Loma Linda University Behavioral Medicine Center (BMC)

All Charges

Charge

Type

Setting

Price

ONDANSETRON 8 MG DISINTEGRATING TABLET [27698]

Facility

$1.01

Service Code	NDC 65862-391-10
Hospital Charge Code	1711783
Hospital Revenue Code	259
Min. Negotiated Rate	$0.56
Max. Negotiated Rate	$0.76
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$0.61
Rate for Payer: Aetna of CA Government/Medicare	$0.61
Rate for Payer: Cash Price	$0.45
Rate for Payer: Health Smart Auto/Commercial	$0.61
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$0.61
Rate for Payer: LLUH Dept of Risk Management WC	$0.56
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$0.76

ONDANSETRON 8 MG DISINTEGRATING TABLET [27698]

Facility

$1.35

Service Code	NDC 68001-247-17
Hospital Charge Code	1711783
Hospital Revenue Code	259
Min. Negotiated Rate	$0.74
Max. Negotiated Rate	$1.08
Rate for Payer: Cash Price	$0.61
Rate for Payer: Cigna of CA HMO/PPO	$1.08
Rate for Payer: Health Smart Auto/Commercial	$0.81
Rate for Payer: LLUH Dept of Risk Management WC	$0.74
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$1.01

ONDANSETRON 8 MG DISINTEGRATING TABLET [27698]

Facility

$0.73

Service Code	NDC 62756-356-60
Hospital Charge Code	1711783
Hospital Revenue Code	259
Min. Negotiated Rate	$0.40
Max. Negotiated Rate	$0.58
Rate for Payer: Cash Price	$0.33
Rate for Payer: Cigna of CA HMO/PPO	$0.58
Rate for Payer: Health Smart Auto/Commercial	$0.44
Rate for Payer: LLUH Dept of Risk Management WC	$0.40
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$0.55

ONDANSETRON 8 MG DISINTEGRATING TABLET [27698]

Facility

$0.73

Service Code	NDC 62756-356-64
Hospital Charge Code	1711783
Hospital Revenue Code	259
Min. Negotiated Rate	$0.40
Max. Negotiated Rate	$0.55
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$0.44
Rate for Payer: Aetna of CA Government/Medicare	$0.44
Rate for Payer: Cash Price	$0.33
Rate for Payer: Health Smart Auto/Commercial	$0.44
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$0.44
Rate for Payer: LLUH Dept of Risk Management WC	$0.40
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$0.55

ONDANSETRON 8 MG DISINTEGRATING TABLET [27698]

Facility

$0.76

Service Code	NDC 68462-158-11
Hospital Charge Code	1711783
Hospital Revenue Code	259
Min. Negotiated Rate	$0.42
Max. Negotiated Rate	$0.61
Rate for Payer: Cash Price	$0.34
Rate for Payer: Cigna of CA HMO/PPO	$0.61
Rate for Payer: Health Smart Auto/Commercial	$0.46
Rate for Payer: LLUH Dept of Risk Management WC	$0.42
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$0.57

ONDANSETRON 8 MG DISINTEGRATING TABLET [27698]

Facility

$1.35

Service Code	NDC 68001-247-17
Hospital Charge Code	1711783
Hospital Revenue Code	259
Min. Negotiated Rate	$0.74
Max. Negotiated Rate	$1.01
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$0.81
Rate for Payer: Aetna of CA Government/Medicare	$0.81
Rate for Payer: Cash Price	$0.61
Rate for Payer: Health Smart Auto/Commercial	$0.81
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$0.81
Rate for Payer: LLUH Dept of Risk Management WC	$0.74
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$1.01

ONDANSETRON 8 MG DISINTEGRATING TABLET [27698]

Facility

$0.76

Service Code	NDC 68462-158-11
Hospital Charge Code	1711783
Hospital Revenue Code	259
Min. Negotiated Rate	$0.42
Max. Negotiated Rate	$0.57
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$0.46
Rate for Payer: Aetna of CA Government/Medicare	$0.46
Rate for Payer: Cash Price	$0.34
Rate for Payer: Health Smart Auto/Commercial	$0.46
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$0.46
Rate for Payer: LLUH Dept of Risk Management WC	$0.42
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$0.57

ONDANSETRON 8 MG DISINTEGRATING TABLET [27698]

Facility

$43.85

Service Code	NDC 0173-0570-10
Hospital Charge Code	1711783
Hospital Revenue Code	259
Min. Negotiated Rate	$24.12
Max. Negotiated Rate	$35.08
Rate for Payer: Cash Price	$19.73
Rate for Payer: Cigna of CA HMO/PPO	$35.08
Rate for Payer: Health Smart Auto/Commercial	$26.31
Rate for Payer: LLUH Dept of Risk Management WC	$24.12
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$32.89

ONDANSETRON 8 MG DISINTEGRATING TABLET [27698]

Facility

$0.73

Service Code	NDC 62756-356-66
Hospital Charge Code	1711783
Hospital Revenue Code	259
Min. Negotiated Rate	$0.40
Max. Negotiated Rate	$0.55
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$0.44
Rate for Payer: Aetna of CA Government/Medicare	$0.44
Rate for Payer: Cash Price	$0.33
Rate for Payer: Health Smart Auto/Commercial	$0.44
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$0.44
Rate for Payer: LLUH Dept of Risk Management WC	$0.40
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$0.55

ONDANSETRON 8 MG DISINTEGRATING TABLET [27698]

Facility

$0.76

Service Code	NDC 68462-158-40
Hospital Charge Code	1711783
Hospital Revenue Code	259
Min. Negotiated Rate	$0.42
Max. Negotiated Rate	$0.61
Rate for Payer: Cash Price	$0.34
Rate for Payer: Cigna of CA HMO/PPO	$0.61
Rate for Payer: Health Smart Auto/Commercial	$0.46
Rate for Payer: LLUH Dept of Risk Management WC	$0.42
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$0.57

ONDANSETRON 8 MG DISINTEGRATING TABLET [27698]

Facility

$0.73

Service Code	NDC 62756-356-64
Hospital Charge Code	1711783
Hospital Revenue Code	259
Min. Negotiated Rate	$0.40
Max. Negotiated Rate	$0.58
Rate for Payer: Cash Price	$0.33
Rate for Payer: Cigna of CA HMO/PPO	$0.58
Rate for Payer: Health Smart Auto/Commercial	$0.44
Rate for Payer: LLUH Dept of Risk Management WC	$0.40
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$0.55

ONDANSETRON 8 MG DISINTEGRATING TABLET [27698]

Facility

$1.38

Service Code	NDC 0781-5239-64
Hospital Charge Code	1711783
Hospital Revenue Code	259
Min. Negotiated Rate	$0.76
Max. Negotiated Rate	$1.04
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$0.83
Rate for Payer: Aetna of CA Government/Medicare	$0.83
Rate for Payer: Cash Price	$0.62
Rate for Payer: Health Smart Auto/Commercial	$0.83
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$0.83
Rate for Payer: LLUH Dept of Risk Management WC	$0.76
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$1.04

ONDANSETRON 8 MG DISINTEGRATING TABLET [27698]

Facility

$0.48

Service Code	NDC 57237-078-10
Hospital Charge Code	1711783
Hospital Revenue Code	259
Min. Negotiated Rate	$0.26
Max. Negotiated Rate	$0.38
Rate for Payer: Cash Price	$0.22
Rate for Payer: Cigna of CA HMO/PPO	$0.38
Rate for Payer: Health Smart Auto/Commercial	$0.29
Rate for Payer: LLUH Dept of Risk Management WC	$0.26
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$0.36

ONDANSETRON 8 MG DISINTEGRATING TABLET [27698]

Facility

$0.76

Service Code	NDC 68462-158-13
Hospital Charge Code	1711783
Hospital Revenue Code	259
Min. Negotiated Rate	$0.42
Max. Negotiated Rate	$0.57
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$0.46
Rate for Payer: Aetna of CA Government/Medicare	$0.46
Rate for Payer: Cash Price	$0.34
Rate for Payer: Health Smart Auto/Commercial	$0.46
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$0.46
Rate for Payer: LLUH Dept of Risk Management WC	$0.42
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$0.57

ONDANSETRON 8 MG DISINTEGRATING TABLET [27698]

Facility

$1.38

Service Code	NDC 0781-5239-06
Hospital Charge Code	1711783
Hospital Revenue Code	259
Min. Negotiated Rate	$0.76
Max. Negotiated Rate	$1.04
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$0.83
Rate for Payer: Aetna of CA Government/Medicare	$0.83
Rate for Payer: Cash Price	$0.62
Rate for Payer: Health Smart Auto/Commercial	$0.83
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$0.83
Rate for Payer: LLUH Dept of Risk Management WC	$0.76
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$1.04

ONDANSETRON 8 MG DISINTEGRATING TABLET [27698]

Facility

$0.48

Service Code	NDC 57237-078-10
Hospital Charge Code	1711783
Hospital Revenue Code	259
Min. Negotiated Rate	$0.26
Max. Negotiated Rate	$0.36
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$0.29
Rate for Payer: Aetna of CA Government/Medicare	$0.29
Rate for Payer: Cash Price	$0.22
Rate for Payer: Health Smart Auto/Commercial	$0.29
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$0.29
Rate for Payer: LLUH Dept of Risk Management WC	$0.26
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$0.36

ONDANSETRON 8 MG DISINTEGRATING TABLET [27698]

Facility

$1.38

Service Code	NDC 0781-5239-64
Hospital Charge Code	1711783
Hospital Revenue Code	259
Min. Negotiated Rate	$0.76
Max. Negotiated Rate	$1.10
Rate for Payer: Cash Price	$0.62
Rate for Payer: Cigna of CA HMO/PPO	$1.10
Rate for Payer: Health Smart Auto/Commercial	$0.83
Rate for Payer: LLUH Dept of Risk Management WC	$0.76
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$1.04

ONDANSETRON 8 MG DISINTEGRATING TABLET [27698]

Facility

$0.76

Service Code	NDC 68462-158-13
Hospital Charge Code	1711783
Hospital Revenue Code	259
Min. Negotiated Rate	$0.42
Max. Negotiated Rate	$0.61
Rate for Payer: Cash Price	$0.34
Rate for Payer: Cigna of CA HMO/PPO	$0.61
Rate for Payer: Health Smart Auto/Commercial	$0.46
Rate for Payer: LLUH Dept of Risk Management WC	$0.42
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$0.57

ONDANSETRON HCL 2 MG/ML INTRAVENOUS SOLUTION [106349]

Facility

$0.30

Service Code	CPT J2405
Hospital Charge Code	1754628
Hospital Revenue Code	636
Min. Negotiated Rate	$0.17
Max. Negotiated Rate	$0.24
Rate for Payer: Cash Price	$0.14
Rate for Payer: Cash Price	$0.24
Rate for Payer: Cigna of CA HMO/PPO	$0.24
Rate for Payer: Cigna of CA HMO/PPO	$0.42
Rate for Payer: Health Smart Auto/Commercial	$0.32
Rate for Payer: Health Smart Auto/Commercial	$0.18
Rate for Payer: LLUH Dept of Risk Management WC	$0.29
Rate for Payer: LLUH Dept of Risk Management WC	$0.17
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$0.40
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$0.23

ONDANSETRON HCL 2 MG/ML INTRAVENOUS SOLUTION [106349]

Facility

$0.30

Service Code	CPT J2405
Hospital Charge Code	1754628
Hospital Revenue Code	636
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 EPO/HMO/POS/PPO	$0.32
Rate for Payer: Aetna of CA Government/Medicare	$0.32
Rate for Payer: Aetna of CA Government/Medicare	$0.18
Rate for Payer: Cash Price	$0.24
Rate for Payer: Cash Price	$0.14
Rate for Payer: Health Smart Auto/Commercial	$0.32
Rate for Payer: Health Smart Auto/Commercial	$0.18
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$0.32
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$0.18
Rate for Payer: LLUH Dept of Risk Management WC	$0.29
Rate for Payer: LLUH Dept of Risk Management WC	$0.17
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$0.23
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$0.40

ONDANSETRON HCL 4 MG/5 ML ORAL SOLUTION [18877]

Facility

$0.60

Service Code	NDC 54838-555-50
Hospital Charge Code	1715969
Hospital Revenue Code	636
Min. Negotiated Rate	$0.33
Max. Negotiated Rate	$0.48
Rate for Payer: Cash Price	$0.27
Rate for Payer: Cigna of CA HMO/PPO	$0.48
Rate for Payer: Health Smart Auto/Commercial	$0.36
Rate for Payer: LLUH Dept of Risk Management WC	$0.33
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$0.45

ONDANSETRON HCL 4 MG/5 ML ORAL SOLUTION [18877]

Facility

$1.70

Service Code	NDC 16714-671-02
Hospital Charge Code	1715969
Hospital Revenue Code	636
Min. Negotiated Rate	$0.94
Max. Negotiated Rate	$1.28
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$1.02
Rate for Payer: Aetna of CA Government/Medicare	$1.02
Rate for Payer: Cash Price	$0.77
Rate for Payer: Health Smart Auto/Commercial	$1.02
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$1.02
Rate for Payer: LLUH Dept of Risk Management WC	$0.94
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$1.28

ONDANSETRON HCL 4 MG/5 ML ORAL SOLUTION [18877]

Facility

$0.60

Service Code	NDC 65162-691-79
Hospital Charge Code	1715969
Hospital Revenue Code	636
Min. Negotiated Rate	$0.33
Max. Negotiated Rate	$0.48
Rate for Payer: Cash Price	$0.27
Rate for Payer: Cigna of CA HMO/PPO	$0.48
Rate for Payer: Health Smart Auto/Commercial	$0.36
Rate for Payer: LLUH Dept of Risk Management WC	$0.33
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$0.45

ONDANSETRON HCL 4 MG/5 ML ORAL SOLUTION [18877]

Facility

$0.60

Service Code	NDC 54838-555-50
Hospital Charge Code	1715969
Hospital Revenue Code	636
Min. Negotiated Rate	$0.33
Max. Negotiated Rate	$0.45
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$0.36
Rate for Payer: Aetna of CA Government/Medicare	$0.36
Rate for Payer: Cash Price	$0.27
Rate for Payer: Health Smart Auto/Commercial	$0.36
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$0.36
Rate for Payer: LLUH Dept of Risk Management WC	$0.33
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$0.45

ONDANSETRON HCL 4 MG/5 ML ORAL SOLUTION [18877]

Facility

$0.60

Service Code	NDC 65162-691-79
Hospital Charge Code	1715969
Hospital Revenue Code	636
Min. Negotiated Rate	$0.33
Max. Negotiated Rate	$0.45
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$0.36
Rate for Payer: Aetna of CA Government/Medicare	$0.36
Rate for Payer: Cash Price	$0.27
Rate for Payer: Health Smart Auto/Commercial	$0.36
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$0.36
Rate for Payer: LLUH Dept of Risk Management WC	$0.33
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$0.45

Know your out-of-pocket cost for care.

All Charges