Loma Linda University Behavioral Medicine Center (BMC)

All Charges

Charge

Type

Setting

Price

OLANZAPINE 5 MG TABLET [17936]

Facility

$0.43

Service Code	NDC 0904-6377-61
Hospital Charge Code	1713141
Hospital Revenue Code	259
Min. Negotiated Rate	$0.24
Max. Negotiated Rate	$0.34
Rate for Payer: Cash Price	$0.19
Rate for Payer: Cigna of CA HMO/PPO	$0.34
Rate for Payer: Health Smart Auto/Commercial	$0.26
Rate for Payer: LLUH Dept of Risk Management WC	$0.24
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$0.32

OLANZAPINE 5 MG TABLET [17936]

Facility

$0.19

Service Code	NDC 69543-381-90
Hospital Charge Code	1713141
Hospital Revenue Code	259
Min. Negotiated Rate	$0.10
Max. Negotiated Rate	$0.15
Rate for Payer: Cash Price	$0.09
Rate for Payer: Cigna of CA HMO/PPO	$0.15
Rate for Payer: Health Smart Auto/Commercial	$0.11
Rate for Payer: LLUH Dept of Risk Management WC	$0.10
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$0.14

OLANZAPINE 5 MG TABLET [17936]

Facility

$0.43

Service Code	NDC 65862-562-30
Hospital Charge Code	1713141
Hospital Revenue Code	259
Min. Negotiated Rate	$0.24
Max. Negotiated Rate	$0.32
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$0.26
Rate for Payer: Aetna of CA Government/Medicare	$0.26
Rate for Payer: Cash Price	$0.19
Rate for Payer: Health Smart Auto/Commercial	$0.26
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$0.26
Rate for Payer: LLUH Dept of Risk Management WC	$0.24
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$0.32

OLANZAPINE 5 MG TABLET [17936]

Facility

$0.28

Service Code	NDC 60505-3111-0
Hospital Charge Code	1713141
Hospital Revenue Code	259
Min. Negotiated Rate	$0.15
Max. Negotiated Rate	$0.21
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	$0.15
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$0.21

OLANZAPINE 5 MG TABLET [17936]

Facility

$0.28

Service Code	NDC 60505-3111-0
Hospital Charge Code	1713141
Hospital Revenue Code	259
Min. Negotiated Rate	$0.15
Max. Negotiated Rate	$0.22
Rate for Payer: Cash Price	$0.13
Rate for Payer: Cigna of CA HMO/PPO	$0.22
Rate for Payer: Health Smart Auto/Commercial	$0.17
Rate for Payer: LLUH Dept of Risk Management WC	$0.15
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$0.21

OLANZAPINE 5 MG TABLET [17936]

Facility

$0.28

Service Code	NDC 43598-164-30
Hospital Charge Code	1713141
Hospital Revenue Code	259
Min. Negotiated Rate	$0.15
Max. Negotiated Rate	$0.21
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	$0.15
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$0.21

OLANZAPINE 5 MG TABLET [17936]

Facility

$0.20

Service Code	NDC 69543-381-30
Hospital Charge Code	1713141
Hospital Revenue Code	259
Min. Negotiated Rate	$0.11
Max. Negotiated Rate	$0.16
Rate for Payer: Cash Price	$0.09
Rate for Payer: Cigna of CA HMO/PPO	$0.16
Rate for Payer: Health Smart Auto/Commercial	$0.12
Rate for Payer: LLUH Dept of Risk Management WC	$0.11
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$0.15

OLANZAPINE 5 MG TABLET [17936]

Facility

$0.20

Service Code	NDC 69543-381-30
Hospital Charge Code	1713141
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

OLANZAPINE 5 MG TABLET [17936]

Facility

$0.43

Service Code	NDC 0904-6377-61
Hospital Charge Code	1713141
Hospital Revenue Code	259
Min. Negotiated Rate	$0.24
Max. Negotiated Rate	$0.32
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$0.26
Rate for Payer: Aetna of CA Government/Medicare	$0.26
Rate for Payer: Cash Price	$0.19
Rate for Payer: Health Smart Auto/Commercial	$0.26
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$0.26
Rate for Payer: LLUH Dept of Risk Management WC	$0.24
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$0.32

OLANZAPINE 5 MG TABLET [17936]

Facility

$0.43

Service Code	NDC 65862-562-30
Hospital Charge Code	1713141
Hospital Revenue Code	259
Min. Negotiated Rate	$0.24
Max. Negotiated Rate	$0.34
Rate for Payer: Cash Price	$0.19
Rate for Payer: Cigna of CA HMO/PPO	$0.34
Rate for Payer: Health Smart Auto/Commercial	$0.26
Rate for Payer: LLUH Dept of Risk Management WC	$0.24
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$0.32

OLANZAPINE 5 MG TABLET [17936]

Facility

$0.28

Service Code	NDC 43598-164-30
Hospital Charge Code	1713141
Hospital Revenue Code	259
Min. Negotiated Rate	$0.15
Max. Negotiated Rate	$0.22
Rate for Payer: Cash Price	$0.13
Rate for Payer: Cigna of CA HMO/PPO	$0.22
Rate for Payer: Health Smart Auto/Commercial	$0.17
Rate for Payer: LLUH Dept of Risk Management WC	$0.15
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$0.21

OLANZAPINE 7.5 MG TABLET [17938]

Facility

$0.34

Service Code	NDC 60505-3112-0
Hospital Charge Code	1713142
Hospital Revenue Code	259
Min. Negotiated Rate	$0.19
Max. Negotiated Rate	$0.26
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$0.20
Rate for Payer: Aetna of CA Government/Medicare	$0.20
Rate for Payer: Cash Price	$0.15
Rate for Payer: Health Smart Auto/Commercial	$0.20
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$0.20
Rate for Payer: LLUH Dept of Risk Management WC	$0.19
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$0.26

OLANZAPINE 7.5 MG TABLET [17938]

Facility

$0.34

Service Code	NDC 43598-165-30
Hospital Charge Code	1713142
Hospital Revenue Code	259
Min. Negotiated Rate	$0.19
Max. Negotiated Rate	$0.26
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$0.20
Rate for Payer: Aetna of CA Government/Medicare	$0.20
Rate for Payer: Cash Price	$0.15
Rate for Payer: Health Smart Auto/Commercial	$0.20
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$0.20
Rate for Payer: LLUH Dept of Risk Management WC	$0.19
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$0.26

OLANZAPINE 7.5 MG TABLET [17938]

Facility

$0.34

Service Code	NDC 60505-3112-0
Hospital Charge Code	1713142
Hospital Revenue Code	259
Min. Negotiated Rate	$0.19
Max. Negotiated Rate	$0.27
Rate for Payer: Cash Price	$0.15
Rate for Payer: Cigna of CA HMO/PPO	$0.27
Rate for Payer: Health Smart Auto/Commercial	$0.20
Rate for Payer: LLUH Dept of Risk Management WC	$0.19
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$0.26

OLANZAPINE 7.5 MG TABLET [17938]

Facility

$0.34

Service Code	NDC 43598-165-30
Hospital Charge Code	1713142
Hospital Revenue Code	259
Min. Negotiated Rate	$0.19
Max. Negotiated Rate	$0.27
Rate for Payer: Cash Price	$0.15
Rate for Payer: Cigna of CA HMO/PPO	$0.27
Rate for Payer: Health Smart Auto/Commercial	$0.20
Rate for Payer: LLUH Dept of Risk Management WC	$0.19
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$0.26

OLOPATADINE 0.1 % EYE DROPS [19452]

Facility

$1.81

Service Code	NDC 46122-672-64
Hospital Charge Code	1740310
Hospital Revenue Code	259
Min. Negotiated Rate	$1.00
Max. Negotiated Rate	$1.45
Rate for Payer: Cash Price	$0.81
Rate for Payer: Cigna of CA HMO/PPO	$1.45
Rate for Payer: Health Smart Auto/Commercial	$1.09
Rate for Payer: LLUH Dept of Risk Management WC	$1.00
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$1.36

OLOPATADINE 0.1 % EYE DROPS [19452]

Facility

$6.00

Service Code	NDC 70069-007-01
Hospital Charge Code	1740310
Hospital Revenue Code	259
Min. Negotiated Rate	$3.30
Max. Negotiated Rate	$4.80
Rate for Payer: Cash Price	$2.70
Rate for Payer: Cigna of CA HMO/PPO	$4.80
Rate for Payer: Health Smart Auto/Commercial	$3.60
Rate for Payer: LLUH Dept of Risk Management WC	$3.30
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$4.50

OLOPATADINE 0.1 % EYE DROPS [19452]

Facility

$6.00

Service Code	NDC 70069-007-01
Hospital Charge Code	1740310
Hospital Revenue Code	259
Min. Negotiated Rate	$3.30
Max. Negotiated Rate	$4.50
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$3.60
Rate for Payer: Aetna of CA Government/Medicare	$3.60
Rate for Payer: Cash Price	$2.70
Rate for Payer: Health Smart Auto/Commercial	$3.60
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$3.60
Rate for Payer: LLUH Dept of Risk Management WC	$3.30
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$4.50

OLOPATADINE 0.1 % EYE DROPS [19452]

Facility

$9.49

Service Code	NDC 60505-0575-1
Hospital Charge Code	1740310
Hospital Revenue Code	259
Min. Negotiated Rate	$5.22
Max. Negotiated Rate	$7.59
Rate for Payer: Cash Price	$4.27
Rate for Payer: Cigna of CA HMO/PPO	$7.59
Rate for Payer: Health Smart Auto/Commercial	$5.69
Rate for Payer: LLUH Dept of Risk Management WC	$5.22
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$7.12

OLOPATADINE 0.1 % EYE DROPS [19452]

Facility

$1.81

Service Code	NDC 46122-672-64
Hospital Charge Code	1740310
Hospital Revenue Code	259
Min. Negotiated Rate	$1.00
Max. Negotiated Rate	$1.36
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$1.09
Rate for Payer: Aetna of CA Government/Medicare	$1.09
Rate for Payer: Cash Price	$0.81
Rate for Payer: Health Smart Auto/Commercial	$1.09
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$1.09
Rate for Payer: LLUH Dept of Risk Management WC	$1.00
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$1.36

OLOPATADINE 0.1 % EYE DROPS [19452]

Facility

$9.49

Service Code	NDC 60505-0575-1
Hospital Charge Code	1740310
Hospital Revenue Code	259
Min. Negotiated Rate	$5.22
Max. Negotiated Rate	$7.12
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$5.69
Rate for Payer: Aetna of CA Government/Medicare	$5.69
Rate for Payer: Cash Price	$4.27
Rate for Payer: Health Smart Auto/Commercial	$5.69
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$5.69
Rate for Payer: LLUH Dept of Risk Management WC	$5.22
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$7.12

OLUTASIDENIB 150 MG CAPSULE [236323]

Facility

$644.00

Service Code	NDC 71332-005-01
Hospital Charge Code	ERX236323
Hospital Revenue Code	259
Min. Negotiated Rate	$354.20
Max. Negotiated Rate	$483.00
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$386.40
Rate for Payer: Aetna of CA Government/Medicare	$386.40
Rate for Payer: Cash Price	$289.80
Rate for Payer: Health Smart Auto/Commercial	$386.40
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$386.40
Rate for Payer: LLUH Dept of Risk Management WC	$354.20
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$483.00

OLUTASIDENIB 150 MG CAPSULE [236323]

Facility

$644.00

Service Code	NDC 71332-005-01
Hospital Charge Code	ERX236323
Hospital Revenue Code	259
Min. Negotiated Rate	$354.20
Max. Negotiated Rate	$515.20
Rate for Payer: Cash Price	$289.80
Rate for Payer: Cigna of CA HMO/PPO	$515.20
Rate for Payer: Health Smart Auto/Commercial	$386.40
Rate for Payer: LLUH Dept of Risk Management WC	$354.20
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$483.00

OMALIZUMAB 150 MG/ML SUBCUTANEOUS SYRINGE [223366]

Facility

$1,567.88

Service Code	CPT J2357
Hospital Charge Code	NDG223366
Hospital Revenue Code	636
Min. Negotiated Rate	$862.33
Max. Negotiated Rate	$1,175.91
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$940.73
Rate for Payer: Aetna of CA Government/Medicare	$940.73
Rate for Payer: Cash Price	$705.55
Rate for Payer: Health Smart Auto/Commercial	$940.73
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$940.73
Rate for Payer: LLUH Dept of Risk Management WC	$862.33
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$1,175.91

OMALIZUMAB 150 MG/ML SUBCUTANEOUS SYRINGE [223366]

Facility

$1,567.88

Service Code	CPT J2357
Hospital Charge Code	NDG223366
Hospital Revenue Code	636
Min. Negotiated Rate	$862.33
Max. Negotiated Rate	$1,254.30
Rate for Payer: Cash Price	$705.55
Rate for Payer: Cigna of CA HMO/PPO	$1,254.30
Rate for Payer: Health Smart Auto/Commercial	$940.73
Rate for Payer: LLUH Dept of Risk Management WC	$862.33
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$1,175.91

Know your out-of-pocket cost for care.

All Charges