Loma Linda University Behavioral Medicine Center (BMC)

All Charges

Charge

Type

Setting

Price

ORPHENADRINE CITRATE 30 MG/ML INJECTION SOLUTION [5886]

Facility

$7.20

Service Code	CPT J2360
Hospital Charge Code	NDG5886
Hospital Revenue Code	636
Min. Negotiated Rate	$3.96
Max. Negotiated Rate	$5.76
Rate for Payer: Cash Price	$3.24
Rate for Payer: Cash Price	$4.28
Rate for Payer: Cigna of CA HMO/PPO	$5.76
Rate for Payer: Cigna of CA HMO/PPO	$7.62
Rate for Payer: Health Smart Auto/Commercial	$4.32
Rate for Payer: Health Smart Auto/Commercial	$5.71
Rate for Payer: LLUH Dept of Risk Management WC	$5.24
Rate for Payer: LLUH Dept of Risk Management WC	$3.96
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$7.14
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$5.40

ORPHENADRINE CITRATE 30 MG/ML INJECTION SOLUTION [5886]

Facility

$9.52

Service Code	CPT J2360
Hospital Charge Code	NDG5886
Hospital Revenue Code	636
Min. Negotiated Rate	$5.24
Max. Negotiated Rate	$7.14
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$5.71
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$4.32
Rate for Payer: Aetna of CA Government/Medicare	$5.71
Rate for Payer: Aetna of CA Government/Medicare	$4.32
Rate for Payer: Cash Price	$3.24
Rate for Payer: Cash Price	$4.28
Rate for Payer: Health Smart Auto/Commercial	$4.32
Rate for Payer: Health Smart Auto/Commercial	$5.71
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$4.32
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$5.71
Rate for Payer: LLUH Dept of Risk Management WC	$3.96
Rate for Payer: LLUH Dept of Risk Management WC	$5.24
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$5.40
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$7.14

OSELTAMIVIR 30 MG CAPSULE [88704]

Facility

$9.55

Service Code	NDC 69238-1264-1
Hospital Charge Code	1712606
Hospital Revenue Code	259
Min. Negotiated Rate	$5.25
Max. Negotiated Rate	$7.64
Rate for Payer: Cash Price	$4.30
Rate for Payer: Cigna of CA HMO/PPO	$7.64
Rate for Payer: Health Smart Auto/Commercial	$5.73
Rate for Payer: LLUH Dept of Risk Management WC	$5.25
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$7.16

OSELTAMIVIR 30 MG CAPSULE [88704]

Facility

$3.12

Service Code	NDC 68180-675-11
Hospital Charge Code	1712606
Hospital Revenue Code	259
Min. Negotiated Rate	$1.72
Max. Negotiated Rate	$2.34
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	$1.40
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 Beech St/Commercial/PHCS	$2.34

OSELTAMIVIR 30 MG CAPSULE [88704]

Facility

$11.23

Service Code	NDC 47781-468-13
Hospital Charge Code	1712606
Hospital Revenue Code	259
Min. Negotiated Rate	$6.18
Max. Negotiated Rate	$8.42
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$6.74
Rate for Payer: Aetna of CA Government/Medicare	$6.74
Rate for Payer: Cash Price	$5.05
Rate for Payer: Health Smart Auto/Commercial	$6.74
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$6.74
Rate for Payer: LLUH Dept of Risk Management WC	$6.18
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$8.42

OSELTAMIVIR 30 MG CAPSULE [88704]

Facility

$3.12

Service Code	NDC 68180-675-11
Hospital Charge Code	1712606
Hospital Revenue Code	259
Min. Negotiated Rate	$1.72
Max. Negotiated Rate	$2.50
Rate for Payer: Cash Price	$1.40
Rate for Payer: Cigna of CA 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 Beech St/Commercial/PHCS	$2.34

OSELTAMIVIR 30 MG CAPSULE [88704]

Facility

$9.55

Service Code	NDC 69238-1264-1
Hospital Charge Code	1712606
Hospital Revenue Code	259
Min. Negotiated Rate	$5.25
Max. Negotiated Rate	$7.16
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$5.73
Rate for Payer: Aetna of CA Government/Medicare	$5.73
Rate for Payer: Cash Price	$4.30
Rate for Payer: Health Smart Auto/Commercial	$5.73
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$5.73
Rate for Payer: LLUH Dept of Risk Management WC	$5.25
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$7.16

OSELTAMIVIR 30 MG CAPSULE [88704]

Facility

$11.23

Service Code	NDC 47781-468-13
Hospital Charge Code	1712606
Hospital Revenue Code	259
Min. Negotiated Rate	$6.18
Max. Negotiated Rate	$8.98
Rate for Payer: Cash Price	$5.05
Rate for Payer: Cigna of CA HMO/PPO	$8.98
Rate for Payer: Health Smart Auto/Commercial	$6.74
Rate for Payer: LLUH Dept of Risk Management WC	$6.18
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$8.42

OSELTAMIVIR 45 MG CAPSULE [88705]

Facility

$16.72

Service Code	NDC 0004-0801-85
Hospital Charge Code	ERX88705
Hospital Revenue Code	259
Min. Negotiated Rate	$9.20
Max. Negotiated Rate	$12.54
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	$7.52
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 Beech St/Commercial/PHCS	$12.54

OSELTAMIVIR 45 MG CAPSULE [88705]

Facility

$16.72

Service Code	NDC 0004-0801-85
Hospital Charge Code	ERX88705
Hospital Revenue Code	259
Min. Negotiated Rate	$9.20
Max. Negotiated Rate	$13.38
Rate for Payer: Cash Price	$7.52
Rate for Payer: Cigna of CA 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 Beech St/Commercial/PHCS	$12.54

OSELTAMIVIR 6 MG/ML ORAL SUSPENSION [187854]

Facility

$3.04

Service Code	NDC 0004-0822-05
Hospital Charge Code	1715279
Hospital Revenue Code	259
Min. Negotiated Rate	$1.67
Max. Negotiated Rate	$2.28
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	$1.37
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 Beech St/Commercial/PHCS	$2.28

OSELTAMIVIR 6 MG/ML ORAL SUSPENSION [187854]

Facility

$0.60

Service Code	NDC 68180-678-01
Hospital Charge Code	1715279
Hospital Revenue Code	259
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

OSELTAMIVIR 6 MG/ML ORAL SUSPENSION [187854]

Facility

$3.04

Service Code	NDC 0004-0822-05
Hospital Charge Code	1715279
Hospital Revenue Code	259
Min. Negotiated Rate	$1.67
Max. Negotiated Rate	$2.43
Rate for Payer: Cash Price	$1.37
Rate for Payer: Cigna of CA 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 Beech St/Commercial/PHCS	$2.28

OSELTAMIVIR 6 MG/ML ORAL SUSPENSION [187854]

Facility

$0.60

Service Code	NDC 68180-678-01
Hospital Charge Code	1715279
Hospital Revenue Code	259
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

OSELTAMIVIR 75 MG CAPSULE [26546]

Facility

$3.12

Service Code	NDC 31722-632-31
Hospital Charge Code	1712299
Hospital Revenue Code	259
Min. Negotiated Rate	$1.72
Max. Negotiated Rate	$2.34
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	$1.40
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 Beech St/Commercial/PHCS	$2.34

OSELTAMIVIR 75 MG CAPSULE [26546]

Facility

$10.41

Service Code	NDC 69238-1266-1
Hospital Charge Code	1712299
Hospital Revenue Code	259
Min. Negotiated Rate	$5.73
Max. Negotiated Rate	$8.33
Rate for Payer: Cash Price	$4.68
Rate for Payer: Cigna of CA HMO/PPO	$8.33
Rate for Payer: Health Smart Auto/Commercial	$6.25
Rate for Payer: LLUH Dept of Risk Management WC	$5.73
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$7.81

OSELTAMIVIR 75 MG CAPSULE [26546]

Facility

$3.12

Service Code	NDC 31722-632-31
Hospital Charge Code	1712299
Hospital Revenue Code	259
Min. Negotiated Rate	$1.72
Max. Negotiated Rate	$2.50
Rate for Payer: Cash Price	$1.40
Rate for Payer: Cigna of CA 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 Beech St/Commercial/PHCS	$2.34

OSELTAMIVIR 75 MG CAPSULE [26546]

Facility

$18.23

Service Code	NDC 0004-0800-85
Hospital Charge Code	1712299
Hospital Revenue Code	259
Min. Negotiated Rate	$10.03
Max. Negotiated Rate	$13.67
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	$8.20
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 Beech St/Commercial/PHCS	$13.67

OSELTAMIVIR 75 MG CAPSULE [26546]

Facility

$10.41

Service Code	NDC 69238-1266-1
Hospital Charge Code	1712299
Hospital Revenue Code	259
Min. Negotiated Rate	$5.73
Max. Negotiated Rate	$7.81
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$6.25
Rate for Payer: Aetna of CA Government/Medicare	$6.25
Rate for Payer: Cash Price	$4.68
Rate for Payer: Health Smart Auto/Commercial	$6.25
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$6.25
Rate for Payer: LLUH Dept of Risk Management WC	$5.73
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$7.81

OSELTAMIVIR 75 MG CAPSULE [26546]

Facility

$18.23

Service Code	NDC 0004-0800-85
Hospital Charge Code	1712299
Hospital Revenue Code	259
Min. Negotiated Rate	$10.03
Max. Negotiated Rate	$14.58
Rate for Payer: Cash Price	$8.20
Rate for Payer: Cigna of CA 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 Beech St/Commercial/PHCS	$13.67

OSTOMY ADHESIVE PASTE [115464]

Facility

$0.16

Service Code	NDC 6845510690
Hospital Charge Code	1743626
Hospital Revenue Code	271
Min. Negotiated Rate	$0.09
Max. Negotiated Rate	$0.13
Rate for Payer: Cash Price	$0.07
Rate for Payer: Cigna of CA HMO/PPO	$0.13
Rate for Payer: Health Smart Auto/Commercial	$0.10
Rate for Payer: LLUH Dept of Risk Management WC	$0.09
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$0.12

OSTOMY ADHESIVE PASTE [115464]

Facility

$0.16

Service Code	NDC 6845510690
Hospital Charge Code	1743626
Hospital Revenue Code	271
Min. Negotiated Rate	$0.09
Max. Negotiated Rate	$0.12
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	$0.07
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 Beech St/Commercial/PHCS	$0.12

OSTOMY SUPPLIES POWDER [110541]

Facility

$0.26

Service Code	NDC 6845510826
Hospital Charge Code	1743566
Hospital Revenue Code	271
Min. Negotiated Rate	$0.14
Max. Negotiated Rate	$0.21
Rate for Payer: Cash Price	$0.12
Rate for Payer: Cigna of CA HMO/PPO	$0.21
Rate for Payer: Health Smart Auto/Commercial	$0.16
Rate for Payer: LLUH Dept of Risk Management WC	$0.14
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$0.20

OSTOMY SUPPLIES POWDER [110541]

Facility

$0.26

Service Code	NDC 6845510826
Hospital Charge Code	1743566
Hospital Revenue Code	271
Min. Negotiated Rate	$0.14
Max. Negotiated Rate	$0.20
Rate for Payer: Health Smart Auto/Commercial	$0.16
Rate for Payer: Cash Price	$0.12
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$0.16
Rate for Payer: Aetna of CA Government/Medicare	$0.16
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$0.16
Rate for Payer: LLUH Dept of Risk Management WC	$0.14
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$0.20

OXACILLIN 10 GRAM SOLUTION FOR INJECTION [5925]

Facility

$133.20

Service Code	CPT J2700
Hospital Charge Code	ERX5925
Hospital Revenue Code	636
Min. Negotiated Rate	$73.26
Max. Negotiated Rate	$99.90
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$79.92
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$84.10
Rate for Payer: Aetna of CA Government/Medicare	$79.92
Rate for Payer: Aetna of CA Government/Medicare	$84.10
Rate for Payer: Cash Price	$63.07
Rate for Payer: Cash Price	$59.94
Rate for Payer: Health Smart Auto/Commercial	$79.92
Rate for Payer: Health Smart Auto/Commercial	$84.10
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$79.92
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$84.10
Rate for Payer: LLUH Dept of Risk Management WC	$73.26
Rate for Payer: LLUH Dept of Risk Management WC	$77.09
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$99.90
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$105.12

Know your out-of-pocket cost for care.

All Charges