Loma Linda University Behavioral Medicine Center (BMC)

All Charges

Charge

Type

Setting

Price

TACROLIMUS 0.1 % TOPICAL OINTMENT [29443]

Facility

$5.42

Service Code	NDC 0168-0416-30
Hospital Charge Code	1743679
Hospital Revenue Code	259
Min. Negotiated Rate	$2.98
Max. Negotiated Rate	$4.34
Rate for Payer: Cash Price	$2.44
Rate for Payer: Cigna of CA HMO/PPO	$4.34
Rate for Payer: Health Smart Auto/Commercial	$3.25
Rate for Payer: LLUH Dept of Risk Management WC	$2.98
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$4.06

TACROLIMUS 0.1 % TOPICAL OINTMENT [29443]

Facility

$5.42

Service Code	NDC 0168-0416-30
Hospital Charge Code	1743679
Hospital Revenue Code	259
Min. Negotiated Rate	$2.98
Max. Negotiated Rate	$4.06
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$3.25
Rate for Payer: Aetna of CA Government/Medicare	$3.25
Rate for Payer: Cash Price	$2.44
Rate for Payer: Health Smart Auto/Commercial	$3.25
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$3.25
Rate for Payer: LLUH Dept of Risk Management WC	$2.98
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$4.06

TACROLIMUS 0.1 % TOPICAL OINTMENT [29443]

Facility

$4.00

Service Code	NDC 68462-534-65
Hospital Charge Code	NDG29443
Hospital Revenue Code	259
Min. Negotiated Rate	$2.20
Max. Negotiated Rate	$3.00
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$2.40
Rate for Payer: Aetna of CA Government/Medicare	$2.40
Rate for Payer: Cash Price	$1.80
Rate for Payer: Health Smart Auto/Commercial	$2.40
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$2.40
Rate for Payer: LLUH Dept of Risk Management WC	$2.20
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$3.00

TACROLIMUS 0.1 % TOPICAL OINTMENT [29443]

Facility

$4.00

Service Code	NDC 45802-700-01
Hospital Charge Code	NDG29443
Hospital Revenue Code	259
Min. Negotiated Rate	$2.20
Max. Negotiated Rate	$3.20
Rate for Payer: Cash Price	$1.80
Rate for Payer: Cigna of CA HMO/PPO	$3.20
Rate for Payer: Health Smart Auto/Commercial	$2.40
Rate for Payer: LLUH Dept of Risk Management WC	$2.20
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$3.00

TACROLIMUS 0.1 % TOPICAL OINTMENT [29443]

Facility

$4.00

Service Code	NDC 45802-700-01
Hospital Charge Code	NDG29443
Hospital Revenue Code	259
Min. Negotiated Rate	$2.20
Max. Negotiated Rate	$3.00
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$2.40
Rate for Payer: Aetna of CA Government/Medicare	$2.40
Rate for Payer: Cash Price	$1.80
Rate for Payer: Health Smart Auto/Commercial	$2.40
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$2.40
Rate for Payer: LLUH Dept of Risk Management WC	$2.20
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$3.00

TACROLIMUS 0.1 % TOPICAL OINTMENT [29443]

Facility

$4.00

Service Code	NDC 16729-422-10
Hospital Charge Code	1743679
Hospital Revenue Code	259
Min. Negotiated Rate	$2.20
Max. Negotiated Rate	$3.20
Rate for Payer: Cash Price	$1.80
Rate for Payer: Cigna of CA HMO/PPO	$3.20
Rate for Payer: Health Smart Auto/Commercial	$2.40
Rate for Payer: LLUH Dept of Risk Management WC	$2.20
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$3.00

TACROLIMUS 0.1 % TOPICAL OINTMENT [29443]

Facility

$4.00

Service Code	NDC 16729-422-10
Hospital Charge Code	1743679
Hospital Revenue Code	259
Min. Negotiated Rate	$2.20
Max. Negotiated Rate	$3.00
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$2.40
Rate for Payer: Aetna of CA Government/Medicare	$2.40
Rate for Payer: Cash Price	$1.80
Rate for Payer: Health Smart Auto/Commercial	$2.40
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$2.40
Rate for Payer: LLUH Dept of Risk Management WC	$2.20
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$3.00

TACROLIMUS 0.1 % TOPICAL OINTMENT [29443]

Facility

$5.42

Service Code	NDC 0168-0416-60
Hospital Charge Code	NDG29443
Hospital Revenue Code	259
Min. Negotiated Rate	$2.98
Max. Negotiated Rate	$4.34
Rate for Payer: Cash Price	$2.44
Rate for Payer: Cigna of CA HMO/PPO	$4.34
Rate for Payer: Health Smart Auto/Commercial	$3.25
Rate for Payer: LLUH Dept of Risk Management WC	$2.98
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$4.06

TACROLIMUS 0.5 MG CAPSULE, IMMEDIATE-RELEASE [24914]

Facility

$4.19

Service Code	CPT J7507
Hospital Charge Code	1711775
Hospital Revenue Code	636
Min. Negotiated Rate	$2.30
Max. Negotiated Rate	$3.35
Rate for Payer: Cash Price	$1.89
Rate for Payer: Cash Price	$0.25
Rate for Payer: Cash Price	$0.59
Rate for Payer: Cash Price	$0.18
Rate for Payer: Cigna of CA HMO/PPO	$1.06
Rate for Payer: Cigna of CA HMO/PPO	$0.32
Rate for Payer: Cigna of CA HMO/PPO	$3.35
Rate for Payer: Cigna of CA HMO/PPO	$0.45
Rate for Payer: Health Smart Auto/Commercial	$2.51
Rate for Payer: Health Smart Auto/Commercial	$0.24
Rate for Payer: Health Smart Auto/Commercial	$0.34
Rate for Payer: Health Smart Auto/Commercial	$0.79
Rate for Payer: LLUH Dept of Risk Management WC	$0.73
Rate for Payer: LLUH Dept of Risk Management WC	$0.31
Rate for Payer: LLUH Dept of Risk Management WC	$2.30
Rate for Payer: LLUH Dept of Risk Management WC	$0.22
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$0.30
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$0.99
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$3.14
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$0.42

TACROLIMUS 0.5 MG CAPSULE, IMMEDIATE-RELEASE [24914]

Facility

$0.40

Service Code	CPT J7507
Hospital Charge Code	1711775
Hospital Revenue Code	636
Min. Negotiated Rate	$0.22
Max. Negotiated Rate	$0.30
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$0.24
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$0.34
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$0.79
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$2.51
Rate for Payer: Aetna of CA Government/Medicare	$0.34
Rate for Payer: Aetna of CA Government/Medicare	$2.51
Rate for Payer: Aetna of CA Government/Medicare	$0.79
Rate for Payer: Aetna of CA Government/Medicare	$0.24
Rate for Payer: Cash Price	$0.25
Rate for Payer: Cash Price	$1.89
Rate for Payer: Cash Price	$0.59
Rate for Payer: Cash Price	$0.18
Rate for Payer: Health Smart Auto/Commercial	$0.34
Rate for Payer: Health Smart Auto/Commercial	$0.24
Rate for Payer: Health Smart Auto/Commercial	$2.51
Rate for Payer: Health Smart Auto/Commercial	$0.79
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$2.51
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$0.34
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$0.79
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$0.24
Rate for Payer: LLUH Dept of Risk Management WC	$0.73
Rate for Payer: LLUH Dept of Risk Management WC	$0.31
Rate for Payer: LLUH Dept of Risk Management WC	$2.30
Rate for Payer: LLUH Dept of Risk Management WC	$0.22
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$0.99
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$3.14
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$0.30
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$0.42

TACROLIMUS 0.5 MG/ML COMPOUNDED ORAL SUSPENSION [40840050]

Facility

$3.62

Service Code	CPT J7507
Hospital Charge Code	NDC40840050
Hospital Revenue Code	636
Min. Negotiated Rate	$1.99
Max. Negotiated Rate	$2.90
Rate for Payer: Cash Price	$1.63
Rate for Payer: Cigna of CA HMO/PPO	$2.90
Rate for Payer: Health Smart Auto/Commercial	$2.17
Rate for Payer: LLUH Dept of Risk Management WC	$1.99
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$2.72

TACROLIMUS 0.5 MG/ML COMPOUNDED ORAL SUSPENSION [40840050]

Facility

$3.62

Service Code	CPT J7507
Hospital Charge Code	NDC40840050
Hospital Revenue Code	636
Min. Negotiated Rate	$1.99
Max. Negotiated Rate	$2.72
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$2.17
Rate for Payer: Aetna of CA Government/Medicare	$2.17
Rate for Payer: Cash Price	$1.63
Rate for Payer: Health Smart Auto/Commercial	$2.17
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$2.17
Rate for Payer: LLUH Dept of Risk Management WC	$1.99
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$2.72

TACROLIMUS 1 MG CAPSULE, IMMEDIATE-RELEASE [12933]

Facility

$8.37

Service Code	CPT J7507
Hospital Charge Code	1712166
Hospital Revenue Code	636
Min. Negotiated Rate	$4.60
Max. Negotiated Rate	$6.28
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$5.02
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$0.67
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$0.66
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$0.52
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: Aetna of CA Government/Medicare	$0.52
Rate for Payer: Aetna of CA Government/Medicare	$0.66
Rate for Payer: Aetna of CA Government/Medicare	$0.67
Rate for Payer: Aetna of CA Government/Medicare	$5.02
Rate for Payer: Cash Price	$0.50
Rate for Payer: Cash Price	$0.32
Rate for Payer: Cash Price	$0.39
Rate for Payer: Cash Price	$3.77
Rate for Payer: Cash Price	$0.50
Rate for Payer: Health Smart Auto/Commercial	$5.02
Rate for Payer: Health Smart Auto/Commercial	$0.67
Rate for Payer: Health Smart Auto/Commercial	$0.52
Rate for Payer: Health Smart Auto/Commercial	$0.42
Rate for Payer: Health Smart Auto/Commercial	$0.66
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$0.42
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$5.02
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$0.67
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$0.52
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$0.66
Rate for Payer: LLUH Dept of Risk Management WC	$0.62
Rate for Payer: LLUH Dept of Risk Management WC	$0.39
Rate for Payer: LLUH Dept of Risk Management WC	$4.60
Rate for Payer: LLUH Dept of Risk Management WC	$0.61
Rate for Payer: LLUH Dept of Risk Management WC	$0.48
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$6.28
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$0.84
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$0.83
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$0.53
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$0.65

TACROLIMUS 1 MG CAPSULE, IMMEDIATE-RELEASE [12933]

Facility

$1.12

Service Code	CPT J7507
Hospital Charge Code	1712166
Hospital Revenue Code	636
Min. Negotiated Rate	$0.62
Max. Negotiated Rate	$0.90
Rate for Payer: Cash Price	$0.50
Rate for Payer: Cash Price	$0.32
Rate for Payer: Cash Price	$0.50
Rate for Payer: Cash Price	$3.77
Rate for Payer: Cash Price	$0.39
Rate for Payer: Cigna of CA HMO/PPO	$0.90
Rate for Payer: Cigna of CA HMO/PPO	$0.56
Rate for Payer: Cigna of CA HMO/PPO	$0.70
Rate for Payer: Cigna of CA HMO/PPO	$6.70
Rate for Payer: Cigna of CA HMO/PPO	$0.88
Rate for Payer: Health Smart Auto/Commercial	$0.67
Rate for Payer: Health Smart Auto/Commercial	$0.66
Rate for Payer: Health Smart Auto/Commercial	$0.52
Rate for Payer: Health Smart Auto/Commercial	$0.42
Rate for Payer: Health Smart Auto/Commercial	$5.02
Rate for Payer: LLUH Dept of Risk Management WC	$0.62
Rate for Payer: LLUH Dept of Risk Management WC	$0.48
Rate for Payer: LLUH Dept of Risk Management WC	$0.39
Rate for Payer: LLUH Dept of Risk Management WC	$4.60
Rate for Payer: LLUH Dept of Risk Management WC	$0.61
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$0.84
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$0.53
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$0.83
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$6.28
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$0.65

TACROLIMUS 5 MG CAPSULE, IMMEDIATE-RELEASE [12934]

Facility

$5.40

Service Code	CPT J7507
Hospital Charge Code	1712165
Hospital Revenue Code	636
Min. Negotiated Rate	$2.97
Max. Negotiated Rate	$4.05
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$3.24
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$25.11
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$2.48
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$2.10
Rate for Payer: Aetna of CA Government/Medicare	$2.48
Rate for Payer: Aetna of CA Government/Medicare	$2.10
Rate for Payer: Aetna of CA Government/Medicare	$25.11
Rate for Payer: Aetna of CA Government/Medicare	$3.24
Rate for Payer: Cash Price	$1.58
Rate for Payer: Cash Price	$18.83
Rate for Payer: Cash Price	$2.43
Rate for Payer: Cash Price	$1.86
Rate for Payer: Health Smart Auto/Commercial	$2.10
Rate for Payer: Health Smart Auto/Commercial	$25.11
Rate for Payer: Health Smart Auto/Commercial	$3.24
Rate for Payer: Health Smart Auto/Commercial	$2.48
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$25.11
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$2.48
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$3.24
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$2.10
Rate for Payer: LLUH Dept of Risk Management WC	$1.92
Rate for Payer: LLUH Dept of Risk Management WC	$2.97
Rate for Payer: LLUH Dept of Risk Management WC	$23.02
Rate for Payer: LLUH Dept of Risk Management WC	$2.28
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$4.05
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$31.39
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$2.62
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$3.10

TACROLIMUS 5 MG CAPSULE, IMMEDIATE-RELEASE [12934]

Facility

$3.50

Service Code	CPT J7507
Hospital Charge Code	1712165
Hospital Revenue Code	636
Min. Negotiated Rate	$1.92
Max. Negotiated Rate	$2.80
Rate for Payer: Cash Price	$1.58
Rate for Payer: Cash Price	$18.83
Rate for Payer: Cash Price	$1.86
Rate for Payer: Cash Price	$2.43
Rate for Payer: Cigna of CA HMO/PPO	$4.32
Rate for Payer: Cigna of CA HMO/PPO	$2.80
Rate for Payer: Cigna of CA HMO/PPO	$33.48
Rate for Payer: Cigna of CA HMO/PPO	$3.31
Rate for Payer: Health Smart Auto/Commercial	$25.11
Rate for Payer: Health Smart Auto/Commercial	$2.10
Rate for Payer: Health Smart Auto/Commercial	$3.24
Rate for Payer: Health Smart Auto/Commercial	$2.48
Rate for Payer: LLUH Dept of Risk Management WC	$1.92
Rate for Payer: LLUH Dept of Risk Management WC	$2.28
Rate for Payer: LLUH Dept of Risk Management WC	$23.02
Rate for Payer: LLUH Dept of Risk Management WC	$2.97
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$31.39
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$4.05
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$2.62
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$3.10

TACROLIMUS ORAL SUSPENSION COMPOUND 0.5 MG/ML [4080345]

Facility

$2.61

Service Code	NDC 9994-0803-45
Hospital Charge Code	1715948
Hospital Revenue Code	259
Min. Negotiated Rate	$1.44
Max. Negotiated Rate	$2.09
Rate for Payer: Cash Price	$1.17
Rate for Payer: Cigna of CA HMO/PPO	$2.09
Rate for Payer: Health Smart Auto/Commercial	$1.57
Rate for Payer: LLUH Dept of Risk Management WC	$1.44
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$1.96

TACROLIMUS ORAL SUSPENSION COMPOUND 0.5 MG/ML [4080345]

Facility

$2.61

Service Code	NDC 9994-0803-45
Hospital Charge Code	1715948
Hospital Revenue Code	259
Min. Negotiated Rate	$1.44
Max. Negotiated Rate	$1.96
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$1.57
Rate for Payer: Aetna of CA Government/Medicare	$1.57
Rate for Payer: Cash Price	$1.17
Rate for Payer: Health Smart Auto/Commercial	$1.57
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$1.57
Rate for Payer: LLUH Dept of Risk Management WC	$1.44
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$1.96

TACROLIMUS XR 0.75 MG TABLET,EXTENDED RELEASE 24 HR [211104]

Facility

$5.91

Service Code	CPT J7508
Hospital Charge Code	ERX211104
Hospital Revenue Code	636
Min. Negotiated Rate	$3.25
Max. Negotiated Rate	$4.73
Rate for Payer: Health Smart Auto/Commercial	$3.55
Rate for Payer: Cash Price	$2.66
Rate for Payer: Cigna of CA HMO/PPO	$4.73
Rate for Payer: LLUH Dept of Risk Management WC	$3.25
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$4.43

TACROLIMUS XR 0.75 MG TABLET,EXTENDED RELEASE 24 HR [211104]

Facility

$5.91

Service Code	CPT J7508
Hospital Charge Code	ERX211104
Hospital Revenue Code	636
Min. Negotiated Rate	$3.25
Max. Negotiated Rate	$4.43
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$3.55
Rate for Payer: Aetna of CA Government/Medicare	$3.55
Rate for Payer: Cash Price	$2.66
Rate for Payer: Health Smart Auto/Commercial	$3.55
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$3.55
Rate for Payer: LLUH Dept of Risk Management WC	$3.25
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$4.43

TACROLIMUS XR 1 MG TABLET,EXTENDED RELEASE 24 HR [211105]

Facility

$7.88

Service Code	CPT J7503
Hospital Charge Code	ERX211105
Hospital Revenue Code	636
Min. Negotiated Rate	$4.33
Max. Negotiated Rate	$5.91
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$4.73
Rate for Payer: Aetna of CA Government/Medicare	$4.73
Rate for Payer: Cash Price	$3.55
Rate for Payer: Health Smart Auto/Commercial	$4.73
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$4.73
Rate for Payer: LLUH Dept of Risk Management WC	$4.33
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$5.91

TACROLIMUS XR 1 MG TABLET,EXTENDED RELEASE 24 HR [211105]

Facility

$7.88

Service Code	CPT J7503
Hospital Charge Code	ERX211105
Hospital Revenue Code	636
Min. Negotiated Rate	$4.33
Max. Negotiated Rate	$6.30
Rate for Payer: Cash Price	$3.55
Rate for Payer: Cigna of CA HMO/PPO	$6.30
Rate for Payer: Health Smart Auto/Commercial	$4.73
Rate for Payer: LLUH Dept of Risk Management WC	$4.33
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$5.91

TACROLIMUS XR 4 MG TABLET,EXTENDED RELEASE 24 HR [211106]

Facility

$31.52

Service Code	CPT J7503
Hospital Charge Code	ERX211106
Hospital Revenue Code	636
Min. Negotiated Rate	$17.34
Max. Negotiated Rate	$23.64
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$18.91
Rate for Payer: Aetna of CA Government/Medicare	$18.91
Rate for Payer: Cash Price	$14.18
Rate for Payer: Health Smart Auto/Commercial	$18.91
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$18.91
Rate for Payer: LLUH Dept of Risk Management WC	$17.34
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$23.64

TACROLIMUS XR 4 MG TABLET,EXTENDED RELEASE 24 HR [211106]

Facility

$31.52

Service Code	CPT J7503
Hospital Charge Code	ERX211106
Hospital Revenue Code	636
Min. Negotiated Rate	$17.34
Max. Negotiated Rate	$25.22
Rate for Payer: Cash Price	$14.18
Rate for Payer: Cigna of CA HMO/PPO	$25.22
Rate for Payer: Health Smart Auto/Commercial	$18.91
Rate for Payer: LLUH Dept of Risk Management WC	$17.34
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$23.64

TADALAFIL 20 MG TABLET (PULMONARY HYPERTENSION) [214774]

Facility

$1.00

Service Code	NDC 27241-123-02
Hospital Charge Code	ERX214774
Hospital Revenue Code	259
Min. Negotiated Rate	$0.55
Max. Negotiated Rate	$0.80
Rate for Payer: Cash Price	$0.45
Rate for Payer: Cigna of CA HMO/PPO	$0.80
Rate for Payer: Health Smart Auto/Commercial	$0.60
Rate for Payer: LLUH Dept of Risk Management WC	$0.55
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$0.75

Know your out-of-pocket cost for care.

All Charges