Loma Linda University Behavioral Medicine Center (BMC)

All Charges

Charge

Type

Setting

Price

TELMISARTAN 80 MG TABLET [24336]

Facility

$5.61

Service Code	NDC 0597-0041-37
Hospital Charge Code	1710961
Hospital Revenue Code	259
Min. Negotiated Rate	$3.09
Max. Negotiated Rate	$4.49
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

TEMAZEPAM 15 MG CAPSULE [7753]

Facility

$0.11

Service Code	NDC 67877-146-01
Hospital Charge Code	1730140
Hospital Revenue Code	259
Min. Negotiated Rate	$0.06
Max. Negotiated Rate	$0.08
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$0.07
Rate for Payer: Aetna of CA Government/Medicare	$0.07
Rate for Payer: Cash Price	$0.05
Rate for Payer: Health Smart Auto/Commercial	$0.07
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$0.07
Rate for Payer: LLUH Dept of Risk Management WC	$0.06
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$0.08

TEMAZEPAM 15 MG CAPSULE [7753]

Facility

$0.14

Service Code	NDC 65162-556-10
Hospital Charge Code	1730140
Hospital Revenue Code	259
Min. Negotiated Rate	$0.08
Max. Negotiated Rate	$0.11
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$0.08
Rate for Payer: Aetna of CA Government/Medicare	$0.08
Rate for Payer: Cash Price	$0.06
Rate for Payer: Health Smart Auto/Commercial	$0.08
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$0.08
Rate for Payer: LLUH Dept of Risk Management WC	$0.08
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$0.11

TEMAZEPAM 15 MG CAPSULE [7753]

Facility

$0.11

Service Code	NDC 0228-2076-10
Hospital Charge Code	1730140
Hospital Revenue Code	259
Min. Negotiated Rate	$0.06
Max. Negotiated Rate	$0.08
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$0.07
Rate for Payer: Aetna of CA Government/Medicare	$0.07
Rate for Payer: Cash Price	$0.05
Rate for Payer: Health Smart Auto/Commercial	$0.07
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$0.07
Rate for Payer: LLUH Dept of Risk Management WC	$0.06
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$0.08

TEMAZEPAM 15 MG CAPSULE [7753]

Facility

$0.11

Service Code	NDC 67877-146-05
Hospital Charge Code	1730140
Hospital Revenue Code	259
Min. Negotiated Rate	$0.06
Max. Negotiated Rate	$0.08
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$0.07
Rate for Payer: Aetna of CA Government/Medicare	$0.07
Rate for Payer: Cash Price	$0.05
Rate for Payer: Health Smart Auto/Commercial	$0.07
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$0.07
Rate for Payer: LLUH Dept of Risk Management WC	$0.06
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$0.08

TEMAZEPAM 15 MG CAPSULE [7753]

Facility

$0.11

Service Code	NDC 67877-146-01
Hospital Charge Code	1730140
Hospital Revenue Code	259
Min. Negotiated Rate	$0.06
Max. Negotiated Rate	$0.09
Rate for Payer: Cash Price	$0.05
Rate for Payer: Cigna of CA HMO/PPO	$0.09
Rate for Payer: Health Smart Auto/Commercial	$0.07
Rate for Payer: LLUH Dept of Risk Management WC	$0.06
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$0.08

TEMAZEPAM 15 MG CAPSULE [7753]

Facility

$0.11

Service Code	NDC 0228-2076-10
Hospital Charge Code	1730140
Hospital Revenue Code	259
Min. Negotiated Rate	$0.06
Max. Negotiated Rate	$0.09
Rate for Payer: Cash Price	$0.05
Rate for Payer: Cigna of CA HMO/PPO	$0.09
Rate for Payer: Health Smart Auto/Commercial	$0.07
Rate for Payer: LLUH Dept of Risk Management WC	$0.06
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$0.08

TEMAZEPAM 15 MG CAPSULE [7753]

Facility

$0.11

Service Code	NDC 67877-146-05
Hospital Charge Code	1730140
Hospital Revenue Code	259
Min. Negotiated Rate	$0.06
Max. Negotiated Rate	$0.09
Rate for Payer: Cash Price	$0.05
Rate for Payer: Cigna of CA HMO/PPO	$0.09
Rate for Payer: Health Smart Auto/Commercial	$0.07
Rate for Payer: LLUH Dept of Risk Management WC	$0.06
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$0.08

TEMAZEPAM 15 MG CAPSULE [7753]

Facility

$0.14

Service Code	NDC 65162-556-10
Hospital Charge Code	1730140
Hospital Revenue Code	259
Min. Negotiated Rate	$0.08
Max. Negotiated Rate	$0.11
Rate for Payer: Cash Price	$0.06
Rate for Payer: Cigna of CA HMO/PPO	$0.11
Rate for Payer: Health Smart Auto/Commercial	$0.08
Rate for Payer: LLUH Dept of Risk Management WC	$0.08
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$0.11

TEMAZEPAM 30 MG CAPSULE [7754]

Facility

$0.14

Service Code	NDC 0378-5050-01
Hospital Charge Code	1730141
Hospital Revenue Code	259
Min. Negotiated Rate	$0.08
Max. Negotiated Rate	$0.11
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$0.08
Rate for Payer: Aetna of CA Government/Medicare	$0.08
Rate for Payer: Cash Price	$0.06
Rate for Payer: Health Smart Auto/Commercial	$0.08
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$0.08
Rate for Payer: LLUH Dept of Risk Management WC	$0.08
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$0.11

TEMAZEPAM 30 MG CAPSULE [7754]

Facility

$0.14

Service Code	NDC 0378-5050-01
Hospital Charge Code	1730141
Hospital Revenue Code	259
Min. Negotiated Rate	$0.08
Max. Negotiated Rate	$0.11
Rate for Payer: Cash Price	$0.06
Rate for Payer: Cigna of CA HMO/PPO	$0.11
Rate for Payer: Health Smart Auto/Commercial	$0.08
Rate for Payer: LLUH Dept of Risk Management WC	$0.08
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$0.11

TEMAZEPAM 7.5 MG CAPSULE [11500]

Facility

$4.20

Service Code	NDC 0904-6436-04
Hospital Charge Code	1730166
Hospital Revenue Code	259
Min. Negotiated Rate	$2.31
Max. Negotiated Rate	$3.36
Rate for Payer: Cash Price	$1.89
Rate for Payer: Cigna of CA HMO/PPO	$3.36
Rate for Payer: Health Smart Auto/Commercial	$2.52
Rate for Payer: LLUH Dept of Risk Management WC	$2.31
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$3.15

TEMAZEPAM 7.5 MG CAPSULE [11500]

Facility

$4.20

Service Code	NDC 0904-6436-04
Hospital Charge Code	1730166
Hospital Revenue Code	259
Min. Negotiated Rate	$2.31
Max. Negotiated Rate	$3.15
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$2.52
Rate for Payer: Aetna of CA Government/Medicare	$2.52
Rate for Payer: Cash Price	$1.89
Rate for Payer: Health Smart Auto/Commercial	$2.52
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$2.52
Rate for Payer: LLUH Dept of Risk Management WC	$2.31
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$3.15

TEMOZOLOMIDE 100 MG INTRAVENOUS SOLUTION [97260]

Facility

$1,203.73

Service Code	CPT J9328
Hospital Charge Code	1755760
Hospital Revenue Code	636
Min. Negotiated Rate	$662.05
Max. Negotiated Rate	$962.98
Rate for Payer: Cash Price	$541.68
Rate for Payer: Cigna of CA HMO/PPO	$962.98
Rate for Payer: Health Smart Auto/Commercial	$722.24
Rate for Payer: LLUH Dept of Risk Management WC	$662.05
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$902.80

TEMOZOLOMIDE 100 MG INTRAVENOUS SOLUTION [97260]

Facility

$1,203.73

Service Code	CPT J9328
Hospital Charge Code	1755760
Hospital Revenue Code	636
Min. Negotiated Rate	$662.05
Max. Negotiated Rate	$902.80
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$722.24
Rate for Payer: Aetna of CA Government/Medicare	$722.24
Rate for Payer: Cash Price	$541.68
Rate for Payer: Health Smart Auto/Commercial	$722.24
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$722.24
Rate for Payer: LLUH Dept of Risk Management WC	$662.05
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$902.80

TEMOZOLOMIDE ORAL SUSPENSION COMPOUND 10 MG/ML [4080346]

Facility

$26.03

Service Code	CPT J8700
Hospital Charge Code	1715241
Hospital Revenue Code	636
Min. Negotiated Rate	$14.32
Max. Negotiated Rate	$20.82
Rate for Payer: Cash Price	$11.71
Rate for Payer: Cigna of CA HMO/PPO	$20.82
Rate for Payer: Health Smart Auto/Commercial	$15.62
Rate for Payer: LLUH Dept of Risk Management WC	$14.32
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$19.52

TEMOZOLOMIDE ORAL SUSPENSION COMPOUND 10 MG/ML [4080346]

Facility

$26.03

Service Code	CPT J8700
Hospital Charge Code	1715241
Hospital Revenue Code	636
Min. Negotiated Rate	$14.32
Max. Negotiated Rate	$19.52
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$15.62
Rate for Payer: Aetna of CA Government/Medicare	$15.62
Rate for Payer: Cash Price	$11.71
Rate for Payer: Health Smart Auto/Commercial	$15.62
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$15.62
Rate for Payer: LLUH Dept of Risk Management WC	$14.32
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$19.52

TEMSIROLIMUS 30 MG/3 ML (10 MG/ML) (FIRST DILUTION) INTRAVENOUS SOLN [82228]

Facility

$1,547.87

Service Code	CPT J9330
Hospital Charge Code	1720968
Hospital Revenue Code	636
Min. Negotiated Rate	$851.33
Max. Negotiated Rate	$1,238.30
Rate for Payer: Cash Price	$696.54
Rate for Payer: Cigna of CA HMO/PPO	$1,238.30
Rate for Payer: Health Smart Auto/Commercial	$928.72
Rate for Payer: LLUH Dept of Risk Management WC	$851.33
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$1,160.90

TEMSIROLIMUS 30 MG/3 ML (10 MG/ML) (FIRST DILUTION) INTRAVENOUS SOLN [82228]

Facility

$1,547.87

Service Code	CPT J9330
Hospital Charge Code	1720968
Hospital Revenue Code	636
Min. Negotiated Rate	$851.33
Max. Negotiated Rate	$1,160.90
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$928.72
Rate for Payer: Aetna of CA Government/Medicare	$928.72
Rate for Payer: Cash Price	$696.54
Rate for Payer: Health Smart Auto/Commercial	$928.72
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$928.72
Rate for Payer: LLUH Dept of Risk Management WC	$851.33
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$1,160.90

TENECTEPLASE 50 MG INTRAVENOUS SOLUTION [220772]

Facility

$8,853.91

Service Code	CPT J3101
Hospital Charge Code	ERX220772
Hospital Revenue Code	636
Min. Negotiated Rate	$4,869.65
Max. Negotiated Rate	$6,640.43
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$5,312.35
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$4,477.58
Rate for Payer: Aetna of CA Government/Medicare	$4,477.58
Rate for Payer: Aetna of CA Government/Medicare	$5,312.35
Rate for Payer: Cash Price	$3,984.26
Rate for Payer: Cash Price	$3,358.18
Rate for Payer: Health Smart Auto/Commercial	$4,477.58
Rate for Payer: Health Smart Auto/Commercial	$5,312.35
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$4,477.58
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$5,312.35
Rate for Payer: LLUH Dept of Risk Management WC	$4,104.45
Rate for Payer: LLUH Dept of Risk Management WC	$4,869.65
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$5,596.97
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$6,640.43

TENECTEPLASE 50 MG INTRAVENOUS SOLUTION [220772]

Facility

$8,853.91

Service Code	CPT J3101
Hospital Charge Code	ERX220772
Hospital Revenue Code	636
Min. Negotiated Rate	$4,869.65
Max. Negotiated Rate	$7,083.13
Rate for Payer: Cash Price	$3,984.26
Rate for Payer: Cash Price	$3,358.18
Rate for Payer: Cigna of CA HMO/PPO	$5,970.10
Rate for Payer: Cigna of CA HMO/PPO	$7,083.13
Rate for Payer: Health Smart Auto/Commercial	$5,312.35
Rate for Payer: Health Smart Auto/Commercial	$4,477.58
Rate for Payer: LLUH Dept of Risk Management WC	$4,104.45
Rate for Payer: LLUH Dept of Risk Management WC	$4,869.65
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$5,596.97
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$6,640.43

TENOFOVIR ALAFENAMIDE 25 MG TABLET [216415]

Facility

$54.97

Service Code	NDC 61958-2301-1
Hospital Charge Code	ERX216415
Hospital Revenue Code	259
Min. Negotiated Rate	$30.23
Max. Negotiated Rate	$43.98
Rate for Payer: Cash Price	$24.74
Rate for Payer: Cigna of CA HMO/PPO	$43.98
Rate for Payer: Health Smart Auto/Commercial	$32.98
Rate for Payer: LLUH Dept of Risk Management WC	$30.23
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$41.23

TENOFOVIR ALAFENAMIDE 25 MG TABLET [216415]

Facility

$54.97

Service Code	NDC 61958-2301-1
Hospital Charge Code	ERX216415
Hospital Revenue Code	259
Min. Negotiated Rate	$30.23
Max. Negotiated Rate	$41.23
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$32.98
Rate for Payer: Aetna of CA Government/Medicare	$32.98
Rate for Payer: Cash Price	$24.74
Rate for Payer: Health Smart Auto/Commercial	$32.98
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$32.98
Rate for Payer: LLUH Dept of Risk Management WC	$30.23
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$41.23

TENOFOVIR DISOPROXIL FUMARATE 300 MG TABLET [31684]

Facility

$4.21

Service Code	NDC 50268-758-11
Hospital Charge Code	1710955
Hospital Revenue Code	259
Min. Negotiated Rate	$2.32
Max. Negotiated Rate	$3.37
Rate for Payer: Cash Price	$1.89
Rate for Payer: Cigna of CA HMO/PPO	$3.37
Rate for Payer: Health Smart Auto/Commercial	$2.53
Rate for Payer: LLUH Dept of Risk Management WC	$2.32
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$3.16

TENOFOVIR DISOPROXIL FUMARATE 300 MG TABLET [31684]

Facility

$4.21

Service Code	NDC 50268-758-11
Hospital Charge Code	1710955
Hospital Revenue Code	259
Min. Negotiated Rate	$2.32
Max. Negotiated Rate	$3.16
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$2.53
Rate for Payer: Aetna of CA Government/Medicare	$2.53
Rate for Payer: Cash Price	$1.89
Rate for Payer: Health Smart Auto/Commercial	$2.53
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$2.53
Rate for Payer: LLUH Dept of Risk Management WC	$2.32
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$3.16

Know your out-of-pocket cost for care.

All Charges