Price Transparency

Know your out-of-pocket cost for care.

All Charges

Charge

Type

Setting

Price

THIAMINE MONONITRATE (VITAMIN B1) 100 MG TABLET [121375]

Facility

IP

$0.20

Service Code	NDC 5026885111
Hospital Charge Code	901700029
Hospital Revenue Code	259
Min. Negotiated Rate	$0.11
Max. Negotiated Rate	$0.16
Rate for Payer: Cash Price	$0.11
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO 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 Commercial	$0.15

THIAMINE MONONITRATE (VITAMIN B1) 100 MG TABLET [121375]

Facility

IP

$0.20

Service Code	NDC 5026885115
Hospital Charge Code	901700029
Hospital Revenue Code	259
Min. Negotiated Rate	$0.11
Max. Negotiated Rate	$0.16
Rate for Payer: Cash Price	$0.11
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO 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 Commercial	$0.15

THIAMINE MONONITRATE (VITAMIN B1) 100 MG TABLET [121375]

Facility

OP

$0.20

Service Code	NDC 5026885111
Hospital Charge Code	901700029
Hospital Revenue Code	259
Min. Negotiated Rate	$0.11
Max. Negotiated Rate	$0.16
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	$0.11
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$0.16
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 Commercial	$0.15

THIAMINE MONONITRATE (VITAMIN B1) 100 MG TABLET [121375]

Facility

OP

$0.19

Service Code	NDC 7733393425
Hospital Charge Code	901700029
Hospital Revenue Code	259
Min. Negotiated Rate	$0.10
Max. Negotiated Rate	$0.15
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$0.11
Rate for Payer: Aetna of CA Government/Medicare	$0.11
Rate for Payer: Cash Price	$0.11
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$0.15
Rate for Payer: Health Smart Auto/Commercial	$0.11
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$0.11
Rate for Payer: LLUH Dept of Risk Management WC	$0.10
Rate for Payer: Multiplan Commercial	$0.14

THIAMINE MONONITRATE (VITAMIN B1) 100 MG TABLET [121375]

Facility

IP

$0.19

Service Code	NDC 7733393425
Hospital Charge Code	901700029
Hospital Revenue Code	259
Min. Negotiated Rate	$0.10
Max. Negotiated Rate	$0.15
Rate for Payer: Cash Price	$0.11
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO 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 Commercial	$0.14

THIAMINE MONONITRATE (VITAMIN B1) 100 MG TABLET [121375]

Facility

OP

$0.20

Service Code	NDC 5026885115
Hospital Charge Code	901700029
Hospital Revenue Code	259
Min. Negotiated Rate	$0.11
Max. Negotiated Rate	$0.16
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	$0.11
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$0.16
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 Commercial	$0.15

THIOGUANINE ORAL SUSPENSION COMPOUND 20 MG/ML [4080349]

Facility

OP

$6.03

Service Code	NDC 9994-0803-49
Hospital Charge Code	901700029
Hospital Revenue Code	259
Min. Negotiated Rate	$3.32
Max. Negotiated Rate	$4.82
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$3.62
Rate for Payer: Aetna of CA Government/Medicare	$3.62
Rate for Payer: Cash Price	$3.31
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$4.82
Rate for Payer: Health Smart Auto/Commercial	$3.62
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$3.62
Rate for Payer: LLUH Dept of Risk Management WC	$3.32
Rate for Payer: Multiplan Commercial	$4.52

THIOGUANINE ORAL SUSPENSION COMPOUND 20 MG/ML [4080349]

Facility

IP

$6.03

Service Code	NDC 9994-0803-49
Hospital Charge Code	901700029
Hospital Revenue Code	259
Min. Negotiated Rate	$3.32
Max. Negotiated Rate	$4.82
Rate for Payer: Cash Price	$3.31
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$4.82
Rate for Payer: Health Smart Auto/Commercial	$3.62
Rate for Payer: LLUH Dept of Risk Management WC	$3.32
Rate for Payer: Multiplan Commercial	$4.52

THIORIDAZINE 25 MG TABLET [7899]

Facility

IP

$0.64

Service Code	NDC 51079-566-01
Hospital Charge Code	901700029
Hospital Revenue Code	259
Min. Negotiated Rate	$0.35
Max. Negotiated Rate	$0.51
Rate for Payer: Cash Price	$0.35
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$0.51
Rate for Payer: Health Smart Auto/Commercial	$0.38
Rate for Payer: LLUH Dept of Risk Management WC	$0.35
Rate for Payer: Multiplan Commercial	$0.48

THIORIDAZINE 25 MG TABLET [7899]

Facility

OP

$0.64

Service Code	NDC 51079-566-01
Hospital Charge Code	901700029
Hospital Revenue Code	259
Min. Negotiated Rate	$0.35
Max. Negotiated Rate	$0.51
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$0.38
Rate for Payer: Aetna of CA Government/Medicare	$0.38
Rate for Payer: Cash Price	$0.35
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$0.51
Rate for Payer: Health Smart Auto/Commercial	$0.38
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$0.38
Rate for Payer: LLUH Dept of Risk Management WC	$0.35
Rate for Payer: Multiplan Commercial	$0.48

THIOTEPA 15 MG SOLUTION FOR INJECTION [7901]

Facility

OP

$900.00

Service Code	HCPCS J9342
Hospital Charge Code	901700025
Hospital Revenue Code	636
Min. Negotiated Rate	$495.00
Max. Negotiated Rate	$720.00
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$540.00
Rate for Payer: Aetna of CA Government/Medicare	$540.00
Rate for Payer: Cash Price	$495.00
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$720.00
Rate for Payer: Health Smart Auto/Commercial	$540.00
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$540.00
Rate for Payer: LLUH Dept of Risk Management WC	$495.00
Rate for Payer: Multiplan Commercial	$675.00

THIOTEPA 15 MG SOLUTION FOR INJECTION [7901]

Facility

IP

$900.00

Service Code	HCPCS J9342
Hospital Charge Code	901700025
Hospital Revenue Code	636
Min. Negotiated Rate	$495.00
Max. Negotiated Rate	$720.00
Rate for Payer: Cash Price	$495.00
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$720.00
Rate for Payer: Health Smart Auto/Commercial	$540.00
Rate for Payer: LLUH Dept of Risk Management WC	$495.00
Rate for Payer: Multiplan Commercial	$675.00

THROMBIN(HUMAN)-FIBRINOGEN-APROTININ SYN-CALCIUM 10 ML TOPICAL SYRINGE [221104]

Facility

OP

$85.86

Service Code	NDC 0338-9568-01
Hospital Charge Code	901700004
Hospital Revenue Code	250
Min. Negotiated Rate	$47.22
Max. Negotiated Rate	$68.69
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$51.52
Rate for Payer: Aetna of CA Government/Medicare	$51.52
Rate for Payer: Cash Price	$47.22
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$68.69
Rate for Payer: Health Smart Auto/Commercial	$51.52
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$51.52
Rate for Payer: LLUH Dept of Risk Management WC	$47.22
Rate for Payer: Multiplan Commercial	$64.39

THROMBIN(HUMAN)-FIBRINOGEN-APROTININ SYN-CALCIUM 10 ML TOPICAL SYRINGE [221104]

Facility

IP

$85.86

Service Code	NDC 0338-9568-01
Hospital Charge Code	901700004
Hospital Revenue Code	250
Min. Negotiated Rate	$47.22
Max. Negotiated Rate	$68.69
Rate for Payer: Cash Price	$47.22
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$68.69
Rate for Payer: Health Smart Auto/Commercial	$51.52
Rate for Payer: LLUH Dept of Risk Management WC	$47.22
Rate for Payer: Multiplan Commercial	$64.39

THROMBIN(HUMAN)-FIBRINOGEN-APROTININ SYN-CALCIUM 4 ML TOPICAL SYRINGE [221103]

Facility

IP

$87.49

Service Code	NDC 0338-9564-01
Hospital Charge Code	901700004
Hospital Revenue Code	250
Min. Negotiated Rate	$48.12
Max. Negotiated Rate	$69.99
Rate for Payer: Cash Price	$48.12
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$69.99
Rate for Payer: Health Smart Auto/Commercial	$52.49
Rate for Payer: LLUH Dept of Risk Management WC	$48.12
Rate for Payer: Multiplan Commercial	$65.62

THROMBIN(HUMAN)-FIBRINOGEN-APROTININ SYN-CALCIUM 4 ML TOPICAL SYRINGE [221103]

Facility

OP

$87.49

Service Code	NDC 0338-9564-01
Hospital Charge Code	901700004
Hospital Revenue Code	250
Min. Negotiated Rate	$48.12
Max. Negotiated Rate	$69.99
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$52.49
Rate for Payer: Aetna of CA Government/Medicare	$52.49
Rate for Payer: Cash Price	$48.12
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$69.99
Rate for Payer: Health Smart Auto/Commercial	$52.49
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$52.49
Rate for Payer: LLUH Dept of Risk Management WC	$48.12
Rate for Payer: Multiplan Commercial	$65.62

THROMBIN (RECOMBINANT) 5,000 UNIT TOPICAL SOLUTION [89570]

Facility

IP

$103.20

Service Code	NDC 0338-0322-01
Hospital Charge Code	901700003
Hospital Revenue Code	250
Min. Negotiated Rate	$56.76
Max. Negotiated Rate	$82.56
Rate for Payer: Cash Price	$56.76
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$82.56
Rate for Payer: Health Smart Auto/Commercial	$61.92
Rate for Payer: LLUH Dept of Risk Management WC	$56.76
Rate for Payer: Multiplan Commercial	$77.40

THROMBIN (RECOMBINANT) 5,000 UNIT TOPICAL SOLUTION [89570]

Facility

OP

$103.20

Service Code	NDC 0338-0324-01
Hospital Charge Code	901700003
Hospital Revenue Code	250
Min. Negotiated Rate	$56.76
Max. Negotiated Rate	$82.56
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$61.92
Rate for Payer: Aetna of CA Government/Medicare	$61.92
Rate for Payer: Cash Price	$56.76
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$82.56
Rate for Payer: Health Smart Auto/Commercial	$61.92
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$61.92
Rate for Payer: LLUH Dept of Risk Management WC	$56.76
Rate for Payer: Multiplan Commercial	$77.40

THROMBIN (RECOMBINANT) 5,000 UNIT TOPICAL SOLUTION [89570]

Facility

OP

$103.20

Service Code	NDC 0338-0322-01
Hospital Charge Code	901700003
Hospital Revenue Code	250
Min. Negotiated Rate	$56.76
Max. Negotiated Rate	$82.56
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$61.92
Rate for Payer: Aetna of CA Government/Medicare	$61.92
Rate for Payer: Cash Price	$56.76
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$82.56
Rate for Payer: Health Smart Auto/Commercial	$61.92
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$61.92
Rate for Payer: LLUH Dept of Risk Management WC	$56.76
Rate for Payer: Multiplan Commercial	$77.40

THROMBIN (RECOMBINANT) 5,000 UNIT TOPICAL SOLUTION [89570]

Facility

IP

$103.20

Service Code	NDC 0338-0324-01
Hospital Charge Code	901700003
Hospital Revenue Code	250
Min. Negotiated Rate	$56.76
Max. Negotiated Rate	$82.56
Rate for Payer: Cash Price	$56.76
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$82.56
Rate for Payer: Health Smart Auto/Commercial	$61.92
Rate for Payer: LLUH Dept of Risk Management WC	$56.76
Rate for Payer: Multiplan Commercial	$77.40

THYROID (PORK) 15 MG TABLET [120628]

Facility

OP

$0.70

Service Code	NDC 42192-327-01
Hospital Charge Code	901700029
Hospital Revenue Code	259
Min. Negotiated Rate	$0.39
Max. Negotiated Rate	$0.56
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$0.42
Rate for Payer: Aetna of CA Government/Medicare	$0.42
Rate for Payer: Cash Price	$0.39
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$0.56
Rate for Payer: Health Smart Auto/Commercial	$0.42
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$0.42
Rate for Payer: LLUH Dept of Risk Management WC	$0.39
Rate for Payer: Multiplan Commercial	$0.53

THYROID (PORK) 15 MG TABLET [120628]

Facility

IP

$0.70

Service Code	NDC 42192-327-01
Hospital Charge Code	901700029
Hospital Revenue Code	259
Min. Negotiated Rate	$0.39
Max. Negotiated Rate	$0.56
Rate for Payer: Cash Price	$0.39
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$0.56
Rate for Payer: Health Smart Auto/Commercial	$0.42
Rate for Payer: LLUH Dept of Risk Management WC	$0.39
Rate for Payer: Multiplan Commercial	$0.53

THYROID (PORK) 15 MG TABLET [120628]

Facility

IP

$0.62

Service Code	NDC 75834-310-01
Hospital Charge Code	901700029
Hospital Revenue Code	259
Min. Negotiated Rate	$0.34
Max. Negotiated Rate	$0.50
Rate for Payer: Cash Price	$0.34
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$0.50
Rate for Payer: Health Smart Auto/Commercial	$0.37
Rate for Payer: LLUH Dept of Risk Management WC	$0.34
Rate for Payer: Multiplan Commercial	$0.47

THYROID (PORK) 15 MG TABLET [120628]

Facility

OP

$0.62

Service Code	NDC 75834-310-01
Hospital Charge Code	901700029
Hospital Revenue Code	259
Min. Negotiated Rate	$0.34
Max. Negotiated Rate	$0.50
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$0.37
Rate for Payer: Aetna of CA Government/Medicare	$0.37
Rate for Payer: Cash Price	$0.34
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$0.50
Rate for Payer: Health Smart Auto/Commercial	$0.37
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$0.37
Rate for Payer: LLUH Dept of Risk Management WC	$0.34
Rate for Payer: Multiplan Commercial	$0.47

THYROID (PORK) 180 MG TABLET [120633]

Facility

OP

$1.85

Service Code	NDC 0456-0462-01
Hospital Charge Code	901700029
Hospital Revenue Code	259
Min. Negotiated Rate	$1.02
Max. Negotiated Rate	$1.48
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$1.11
Rate for Payer: Aetna of CA Government/Medicare	$1.11
Rate for Payer: Cash Price	$1.02
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$1.48
Rate for Payer: Health Smart Auto/Commercial	$1.11
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$1.11
Rate for Payer: LLUH Dept of Risk Management WC	$1.02
Rate for Payer: Multiplan Commercial	$1.39

<<
<
613
614
615
616
617
618
619
620
621
622
>
>>