Loma Linda University Behavioral Medicine Center (BMC)

All Charges

Charge

Type

Setting

Price

TERBINAFINE HCL 1 % TOPICAL CREAM [27023]

Facility

$0.42

Service Code	NDC 24385-524-03
Hospital Charge Code	NDG27023B
Hospital Revenue Code	259
Min. Negotiated Rate	$0.23
Max. Negotiated Rate	$0.34
Rate for Payer: Health Smart Auto/Commercial	$0.25
Rate for Payer: Cash Price	$0.19
Rate for Payer: Cigna of CA HMO/PPO	$0.34
Rate for Payer: LLUH Dept of Risk Management WC	$0.23
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$0.32

TERBINAFINE HCL 1 % TOPICAL CREAM [27023]

Facility

$0.40

Service Code	NDC 8770140472
Hospital Charge Code	NDG27023B
Hospital Revenue Code	259
Min. Negotiated Rate	$0.22
Max. Negotiated Rate	$0.30
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$0.24
Rate for Payer: Aetna of CA Government/Medicare	$0.24
Rate for Payer: Cash Price	$0.18
Rate for Payer: Health Smart Auto/Commercial	$0.24
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$0.24
Rate for Payer: LLUH Dept of Risk Management WC	$0.22
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$0.30

TERBINAFINE HCL 1 % TOPICAL CREAM [27023]

Facility

$0.52

Service Code	NDC 51672-2080-1
Hospital Charge Code	NDG27023
Hospital Revenue Code	259
Min. Negotiated Rate	$0.29
Max. Negotiated Rate	$0.39
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$0.31
Rate for Payer: Aetna of CA Government/Medicare	$0.31
Rate for Payer: Cash Price	$0.23
Rate for Payer: Health Smart Auto/Commercial	$0.31
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$0.31
Rate for Payer: LLUH Dept of Risk Management WC	$0.29
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$0.39

TERBINAFINE HCL 1 % TOPICAL CREAM [27023]

Facility

$0.50

Service Code	NDC 8770140471
Hospital Charge Code	NDG27023
Hospital Revenue Code	259
Min. Negotiated Rate	$0.28
Max. Negotiated Rate	$0.38
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$0.30
Rate for Payer: Aetna of CA Government/Medicare	$0.30
Rate for Payer: Cash Price	$0.23
Rate for Payer: Health Smart Auto/Commercial	$0.30
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$0.30
Rate for Payer: LLUH Dept of Risk Management WC	$0.28
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$0.38

TERBINAFINE HCL 1 % TOPICAL CREAM [27023]

Facility

$0.50

Service Code	NDC 8770140471
Hospital Charge Code	NDG27023
Hospital Revenue Code	259
Min. Negotiated Rate	$0.28
Max. Negotiated Rate	$0.40
Rate for Payer: Cash Price	$0.23
Rate for Payer: Cigna of CA HMO/PPO	$0.40
Rate for Payer: Health Smart Auto/Commercial	$0.30
Rate for Payer: LLUH Dept of Risk Management WC	$0.28
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$0.38

TERBINAFINE HCL 250 MG TABLET [12724]

Facility

$0.30

Service Code	NDC 65862-079-30
Hospital Charge Code	1711662
Hospital Revenue Code	259
Min. Negotiated Rate	$0.17
Max. Negotiated Rate	$0.24
Rate for Payer: Cash Price	$0.14
Rate for Payer: Cigna of CA HMO/PPO	$0.24
Rate for Payer: Health Smart Auto/Commercial	$0.18
Rate for Payer: LLUH Dept of Risk Management WC	$0.17
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$0.23

TERBINAFINE HCL 250 MG TABLET [12724]

Facility

$0.30

Service Code	NDC 42043-410-03
Hospital Charge Code	1711662
Hospital Revenue Code	259
Min. Negotiated Rate	$0.17
Max. Negotiated Rate	$0.24
Rate for Payer: Cash Price	$0.14
Rate for Payer: Cigna of CA HMO/PPO	$0.24
Rate for Payer: Health Smart Auto/Commercial	$0.18
Rate for Payer: LLUH Dept of Risk Management WC	$0.17
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$0.23

TERBINAFINE HCL 250 MG TABLET [12724]

Facility

$0.30

Service Code	NDC 65862-079-30
Hospital Charge Code	1711662
Hospital Revenue Code	259
Min. Negotiated Rate	$0.17
Max. Negotiated Rate	$0.23
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$0.18
Rate for Payer: Aetna of CA Government/Medicare	$0.18
Rate for Payer: Cash Price	$0.14
Rate for Payer: Health Smart Auto/Commercial	$0.18
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$0.18
Rate for Payer: LLUH Dept of Risk Management WC	$0.17
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$0.23

TERBINAFINE HCL 250 MG TABLET [12724]

Facility

$0.30

Service Code	NDC 42043-410-03
Hospital Charge Code	1711662
Hospital Revenue Code	259
Min. Negotiated Rate	$0.17
Max. Negotiated Rate	$0.23
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$0.18
Rate for Payer: Aetna of CA Government/Medicare	$0.18
Rate for Payer: Cash Price	$0.14
Rate for Payer: Health Smart Auto/Commercial	$0.18
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$0.18
Rate for Payer: LLUH Dept of Risk Management WC	$0.17
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$0.23

TERBUTALINE 1 MG/ML CONTINUOUS INFUSION (STRAIGHT DRUG) [4080921]

Facility

$23.64

Service Code	CPT J3105
Hospital Charge Code	1720063
Hospital Revenue Code	636
Min. Negotiated Rate	$13.00
Max. Negotiated Rate	$17.73
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$14.18
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$2.88
Rate for Payer: Aetna of CA Government/Medicare	$2.88
Rate for Payer: Aetna of CA Government/Medicare	$14.18
Rate for Payer: Cash Price	$10.64
Rate for Payer: Cash Price	$2.16
Rate for Payer: Health Smart Auto/Commercial	$2.88
Rate for Payer: Health Smart Auto/Commercial	$14.18
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$2.88
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$14.18
Rate for Payer: LLUH Dept of Risk Management WC	$13.00
Rate for Payer: LLUH Dept of Risk Management WC	$2.64
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$17.73
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$3.60

TERBUTALINE 1 MG/ML CONTINUOUS INFUSION (STRAIGHT DRUG) [4080921]

Facility

$4.80

Service Code	CPT J3105
Hospital Charge Code	1720063
Hospital Revenue Code	636
Min. Negotiated Rate	$2.64
Max. Negotiated Rate	$3.84
Rate for Payer: Cash Price	$2.16
Rate for Payer: Cash Price	$10.64
Rate for Payer: Cigna of CA HMO/PPO	$3.84
Rate for Payer: Cigna of CA HMO/PPO	$18.91
Rate for Payer: Health Smart Auto/Commercial	$2.88
Rate for Payer: Health Smart Auto/Commercial	$14.18
Rate for Payer: LLUH Dept of Risk Management WC	$2.64
Rate for Payer: LLUH Dept of Risk Management WC	$13.00
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$17.73
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$3.60

TERBUTALINE 1 MG/ML MED NEB SOLUTION [192332]

Facility

$4.80

Service Code	NDC 0143-9746-10
Hospital Charge Code	1720063
Hospital Revenue Code	259
Min. Negotiated Rate	$2.64
Max. Negotiated Rate	$3.60
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$2.88
Rate for Payer: Aetna of CA Government/Medicare	$2.88
Rate for Payer: Cash Price	$2.16
Rate for Payer: Health Smart Auto/Commercial	$2.88
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$2.88
Rate for Payer: LLUH Dept of Risk Management WC	$2.64
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$3.60

TERBUTALINE 1 MG/ML MED NEB SOLUTION [192332]

Facility

$23.64

Service Code	NDC 63323-665-01
Hospital Charge Code	1720063
Hospital Revenue Code	259
Min. Negotiated Rate	$13.00
Max. Negotiated Rate	$18.91
Rate for Payer: Cash Price	$10.64
Rate for Payer: Cigna of CA HMO/PPO	$18.91
Rate for Payer: Health Smart Auto/Commercial	$14.18
Rate for Payer: LLUH Dept of Risk Management WC	$13.00
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$17.73

TERBUTALINE 1 MG/ML MED NEB SOLUTION [192332]

Facility

$23.64

Service Code	NDC 63323-665-01
Hospital Charge Code	1720063
Hospital Revenue Code	259
Min. Negotiated Rate	$13.00
Max. Negotiated Rate	$17.73
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$14.18
Rate for Payer: Aetna of CA Government/Medicare	$14.18
Rate for Payer: Cash Price	$10.64
Rate for Payer: Health Smart Auto/Commercial	$14.18
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$14.18
Rate for Payer: LLUH Dept of Risk Management WC	$13.00
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$17.73

TERBUTALINE 1 MG/ML MED NEB SOLUTION [192332]

Facility

$4.80

Service Code	NDC 0143-9746-10
Hospital Charge Code	1720063
Hospital Revenue Code	259
Min. Negotiated Rate	$2.64
Max. Negotiated Rate	$3.84
Rate for Payer: Cash Price	$2.16
Rate for Payer: Cigna of CA HMO/PPO	$3.84
Rate for Payer: Health Smart Auto/Commercial	$2.88
Rate for Payer: LLUH Dept of Risk Management WC	$2.64
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$3.60

TERBUTALINE 1 MG/ML SUBCUTANEOUS SOLUTION [11507]

Facility

$4.80

Service Code	CPT J3105
Hospital Charge Code	1720063
Hospital Revenue Code	636
Min. Negotiated Rate	$2.64
Max. Negotiated Rate	$3.84
Rate for Payer: Cash Price	$2.16
Rate for Payer: Cash Price	$0.97
Rate for Payer: Cash Price	$10.64
Rate for Payer: Cigna of CA HMO/PPO	$1.73
Rate for Payer: Cigna of CA HMO/PPO	$3.84
Rate for Payer: Cigna of CA HMO/PPO	$18.91
Rate for Payer: Health Smart Auto/Commercial	$14.18
Rate for Payer: Health Smart Auto/Commercial	$1.30
Rate for Payer: Health Smart Auto/Commercial	$2.88
Rate for Payer: LLUH Dept of Risk Management WC	$1.19
Rate for Payer: LLUH Dept of Risk Management WC	$13.00
Rate for Payer: LLUH Dept of Risk Management WC	$2.64
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$3.60
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$17.73
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$1.62

TERBUTALINE 1 MG/ML SUBCUTANEOUS SOLUTION [11507]

Facility

$4.80

Service Code	CPT J3105
Hospital Charge Code	1720063
Hospital Revenue Code	636
Min. Negotiated Rate	$2.64
Max. Negotiated Rate	$3.60
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$2.88
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$14.18
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$1.30
Rate for Payer: Aetna of CA Government/Medicare	$14.18
Rate for Payer: Aetna of CA Government/Medicare	$1.30
Rate for Payer: Aetna of CA Government/Medicare	$2.88
Rate for Payer: Cash Price	$0.97
Rate for Payer: Cash Price	$2.16
Rate for Payer: Cash Price	$10.64
Rate for Payer: Health Smart Auto/Commercial	$1.30
Rate for Payer: Health Smart Auto/Commercial	$2.88
Rate for Payer: Health Smart Auto/Commercial	$14.18
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$2.88
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$1.30
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$14.18
Rate for Payer: LLUH Dept of Risk Management WC	$1.19
Rate for Payer: LLUH Dept of Risk Management WC	$2.64
Rate for Payer: LLUH Dept of Risk Management WC	$13.00
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$3.60
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$17.73
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$1.62

TERBUTALINE 2.5 MG TABLET [11508]

Facility

$5.22

Service Code	NDC 0527-1318-01
Hospital Charge Code	1711328
Hospital Revenue Code	259
Min. Negotiated Rate	$2.87
Max. Negotiated Rate	$3.92
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$3.13
Rate for Payer: Aetna of CA Government/Medicare	$3.13
Rate for Payer: Cash Price	$2.35
Rate for Payer: Health Smart Auto/Commercial	$3.13
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$3.13
Rate for Payer: LLUH Dept of Risk Management WC	$2.87
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$3.92

TERBUTALINE 2.5 MG TABLET [11508]

Facility

$5.22

Service Code	NDC 0527-1318-01
Hospital Charge Code	1711328
Hospital Revenue Code	259
Min. Negotiated Rate	$2.87
Max. Negotiated Rate	$4.18
Rate for Payer: Cash Price	$2.35
Rate for Payer: Cigna of CA HMO/PPO	$4.18
Rate for Payer: Health Smart Auto/Commercial	$3.13
Rate for Payer: LLUH Dept of Risk Management WC	$2.87
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$3.92

TERBUTALINE 2.5 MG TABLET [11508]

Facility

$3.00

Service Code	NDC 24979-132-01
Hospital Charge Code	1711328
Hospital Revenue Code	259
Min. Negotiated Rate	$1.65
Max. Negotiated Rate	$2.40
Rate for Payer: Cash Price	$1.35
Rate for Payer: Cigna of CA HMO/PPO	$2.40
Rate for Payer: Health Smart Auto/Commercial	$1.80
Rate for Payer: LLUH Dept of Risk Management WC	$1.65
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$2.25

TERBUTALINE 2.5 MG TABLET [11508]

Facility

$3.00

Service Code	NDC 24979-132-01
Hospital Charge Code	1711328
Hospital Revenue Code	259
Min. Negotiated Rate	$1.65
Max. Negotiated Rate	$2.25
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$1.80
Rate for Payer: Aetna of CA Government/Medicare	$1.80
Rate for Payer: Cash Price	$1.35
Rate for Payer: Health Smart Auto/Commercial	$1.80
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$1.80
Rate for Payer: LLUH Dept of Risk Management WC	$1.65
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$2.25

TERBUTALINE 5 MG TABLET [11509]

Facility

$6.38

Service Code	NDC 0527-1311-01
Hospital Charge Code	1712001
Hospital Revenue Code	259
Min. Negotiated Rate	$3.51
Max. Negotiated Rate	$5.10
Rate for Payer: Cash Price	$2.87
Rate for Payer: Cigna of CA HMO/PPO	$5.10
Rate for Payer: Health Smart Auto/Commercial	$3.83
Rate for Payer: LLUH Dept of Risk Management WC	$3.51
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$4.78

TERBUTALINE 5 MG TABLET [11509]

Facility

$3.00

Service Code	NDC 24979-133-01
Hospital Charge Code	1712001
Hospital Revenue Code	259
Min. Negotiated Rate	$1.65
Max. Negotiated Rate	$2.25
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$1.80
Rate for Payer: Aetna of CA Government/Medicare	$1.80
Rate for Payer: Cash Price	$1.35
Rate for Payer: Health Smart Auto/Commercial	$1.80
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$1.80
Rate for Payer: LLUH Dept of Risk Management WC	$1.65
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$2.25

TERBUTALINE 5 MG TABLET [11509]

Facility

$3.00

Service Code	NDC 24979-133-01
Hospital Charge Code	1712001
Hospital Revenue Code	259
Min. Negotiated Rate	$1.65
Max. Negotiated Rate	$2.40
Rate for Payer: Cash Price	$1.35
Rate for Payer: Cigna of CA HMO/PPO	$2.40
Rate for Payer: Health Smart Auto/Commercial	$1.80
Rate for Payer: LLUH Dept of Risk Management WC	$1.65
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$2.25

TERBUTALINE 5 MG TABLET [11509]

Facility

$6.38

Service Code	NDC 0527-1311-01
Hospital Charge Code	1712001
Hospital Revenue Code	259
Min. Negotiated Rate	$3.51
Max. Negotiated Rate	$4.78
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$3.83
Rate for Payer: Aetna of CA Government/Medicare	$3.83
Rate for Payer: Cash Price	$2.87
Rate for Payer: Health Smart Auto/Commercial	$3.83
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$3.83
Rate for Payer: LLUH Dept of Risk Management WC	$3.51
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$4.78

Know your out-of-pocket cost for care.

All Charges