Loma Linda University Behavioral Medicine Center (BMC)

All Charges

Charge

Type

Setting

Price

TIMOLOL MALEATE 0.25 % EYE DROPS [11561]

Facility

$0.72

Service Code	NDC 60758-802-05
Hospital Charge Code	1740182
Hospital Revenue Code	259
Min. Negotiated Rate	$0.40
Max. Negotiated Rate	$0.54
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	$0.40
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$0.54

TIMOLOL MALEATE 0.5 % EYE DROPS [11562]

Facility

$2.33

Service Code	NDC 64980-514-05
Hospital Charge Code	1740181
Hospital Revenue Code	259
Min. Negotiated Rate	$1.28
Max. Negotiated Rate	$1.75
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$1.40
Rate for Payer: Aetna of CA Government/Medicare	$1.40
Rate for Payer: Cash Price	$1.05
Rate for Payer: Health Smart Auto/Commercial	$1.40
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$1.40
Rate for Payer: LLUH Dept of Risk Management WC	$1.28
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$1.75

TIMOLOL MALEATE 0.5 % EYE DROPS [11562]

Facility

$2.32

Service Code	NDC 61314-227-05
Hospital Charge Code	1740181
Hospital Revenue Code	259
Min. Negotiated Rate	$1.28
Max. Negotiated Rate	$1.74
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$1.39
Rate for Payer: Aetna of CA Government/Medicare	$1.39
Rate for Payer: Cash Price	$1.04
Rate for Payer: Health Smart Auto/Commercial	$1.39
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$1.39
Rate for Payer: LLUH Dept of Risk Management WC	$1.28
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$1.74

TIMOLOL MALEATE 0.5 % EYE DROPS [11562]

Facility

$2.33

Service Code	NDC 64980-514-05
Hospital Charge Code	1740181
Hospital Revenue Code	259
Min. Negotiated Rate	$1.28
Max. Negotiated Rate	$1.86
Rate for Payer: Cash Price	$1.05
Rate for Payer: Cigna of CA HMO/PPO	$1.86
Rate for Payer: Health Smart Auto/Commercial	$1.40
Rate for Payer: LLUH Dept of Risk Management WC	$1.28
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$1.75

TIMOLOL MALEATE 0.5 % EYE DROPS [11562]

Facility

$2.32

Service Code	NDC 61314-227-05
Hospital Charge Code	1740181
Hospital Revenue Code	259
Min. Negotiated Rate	$1.28
Max. Negotiated Rate	$1.86
Rate for Payer: Cash Price	$1.04
Rate for Payer: Cigna of CA HMO/PPO	$1.86
Rate for Payer: Health Smart Auto/Commercial	$1.39
Rate for Payer: LLUH Dept of Risk Management WC	$1.28
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$1.74

TIMOLOL MALEATE 0.5 % EYE DROPS [11562]

Facility

$1.31

Service Code	NDC 60758-801-05
Hospital Charge Code	1740181
Hospital Revenue Code	259
Min. Negotiated Rate	$0.72
Max. Negotiated Rate	$0.98
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$0.79
Rate for Payer: Aetna of CA Government/Medicare	$0.79
Rate for Payer: Cash Price	$0.59
Rate for Payer: Health Smart Auto/Commercial	$0.79
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$0.79
Rate for Payer: LLUH Dept of Risk Management WC	$0.72
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$0.98

TIMOLOL MALEATE 0.5 % EYE DROPS [11562]

Facility

$1.31

Service Code	NDC 60758-801-05
Hospital Charge Code	1740181
Hospital Revenue Code	259
Min. Negotiated Rate	$0.72
Max. Negotiated Rate	$1.05
Rate for Payer: Cash Price	$0.59
Rate for Payer: Cigna of CA HMO/PPO	$1.05
Rate for Payer: Health Smart Auto/Commercial	$0.79
Rate for Payer: LLUH Dept of Risk Management WC	$0.72
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$0.98

TIOTROPIUM BROMIDE 18 MCG CAPSULE WITH INHALATION DEVICE [38315]

Facility

$24.34

Service Code	NDC 0597-0075-75
Hospital Charge Code	1744109
Hospital Revenue Code	259
Min. Negotiated Rate	$13.39
Max. Negotiated Rate	$19.47
Rate for Payer: Cash Price	$10.95
Rate for Payer: Cigna of CA HMO/PPO	$19.47
Rate for Payer: Health Smart Auto/Commercial	$14.60
Rate for Payer: LLUH Dept of Risk Management WC	$13.39
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$18.26

TIOTROPIUM BROMIDE 18 MCG CAPSULE WITH INHALATION DEVICE [38315]

Facility

$24.34

Service Code	NDC 0597-0075-75
Hospital Charge Code	1744109
Hospital Revenue Code	259
Min. Negotiated Rate	$13.39
Max. Negotiated Rate	$18.26
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$14.60
Rate for Payer: Aetna of CA Government/Medicare	$14.60
Rate for Payer: Cash Price	$10.95
Rate for Payer: Health Smart Auto/Commercial	$14.60
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$14.60
Rate for Payer: LLUH Dept of Risk Management WC	$13.39
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$18.26

TIOTROPIUM BROMIDE 2.5 MCG/ACTUATION MIST FOR INHALATION [207738]

Facility

$22.50

Service Code	NDC 0597-0100-51
Hospital Charge Code	ERX207738
Hospital Revenue Code	259
Min. Negotiated Rate	$12.38
Max. Negotiated Rate	$16.88
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$13.50
Rate for Payer: Aetna of CA Government/Medicare	$13.50
Rate for Payer: Cash Price	$10.13
Rate for Payer: Health Smart Auto/Commercial	$13.50
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$13.50
Rate for Payer: LLUH Dept of Risk Management WC	$12.38
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$16.88

TIOTROPIUM BROMIDE 2.5 MCG/ACTUATION MIST FOR INHALATION [207738]

Facility

$22.50

Service Code	NDC 0597-0100-51
Hospital Charge Code	ERX207738
Hospital Revenue Code	259
Min. Negotiated Rate	$12.38
Max. Negotiated Rate	$18.00
Rate for Payer: Cash Price	$10.13
Rate for Payer: Cigna of CA HMO/PPO	$18.00
Rate for Payer: Health Smart Auto/Commercial	$13.50
Rate for Payer: LLUH Dept of Risk Management WC	$12.38
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$16.88

TIROFIBAN 12.5 MG/250 ML (50 MCG/ML)-0.9 % SODIUM CHLORIDE INTRAVENOUS [120194]

Facility

$1.15

Service Code	CPT J3246
Hospital Charge Code	NDG120194
Hospital Revenue Code	636
Min. Negotiated Rate	$0.63
Max. Negotiated Rate	$0.92
Rate for Payer: Cash Price	$0.52
Rate for Payer: Cigna of CA HMO/PPO	$0.92
Rate for Payer: Health Smart Auto/Commercial	$0.69
Rate for Payer: LLUH Dept of Risk Management WC	$0.63
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$0.86

TIROFIBAN 12.5 MG/250 ML (50 MCG/ML)-0.9 % SODIUM CHLORIDE INTRAVENOUS [120194]

Facility

$1.15

Service Code	CPT J3246
Hospital Charge Code	NDG120194
Hospital Revenue Code	636
Min. Negotiated Rate	$0.63
Max. Negotiated Rate	$0.86
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$0.69
Rate for Payer: Aetna of CA Government/Medicare	$0.69
Rate for Payer: Cash Price	$0.52
Rate for Payer: Health Smart Auto/Commercial	$0.69
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$0.69
Rate for Payer: LLUH Dept of Risk Management WC	$0.63
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$0.86

TIROFIBAN 5 MG/100 ML (50 MCG/ML)-0.9 % SODIUM CHLORIDE INTRAVENOUS [23050]

Facility

$1.10

Service Code	CPT J3246
Hospital Charge Code	NDG23050
Hospital Revenue Code	636
Min. Negotiated Rate	$0.61
Max. Negotiated Rate	$0.88
Rate for Payer: Cash Price	$0.50
Rate for Payer: Cigna of CA HMO/PPO	$0.88
Rate for Payer: Health Smart Auto/Commercial	$0.66
Rate for Payer: LLUH Dept of Risk Management WC	$0.61
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$0.83

TIROFIBAN 5 MG/100 ML (50 MCG/ML)-0.9 % SODIUM CHLORIDE INTRAVENOUS [23050]

Facility

$1.10

Service Code	CPT J3246
Hospital Charge Code	NDG23050
Hospital Revenue Code	636
Min. Negotiated Rate	$0.61
Max. Negotiated Rate	$0.83
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$0.66
Rate for Payer: Aetna of CA Government/Medicare	$0.66
Rate for Payer: Cash Price	$0.50
Rate for Payer: Health Smart Auto/Commercial	$0.66
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$0.66
Rate for Payer: LLUH Dept of Risk Management WC	$0.61
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$0.83

TISOTUMAB VEDOTIN-TFTV 40 MG INTRAVENOUS SOLUTION [232793]

Facility

$7,622.40

Service Code	NDC 51144-003-01
Hospital Charge Code	ERX232793
Hospital Revenue Code	636
Min. Negotiated Rate	$4,192.32
Max. Negotiated Rate	$5,716.80
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$4,573.44
Rate for Payer: Aetna of CA Government/Medicare	$4,573.44
Rate for Payer: Cash Price	$3,430.08
Rate for Payer: Health Smart Auto/Commercial	$4,573.44
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$4,573.44
Rate for Payer: LLUH Dept of Risk Management WC	$4,192.32
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$5,716.80

TISOTUMAB VEDOTIN-TFTV 40 MG INTRAVENOUS SOLUTION [232793]

Facility

$7,622.40

Service Code	NDC 51144-003-01
Hospital Charge Code	ERX232793
Hospital Revenue Code	636
Min. Negotiated Rate	$4,192.32
Max. Negotiated Rate	$6,097.92
Rate for Payer: Cash Price	$3,430.08
Rate for Payer: Cigna of CA HMO/PPO	$6,097.92
Rate for Payer: Health Smart Auto/Commercial	$4,573.44
Rate for Payer: LLUH Dept of Risk Management WC	$4,192.32
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$5,716.80

TIZANIDINE 2 MG TABLET [14792]

Facility

$1.29

Service Code	NDC 68084-775-25
Hospital Charge Code	1712365
Hospital Revenue Code	259
Min. Negotiated Rate	$0.71
Max. Negotiated Rate	$0.97
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$0.77
Rate for Payer: Aetna of CA Government/Medicare	$0.77
Rate for Payer: Cash Price	$0.58
Rate for Payer: Health Smart Auto/Commercial	$0.77
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$0.77
Rate for Payer: LLUH Dept of Risk Management WC	$0.71
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$0.97

TIZANIDINE 2 MG TABLET [14792]

Facility

$1.29

Service Code	NDC 68084-775-95
Hospital Charge Code	1712365
Hospital Revenue Code	259
Min. Negotiated Rate	$0.71
Max. Negotiated Rate	$0.97
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$0.77
Rate for Payer: Aetna of CA Government/Medicare	$0.77
Rate for Payer: Cash Price	$0.58
Rate for Payer: Health Smart Auto/Commercial	$0.77
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$0.77
Rate for Payer: LLUH Dept of Risk Management WC	$0.71
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$0.97

TIZANIDINE 2 MG TABLET [14792]

Facility

$0.20

Service Code	NDC 60505-0251-3
Hospital Charge Code	1712365
Hospital Revenue Code	259
Min. Negotiated Rate	$0.11
Max. Negotiated Rate	$0.16
Rate for Payer: Cash Price	$0.09
Rate for Payer: Cigna of CA 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 Beech St/Commercial/PHCS	$0.15

TIZANIDINE 2 MG TABLET [14792]

Facility

$1.29

Service Code	NDC 68084-775-95
Hospital Charge Code	1712365
Hospital Revenue Code	259
Min. Negotiated Rate	$0.71
Max. Negotiated Rate	$1.03
Rate for Payer: Cash Price	$0.58
Rate for Payer: Cigna of CA HMO/PPO	$1.03
Rate for Payer: Health Smart Auto/Commercial	$0.77
Rate for Payer: LLUH Dept of Risk Management WC	$0.71
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$0.97

TIZANIDINE 2 MG TABLET [14792]

Facility

$0.20

Service Code	NDC 60505-0251-3
Hospital Charge Code	1712365
Hospital Revenue Code	259
Min. Negotiated Rate	$0.11
Max. Negotiated Rate	$0.15
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	$0.09
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 Beech St/Commercial/PHCS	$0.15

TIZANIDINE 2 MG TABLET [14792]

Facility

$1.29

Service Code	NDC 68084-775-25
Hospital Charge Code	1712365
Hospital Revenue Code	259
Min. Negotiated Rate	$0.71
Max. Negotiated Rate	$1.03
Rate for Payer: Cash Price	$0.58
Rate for Payer: Cigna of CA HMO/PPO	$1.03
Rate for Payer: Health Smart Auto/Commercial	$0.77
Rate for Payer: LLUH Dept of Risk Management WC	$0.71
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$0.97

TIZANIDINE 4 MG TABLET [14793]

Facility

$0.12

Service Code	NDC 55111-180-15
Hospital Charge Code	1710900
Hospital Revenue Code	259
Min. Negotiated Rate	$0.07
Max. Negotiated Rate	$0.10
Rate for Payer: Cash Price	$0.05
Rate for Payer: Cigna of CA HMO/PPO	$0.10
Rate for Payer: Health Smart Auto/Commercial	$0.07
Rate for Payer: LLUH Dept of Risk Management WC	$0.07
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$0.09

TIZANIDINE 4 MG TABLET [14793]

Facility

$0.79

Service Code	NDC 50268-760-11
Hospital Charge Code	1710900
Hospital Revenue Code	259
Min. Negotiated Rate	$0.43
Max. Negotiated Rate	$0.59
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$0.47
Rate for Payer: Aetna of CA Government/Medicare	$0.47
Rate for Payer: Cash Price	$0.36
Rate for Payer: Health Smart Auto/Commercial	$0.47
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$0.47
Rate for Payer: LLUH Dept of Risk Management WC	$0.43
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$0.59

Know your out-of-pocket cost for care.

All Charges