Loma Linda University Behavioral Medicine Center (BMC)

All Charges

Charge

Type

Setting

Price

DULOXETINE 30 MG CAPSULE,DELAYED RELEASE [39276]

Facility

$0.56

Service Code	NDC 68001-414-05
Hospital Charge Code	1711840
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

DULOXETINE 30 MG CAPSULE,DELAYED RELEASE [39276]

Facility

$1.47

Service Code	NDC 50268-287-11
Hospital Charge Code	1711840
Hospital Revenue Code	259
Min. Negotiated Rate	$0.81
Max. Negotiated Rate	$1.10
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$0.88
Rate for Payer: Aetna of CA Government/Medicare	$0.88
Rate for Payer: Cash Price	$0.66
Rate for Payer: Health Smart Auto/Commercial	$0.88
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$0.88
Rate for Payer: LLUH Dept of Risk Management WC	$0.81
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$1.10

DULOXETINE 30 MG CAPSULE,DELAYED RELEASE [39276]

Facility

$1.47

Service Code	NDC 50268-287-13
Hospital Charge Code	1711840
Hospital Revenue Code	259
Min. Negotiated Rate	$0.81
Max. Negotiated Rate	$1.18
Rate for Payer: Cash Price	$0.66
Rate for Payer: Cigna of CA HMO/PPO	$1.18
Rate for Payer: Health Smart Auto/Commercial	$0.88
Rate for Payer: LLUH Dept of Risk Management WC	$0.81
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$1.10

DULOXETINE 30 MG CAPSULE,DELAYED RELEASE [39276]

Facility

$0.56

Service Code	NDC 68001-414-05
Hospital Charge Code	1711840
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

DULOXETINE 30 MG CAPSULE,DELAYED RELEASE [39276]

Facility

$0.57

Service Code	NDC 68001-414-04
Hospital Charge Code	1711840
Hospital Revenue Code	259
Min. Negotiated Rate	$0.31
Max. Negotiated Rate	$0.43
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	$0.26
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	$0.43

DULOXETINE 30 MG CAPSULE,DELAYED RELEASE [39276]

Facility

$0.57

Service Code	NDC 68001-414-04
Hospital Charge Code	1711840
Hospital Revenue Code	259
Min. Negotiated Rate	$0.31
Max. Negotiated Rate	$0.46
Rate for Payer: Cash Price	$0.26
Rate for Payer: Cigna of CA HMO/PPO	$0.46
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	$0.43

DULOXETINE 30 MG CAPSULE,DELAYED RELEASE [39276]

Facility

$0.20

Service Code	NDC 67877-264-30
Hospital Charge Code	1711840
Hospital Revenue Code	259
Min. Negotiated Rate	$0.11
Max. Negotiated Rate	$0.15
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$0.12
Rate for Payer: Aetna of CA Government/Medicare	$0.12
Rate for Payer: Cash Price	$0.09
Rate for Payer: Health Smart Auto/Commercial	$0.12
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$0.12
Rate for Payer: LLUH Dept of Risk Management WC	$0.11
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$0.15

DULOXETINE 30 MG CAPSULE,DELAYED RELEASE [39276]

Facility

$0.59

Service Code	NDC 43547-380-03
Hospital Charge Code	1711840
Hospital Revenue Code	259
Min. Negotiated Rate	$0.32
Max. Negotiated Rate	$0.44
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$0.35
Rate for Payer: Aetna of CA Government/Medicare	$0.35
Rate for Payer: Cash Price	$0.27
Rate for Payer: Health Smart Auto/Commercial	$0.35
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$0.35
Rate for Payer: LLUH Dept of Risk Management WC	$0.32
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$0.44

DULOXETINE 30 MG CAPSULE,DELAYED RELEASE [39276]

Facility

$0.59

Service Code	NDC 43547-380-03
Hospital Charge Code	1711840
Hospital Revenue Code	259
Min. Negotiated Rate	$0.32
Max. Negotiated Rate	$0.47
Rate for Payer: Cash Price	$0.27
Rate for Payer: Cigna of CA HMO/PPO	$0.47
Rate for Payer: Health Smart Auto/Commercial	$0.35
Rate for Payer: LLUH Dept of Risk Management WC	$0.32
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$0.44

DULOXETINE 60 MG CAPSULE,DELAYED RELEASE [39277]

Facility

$0.36

Service Code	NDC 68001-415-04
Hospital Charge Code	1711841
Hospital Revenue Code	259
Min. Negotiated Rate	$0.20
Max. Negotiated Rate	$0.27
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$0.22
Rate for Payer: Aetna of CA Government/Medicare	$0.22
Rate for Payer: Cash Price	$0.16
Rate for Payer: Health Smart Auto/Commercial	$0.22
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$0.22
Rate for Payer: LLUH Dept of Risk Management WC	$0.20
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$0.27

DULOXETINE 60 MG CAPSULE,DELAYED RELEASE [39277]

Facility

$0.40

Service Code	NDC 57237-019-30
Hospital Charge Code	1711841
Hospital Revenue Code	259
Min. Negotiated Rate	$0.22
Max. Negotiated Rate	$0.32
Rate for Payer: Cash Price	$0.18
Rate for Payer: Cigna of CA HMO/PPO	$0.32
Rate for Payer: Health Smart Auto/Commercial	$0.24
Rate for Payer: LLUH Dept of Risk Management WC	$0.22
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$0.30

DULOXETINE 60 MG CAPSULE,DELAYED RELEASE [39277]

Facility

$0.59

Service Code	NDC 43547-381-03
Hospital Charge Code	1711841
Hospital Revenue Code	259
Min. Negotiated Rate	$0.32
Max. Negotiated Rate	$0.47
Rate for Payer: Cash Price	$0.27
Rate for Payer: Cigna of CA HMO/PPO	$0.47
Rate for Payer: Health Smart Auto/Commercial	$0.35
Rate for Payer: LLUH Dept of Risk Management WC	$0.32
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$0.44

DULOXETINE 60 MG CAPSULE,DELAYED RELEASE [39277]

Facility

$0.40

Service Code	NDC 57237-019-30
Hospital Charge Code	1711841
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

DULOXETINE 60 MG CAPSULE,DELAYED RELEASE [39277]

Facility

$0.59

Service Code	NDC 43547-381-03
Hospital Charge Code	1711841
Hospital Revenue Code	259
Min. Negotiated Rate	$0.32
Max. Negotiated Rate	$0.44
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$0.35
Rate for Payer: Aetna of CA Government/Medicare	$0.35
Rate for Payer: Cash Price	$0.27
Rate for Payer: Health Smart Auto/Commercial	$0.35
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$0.35
Rate for Payer: LLUH Dept of Risk Management WC	$0.32
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$0.44

DULOXETINE 60 MG CAPSULE,DELAYED RELEASE [39277]

Facility

$0.36

Service Code	NDC 68001-415-04
Hospital Charge Code	1711841
Hospital Revenue Code	259
Min. Negotiated Rate	$0.20
Max. Negotiated Rate	$0.29
Rate for Payer: Cash Price	$0.16
Rate for Payer: Cigna of CA HMO/PPO	$0.29
Rate for Payer: Health Smart Auto/Commercial	$0.22
Rate for Payer: LLUH Dept of Risk Management WC	$0.20
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$0.27

DURVALUMAB 50 MG/ML INTRAVENOUS SOLUTION [217071]

Facility

$473.79

Service Code	NDC 0310-4611-50
Hospital Charge Code	NDG217071A
Hospital Revenue Code	636
Min. Negotiated Rate	$260.58
Max. Negotiated Rate	$379.03
Rate for Payer: Cash Price	$213.21
Rate for Payer: Cigna of CA HMO/PPO	$379.03
Rate for Payer: Health Smart Auto/Commercial	$284.27
Rate for Payer: LLUH Dept of Risk Management WC	$260.58
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$355.34

DURVALUMAB 50 MG/ML INTRAVENOUS SOLUTION [217071]

Facility

$473.79

Service Code	NDC 0310-4500-12
Hospital Charge Code	NDG217071
Hospital Revenue Code	636
Min. Negotiated Rate	$260.58
Max. Negotiated Rate	$355.34
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$284.27
Rate for Payer: Aetna of CA Government/Medicare	$284.27
Rate for Payer: Cash Price	$213.21
Rate for Payer: Health Smart Auto/Commercial	$284.27
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$284.27
Rate for Payer: LLUH Dept of Risk Management WC	$260.58
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$355.34

DURVALUMAB 50 MG/ML INTRAVENOUS SOLUTION [217071]

Facility

$473.79

Service Code	NDC 0310-4500-12
Hospital Charge Code	NDG217071
Hospital Revenue Code	636
Min. Negotiated Rate	$260.58
Max. Negotiated Rate	$379.03
Rate for Payer: Cash Price	$213.21
Rate for Payer: Cigna of CA HMO/PPO	$379.03
Rate for Payer: Health Smart Auto/Commercial	$284.27
Rate for Payer: LLUH Dept of Risk Management WC	$260.58
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$355.34

DURVALUMAB 50 MG/ML INTRAVENOUS SOLUTION [217071]

Facility

$473.79

Service Code	NDC 0310-4611-50
Hospital Charge Code	NDG217071A
Hospital Revenue Code	636
Min. Negotiated Rate	$260.58
Max. Negotiated Rate	$355.34
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$284.27
Rate for Payer: Aetna of CA Government/Medicare	$284.27
Rate for Payer: Cash Price	$213.21
Rate for Payer: Health Smart Auto/Commercial	$284.27
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$284.27
Rate for Payer: LLUH Dept of Risk Management WC	$260.58
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$355.34

DUTASTERIDE 0.5 MG CAPSULE [34089]

Facility

$11.00

Service Code	NDC 0173-0712-04
Hospital Charge Code	1710969
Hospital Revenue Code	259
Min. Negotiated Rate	$6.05
Max. Negotiated Rate	$8.25
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$6.60
Rate for Payer: Aetna of CA Government/Medicare	$6.60
Rate for Payer: Cash Price	$4.95
Rate for Payer: Health Smart Auto/Commercial	$6.60
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$6.60
Rate for Payer: LLUH Dept of Risk Management WC	$6.05
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$8.25

DUTASTERIDE 0.5 MG CAPSULE [34089]

Facility

$11.00

Service Code	NDC 0173-0712-15
Hospital Charge Code	1710969
Hospital Revenue Code	259
Min. Negotiated Rate	$6.05
Max. Negotiated Rate	$8.25
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$6.60
Rate for Payer: Aetna of CA Government/Medicare	$6.60
Rate for Payer: Cash Price	$4.95
Rate for Payer: Health Smart Auto/Commercial	$6.60
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$6.60
Rate for Payer: LLUH Dept of Risk Management WC	$6.05
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$8.25

DUTASTERIDE 0.5 MG CAPSULE [34089]

Facility

$11.00

Service Code	NDC 0173-0712-04
Hospital Charge Code	1710969
Hospital Revenue Code	259
Min. Negotiated Rate	$6.05
Max. Negotiated Rate	$8.80
Rate for Payer: Cash Price	$4.95
Rate for Payer: Cigna of CA HMO/PPO	$8.80
Rate for Payer: Health Smart Auto/Commercial	$6.60
Rate for Payer: LLUH Dept of Risk Management WC	$6.05
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$8.25

DUTASTERIDE 0.5 MG CAPSULE [34089]

Facility

$0.38

Service Code	NDC 42806-549-30
Hospital Charge Code	1710969
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

DUTASTERIDE 0.5 MG CAPSULE [34089]

Facility

$11.00

Service Code	NDC 0173-0712-15
Hospital Charge Code	1710969
Hospital Revenue Code	259
Min. Negotiated Rate	$6.05
Max. Negotiated Rate	$8.80
Rate for Payer: Cash Price	$4.95
Rate for Payer: Cigna of CA HMO/PPO	$8.80
Rate for Payer: Health Smart Auto/Commercial	$6.60
Rate for Payer: LLUH Dept of Risk Management WC	$6.05
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$8.25

DUTASTERIDE 0.5 MG CAPSULE [34089]

Facility

$0.38

Service Code	NDC 42806-549-30
Hospital Charge Code	1710969
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

Know your out-of-pocket cost for care.

All Charges