Loma Linda University Behavioral Medicine Center (BMC)

All Charges

Charge

Type

Setting

Price

TADALAFIL 20 MG TABLET (PULMONARY HYPERTENSION) [214774]

Facility

$1.00

Service Code	NDC 69097-526-03
Hospital Charge Code	ERX214774
Hospital Revenue Code	259
Min. Negotiated Rate	$0.55
Max. Negotiated Rate	$0.75
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$0.60
Rate for Payer: Aetna of CA Government/Medicare	$0.60
Rate for Payer: Cash Price	$0.45
Rate for Payer: Health Smart Auto/Commercial	$0.60
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$0.60
Rate for Payer: LLUH Dept of Risk Management WC	$0.55
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$0.75

TADALAFIL 20 MG TABLET (PULMONARY HYPERTENSION) [214774]

Facility

$1.00

Service Code	NDC 33342-278-09
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

TADALAFIL 20 MG TABLET (PULMONARY HYPERTENSION) [214774]

Facility

$1.00

Service Code	NDC 33342-278-09
Hospital Charge Code	ERX214774
Hospital Revenue Code	259
Min. Negotiated Rate	$0.55
Max. Negotiated Rate	$0.75
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$0.60
Rate for Payer: Aetna of CA Government/Medicare	$0.60
Rate for Payer: Cash Price	$0.45
Rate for Payer: Health Smart Auto/Commercial	$0.60
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$0.60
Rate for Payer: LLUH Dept of Risk Management WC	$0.55
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$0.75

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	$0.75
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$0.60
Rate for Payer: Aetna of CA Government/Medicare	$0.60
Rate for Payer: Cash Price	$0.45
Rate for Payer: Health Smart Auto/Commercial	$0.60
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$0.60
Rate for Payer: LLUH Dept of Risk Management WC	$0.55
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$0.75

TADALAFIL 20 MG TABLET (PULMONARY HYPERTENSION) [214774]

Facility

$1.00

Service Code	NDC 69097-526-03
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

TADALAFIL 5 MG TABLET [37400]

Facility

$0.36

Service Code	NDC 43598-575-30
Hospital Charge Code	ERX37400
Hospital Revenue Code	259
Min. Negotiated Rate	$0.20
Max. Negotiated Rate	$0.27
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$0.22
Rate for Payer: Aetna of CA Government/Medicare	$0.22
Rate for Payer: Cash Price	$0.16
Rate for Payer: Health Smart Auto/Commercial	$0.22
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$0.22
Rate for Payer: LLUH Dept of Risk Management WC	$0.20
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$0.27

TADALAFIL 5 MG TABLET [37400]

Facility

$0.36

Service Code	NDC 43598-575-30
Hospital Charge Code	ERX37400
Hospital Revenue Code	259
Min. Negotiated Rate	$0.20
Max. Negotiated Rate	$0.29
Rate for Payer: Cash Price	$0.16
Rate for Payer: Cigna of CA HMO/PPO	$0.29
Rate for Payer: Health Smart Auto/Commercial	$0.22
Rate for Payer: LLUH Dept of Risk Management WC	$0.20
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$0.27

TADALAFIL ORAL SUSPENSION COMPOUND 5 MG/ML [4081077]

Facility

$0.25

Service Code	NDC 99994-0810-77
Hospital Charge Code	NDC4081077
Hospital Revenue Code	259
Min. Negotiated Rate	$0.14
Max. Negotiated Rate	$0.19
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$0.15
Rate for Payer: Aetna of CA Government/Medicare	$0.15
Rate for Payer: Cash Price	$0.11
Rate for Payer: Health Smart Auto/Commercial	$0.15
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$0.15
Rate for Payer: LLUH Dept of Risk Management WC	$0.14
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$0.19

TADALAFIL ORAL SUSPENSION COMPOUND 5 MG/ML [4081077]

Facility

$0.25

Service Code	NDC 99994-0810-77
Hospital Charge Code	NDC4081077
Hospital Revenue Code	259
Min. Negotiated Rate	$0.14
Max. Negotiated Rate	$0.20
Rate for Payer: Cash Price	$0.11
Rate for Payer: Cigna of CA HMO/PPO	$0.20
Rate for Payer: Health Smart Auto/Commercial	$0.15
Rate for Payer: LLUH Dept of Risk Management WC	$0.14
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$0.19

TAFASITAMAB-CXIX 200 MG INTRAVENOUS SOLUTION [228997]

Facility

$1,570.38

Service Code	CPT J9349
Hospital Charge Code	ERX228997
Hospital Revenue Code	636
Min. Negotiated Rate	$863.71
Max. Negotiated Rate	$1,256.30
Rate for Payer: Cash Price	$706.67
Rate for Payer: Cigna of CA HMO/PPO	$1,256.30
Rate for Payer: Health Smart Auto/Commercial	$942.23
Rate for Payer: LLUH Dept of Risk Management WC	$863.71
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$1,177.78

TAFASITAMAB-CXIX 200 MG INTRAVENOUS SOLUTION [228997]

Facility

$1,570.38

Service Code	CPT J9349
Hospital Charge Code	ERX228997
Hospital Revenue Code	636
Min. Negotiated Rate	$863.71
Max. Negotiated Rate	$1,177.78
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$942.23
Rate for Payer: Aetna of CA Government/Medicare	$942.23
Rate for Payer: Cash Price	$706.67
Rate for Payer: Health Smart Auto/Commercial	$942.23
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$942.23
Rate for Payer: LLUH Dept of Risk Management WC	$863.71
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$1,177.78

TALIMOGENE LAHERPAREPVEC 10EXP6 (1 MILLION) PFU/ML SUSP FOR INJECTION [211748]

Facility

$76.04

Service Code	CPT J9325
Hospital Charge Code	NDG211748
Hospital Revenue Code	636
Min. Negotiated Rate	$41.82
Max. Negotiated Rate	$60.83
Rate for Payer: Cash Price	$34.22
Rate for Payer: Cigna of CA HMO/PPO	$60.83
Rate for Payer: Health Smart Auto/Commercial	$45.62
Rate for Payer: LLUH Dept of Risk Management WC	$41.82
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$57.03

TALIMOGENE LAHERPAREPVEC 10EXP6 (1 MILLION) PFU/ML SUSP FOR INJECTION [211748]

Facility

$76.04

Service Code	CPT J9325
Hospital Charge Code	NDG211748
Hospital Revenue Code	636
Min. Negotiated Rate	$41.82
Max. Negotiated Rate	$57.03
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$45.62
Rate for Payer: Aetna of CA Government/Medicare	$45.62
Rate for Payer: Cash Price	$34.22
Rate for Payer: Health Smart Auto/Commercial	$45.62
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$45.62
Rate for Payer: LLUH Dept of Risk Management WC	$41.82
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$57.03

TALIMOGENE LAHERPAREPVEC 10EXP8 (100 MILLION)PFU/ML SUSP FOR INJECTION [211749]

Facility

$7,603.57

Service Code	CPT J9325
Hospital Charge Code	NDG211749
Hospital Revenue Code	636
Min. Negotiated Rate	$4,181.96
Max. Negotiated Rate	$6,082.86
Rate for Payer: Cash Price	$3,421.61
Rate for Payer: Cigna of CA HMO/PPO	$6,082.86
Rate for Payer: Health Smart Auto/Commercial	$4,562.14
Rate for Payer: LLUH Dept of Risk Management WC	$4,181.96
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$5,702.68

TALIMOGENE LAHERPAREPVEC 10EXP8 (100 MILLION)PFU/ML SUSP FOR INJECTION [211749]

Facility

$7,603.57

Service Code	CPT J9325
Hospital Charge Code	NDG211749
Hospital Revenue Code	636
Min. Negotiated Rate	$4,181.96
Max. Negotiated Rate	$5,702.68
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$4,562.14
Rate for Payer: Aetna of CA Government/Medicare	$4,562.14
Rate for Payer: Cash Price	$3,421.61
Rate for Payer: Health Smart Auto/Commercial	$4,562.14
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$4,562.14
Rate for Payer: LLUH Dept of Risk Management WC	$4,181.96
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$5,702.68

TAMOXIFEN 10 MG TABLET [7711]

Facility

$0.46

Service Code	CPT S0187
Hospital Charge Code	1710109
Hospital Revenue Code	259
Min. Negotiated Rate	$0.25
Max. Negotiated Rate	$0.37
Rate for Payer: Cash Price	$0.21
Rate for Payer: Cash Price	$0.26
Rate for Payer: Cigna of CA HMO/PPO	$0.46
Rate for Payer: Cigna of CA HMO/PPO	$0.37
Rate for Payer: Health Smart Auto/Commercial	$0.34
Rate for Payer: Health Smart Auto/Commercial	$0.28
Rate for Payer: LLUH Dept of Risk Management WC	$0.25
Rate for Payer: LLUH Dept of Risk Management WC	$0.31
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$0.43
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$0.35

TAMOXIFEN 10 MG TABLET [7711]

Facility

$0.57

Service Code	CPT S0187
Hospital Charge Code	1710109
Hospital Revenue Code	259
Min. Negotiated Rate	$0.31
Max. Negotiated Rate	$0.43
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$0.34
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$0.28
Rate for Payer: Aetna of CA Government/Medicare	$0.28
Rate for Payer: Aetna of CA Government/Medicare	$0.34
Rate for Payer: Cash Price	$0.26
Rate for Payer: Cash Price	$0.21
Rate for Payer: Health Smart Auto/Commercial	$0.34
Rate for Payer: Health Smart Auto/Commercial	$0.28
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$0.28
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$0.34
Rate for Payer: LLUH Dept of Risk Management WC	$0.31
Rate for Payer: LLUH Dept of Risk Management WC	$0.25
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$0.43
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$0.35

TAMOXIFEN 20 MG TABLET [11498]

Facility

$0.46

Service Code	NDC 51862-446-30
Hospital Charge Code	1710943
Hospital Revenue Code	259
Min. Negotiated Rate	$0.25
Max. Negotiated Rate	$0.35
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$0.28
Rate for Payer: Aetna of CA Government/Medicare	$0.28
Rate for Payer: Cash Price	$0.21
Rate for Payer: Health Smart Auto/Commercial	$0.28
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$0.28
Rate for Payer: LLUH Dept of Risk Management WC	$0.25
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$0.35

TAMOXIFEN 20 MG TABLET [11498]

Facility

$0.46

Service Code	NDC 51862-446-30
Hospital Charge Code	1710943
Hospital Revenue Code	259
Min. Negotiated Rate	$0.25
Max. Negotiated Rate	$0.37
Rate for Payer: Cash Price	$0.21
Rate for Payer: Cigna of CA HMO/PPO	$0.37
Rate for Payer: Health Smart Auto/Commercial	$0.28
Rate for Payer: LLUH Dept of Risk Management WC	$0.25
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$0.35

TAMOXIFEN 20 MG TABLET [11498]

Facility

$0.46

Service Code	NDC 59651-300-30
Hospital Charge Code	1710943
Hospital Revenue Code	259
Min. Negotiated Rate	$0.25
Max. Negotiated Rate	$0.37
Rate for Payer: Cash Price	$0.21
Rate for Payer: Cigna of CA HMO/PPO	$0.37
Rate for Payer: Health Smart Auto/Commercial	$0.28
Rate for Payer: LLUH Dept of Risk Management WC	$0.25
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$0.35

TAMOXIFEN 20 MG TABLET [11498]

Facility

$0.46

Service Code	NDC 59651-300-30
Hospital Charge Code	1710943
Hospital Revenue Code	259
Min. Negotiated Rate	$0.25
Max. Negotiated Rate	$0.35
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$0.28
Rate for Payer: Aetna of CA Government/Medicare	$0.28
Rate for Payer: Cash Price	$0.21
Rate for Payer: Health Smart Auto/Commercial	$0.28
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$0.28
Rate for Payer: LLUH Dept of Risk Management WC	$0.25
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$0.35

TAMSULOSIN 0.4 MG CAPSULE [103890]

Facility

$0.33

Service Code	NDC 68382-132-01
Hospital Charge Code	1711755
Hospital Revenue Code	259
Min. Negotiated Rate	$0.18
Max. Negotiated Rate	$0.25
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	$0.18
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$0.25

TAMSULOSIN 0.4 MG CAPSULE [103890]

Facility

$0.29

Service Code	NDC 62756-160-88
Hospital Charge Code	1711755
Hospital Revenue Code	259
Min. Negotiated Rate	$0.16
Max. Negotiated Rate	$0.22
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	$0.16
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$0.22

TAMSULOSIN 0.4 MG CAPSULE [103890]

Facility

$0.07

Service Code	NDC 0904-6401-89
Hospital Charge Code	1711755
Hospital Revenue Code	259
Min. Negotiated Rate	$0.04
Max. Negotiated Rate	$0.05
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$0.04
Rate for Payer: Aetna of CA Government/Medicare	$0.04
Rate for Payer: Cash Price	$0.03
Rate for Payer: Health Smart Auto/Commercial	$0.04
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$0.04
Rate for Payer: LLUH Dept of Risk Management WC	$0.04
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$0.05

TAMSULOSIN 0.4 MG CAPSULE [103890]

Facility

$0.07

Service Code	NDC 0904-6401-89
Hospital Charge Code	1711755
Hospital Revenue Code	259
Min. Negotiated Rate	$0.04
Max. Negotiated Rate	$0.06
Rate for Payer: Cash Price	$0.03
Rate for Payer: Cigna of CA HMO/PPO	$0.06
Rate for Payer: Health Smart Auto/Commercial	$0.04
Rate for Payer: LLUH Dept of Risk Management WC	$0.04
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$0.05

Know your out-of-pocket cost for care.

All Charges