Price Transparency

Know your out-of-pocket cost for care.

All Charges

Charge

Type

Setting

Price

TAMSULOSIN 0.4 MG CAPSULE [103890]

Facility

OP

$0.71

Service Code	NDC 68084-299-11
Hospital Charge Code	1711755
Hospital Revenue Code	259
Min. Negotiated Rate	$0.39
Max. Negotiated Rate	$0.53
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$0.43
Rate for Payer: Aetna of CA Government/Medicare	$0.43
Rate for Payer: Cash Price	$0.32
Rate for Payer: Health Smart Auto/Commercial	$0.43
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$0.43
Rate for Payer: LLUH Dept of Risk Management WC	$0.39
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$0.53

TAMSULOSIN 0.4 MG CAPSULE [103890]

Facility

OP

$0.53

Service Code	NDC 0904-6401-61
Hospital Charge Code	1711755
Hospital Revenue Code	259
Min. Negotiated Rate	$0.29
Max. Negotiated Rate	$0.40
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: Cash Price	$0.24
Rate for Payer: Health Smart Auto/Commercial	$0.32
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$0.32
Rate for Payer: LLUH Dept of Risk Management WC	$0.29
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$0.40

TAMSULOSIN 0.4 MG CAPSULE [103890]

Facility

IP

$0.29

Service Code	NDC 62756-160-88
Hospital Charge Code	1711755
Hospital Revenue Code	259
Min. Negotiated Rate	$0.16
Max. Negotiated Rate	$0.23
Rate for Payer: Cash Price	$0.13
Rate for Payer: Cigna of CA HMO/PPO	$0.23
Rate for Payer: Health Smart Auto/Commercial	$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

OP

$0.71

Service Code	NDC 68084-299-01
Hospital Charge Code	1711755
Hospital Revenue Code	259
Min. Negotiated Rate	$0.39
Max. Negotiated Rate	$0.53
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$0.43
Rate for Payer: Aetna of CA Government/Medicare	$0.43
Rate for Payer: Cash Price	$0.32
Rate for Payer: Health Smart Auto/Commercial	$0.43
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$0.43
Rate for Payer: LLUH Dept of Risk Management WC	$0.39
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$0.53

TAMSULOSIN 0.4 MG CAPSULE [103890]

Facility

IP

$0.53

Service Code	NDC 0904-6401-61
Hospital Charge Code	1711755
Hospital Revenue Code	259
Min. Negotiated Rate	$0.29
Max. Negotiated Rate	$0.42
Rate for Payer: Cash Price	$0.24
Rate for Payer: Cigna of CA HMO/PPO	$0.42
Rate for Payer: Health Smart Auto/Commercial	$0.32
Rate for Payer: LLUH Dept of Risk Management WC	$0.29
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$0.40

TAMSULOSIN 0.4 MG CAPSULE [103890]

Facility

IP

$0.71

Service Code	NDC 68084-299-11
Hospital Charge Code	1711755
Hospital Revenue Code	259
Min. Negotiated Rate	$0.39
Max. Negotiated Rate	$0.57
Rate for Payer: Cash Price	$0.32
Rate for Payer: Cigna of CA HMO/PPO	$0.57
Rate for Payer: Health Smart Auto/Commercial	$0.43
Rate for Payer: LLUH Dept of Risk Management WC	$0.39
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$0.53

TAMSULOSIN 0.4 MG CAPSULE [103890]

Facility

OP

$0.09

Service Code	NDC 65862-598-01
Hospital Charge Code	1711755
Hospital Revenue Code	259
Min. Negotiated Rate	$0.05
Max. Negotiated Rate	$0.07
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$0.05
Rate for Payer: Aetna of CA Government/Medicare	$0.05
Rate for Payer: Cash Price	$0.04
Rate for Payer: Health Smart Auto/Commercial	$0.05
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$0.05
Rate for Payer: LLUH Dept of Risk Management WC	$0.05
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$0.07

TAMSULOSIN 0.4 MG CAPSULE [103890]

Facility

IP

$0.33

Service Code	NDC 68382-132-01
Hospital Charge Code	1711755
Hospital Revenue Code	259
Min. Negotiated Rate	$0.18
Max. Negotiated Rate	$0.26
Rate for Payer: Cash Price	$0.15
Rate for Payer: Cigna of CA HMO/PPO	$0.26
Rate for Payer: Health Smart Auto/Commercial	$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

IP

$0.09

Service Code	NDC 65862-598-01
Hospital Charge Code	1711755
Hospital Revenue Code	259
Min. Negotiated Rate	$0.05
Max. Negotiated Rate	$0.07
Rate for Payer: Cash Price	$0.04
Rate for Payer: Cigna of CA HMO/PPO	$0.07
Rate for Payer: Health Smart Auto/Commercial	$0.05
Rate for Payer: LLUH Dept of Risk Management WC	$0.05
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$0.07

TAMSULOSIN 0.4 MG CAPSULE [103890]

Facility

IP

$0.71

Service Code	NDC 68084-299-01
Hospital Charge Code	1711755
Hospital Revenue Code	259
Min. Negotiated Rate	$0.39
Max. Negotiated Rate	$0.57
Rate for Payer: Cash Price	$0.32
Rate for Payer: Cigna of CA HMO/PPO	$0.57
Rate for Payer: Health Smart Auto/Commercial	$0.43
Rate for Payer: LLUH Dept of Risk Management WC	$0.39
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$0.53

TAPENTADOL 50 MG TABLET [98253]

Facility

IP

$11.56

Service Code	NDC 24510-050-10
Hospital Charge Code	1730175
Hospital Revenue Code	259
Min. Negotiated Rate	$6.36
Max. Negotiated Rate	$9.25
Rate for Payer: Cash Price	$5.20
Rate for Payer: Cigna of CA HMO/PPO	$9.25
Rate for Payer: Health Smart Auto/Commercial	$6.94
Rate for Payer: LLUH Dept of Risk Management WC	$6.36
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$8.67

TAPENTADOL 50 MG TABLET [98253]

Facility

OP

$11.56

Service Code	NDC 24510-050-10
Hospital Charge Code	1730175
Hospital Revenue Code	259
Min. Negotiated Rate	$6.36
Max. Negotiated Rate	$8.67
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$6.94
Rate for Payer: Aetna of CA Government/Medicare	$6.94
Rate for Payer: Cash Price	$5.20
Rate for Payer: Health Smart Auto/Commercial	$6.94
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$6.94
Rate for Payer: LLUH Dept of Risk Management WC	$6.36
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$8.67

TAZEMETOSTAT 200 MG TABLET [226994]

Facility

IP

$88.73

Service Code	NDC 72607-100-00
Hospital Charge Code	ERX226994
Hospital Revenue Code	259
Min. Negotiated Rate	$48.80
Max. Negotiated Rate	$70.98
Rate for Payer: Cash Price	$39.93
Rate for Payer: Cigna of CA HMO/PPO	$70.98
Rate for Payer: Health Smart Auto/Commercial	$53.24
Rate for Payer: LLUH Dept of Risk Management WC	$48.80
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$66.55

TAZEMETOSTAT 200 MG TABLET [226994]

Facility

OP

$88.73

Service Code	NDC 72607-100-00
Hospital Charge Code	ERX226994
Hospital Revenue Code	259
Min. Negotiated Rate	$48.80
Max. Negotiated Rate	$66.55
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$53.24
Rate for Payer: Aetna of CA Government/Medicare	$53.24
Rate for Payer: Cash Price	$39.93
Rate for Payer: Health Smart Auto/Commercial	$53.24
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$53.24
Rate for Payer: LLUH Dept of Risk Management WC	$48.80
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$66.55

TEBENTAFUSP-TEBN 100 MCG/0.5 ML INTRAVENOUS SOLUTION [233477]

Facility

IP

$47,304.00

Service Code	CPT J9274
Hospital Charge Code	NDG233477
Hospital Revenue Code	636
Min. Negotiated Rate	$26,017.20
Max. Negotiated Rate	$37,843.20
Rate for Payer: Cash Price	$21,286.80
Rate for Payer: Cigna of CA HMO/PPO	$37,843.20
Rate for Payer: Health Smart Auto/Commercial	$28,382.40
Rate for Payer: LLUH Dept of Risk Management WC	$26,017.20
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$35,478.00

TEBENTAFUSP-TEBN 100 MCG/0.5 ML INTRAVENOUS SOLUTION [233477]

Facility

OP

$47,304.00

Service Code	CPT J9274
Hospital Charge Code	NDG233477
Hospital Revenue Code	636
Min. Negotiated Rate	$26,017.20
Max. Negotiated Rate	$35,478.00
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$28,382.40
Rate for Payer: Aetna of CA Government/Medicare	$28,382.40
Rate for Payer: Cash Price	$21,286.80
Rate for Payer: Health Smart Auto/Commercial	$28,382.40
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$28,382.40
Rate for Payer: LLUH Dept of Risk Management WC	$26,017.20
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$35,478.00

TECLISTAMAB-CQYV 10 MG/ML SUBCUTANEOUS SOLUTION [236039]

Facility

IP

$708.00

Service Code	CPT J9380
Hospital Charge Code	NDG236039
Hospital Revenue Code	636
Min. Negotiated Rate	$389.40
Max. Negotiated Rate	$566.40
Rate for Payer: Cash Price	$318.60
Rate for Payer: Cigna of CA HMO/PPO	$566.40
Rate for Payer: Health Smart Auto/Commercial	$424.80
Rate for Payer: LLUH Dept of Risk Management WC	$389.40
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$531.00

TECLISTAMAB-CQYV 10 MG/ML SUBCUTANEOUS SOLUTION [236039]

Facility

OP

$708.00

Service Code	CPT J9380
Hospital Charge Code	NDG236039
Hospital Revenue Code	636
Min. Negotiated Rate	$389.40
Max. Negotiated Rate	$531.00
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$424.80
Rate for Payer: Aetna of CA Government/Medicare	$424.80
Rate for Payer: Cash Price	$318.60
Rate for Payer: Health Smart Auto/Commercial	$424.80
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$424.80
Rate for Payer: LLUH Dept of Risk Management WC	$389.40
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$531.00

TECLISTAMAB-CQYV 90 MG/ML SUBCUTANEOUS SOLUTION [236038]

Facility

OP

$6,372.00

Service Code	CPT J9380
Hospital Charge Code	NDG236038
Hospital Revenue Code	636
Min. Negotiated Rate	$3,504.60
Max. Negotiated Rate	$4,779.00
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$3,823.20
Rate for Payer: Aetna of CA Government/Medicare	$3,823.20
Rate for Payer: Cash Price	$2,867.40
Rate for Payer: Health Smart Auto/Commercial	$3,823.20
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$3,823.20
Rate for Payer: LLUH Dept of Risk Management WC	$3,504.60
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$4,779.00

TECLISTAMAB-CQYV 90 MG/ML SUBCUTANEOUS SOLUTION [236038]

Facility

IP

$6,372.00

Service Code	CPT J9380
Hospital Charge Code	NDG236038
Hospital Revenue Code	636
Min. Negotiated Rate	$3,504.60
Max. Negotiated Rate	$5,097.60
Rate for Payer: Cash Price	$2,867.40
Rate for Payer: Cigna of CA HMO/PPO	$5,097.60
Rate for Payer: Health Smart Auto/Commercial	$3,823.20
Rate for Payer: LLUH Dept of Risk Management WC	$3,504.60
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$4,779.00

TEDIZOLID 200 MG INTRAVENOUS SOLUTION [206225]

Facility

OP

$369.29

Service Code	CPT J3090
Hospital Charge Code	ERX206225
Hospital Revenue Code	636
Min. Negotiated Rate	$203.11
Max. Negotiated Rate	$276.97
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$221.57
Rate for Payer: Aetna of CA Government/Medicare	$221.57
Rate for Payer: Cash Price	$166.18
Rate for Payer: Health Smart Auto/Commercial	$221.57
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$221.57
Rate for Payer: LLUH Dept of Risk Management WC	$203.11
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$276.97

TEDIZOLID 200 MG INTRAVENOUS SOLUTION [206225]

Facility

IP

$369.29

Service Code	CPT J3090
Hospital Charge Code	ERX206225
Hospital Revenue Code	636
Min. Negotiated Rate	$203.11
Max. Negotiated Rate	$295.43
Rate for Payer: Cash Price	$166.18
Rate for Payer: Cigna of CA HMO/PPO	$295.43
Rate for Payer: Health Smart Auto/Commercial	$221.57
Rate for Payer: LLUH Dept of Risk Management WC	$203.11
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$276.97

TELMISARTAN 40 MG TABLET [24335]

Facility

IP

$5.61

Service Code	NDC 0597-0040-37
Hospital Charge Code	1710970
Hospital Revenue Code	259
Min. Negotiated Rate	$3.09
Max. Negotiated Rate	$4.49
Rate for Payer: Cash Price	$2.52
Rate for Payer: Cigna of CA HMO/PPO	$4.49
Rate for Payer: Health Smart Auto/Commercial	$3.37
Rate for Payer: LLUH Dept of Risk Management WC	$3.09
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$4.21

TELMISARTAN 40 MG TABLET [24335]

Facility

OP

$5.61

Service Code	NDC 0597-0040-37
Hospital Charge Code	1710970
Hospital Revenue Code	259
Min. Negotiated Rate	$3.09
Max. Negotiated Rate	$4.21
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$3.37
Rate for Payer: Aetna of CA Government/Medicare	$3.37
Rate for Payer: Cash Price	$2.52
Rate for Payer: Health Smart Auto/Commercial	$3.37
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$3.37
Rate for Payer: LLUH Dept of Risk Management WC	$3.09
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$4.21

TELMISARTAN 80 MG TABLET [24336]

Facility

OP

$5.61

Service Code	NDC 0597-0041-37
Hospital Charge Code	1710961
Hospital Revenue Code	259
Min. Negotiated Rate	$3.09
Max. Negotiated Rate	$4.21
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$3.37
Rate for Payer: Aetna of CA Government/Medicare	$3.37
Rate for Payer: Cash Price	$2.52
Rate for Payer: Health Smart Auto/Commercial	$3.37
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$3.37
Rate for Payer: LLUH Dept of Risk Management WC	$3.09
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$4.21

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