Loma Linda University Behavioral Medicine Center (BMC)

All Charges

Charge

Type

Setting

Price

TRIFLUOPERAZINE 10 MG TABLET [8162]

Facility

$3.08

Service Code	NDC 51079-575-01
Hospital Charge Code	1710596
Hospital Revenue Code	259
Min. Negotiated Rate	$1.69
Max. Negotiated Rate	$2.31
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$1.85
Rate for Payer: Aetna of CA Government/Medicare	$1.85
Rate for Payer: Cash Price	$1.39
Rate for Payer: Health Smart Auto/Commercial	$1.85
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$1.85
Rate for Payer: LLUH Dept of Risk Management WC	$1.69
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$2.31

TRIFLUOPERAZINE 1 MG TABLET [8161]

Facility

$1.34

Service Code	NDC 51079-572-20
Hospital Charge Code	1711277
Hospital Revenue Code	259
Min. Negotiated Rate	$0.74
Max. Negotiated Rate	$1.07
Rate for Payer: Cash Price	$0.60
Rate for Payer: Cigna of CA HMO/PPO	$1.07
Rate for Payer: Health Smart Auto/Commercial	$0.80
Rate for Payer: LLUH Dept of Risk Management WC	$0.74
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$1.00

TRIFLUOPERAZINE 1 MG TABLET [8161]

Facility

$1.34

Service Code	NDC 51079-572-20
Hospital Charge Code	1711277
Hospital Revenue Code	259
Min. Negotiated Rate	$0.74
Max. Negotiated Rate	$1.00
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$0.80
Rate for Payer: Aetna of CA Government/Medicare	$0.80
Rate for Payer: Cash Price	$0.60
Rate for Payer: Health Smart Auto/Commercial	$0.80
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$0.80
Rate for Payer: LLUH Dept of Risk Management WC	$0.74
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$1.00

TRIFLUOPERAZINE 2 MG TABLET [8163]

Facility

$2.00

Service Code	NDC 51079-573-01
Hospital Charge Code	1711281
Hospital Revenue Code	259
Min. Negotiated Rate	$1.10
Max. Negotiated Rate	$1.60
Rate for Payer: Cash Price	$0.90
Rate for Payer: Cigna of CA HMO/PPO	$1.60
Rate for Payer: Health Smart Auto/Commercial	$1.20
Rate for Payer: LLUH Dept of Risk Management WC	$1.10
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$1.50

TRIFLUOPERAZINE 2 MG TABLET [8163]

Facility

$2.00

Service Code	NDC 51079-573-01
Hospital Charge Code	1711281
Hospital Revenue Code	259
Min. Negotiated Rate	$1.10
Max. Negotiated Rate	$1.50
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$1.20
Rate for Payer: Aetna of CA Government/Medicare	$1.20
Rate for Payer: Cash Price	$0.90
Rate for Payer: Health Smart Auto/Commercial	$1.20
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$1.20
Rate for Payer: LLUH Dept of Risk Management WC	$1.10
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$1.50

TRIFLUOPERAZINE 5 MG TABLET [8164]

Facility

$2.55

Service Code	NDC 51079-574-20
Hospital Charge Code	1710535
Hospital Revenue Code	259
Min. Negotiated Rate	$1.40
Max. Negotiated Rate	$1.91
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$1.53
Rate for Payer: Aetna of CA Government/Medicare	$1.53
Rate for Payer: Cash Price	$1.15
Rate for Payer: Health Smart Auto/Commercial	$1.53
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$1.53
Rate for Payer: LLUH Dept of Risk Management WC	$1.40
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$1.91

TRIFLUOPERAZINE 5 MG TABLET [8164]

Facility

$2.55

Service Code	NDC 51079-574-20
Hospital Charge Code	1710535
Hospital Revenue Code	259
Min. Negotiated Rate	$1.40
Max. Negotiated Rate	$2.04
Rate for Payer: Cash Price	$1.15
Rate for Payer: Cigna of CA HMO/PPO	$2.04
Rate for Payer: Health Smart Auto/Commercial	$1.53
Rate for Payer: LLUH Dept of Risk Management WC	$1.40
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$1.91

TRIFLURIDINE 1 % EYE DROPS [11595]

Facility

$28.54

Service Code	NDC 61314-044-75
Hospital Charge Code	1740192
Hospital Revenue Code	259
Min. Negotiated Rate	$15.70
Max. Negotiated Rate	$21.40
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$17.12
Rate for Payer: Aetna of CA Government/Medicare	$17.12
Rate for Payer: Cash Price	$12.84
Rate for Payer: Health Smart Auto/Commercial	$17.12
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$17.12
Rate for Payer: LLUH Dept of Risk Management WC	$15.70
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$21.40

TRIFLURIDINE 1 % EYE DROPS [11595]

Facility

$28.54

Service Code	NDC 61314-044-75
Hospital Charge Code	1740192
Hospital Revenue Code	259
Min. Negotiated Rate	$15.70
Max. Negotiated Rate	$22.83
Rate for Payer: Cash Price	$12.84
Rate for Payer: Cigna of CA HMO/PPO	$22.83
Rate for Payer: Health Smart Auto/Commercial	$17.12
Rate for Payer: LLUH Dept of Risk Management WC	$15.70
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$21.40

TRIHEXYPHENIDYL 0.4 MG/ML ORAL ELIXIR [8165]

Facility

$0.10

Service Code	NDC 61748-054-16
Hospital Charge Code	1715924
Hospital Revenue Code	259
Min. Negotiated Rate	$0.06
Max. Negotiated Rate	$0.08
Rate for Payer: Cash Price	$0.05
Rate for Payer: Cigna of CA HMO/PPO	$0.08
Rate for Payer: Health Smart Auto/Commercial	$0.06
Rate for Payer: LLUH Dept of Risk Management WC	$0.06
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$0.08

TRIHEXYPHENIDYL 0.4 MG/ML ORAL ELIXIR [8165]

Facility

$0.10

Service Code	NDC 61748-054-16
Hospital Charge Code	1715924
Hospital Revenue Code	259
Min. Negotiated Rate	$0.06
Max. Negotiated Rate	$0.08
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$0.06
Rate for Payer: Aetna of CA Government/Medicare	$0.06
Rate for Payer: Cash Price	$0.05
Rate for Payer: Health Smart Auto/Commercial	$0.06
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$0.06
Rate for Payer: LLUH Dept of Risk Management WC	$0.06
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$0.08

TRIHEXYPHENIDYL 2 MG TABLET [8166]

Facility

$0.18

Service Code	NDC 0591-5335-01
Hospital Charge Code	1710708
Hospital Revenue Code	259
Min. Negotiated Rate	$0.10
Max. Negotiated Rate	$0.14
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$0.11
Rate for Payer: Aetna of CA Government/Medicare	$0.11
Rate for Payer: Cash Price	$0.08
Rate for Payer: Health Smart Auto/Commercial	$0.11
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$0.11
Rate for Payer: LLUH Dept of Risk Management WC	$0.10
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$0.14

TRIHEXYPHENIDYL 2 MG TABLET [8166]

Facility

$0.18

Service Code	NDC 70954-212-10
Hospital Charge Code	1710708
Hospital Revenue Code	259
Min. Negotiated Rate	$0.10
Max. Negotiated Rate	$0.14
Rate for Payer: Cash Price	$0.08
Rate for Payer: Cigna of CA HMO/PPO	$0.14
Rate for Payer: Health Smart Auto/Commercial	$0.11
Rate for Payer: LLUH Dept of Risk Management WC	$0.10
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$0.14

TRIHEXYPHENIDYL 2 MG TABLET [8166]

Facility

$0.18

Service Code	NDC 0591-5335-01
Hospital Charge Code	1710708
Hospital Revenue Code	259
Min. Negotiated Rate	$0.10
Max. Negotiated Rate	$0.14
Rate for Payer: Cash Price	$0.08
Rate for Payer: Cigna of CA HMO/PPO	$0.14
Rate for Payer: Health Smart Auto/Commercial	$0.11
Rate for Payer: LLUH Dept of Risk Management WC	$0.10
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$0.14

TRIHEXYPHENIDYL 2 MG TABLET [8166]

Facility

$0.18

Service Code	NDC 70954-212-10
Hospital Charge Code	1710708
Hospital Revenue Code	259
Min. Negotiated Rate	$0.10
Max. Negotiated Rate	$0.14
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$0.11
Rate for Payer: Aetna of CA Government/Medicare	$0.11
Rate for Payer: Cash Price	$0.08
Rate for Payer: Health Smart Auto/Commercial	$0.11
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$0.11
Rate for Payer: LLUH Dept of Risk Management WC	$0.10
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$0.14

TRIHEXYPHENIDYL 5 MG TABLET [8167]

Facility

$0.36

Service Code	NDC 0591-5337-01
Hospital Charge Code	1710723
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

TRIHEXYPHENIDYL 5 MG TABLET [8167]

Facility

$0.27

Service Code	NDC 70954-211-10
Hospital Charge Code	1710723
Hospital Revenue Code	259
Min. Negotiated Rate	$0.15
Max. Negotiated Rate	$0.20
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$0.16
Rate for Payer: Aetna of CA Government/Medicare	$0.16
Rate for Payer: Cash Price	$0.12
Rate for Payer: Health Smart Auto/Commercial	$0.16
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$0.16
Rate for Payer: LLUH Dept of Risk Management WC	$0.15
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$0.20

TRIHEXYPHENIDYL 5 MG TABLET [8167]

Facility

$0.36

Service Code	NDC 0591-5337-01
Hospital Charge Code	1710723
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

TRIHEXYPHENIDYL 5 MG TABLET [8167]

Facility

$0.27

Service Code	NDC 70954-211-10
Hospital Charge Code	1710723
Hospital Revenue Code	259
Min. Negotiated Rate	$0.15
Max. Negotiated Rate	$0.22
Rate for Payer: Cash Price	$0.12
Rate for Payer: Cigna of CA HMO/PPO	$0.22
Rate for Payer: Health Smart Auto/Commercial	$0.16
Rate for Payer: LLUH Dept of Risk Management WC	$0.15
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$0.20

TRIMETHOBENZAMIDE 100 MG/ML INTRAMUSCULAR SOLUTION [110953]

Facility

$30.12

Service Code	CPT J3250
Hospital Charge Code	1720380
Hospital Revenue Code	636
Min. Negotiated Rate	$16.57
Max. Negotiated Rate	$24.10
Rate for Payer: Cash Price	$13.55
Rate for Payer: Cigna of CA HMO/PPO	$24.10
Rate for Payer: Health Smart Auto/Commercial	$18.07
Rate for Payer: LLUH Dept of Risk Management WC	$16.57
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$22.59

TRIMETHOBENZAMIDE 100 MG/ML INTRAMUSCULAR SOLUTION [110953]

Facility

$30.12

Service Code	CPT J3250
Hospital Charge Code	1720380
Hospital Revenue Code	636
Min. Negotiated Rate	$16.57
Max. Negotiated Rate	$22.59
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$18.07
Rate for Payer: Aetna of CA Government/Medicare	$18.07
Rate for Payer: Cash Price	$13.55
Rate for Payer: Health Smart Auto/Commercial	$18.07
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$18.07
Rate for Payer: LLUH Dept of Risk Management WC	$16.57
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$22.59

TRIMETHOPRIM 100 MG TABLET [8182]

Facility

$2.24

Service Code	NDC 51862-486-01
Hospital Charge Code	1712507
Hospital Revenue Code	259
Min. Negotiated Rate	$1.23
Max. Negotiated Rate	$1.68
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$1.34
Rate for Payer: Aetna of CA Government/Medicare	$1.34
Rate for Payer: Cash Price	$1.01
Rate for Payer: Health Smart Auto/Commercial	$1.34
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$1.34
Rate for Payer: LLUH Dept of Risk Management WC	$1.23
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$1.68

TRIMETHOPRIM 100 MG TABLET [8182]

Facility

$2.24

Service Code	NDC 51862-486-01
Hospital Charge Code	1712507
Hospital Revenue Code	259
Min. Negotiated Rate	$1.23
Max. Negotiated Rate	$1.79
Rate for Payer: Cash Price	$1.01
Rate for Payer: Cigna of CA HMO/PPO	$1.79
Rate for Payer: Health Smart Auto/Commercial	$1.34
Rate for Payer: LLUH Dept of Risk Management WC	$1.23
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$1.68

TROMETHAMINE 36 MG/ML (0.3 M) INTRAVENOUS SOLUTION [11608]

Facility

$0.78

Service Code	NDC 0409-1593-14
Hospital Charge Code	1758619
Hospital Revenue Code	250
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	$0.35
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

TROMETHAMINE 36 MG/ML (0.3 M) INTRAVENOUS SOLUTION [11608]

Facility

$0.78

Service Code	NDC 0409-1593-14
Hospital Charge Code	1758619
Hospital Revenue Code	250
Min. Negotiated Rate	$0.43
Max. Negotiated Rate	$0.62
Rate for Payer: Cash Price	$0.35
Rate for Payer: Cigna of CA HMO/PPO	$0.62
Rate for Payer: Health Smart Auto/Commercial	$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