Loma Linda University Behavioral Medicine Center (BMC)

All Charges

Charge

Type

Setting

Price

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 25 MG TABLET [1044]

Facility

$0.55

Service Code	NDC 65162-573-10
Hospital Charge Code	1711230
Hospital Revenue Code	259
Min. Negotiated Rate	$0.30
Max. Negotiated Rate	$0.44
Rate for Payer: Cash Price	$0.25
Rate for Payer: Cigna of CA HMO/PPO	$0.44
Rate for Payer: Health Smart Auto/Commercial	$0.33
Rate for Payer: LLUH Dept of Risk Management WC	$0.30
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$0.41

BETHANECHOL CHLORIDE 25 MG TABLET [1044]

Facility

$0.61

Service Code	NDC 0527-1356-01
Hospital Charge Code	1711230
Hospital Revenue Code	259
Min. Negotiated Rate	$0.34
Max. Negotiated Rate	$0.49
Rate for Payer: Cash Price	$0.27
Rate for Payer: Cigna of CA HMO/PPO	$0.49
Rate for Payer: Health Smart Auto/Commercial	$0.37
Rate for Payer: LLUH Dept of Risk Management WC	$0.34
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$0.46

BETHANECHOL CHLORIDE 25 MG TABLET [1044]

Facility

$0.55

Service Code	NDC 0832-0512-00
Hospital Charge Code	1711230
Hospital Revenue Code	259
Min. Negotiated Rate	$0.30
Max. Negotiated Rate	$0.44
Rate for Payer: Cash Price	$0.25
Rate for Payer: Cigna of CA HMO/PPO	$0.44
Rate for Payer: Health Smart Auto/Commercial	$0.33
Rate for Payer: LLUH Dept of Risk Management WC	$0.30
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$0.41

BETHANECHOL CHLORIDE 25 MG TABLET [1044]

Facility

$1.09

Service Code	NDC 0832-0512-89
Hospital Charge Code	1711230
Hospital Revenue Code	259
Min. Negotiated Rate	$0.60
Max. Negotiated Rate	$0.87
Rate for Payer: Cash Price	$0.49
Rate for Payer: Cigna of CA HMO/PPO	$0.87
Rate for Payer: Health Smart Auto/Commercial	$0.65
Rate for Payer: LLUH Dept of Risk Management WC	$0.60
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$0.82

BETHANECHOL CHLORIDE 25 MG TABLET [1044]

Facility

$1.10

Service Code	NDC 0832-0512-01
Hospital Charge Code	1711230
Hospital Revenue Code	259
Min. Negotiated Rate	$0.61
Max. Negotiated Rate	$0.83
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$0.66
Rate for Payer: Aetna of CA Government/Medicare	$0.66
Rate for Payer: Cash Price	$0.50
Rate for Payer: Health Smart Auto/Commercial	$0.66
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$0.66
Rate for Payer: LLUH Dept of Risk Management WC	$0.61
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$0.83

BETHANECHOL CHLORIDE 25 MG TABLET [1044]

Facility

$0.55

Service Code	NDC 0832-0512-00
Hospital Charge Code	1711230
Hospital Revenue Code	259
Min. Negotiated Rate	$0.30
Max. Negotiated Rate	$0.41
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$0.33
Rate for Payer: Aetna of CA Government/Medicare	$0.33
Rate for Payer: Cash Price	$0.25
Rate for Payer: Health Smart Auto/Commercial	$0.33
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$0.33
Rate for Payer: LLUH Dept of Risk Management WC	$0.30
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$0.41

BETHANECHOL CHLORIDE 25 MG TABLET [1044]

Facility

$0.55

Service Code	NDC 65162-573-10
Hospital Charge Code	1711230
Hospital Revenue Code	259
Min. Negotiated Rate	$0.30
Max. Negotiated Rate	$0.41
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$0.33
Rate for Payer: Aetna of CA Government/Medicare	$0.33
Rate for Payer: Cash Price	$0.25
Rate for Payer: Health Smart Auto/Commercial	$0.33
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$0.33
Rate for Payer: LLUH Dept of Risk Management WC	$0.30
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$0.41

BETHANECHOL CHLORIDE 25 MG TABLET [1044]

Facility

$1.09

Service Code	NDC 0832-0512-89
Hospital Charge Code	1711230
Hospital Revenue Code	259
Min. Negotiated Rate	$0.60
Max. Negotiated Rate	$0.82
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$0.65
Rate for Payer: Aetna of CA Government/Medicare	$0.65
Rate for Payer: Cash Price	$0.49
Rate for Payer: Health Smart Auto/Commercial	$0.65
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$0.65
Rate for Payer: LLUH Dept of Risk Management WC	$0.60
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$0.82

BETHANECHOL CHLORIDE 25 MG TABLET [1044]

Facility

$0.61

Service Code	NDC 0527-1356-01
Hospital Charge Code	1711230
Hospital Revenue Code	259
Min. Negotiated Rate	$0.34
Max. Negotiated Rate	$0.46
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$0.37
Rate for Payer: Aetna of CA Government/Medicare	$0.37
Rate for Payer: Cash Price	$0.27
Rate for Payer: Health Smart Auto/Commercial	$0.37
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$0.37
Rate for Payer: LLUH Dept of Risk Management WC	$0.34
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$0.46

BETHANECHOL CHLORIDE 25 MG TABLET [1044]

Facility

$1.10

Service Code	NDC 0832-0512-01
Hospital Charge Code	1711230
Hospital Revenue Code	259
Min. Negotiated Rate	$0.61
Max. Negotiated Rate	$0.88
Rate for Payer: Cash Price	$0.50
Rate for Payer: Cigna of CA HMO/PPO	$0.88
Rate for Payer: Health Smart Auto/Commercial	$0.66
Rate for Payer: LLUH Dept of Risk Management WC	$0.61
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$0.83

BETHANECHOL CHLORIDE 5 MG TABLET [1045]

Facility

$0.29

Service Code	NDC 0832-0510-00
Hospital Charge Code	1711212
Hospital Revenue Code	259
Min. Negotiated Rate	$0.16
Max. Negotiated Rate	$0.23
Rate for Payer: Cash Price	$0.13
Rate for Payer: Cigna of CA HMO/PPO	$0.23
Rate for Payer: Health Smart Auto/Commercial	$0.17
Rate for Payer: LLUH Dept of Risk Management WC	$0.16
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$0.22

BETHANECHOL CHLORIDE 5 MG TABLET [1045]

Facility

$0.29

Service Code	NDC 0832-0510-00
Hospital Charge Code	1711212
Hospital Revenue Code	259
Min. Negotiated Rate	$0.16
Max. Negotiated Rate	$0.22
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$0.17
Rate for Payer: Aetna of CA Government/Medicare	$0.17
Rate for Payer: Cash Price	$0.13
Rate for Payer: Health Smart Auto/Commercial	$0.17
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$0.17
Rate for Payer: LLUH Dept of Risk Management WC	$0.16
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$0.22

BETHANECHOL ORAL SUSPENSION COMPOUND 1 MG/ML [4080248]

Facility

$0.09

Service Code	NDC 9994-0802-48
Hospital Charge Code	1715519
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

BETHANECHOL ORAL SUSPENSION COMPOUND 1 MG/ML [4080248]

Facility

$0.09

Service Code	NDC 9994-0802-48
Hospital Charge Code	1715519
Hospital Revenue Code	259
Min. Negotiated Rate	$0.05
Max. Negotiated Rate	$0.07
Rate for Payer: Cash Price	$0.04
Rate for Payer: Cigna of CA 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 Beech St/Commercial/PHCS	$0.07

BEVACIZUMAB 25 MG/ML INTRAVENOUS SOLUTION [38022]

Facility

$239.08

Service Code	CPT J9035
Hospital Charge Code	1722042
Hospital Revenue Code	636
Min. Negotiated Rate	$131.49
Max. Negotiated Rate	$191.26
Rate for Payer: Cash Price	$107.59
Rate for Payer: Cigna of CA HMO/PPO	$191.26
Rate for Payer: Health Smart Auto/Commercial	$143.45
Rate for Payer: LLUH Dept of Risk Management WC	$131.49
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$179.31

BEVACIZUMAB 25 MG/ML INTRAVENOUS SOLUTION [38022]

Facility

$239.08

Service Code	CPT J9035
Hospital Charge Code	1722041
Hospital Revenue Code	636
Min. Negotiated Rate	$131.49
Max. Negotiated Rate	$191.26
Rate for Payer: Cash Price	$107.59
Rate for Payer: Cigna of CA HMO/PPO	$191.26
Rate for Payer: Health Smart Auto/Commercial	$143.45
Rate for Payer: LLUH Dept of Risk Management WC	$131.49
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$179.31

BEVACIZUMAB 25 MG/ML INTRAVENOUS SOLUTION [38022]

Facility

$239.08

Service Code	CPT J9035
Hospital Charge Code	1722042
Hospital Revenue Code	636
Min. Negotiated Rate	$131.49
Max. Negotiated Rate	$179.31
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$143.45
Rate for Payer: Aetna of CA Government/Medicare	$143.45
Rate for Payer: Cash Price	$107.59
Rate for Payer: Health Smart Auto/Commercial	$143.45
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$143.45
Rate for Payer: LLUH Dept of Risk Management WC	$131.49
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$179.31

BEVACIZUMAB 25 MG/ML INTRAVENOUS SOLUTION [38022]

Facility

$239.08

Service Code	CPT J9035
Hospital Charge Code	1722041
Hospital Revenue Code	636
Min. Negotiated Rate	$131.49
Max. Negotiated Rate	$179.31
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$143.45
Rate for Payer: Aetna of CA Government/Medicare	$143.45
Rate for Payer: Cash Price	$107.59
Rate for Payer: Health Smart Auto/Commercial	$143.45
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$143.45
Rate for Payer: LLUH Dept of Risk Management WC	$131.49
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$179.31

BEVACIZUMAB 25 MG/ML INTRAVITREAL INJ [4080972]

Facility

$239.08

Service Code	CPT C9257
Hospital Charge Code	1722041
Hospital Revenue Code	636
Min. Negotiated Rate	$131.49
Max. Negotiated Rate	$179.31
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$143.45
Rate for Payer: Aetna of CA Government/Medicare	$143.45
Rate for Payer: Cash Price	$107.59
Rate for Payer: Health Smart Auto/Commercial	$143.45
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$143.45
Rate for Payer: LLUH Dept of Risk Management WC	$131.49
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$179.31

BEVACIZUMAB 25 MG/ML INTRAVITREAL INJ [4080972]

Facility

$239.08

Service Code	CPT C9257
Hospital Charge Code	1722041
Hospital Revenue Code	636
Min. Negotiated Rate	$131.49
Max. Negotiated Rate	$191.26
Rate for Payer: Cash Price	$107.59
Rate for Payer: Cigna of CA HMO/PPO	$191.26
Rate for Payer: Health Smart Auto/Commercial	$143.45
Rate for Payer: LLUH Dept of Risk Management WC	$131.49
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$179.31

BEVACIZUMAB 25 MG/ML TOPICAL [4081093]

Facility

$239.08

Service Code	NDC 50242-060-01
Hospital Charge Code	1722041
Hospital Revenue Code	272
Min. Negotiated Rate	$131.49
Max. Negotiated Rate	$191.26
Rate for Payer: Cash Price	$107.59
Rate for Payer: Cigna of CA HMO/PPO	$191.26
Rate for Payer: Health Smart Auto/Commercial	$143.45
Rate for Payer: LLUH Dept of Risk Management WC	$131.49
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$179.31

BEVACIZUMAB 25 MG/ML TOPICAL [4081093]

Facility

$239.08

Service Code	NDC 9994-0810-93
Hospital Charge Code	NDC4081093
Hospital Revenue Code	272
Min. Negotiated Rate	$131.49
Max. Negotiated Rate	$179.31
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$143.45
Rate for Payer: Aetna of CA Government/Medicare	$143.45
Rate for Payer: Cash Price	$107.59
Rate for Payer: Health Smart Auto/Commercial	$143.45
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$143.45
Rate for Payer: LLUH Dept of Risk Management WC	$131.49
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$179.31

BEVACIZUMAB 25 MG/ML TOPICAL [4081093]

Facility

$239.08

Service Code	NDC 50242-060-01
Hospital Charge Code	1722041
Hospital Revenue Code	272
Min. Negotiated Rate	$131.49
Max. Negotiated Rate	$179.31
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$143.45
Rate for Payer: Aetna of CA Government/Medicare	$143.45
Rate for Payer: Cash Price	$107.59
Rate for Payer: Health Smart Auto/Commercial	$143.45
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$143.45
Rate for Payer: LLUH Dept of Risk Management WC	$131.49
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$179.31

BEVACIZUMAB 25 MG/ML TOPICAL [4081093]

Facility

$239.08

Service Code	NDC 9994-0810-93
Hospital Charge Code	NDC4081093
Hospital Revenue Code	272
Min. Negotiated Rate	$131.49
Max. Negotiated Rate	$191.26
Rate for Payer: Cash Price	$107.59
Rate for Payer: Cigna of CA HMO/PPO	$191.26
Rate for Payer: Health Smart Auto/Commercial	$143.45
Rate for Payer: LLUH Dept of Risk Management WC	$131.49
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$179.31

Know your out-of-pocket cost for care.

All Charges