Loma Linda University Behavioral Medicine Center (BMC)

All Charges

Charge

Type

Setting

Price

TRANEXAMIC ACID 1,000 MG/10 ML (100 MG/ML) INTRAVENOUS SOLUTION [191168]

Facility

$0.66

Service Code	NDC 81284-611-10
Hospital Charge Code	1721084
Hospital Revenue Code	250
Min. Negotiated Rate	$0.36
Max. Negotiated Rate	$0.50
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$0.40
Rate for Payer: Aetna of CA Government/Medicare	$0.40
Rate for Payer: Cash Price	$0.30
Rate for Payer: Health Smart Auto/Commercial	$0.40
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$0.40
Rate for Payer: LLUH Dept of Risk Management WC	$0.36
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$0.50

TRANEXAMIC ACID 1,000 MG/10 ML (100 MG/ML) INTRAVENOUS SOLUTION [191168]

Facility

$0.66

Service Code	NDC 81284-611-00
Hospital Charge Code	1721084
Hospital Revenue Code	250
Min. Negotiated Rate	$0.36
Max. Negotiated Rate	$0.50
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$0.40
Rate for Payer: Aetna of CA Government/Medicare	$0.40
Rate for Payer: Cash Price	$0.30
Rate for Payer: Health Smart Auto/Commercial	$0.40
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$0.40
Rate for Payer: LLUH Dept of Risk Management WC	$0.36
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$0.50

TRANEXAMIC ACID 1,000 MG/10 ML (100 MG/ML) INTRAVENOUS SOLUTION [191168]

Facility

$1.44

Service Code	NDC 23155-166-41
Hospital Charge Code	1721084
Hospital Revenue Code	250
Min. Negotiated Rate	$0.79
Max. Negotiated Rate	$1.15
Rate for Payer: Cash Price	$0.65
Rate for Payer: Cigna of CA HMO/PPO	$1.15
Rate for Payer: Health Smart Auto/Commercial	$0.86
Rate for Payer: LLUH Dept of Risk Management WC	$0.79
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$1.08

TRANEXAMIC ACID 1,000 MG/10 ML (100 MG/ML) INTRAVENOUS SOLUTION [191168]

Facility

$0.72

Service Code	NDC 55150-188-10
Hospital Charge Code	1721084
Hospital Revenue Code	250
Min. Negotiated Rate	$0.40
Max. Negotiated Rate	$0.58
Rate for Payer: Cash Price	$0.32
Rate for Payer: Cigna of CA HMO/PPO	$0.58
Rate for Payer: Health Smart Auto/Commercial	$0.43
Rate for Payer: LLUH Dept of Risk Management WC	$0.40
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$0.54

TRANEXAMIC ACID 1,000 MG/10 ML (100 MG/ML) INTRAVENOUS SOLUTION [191168]

Facility

$0.87

Service Code	NDC 70860-407-10
Hospital Charge Code	1721084
Hospital Revenue Code	250
Min. Negotiated Rate	$0.48
Max. Negotiated Rate	$0.65
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$0.52
Rate for Payer: Aetna of CA Government/Medicare	$0.52
Rate for Payer: Cash Price	$0.39
Rate for Payer: Health Smart Auto/Commercial	$0.52
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$0.52
Rate for Payer: LLUH Dept of Risk Management WC	$0.48
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$0.65

TRANEXAMIC ACID 1,000 MG/10 ML (100 MG/ML) INTRAVENOUS SOLUTION [191168]

Facility

$0.72

Service Code	NDC 55150-188-10
Hospital Charge Code	1721084
Hospital Revenue Code	250
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

TRANEXAMIC ACID 1,000 MG/10 ML (100 MG/ML) INTRAVENOUS SOLUTION [191168]

Facility

$1.44

Service Code	NDC 23155-166-41
Hospital Charge Code	1721084
Hospital Revenue Code	250
Min. Negotiated Rate	$0.79
Max. Negotiated Rate	$1.08
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$0.86
Rate for Payer: Aetna of CA Government/Medicare	$0.86
Rate for Payer: Cash Price	$0.65
Rate for Payer: Health Smart Auto/Commercial	$0.86
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$0.86
Rate for Payer: LLUH Dept of Risk Management WC	$0.79
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$1.08

TRANEXAMIC ACID 1,000 MG/10 ML (100 MG/ML) INTRAVENOUS SOLUTION [191168]

Facility

$0.66

Service Code	NDC 81284-611-10
Hospital Charge Code	1721084
Hospital Revenue Code	250
Min. Negotiated Rate	$0.36
Max. Negotiated Rate	$0.53
Rate for Payer: Cash Price	$0.30
Rate for Payer: Cigna of CA HMO/PPO	$0.53
Rate for Payer: Health Smart Auto/Commercial	$0.40
Rate for Payer: LLUH Dept of Risk Management WC	$0.36
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$0.50

TRANEXAMIC ACID 1,000 MG/10 ML (100 MG/ML) INTRAVENOUS SOLUTION [191168]

Facility

$0.87

Service Code	NDC 70860-400-41
Hospital Charge Code	1721084
Hospital Revenue Code	250
Min. Negotiated Rate	$0.48
Max. Negotiated Rate	$0.70
Rate for Payer: Cash Price	$0.39
Rate for Payer: Cigna of CA HMO/PPO	$0.70
Rate for Payer: Health Smart Auto/Commercial	$0.52
Rate for Payer: LLUH Dept of Risk Management WC	$0.48
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$0.65

TRANEXAMIC ACID 1,000 MG/10 ML (100 MG/ML) INTRAVENOUS SOLUTION [191168]

Facility

$0.87

Service Code	NDC 70860-400-41
Hospital Charge Code	1721084
Hospital Revenue Code	250
Min. Negotiated Rate	$0.48
Max. Negotiated Rate	$0.65
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$0.52
Rate for Payer: Aetna of CA Government/Medicare	$0.52
Rate for Payer: Cash Price	$0.39
Rate for Payer: Health Smart Auto/Commercial	$0.52
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$0.52
Rate for Payer: LLUH Dept of Risk Management WC	$0.48
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$0.65

TRANEXAMIC ACID 1,000 MG/10 ML (100 MG/ML) INTRAVENOUS SOLUTION [191168]

Facility

$0.66

Service Code	NDC 81284-611-00
Hospital Charge Code	1721084
Hospital Revenue Code	250
Min. Negotiated Rate	$0.36
Max. Negotiated Rate	$0.53
Rate for Payer: Cash Price	$0.30
Rate for Payer: Cigna of CA HMO/PPO	$0.53
Rate for Payer: Health Smart Auto/Commercial	$0.40
Rate for Payer: LLUH Dept of Risk Management WC	$0.36
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$0.50

TRANEXAMIC ACID 650 MG TABLET [104576]

Facility

$5.01

Service Code	NDC 0591-3720-30
Hospital Charge Code	ERX104576
Hospital Revenue Code	259
Min. Negotiated Rate	$2.76
Max. Negotiated Rate	$4.01
Rate for Payer: Cash Price	$2.25
Rate for Payer: Cigna of CA HMO/PPO	$4.01
Rate for Payer: Health Smart Auto/Commercial	$3.01
Rate for Payer: LLUH Dept of Risk Management WC	$2.76
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$3.76

TRANEXAMIC ACID 650 MG TABLET [104576]

Facility

$5.01

Service Code	NDC 0591-3720-30
Hospital Charge Code	ERX104576
Hospital Revenue Code	259
Min. Negotiated Rate	$2.76
Max. Negotiated Rate	$3.76
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$3.01
Rate for Payer: Aetna of CA Government/Medicare	$3.01
Rate for Payer: Cash Price	$2.25
Rate for Payer: Health Smart Auto/Commercial	$3.01
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$3.01
Rate for Payer: LLUH Dept of Risk Management WC	$2.76
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$3.76

TRANEXAMIC ACID 650 MG TABLET [104576]

Facility

$5.21

Service Code	NDC 69918-301-30
Hospital Charge Code	ERX104576
Hospital Revenue Code	259
Min. Negotiated Rate	$2.87
Max. Negotiated Rate	$3.91
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$3.13
Rate for Payer: Aetna of CA Government/Medicare	$3.13
Rate for Payer: Cash Price	$2.34
Rate for Payer: Health Smart Auto/Commercial	$3.13
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$3.13
Rate for Payer: LLUH Dept of Risk Management WC	$2.87
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$3.91

TRANEXAMIC ACID 650 MG TABLET [104576]

Facility

$3.20

Service Code	NDC 62559-265-30
Hospital Charge Code	ERX104576
Hospital Revenue Code	259
Min. Negotiated Rate	$1.76
Max. Negotiated Rate	$2.40
Rate for Payer: Cash Price	$1.44
Rate for Payer: Health Smart Auto/Commercial	$1.92
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$1.92
Rate for Payer: Aetna of CA Government/Medicare	$1.92
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$1.92
Rate for Payer: LLUH Dept of Risk Management WC	$1.76
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$2.40

TRANEXAMIC ACID 650 MG TABLET [104576]

Facility

$5.21

Service Code	NDC 69918-301-30
Hospital Charge Code	ERX104576
Hospital Revenue Code	259
Min. Negotiated Rate	$2.87
Max. Negotiated Rate	$4.17
Rate for Payer: Cash Price	$2.34
Rate for Payer: Cigna of CA HMO/PPO	$4.17
Rate for Payer: Health Smart Auto/Commercial	$3.13
Rate for Payer: LLUH Dept of Risk Management WC	$2.87
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$3.91

TRANEXAMIC ACID 650 MG TABLET [104576]

Facility

$3.20

Service Code	NDC 62559-265-30
Hospital Charge Code	ERX104576
Hospital Revenue Code	259
Min. Negotiated Rate	$1.76
Max. Negotiated Rate	$2.56
Rate for Payer: Cash Price	$1.44
Rate for Payer: Cigna of CA HMO/PPO	$2.56
Rate for Payer: Health Smart Auto/Commercial	$1.92
Rate for Payer: LLUH Dept of Risk Management WC	$1.76
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$2.40

TRANEXAMIC ACID ORAL SOLUTION (IV FORM) 5% (50 MG/ML) [40820838]

Facility

$0.96

Service Code	NDC 9940-8208-38
Hospital Charge Code	NDG40820838
Hospital Revenue Code	259
Min. Negotiated Rate	$0.53
Max. Negotiated Rate	$0.77
Rate for Payer: Cash Price	$0.43
Rate for Payer: Cigna of CA HMO/PPO	$0.77
Rate for Payer: Health Smart Auto/Commercial	$0.58
Rate for Payer: LLUH Dept of Risk Management WC	$0.53
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$0.72

TRANEXAMIC ACID ORAL SOLUTION (IV FORM) 5% (50 MG/ML) [40820838]

Facility

$0.96

Service Code	NDC 9940-8208-38
Hospital Charge Code	NDG40820838
Hospital Revenue Code	259
Min. Negotiated Rate	$0.53
Max. Negotiated Rate	$0.72
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$0.58
Rate for Payer: Aetna of CA Government/Medicare	$0.58
Rate for Payer: Cash Price	$0.43
Rate for Payer: Health Smart Auto/Commercial	$0.58
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$0.58
Rate for Payer: LLUH Dept of Risk Management WC	$0.53
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$0.72

TRASTUZUMAB 150 MG INTRAVENOUS SOLUTION [216113]

Facility

$1,870.10

Service Code	CPT J9355
Hospital Charge Code	ERX216113
Hospital Revenue Code	636
Min. Negotiated Rate	$1,028.56
Max. Negotiated Rate	$1,496.08
Rate for Payer: Cash Price	$841.55
Rate for Payer: Cigna of CA HMO/PPO	$1,496.08
Rate for Payer: Health Smart Auto/Commercial	$1,122.06
Rate for Payer: LLUH Dept of Risk Management WC	$1,028.56
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$1,402.58

TRASTUZUMAB 150 MG INTRAVENOUS SOLUTION [216113]

Facility

$1,870.10

Service Code	CPT J9355
Hospital Charge Code	ERX216113
Hospital Revenue Code	636
Min. Negotiated Rate	$1,028.56
Max. Negotiated Rate	$1,402.58
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$1,122.06
Rate for Payer: Aetna of CA Government/Medicare	$1,122.06
Rate for Payer: Cash Price	$841.55
Rate for Payer: Health Smart Auto/Commercial	$1,122.06
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$1,122.06
Rate for Payer: LLUH Dept of Risk Management WC	$1,028.56
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$1,402.58

TRASTUZUMAB 600 MG-HYALURONIDASE-OYSK 10,000 UNIT/5 ML SUBCUT SOLUTION [224561]

Facility

$1,122.06

Service Code	CPT J9356
Hospital Revenue Code	636
Min. Negotiated Rate	$617.13
Max. Negotiated Rate	$841.54
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$673.24
Rate for Payer: Aetna of CA Government/Medicare	$673.24
Rate for Payer: Cash Price	$504.93
Rate for Payer: Health Smart Auto/Commercial	$673.24
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$673.24
Rate for Payer: LLUH Dept of Risk Management WC	$617.13
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$841.54

TRASTUZUMAB 600 MG-HYALURONIDASE-OYSK 10,000 UNIT/5 ML SUBCUT SOLUTION [224561]

Facility

$1,122.06

Service Code	CPT J9356
Hospital Revenue Code	636
Min. Negotiated Rate	$617.13
Max. Negotiated Rate	$897.65
Rate for Payer: Cash Price	$504.93
Rate for Payer: Cigna of CA HMO/PPO	$897.65
Rate for Payer: Health Smart Auto/Commercial	$673.24
Rate for Payer: LLUH Dept of Risk Management WC	$617.13
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$841.54

TRASTUZUMAB-ANNS 150 MG INTRAVENOUS SOLUTION [226189]

Facility

$1,632.08

Service Code	NDC 55513-141-01
Hospital Charge Code	ERX226189
Hospital Revenue Code	636
Min. Negotiated Rate	$897.64
Max. Negotiated Rate	$1,305.66
Rate for Payer: Cash Price	$734.44
Rate for Payer: Cigna of CA HMO/PPO	$1,305.66
Rate for Payer: Health Smart Auto/Commercial	$979.25
Rate for Payer: LLUH Dept of Risk Management WC	$897.64
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$1,224.06

TRASTUZUMAB-ANNS 150 MG INTRAVENOUS SOLUTION [226189]

Facility

$1,632.08

Service Code	NDC 55513-141-01
Hospital Charge Code	ERX226189
Hospital Revenue Code	636
Min. Negotiated Rate	$897.64
Max. Negotiated Rate	$1,224.06
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$979.25
Rate for Payer: Aetna of CA Government/Medicare	$979.25
Rate for Payer: Cash Price	$734.44
Rate for Payer: Health Smart Auto/Commercial	$979.25
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$979.25
Rate for Payer: LLUH Dept of Risk Management WC	$897.64
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$1,224.06

Know your out-of-pocket cost for care.

All Charges