rate for Payer: LLUH Dept of Risk Management WC	$0.21
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$0.29

BETHANECHOL CHLORIDE 10 MG TABLET [1043]

Facility

$0.82

Service Code	NDC 68084-365-01
Hospital Charge Code	1711218
Hospital Revenue Code	259
Min. Negotiated Rate	$0.45
Max. Negotiated Rate	$0.66
Rate for Payer: Cash Price	$0.37
Rate for Payer: Cigna of CA HMO/PPO	$0.66
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	$0.62

BETHANECHOL CHLORIDE 10 MG TABLET [1043]

Facility

$0.76

Service Code	NDC 0832-0511-89
Hospital Charge Code	1711218
Hospital Revenue Code	259
Min. Negotiated Rate	$0.42
Max. Negotiated Rate	$0.57
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$0.46
Rate for Payer: Aetna of CA Government/Medicare	$0.46
Rate for Payer: Cash Price	$0.34
Rate for Payer: Health Smart Auto/Commercial	$0.46
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$0.46
Rate for Payer: LLUH Dept of Risk Management WC	$0.42
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$0.57

BETHANECHOL CHLORIDE 10 MG TABLET [1043]

Facility

$0.38

Service Code	NDC 0832-0511-00
Hospital Charge Code	1711218
Hospital Revenue Code	259
Min. Negotiated Rate	$0.21
Max. Negotiated Rate	$0.30
Rate for Payer: Cash Price	$0.17
Rate for Payer: Cigna of CA HMO/PPO	$0.30
Rate for Payer: Health Smart Auto/Commercial	$0.23
Rate for Payer: LLUH Dept of Risk Management WC	$0.21
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$0.29

BETHANECHOL CHLORIDE 10 MG TABLET [1043]

Facility

$0.82

Service Code	NDC 68084-365-01
Hospital Charge Code	1711218
Hospital Revenue Code	259
Min. Negotiated Rate	$0.45
Max. Negotiated Rate	$0.62
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	$0.37
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	$0.62

BETHANECHOL CHLORIDE 10 MG TABLET [1043]

Facility

$0.76

Service Code	NDC 0832-0511-89
Hospital Charge Code	1711218
Hospital Revenue Code	259
Min. Negotiated Rate	$0.42
Max. Negotiated Rate	$0.61
Rate for Payer: Cash Price	$0.34
Rate for Payer: Cigna of CA HMO/PPO	$0.61
Rate for Payer: Health Smart Auto/Commercial	$0.46
Rate for Payer: LLUH Dept of Risk Management WC	$0.42
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$0.57

BETHANECHOL CHLORIDE 10 MG TABLET [1043]

Facility

$0.82

Service Code	NDC 68084-365-11
Hospital Charge Code	1711218
Hospital Revenue Code	259
Min. Negotiated Rate	$0.45
Max. Negotiated Rate	$0.66
Rate for Payer: Cash Price	$0.37
Rate for Payer: Cigna of CA HMO/PPO	$0.66
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	$0.62

Know your out-of-pocket cost for care.

All Charges