Loma Linda University Behavioral Medicine Center (BMC)

All Charges

Charge

Type

Setting

Price

OSELTAMIVIR 30 MG CAPSULE [88704]

Facility

$1.44

Service Code	NDC 64380-797-01
Hospital Charge Code	901700029
Hospital Revenue Code	259
Min. Negotiated Rate	$0.79
Max. Negotiated Rate	$1.15
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$0.86
Rate for Payer: Aetna of CA Government/Medicare	$0.86
Rate for Payer: Cash Price	$0.79
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$1.15
Rate for Payer: Health Smart Auto/Commercial	$0.86
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$0.86
Rate for Payer: LLUH Dept of Risk Management WC	$0.79
Rate for Payer: Multiplan Commercial	$1.08

OSELTAMIVIR 30 MG CAPSULE [88704]

Facility

$3.12

Service Code	NDC 31722-630-31
Hospital Charge Code	901700029
Hospital Revenue Code	259
Min. Negotiated Rate	$1.72
Max. Negotiated Rate	$2.50
Rate for Payer: Cash Price	$1.72
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$2.50
Rate for Payer: Health Smart Auto/Commercial	$1.87
Rate for Payer: LLUH Dept of Risk Management WC	$1.72
Rate for Payer: Multiplan Commercial	$2.34

OSELTAMIVIR 30 MG CAPSULE [88704]

Facility

$3.12

Service Code	NDC 68180-675-11
Hospital Charge Code	901700029
Hospital Revenue Code	259
Min. Negotiated Rate	$1.72
Max. Negotiated Rate	$2.50
Rate for Payer: Cash Price	$1.72
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$2.50
Rate for Payer: Health Smart Auto/Commercial	$1.87
Rate for Payer: LLUH Dept of Risk Management WC	$1.72
Rate for Payer: Multiplan Commercial	$2.34

OSELTAMIVIR 30 MG CAPSULE [88704]

Facility

$3.12

Service Code	NDC 68180-675-11
Hospital Charge Code	901700029
Hospital Revenue Code	259
Min. Negotiated Rate	$1.72
Max. Negotiated Rate	$2.50
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$1.87
Rate for Payer: Aetna of CA Government/Medicare	$1.87
Rate for Payer: Cash Price	$1.72
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$2.50
Rate for Payer: Health Smart Auto/Commercial	$1.87
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$1.87
Rate for Payer: LLUH Dept of Risk Management WC	$1.72
Rate for Payer: Multiplan Commercial	$2.34

OSELTAMIVIR 30 MG CAPSULE [88704]

Facility

$3.12

Service Code	NDC 31722-630-31
Hospital Charge Code	901700029
Hospital Revenue Code	259
Min. Negotiated Rate	$1.72
Max. Negotiated Rate	$2.50
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$1.87
Rate for Payer: Aetna of CA Government/Medicare	$1.87
Rate for Payer: Cash Price	$1.72
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$2.50
Rate for Payer: Health Smart Auto/Commercial	$1.87
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$1.87
Rate for Payer: LLUH Dept of Risk Management WC	$1.72
Rate for Payer: Multiplan Commercial	$2.34

OSELTAMIVIR 30 MG CAPSULE [88704]

Facility

$1.44

Service Code	NDC 64380-797-01
Hospital Charge Code	901700029
Hospital Revenue Code	259
Min. Negotiated Rate	$0.79
Max. Negotiated Rate	$1.15
Rate for Payer: Cash Price	$0.79
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$1.15
Rate for Payer: Health Smart Auto/Commercial	$0.86
Rate for Payer: LLUH Dept of Risk Management WC	$0.79
Rate for Payer: Multiplan Commercial	$1.08

OSELTAMIVIR 45 MG CAPSULE [88705]

Facility

$16.72

Service Code	NDC 0004-0801-85
Hospital Charge Code	901700029
Hospital Revenue Code	259
Min. Negotiated Rate	$9.20
Max. Negotiated Rate	$13.38
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$10.03
Rate for Payer: Aetna of CA Government/Medicare	$10.03
Rate for Payer: Cash Price	$9.20
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$13.38
Rate for Payer: Health Smart Auto/Commercial	$10.03
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$10.03
Rate for Payer: LLUH Dept of Risk Management WC	$9.20
Rate for Payer: Multiplan Commercial	$12.54

OSELTAMIVIR 45 MG CAPSULE [88705]

Facility

$16.72

Service Code	NDC 0004-0801-85
Hospital Charge Code	901700029
Hospital Revenue Code	259
Min. Negotiated Rate	$9.20
Max. Negotiated Rate	$13.38
Rate for Payer: Cash Price	$9.20
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$13.38
Rate for Payer: Health Smart Auto/Commercial	$10.03
Rate for Payer: LLUH Dept of Risk Management WC	$9.20
Rate for Payer: Multiplan Commercial	$12.54

OSELTAMIVIR 6 MG/ML ORAL SUSPENSION [187854]

Facility

$0.30

Service Code	NDC 68180-678-01
Hospital Charge Code	901700029
Hospital Revenue Code	259
Min. Negotiated Rate	$0.17
Max. Negotiated Rate	$0.24
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	$0.16
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$0.24
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 Commercial	$0.23

OSELTAMIVIR 6 MG/ML ORAL SUSPENSION [187854]

Facility

$3.04

Service Code	NDC 0004-0822-05
Hospital Charge Code	901700029
Hospital Revenue Code	259
Min. Negotiated Rate	$1.67
Max. Negotiated Rate	$2.43
Rate for Payer: Cash Price	$1.67
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$2.43
Rate for Payer: Health Smart Auto/Commercial	$1.82
Rate for Payer: LLUH Dept of Risk Management WC	$1.67
Rate for Payer: Multiplan Commercial	$2.28

OSELTAMIVIR 6 MG/ML ORAL SUSPENSION [187854]

Facility

$0.30

Service Code	NDC 68180-678-01
Hospital Charge Code	901700029
Hospital Revenue Code	259
Min. Negotiated Rate	$0.17
Max. Negotiated Rate	$0.24
Rate for Payer: Cash Price	$0.16
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO 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 Commercial	$0.23

OSELTAMIVIR 6 MG/ML ORAL SUSPENSION [187854]

Facility

$3.04

Service Code	NDC 0004-0822-05
Hospital Charge Code	901700029
Hospital Revenue Code	259
Min. Negotiated Rate	$1.67
Max. Negotiated Rate	$2.43
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$1.82
Rate for Payer: Aetna of CA Government/Medicare	$1.82
Rate for Payer: Cash Price	$1.67
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$2.43
Rate for Payer: Health Smart Auto/Commercial	$1.82
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$1.82
Rate for Payer: LLUH Dept of Risk Management WC	$1.67
Rate for Payer: Multiplan Commercial	$2.28

OSELTAMIVIR 75 MG CAPSULE [26546]

Facility

$10.40

Service Code	NDC 69238-1266-1
Hospital Charge Code	901700029
Hospital Revenue Code	259
Min. Negotiated Rate	$5.72
Max. Negotiated Rate	$8.32
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$6.24
Rate for Payer: Aetna of CA Government/Medicare	$6.24
Rate for Payer: Cash Price	$5.72
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$8.32
Rate for Payer: Health Smart Auto/Commercial	$6.24
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$6.24
Rate for Payer: LLUH Dept of Risk Management WC	$5.72
Rate for Payer: Multiplan Commercial	$7.80

OSELTAMIVIR 75 MG CAPSULE [26546]

Facility

$3.12

Service Code	NDC 31722-632-31
Hospital Charge Code	901700029
Hospital Revenue Code	259
Min. Negotiated Rate	$1.72
Max. Negotiated Rate	$2.50
Rate for Payer: Cash Price	$1.72
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$2.50
Rate for Payer: Health Smart Auto/Commercial	$1.87
Rate for Payer: LLUH Dept of Risk Management WC	$1.72
Rate for Payer: Multiplan Commercial	$2.34

OSELTAMIVIR 75 MG CAPSULE [26546]

Facility

$3.00

Service Code	NDC 33342-258-66
Hospital Charge Code	901700029
Hospital Revenue Code	259
Min. Negotiated Rate	$1.65
Max. Negotiated Rate	$2.40
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	$1.65
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$2.40
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 Commercial	$2.25

OSELTAMIVIR 75 MG CAPSULE [26546]

Facility

$2.22

Service Code	NDC 72205-044-11
Hospital Charge Code	901700029
Hospital Revenue Code	259
Min. Negotiated Rate	$1.22
Max. Negotiated Rate	$1.78
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$1.33
Rate for Payer: Aetna of CA Government/Medicare	$1.33
Rate for Payer: Cash Price	$1.22
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$1.78
Rate for Payer: Health Smart Auto/Commercial	$1.33
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$1.33
Rate for Payer: LLUH Dept of Risk Management WC	$1.22
Rate for Payer: Multiplan Commercial	$1.67

OSELTAMIVIR 75 MG CAPSULE [26546]

Facility

$18.23

Service Code	NDC 0004-0800-85
Hospital Charge Code	901700029
Hospital Revenue Code	259
Min. Negotiated Rate	$10.03
Max. Negotiated Rate	$14.58
Rate for Payer: Cash Price	$10.02
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$14.58
Rate for Payer: Health Smart Auto/Commercial	$10.94
Rate for Payer: LLUH Dept of Risk Management WC	$10.03
Rate for Payer: Multiplan Commercial	$13.67

OSELTAMIVIR 75 MG CAPSULE [26546]

Facility

$3.00

Service Code	NDC 33342-258-66
Hospital Charge Code	901700029
Hospital Revenue Code	259
Min. Negotiated Rate	$1.65
Max. Negotiated Rate	$2.40
Rate for Payer: Cash Price	$1.65
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO 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 Commercial	$2.25

OSELTAMIVIR 75 MG CAPSULE [26546]

Facility

$18.23

Service Code	NDC 0004-0800-85
Hospital Charge Code	901700029
Hospital Revenue Code	259
Min. Negotiated Rate	$10.03
Max. Negotiated Rate	$14.58
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$10.94
Rate for Payer: Aetna of CA Government/Medicare	$10.94
Rate for Payer: Cash Price	$10.02
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$14.58
Rate for Payer: Health Smart Auto/Commercial	$10.94
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$10.94
Rate for Payer: LLUH Dept of Risk Management WC	$10.03
Rate for Payer: Multiplan Commercial	$13.67

OSELTAMIVIR 75 MG CAPSULE [26546]

Facility

$2.22

Service Code	NDC 72205-044-11
Hospital Charge Code	901700029
Hospital Revenue Code	259
Min. Negotiated Rate	$1.22
Max. Negotiated Rate	$1.78
Rate for Payer: Cash Price	$1.22
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$1.78
Rate for Payer: Health Smart Auto/Commercial	$1.33
Rate for Payer: LLUH Dept of Risk Management WC	$1.22
Rate for Payer: Multiplan Commercial	$1.67

OSELTAMIVIR 75 MG CAPSULE [26546]

Facility

$3.12

Service Code	NDC 31722-632-31
Hospital Charge Code	901700029
Hospital Revenue Code	259
Min. Negotiated Rate	$1.72
Max. Negotiated Rate	$2.50
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$1.87
Rate for Payer: Aetna of CA Government/Medicare	$1.87
Rate for Payer: Cash Price	$1.72
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$2.50
Rate for Payer: Health Smart Auto/Commercial	$1.87
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$1.87
Rate for Payer: LLUH Dept of Risk Management WC	$1.72
Rate for Payer: Multiplan Commercial	$2.34

OSELTAMIVIR 75 MG CAPSULE [26546]

Facility

$2.22

Service Code	NDC 64380-799-01
Hospital Charge Code	901700029
Hospital Revenue Code	259
Min. Negotiated Rate	$1.22
Max. Negotiated Rate	$1.78
Rate for Payer: Cash Price	$1.22
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$1.78
Rate for Payer: Health Smart Auto/Commercial	$1.33
Rate for Payer: LLUH Dept of Risk Management WC	$1.22
Rate for Payer: Multiplan Commercial	$1.67

OSELTAMIVIR 75 MG CAPSULE [26546]

Facility

$2.22

Service Code	NDC 64380-799-01
Hospital Charge Code	901700029
Hospital Revenue Code	259
Min. Negotiated Rate	$1.22
Max. Negotiated Rate	$1.78
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$1.33
Rate for Payer: Aetna of CA Government/Medicare	$1.33
Rate for Payer: Cash Price	$1.22
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$1.78
Rate for Payer: Health Smart Auto/Commercial	$1.33
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$1.33
Rate for Payer: LLUH Dept of Risk Management WC	$1.22
Rate for Payer: Multiplan Commercial	$1.67

OSELTAMIVIR 75 MG CAPSULE [26546]

Facility

$10.40

Service Code	NDC 69238-1266-1
Hospital Charge Code	901700029
Hospital Revenue Code	259
Min. Negotiated Rate	$5.72
Max. Negotiated Rate	$8.32
Rate for Payer: Cash Price	$5.72
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$8.32
Rate for Payer: Health Smart Auto/Commercial	$6.24
Rate for Payer: LLUH Dept of Risk Management WC	$5.72
Rate for Payer: Multiplan Commercial	$7.80

OSTOMY ADHESIVE PASTE [115464]

Facility

$0.16

Service Code	NDC 6845510690
Hospital Charge Code	901700016
Hospital Revenue Code	271
Min. Negotiated Rate	$0.09
Max. Negotiated Rate	$0.13
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$0.10
Rate for Payer: Aetna of CA Government/Medicare	$0.10
Rate for Payer: Cash Price	$0.09
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$0.13
Rate for Payer: Health Smart Auto/Commercial	$0.10
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$0.10
Rate for Payer: LLUH Dept of Risk Management WC	$0.09
Rate for Payer: Multiplan Commercial	$0.12

Know your out-of-pocket cost for care.

All Charges