Loma Linda University Behavioral Medicine Center (BMC)

All Charges

Charge

Type

Setting

Price

CARVEDILOL 6.25 MG TABLET [15747]

Facility

$0.06

Service Code	NDC 68001-154-00
Hospital Charge Code	1711680
Hospital Revenue Code	259
Min. Negotiated Rate	$0.03
Max. Negotiated Rate	$0.05
Rate for Payer: Cash Price	$0.03
Rate for Payer: Cigna of CA HMO/PPO	$0.05
Rate for Payer: Health Smart Auto/Commercial	$0.04
Rate for Payer: LLUH Dept of Risk Management WC	$0.03
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$0.05

CARVEDILOL 6.25 MG TABLET [15747]

Facility

$0.14

Service Code	NDC 68084-854-11
Hospital Charge Code	1711680
Hospital Revenue Code	259
Min. Negotiated Rate	$0.08
Max. Negotiated Rate	$0.11
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$0.08
Rate for Payer: Aetna of CA Government/Medicare	$0.08
Rate for Payer: Cash Price	$0.06
Rate for Payer: Health Smart Auto/Commercial	$0.08
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$0.08
Rate for Payer: LLUH Dept of Risk Management WC	$0.08
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$0.11

CARVEDILOL 6.25 MG TABLET [15747]

Facility

$0.14

Service Code	NDC 68084-854-01
Hospital Charge Code	1711680
Hospital Revenue Code	259
Min. Negotiated Rate	$0.08
Max. Negotiated Rate	$0.11
Rate for Payer: Cash Price	$0.06
Rate for Payer: Cigna of CA HMO/PPO	$0.11
Rate for Payer: Health Smart Auto/Commercial	$0.08
Rate for Payer: LLUH Dept of Risk Management WC	$0.08
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$0.11

CARVEDILOL ORAL SUSPENSION COMPOUND 1.25 MG/ML [4080253]

Facility

$0.10

Service Code	NDC 9994-0802-53
Hospital Charge Code	1715276
Hospital Revenue Code	259
Min. Negotiated Rate	$0.06
Max. Negotiated Rate	$0.08
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$0.06
Rate for Payer: Aetna of CA Government/Medicare	$0.06
Rate for Payer: Cash Price	$0.05
Rate for Payer: Health Smart Auto/Commercial	$0.06
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$0.06
Rate for Payer: LLUH Dept of Risk Management WC	$0.06
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$0.08

CARVEDILOL ORAL SUSPENSION COMPOUND 1.25 MG/ML [4080253]

Facility

$0.10

Service Code	NDC 9994-0802-53
Hospital Charge Code	1715276
Hospital Revenue Code	259
Min. Negotiated Rate	$0.06
Max. Negotiated Rate	$0.08
Rate for Payer: Cash Price	$0.05
Rate for Payer: Cigna of CA HMO/PPO	$0.08
Rate for Payer: Health Smart Auto/Commercial	$0.06
Rate for Payer: LLUH Dept of Risk Management WC	$0.06
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$0.08

CARVEDILOL PHOSPHATE ER 10 MG CAPSULE,EXT.RELEASE24HR MULTIPHASE [77664]

Facility

$9.91

Service Code	NDC 69784-713-13
Hospital Charge Code	1711920
Hospital Revenue Code	259
Min. Negotiated Rate	$5.45
Max. Negotiated Rate	$7.93
Rate for Payer: Cash Price	$4.46
Rate for Payer: Cigna of CA HMO/PPO	$7.93
Rate for Payer: Health Smart Auto/Commercial	$5.95
Rate for Payer: LLUH Dept of Risk Management WC	$5.45
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$7.43

CARVEDILOL PHOSPHATE ER 10 MG CAPSULE,EXT.RELEASE24HR MULTIPHASE [77664]

Facility

$9.91

Service Code	NDC 57664-663-83
Hospital Charge Code	1711920
Hospital Revenue Code	259
Min. Negotiated Rate	$5.45
Max. Negotiated Rate	$7.43
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$5.95
Rate for Payer: Aetna of CA Government/Medicare	$5.95
Rate for Payer: Cash Price	$4.46
Rate for Payer: Health Smart Auto/Commercial	$5.95
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$5.95
Rate for Payer: LLUH Dept of Risk Management WC	$5.45
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$7.43

CARVEDILOL PHOSPHATE ER 10 MG CAPSULE,EXT.RELEASE24HR MULTIPHASE [77664]

Facility

$9.91

Service Code	NDC 69784-713-13
Hospital Charge Code	1711920
Hospital Revenue Code	259
Min. Negotiated Rate	$5.45
Max. Negotiated Rate	$7.43
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$5.95
Rate for Payer: Aetna of CA Government/Medicare	$5.95
Rate for Payer: Cash Price	$4.46
Rate for Payer: Health Smart Auto/Commercial	$5.95
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$5.95
Rate for Payer: LLUH Dept of Risk Management WC	$5.45
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$7.43

CARVEDILOL PHOSPHATE ER 10 MG CAPSULE,EXT.RELEASE24HR MULTIPHASE [77664]

Facility

$9.91

Service Code	NDC 57664-663-83
Hospital Charge Code	1711920
Hospital Revenue Code	259
Min. Negotiated Rate	$5.45
Max. Negotiated Rate	$7.93
Rate for Payer: Cash Price	$4.46
Rate for Payer: Cigna of CA HMO/PPO	$7.93
Rate for Payer: Health Smart Auto/Commercial	$5.95
Rate for Payer: LLUH Dept of Risk Management WC	$5.45
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$7.43

CARVEDILOL PHOSPHATE ER 20 MG CAPSULE,EXT.RELEASE24HR MULTIPHASE [77665]

Facility

$9.91

Service Code	NDC 69784-714-13
Hospital Charge Code	1711921
Hospital Revenue Code	259
Min. Negotiated Rate	$5.45
Max. Negotiated Rate	$7.43
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$5.95
Rate for Payer: Aetna of CA Government/Medicare	$5.95
Rate for Payer: Cash Price	$4.46
Rate for Payer: Health Smart Auto/Commercial	$5.95
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$5.95
Rate for Payer: LLUH Dept of Risk Management WC	$5.45
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$7.43

CARVEDILOL PHOSPHATE ER 20 MG CAPSULE,EXT.RELEASE24HR MULTIPHASE [77665]

Facility

$9.51

Service Code	NDC 60505-4714-3
Hospital Charge Code	1711921
Hospital Revenue Code	259
Min. Negotiated Rate	$5.23
Max. Negotiated Rate	$7.13
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$5.71
Rate for Payer: Aetna of CA Government/Medicare	$5.71
Rate for Payer: Cash Price	$4.28
Rate for Payer: Health Smart Auto/Commercial	$5.71
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$5.71
Rate for Payer: LLUH Dept of Risk Management WC	$5.23
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$7.13

CARVEDILOL PHOSPHATE ER 20 MG CAPSULE,EXT.RELEASE24HR MULTIPHASE [77665]

Facility

$9.91

Service Code	NDC 69784-714-13
Hospital Charge Code	1711921
Hospital Revenue Code	259
Min. Negotiated Rate	$5.45
Max. Negotiated Rate	$7.93
Rate for Payer: Cash Price	$4.46
Rate for Payer: Cigna of CA HMO/PPO	$7.93
Rate for Payer: Health Smart Auto/Commercial	$5.95
Rate for Payer: LLUH Dept of Risk Management WC	$5.45
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$7.43

CARVEDILOL PHOSPHATE ER 20 MG CAPSULE,EXT.RELEASE24HR MULTIPHASE [77665]

Facility

$9.51

Service Code	NDC 60505-3679-3
Hospital Charge Code	1711921
Hospital Revenue Code	259
Min. Negotiated Rate	$5.23
Max. Negotiated Rate	$7.13
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$5.71
Rate for Payer: Aetna of CA Government/Medicare	$5.71
Rate for Payer: Cash Price	$4.28
Rate for Payer: Health Smart Auto/Commercial	$5.71
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$5.71
Rate for Payer: LLUH Dept of Risk Management WC	$5.23
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$7.13

CARVEDILOL PHOSPHATE ER 20 MG CAPSULE,EXT.RELEASE24HR MULTIPHASE [77665]

Facility

$9.51

Service Code	NDC 60505-3679-3
Hospital Charge Code	1711921
Hospital Revenue Code	259
Min. Negotiated Rate	$5.23
Max. Negotiated Rate	$7.61
Rate for Payer: Cash Price	$4.28
Rate for Payer: Cigna of CA HMO/PPO	$7.61
Rate for Payer: Health Smart Auto/Commercial	$5.71
Rate for Payer: LLUH Dept of Risk Management WC	$5.23
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$7.13

CARVEDILOL PHOSPHATE ER 20 MG CAPSULE,EXT.RELEASE24HR MULTIPHASE [77665]

Facility

$9.51

Service Code	NDC 60505-4714-3
Hospital Charge Code	1711921
Hospital Revenue Code	259
Min. Negotiated Rate	$5.23
Max. Negotiated Rate	$7.61
Rate for Payer: Cash Price	$4.28
Rate for Payer: Cigna of CA HMO/PPO	$7.61
Rate for Payer: Health Smart Auto/Commercial	$5.71
Rate for Payer: LLUH Dept of Risk Management WC	$5.23
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$7.13

CARVEDILOL PHOSPHATE ER 20 MG CAPSULE,EXT.RELEASE24HR MULTIPHASE [77665]

Facility

$9.91

Service Code	NDC 57664-664-83
Hospital Charge Code	1711921
Hospital Revenue Code	259
Min. Negotiated Rate	$5.45
Max. Negotiated Rate	$7.43
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$5.95
Rate for Payer: Aetna of CA Government/Medicare	$5.95
Rate for Payer: Cash Price	$4.46
Rate for Payer: Health Smart Auto/Commercial	$5.95
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$5.95
Rate for Payer: LLUH Dept of Risk Management WC	$5.45
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$7.43

CARVEDILOL PHOSPHATE ER 20 MG CAPSULE,EXT.RELEASE24HR MULTIPHASE [77665]

Facility

$9.91

Service Code	NDC 57664-664-83
Hospital Charge Code	1711921
Hospital Revenue Code	259
Min. Negotiated Rate	$5.45
Max. Negotiated Rate	$7.93
Rate for Payer: Cash Price	$4.46
Rate for Payer: Cigna of CA HMO/PPO	$7.93
Rate for Payer: Health Smart Auto/Commercial	$5.95
Rate for Payer: LLUH Dept of Risk Management WC	$5.45
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$7.43

CASPOFUNGIN 50 MG INTRAVENOUS SOLUTION [29567]

Facility

$85.44

Service Code	CPT J0637
Hospital Charge Code	1759988
Hospital Revenue Code	636
Min. Negotiated Rate	$46.99
Max. Negotiated Rate	$64.08
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$51.26
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$49.68
Rate for Payer: Aetna of CA Government/Medicare	$49.68
Rate for Payer: Aetna of CA Government/Medicare	$51.26
Rate for Payer: Cash Price	$37.26
Rate for Payer: Cash Price	$38.45
Rate for Payer: Health Smart Auto/Commercial	$49.68
Rate for Payer: Health Smart Auto/Commercial	$51.26
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$49.68
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$51.26
Rate for Payer: LLUH Dept of Risk Management WC	$46.99
Rate for Payer: LLUH Dept of Risk Management WC	$45.54
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$62.10
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$64.08

CASPOFUNGIN 50 MG INTRAVENOUS SOLUTION [29567]

Facility

$82.80

Service Code	CPT J0637
Hospital Charge Code	1759988
Hospital Revenue Code	636
Min. Negotiated Rate	$45.54
Max. Negotiated Rate	$66.24
Rate for Payer: Cash Price	$37.26
Rate for Payer: Cash Price	$38.45
Rate for Payer: Cigna of CA HMO/PPO	$68.35
Rate for Payer: Cigna of CA HMO/PPO	$66.24
Rate for Payer: Health Smart Auto/Commercial	$51.26
Rate for Payer: Health Smart Auto/Commercial	$49.68
Rate for Payer: LLUH Dept of Risk Management WC	$46.99
Rate for Payer: LLUH Dept of Risk Management WC	$45.54
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$62.10
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$64.08

CASPOFUNGIN 70 MG INTRAVENOUS SOLUTION [29568]

Facility

$118.80

Service Code	CPT J0637
Hospital Charge Code	1759997
Hospital Revenue Code	636
Min. Negotiated Rate	$65.34
Max. Negotiated Rate	$89.10
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$71.28
Rate for Payer: Aetna of CA Government/Medicare	$71.28
Rate for Payer: Cash Price	$53.46
Rate for Payer: Health Smart Auto/Commercial	$71.28
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$71.28
Rate for Payer: LLUH Dept of Risk Management WC	$65.34
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$89.10

CASPOFUNGIN 70 MG INTRAVENOUS SOLUTION [29568]

Facility

$118.80

Service Code	CPT J0637
Hospital Charge Code	1759997
Hospital Revenue Code	636
Min. Negotiated Rate	$65.34
Max. Negotiated Rate	$95.04
Rate for Payer: Cash Price	$53.46
Rate for Payer: Cigna of CA HMO/PPO	$95.04
Rate for Payer: Health Smart Auto/Commercial	$71.28
Rate for Payer: LLUH Dept of Risk Management WC	$65.34
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$89.10

CEFACLOR 250 MG/5 ML ORAL SUSPENSION [9434]

Facility

$1.40

Service Code	NDC 16571-071-12
Hospital Charge Code	NDG9434
Hospital Revenue Code	259
Min. Negotiated Rate	$0.77
Max. Negotiated Rate	$1.05
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$0.84
Rate for Payer: Aetna of CA Government/Medicare	$0.84
Rate for Payer: Cash Price	$0.63
Rate for Payer: Health Smart Auto/Commercial	$0.84
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$0.84
Rate for Payer: LLUH Dept of Risk Management WC	$0.77
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$1.05

CEFACLOR 250 MG/5 ML ORAL SUSPENSION [9434]

Facility

$1.40

Service Code	NDC 16571-071-12
Hospital Charge Code	NDG9434
Hospital Revenue Code	259
Min. Negotiated Rate	$0.77
Max. Negotiated Rate	$1.12
Rate for Payer: Cash Price	$0.63
Rate for Payer: Cigna of CA HMO/PPO	$1.12
Rate for Payer: Health Smart Auto/Commercial	$0.84
Rate for Payer: LLUH Dept of Risk Management WC	$0.77
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$1.05

CEFACLOR 500 MG CAPSULE [9431]

Facility

$2.86

Service Code	NDC 61442-172-30
Hospital Charge Code	1712040
Hospital Revenue Code	259
Min. Negotiated Rate	$1.57
Max. Negotiated Rate	$2.14
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$1.72
Rate for Payer: Aetna of CA Government/Medicare	$1.72
Rate for Payer: Cash Price	$1.29
Rate for Payer: Health Smart Auto/Commercial	$1.72
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$1.72
Rate for Payer: LLUH Dept of Risk Management WC	$1.57
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$2.14

CEFACLOR 500 MG CAPSULE [9431]

Facility

$2.86

Service Code	NDC 61442-172-30
Hospital Charge Code	1712040
Hospital Revenue Code	259
Min. Negotiated Rate	$1.57
Max. Negotiated Rate	$2.29
Rate for Payer: Cash Price	$1.29
Rate for Payer: Cigna of CA HMO/PPO	$2.29
Rate for Payer: Health Smart Auto/Commercial	$1.72
Rate for Payer: LLUH Dept of Risk Management WC	$1.57
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$2.14

Know your out-of-pocket cost for care.

All Charges