Price Transparency

Know your out-of-pocket cost for care.

All Charges

Charge

Type

Setting

Price

ALBUTEROL SULFATE 2.5 MG/3 ML (0.083 %) SOLUTION FOR NEBULIZATION [250]

Facility

OP

$0.12

Service Code	NDC 76204-200-60
Hospital Charge Code	901700029
Hospital Revenue Code	259
Min. Negotiated Rate	$0.07
Max. Negotiated Rate	$0.10
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	$0.06
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$0.10
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	$0.07
Rate for Payer: Multiplan Commercial	$0.09

ALBUTEROL SULFATE 2.5 MG/3 ML (0.083 %) SOLUTION FOR NEBULIZATION [250]

Facility

IP

$0.10

Service Code	NDC 0487-9501-03
Hospital Charge Code	901700029
Hospital Revenue Code	259
Min. Negotiated Rate	$0.06
Max. Negotiated Rate	$0.08
Rate for Payer: Cash Price	$0.06
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO 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 Commercial	$0.08

ALBUTEROL SULFATE 2.5 MG/3 ML (0.083 %) SOLUTION FOR NEBULIZATION [250]

Facility

IP

$0.10

Service Code	NDC 0487-9501-25
Hospital Charge Code	901700029
Hospital Revenue Code	259
Min. Negotiated Rate	$0.06
Max. Negotiated Rate	$0.08
Rate for Payer: Cash Price	$0.06
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO 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 Commercial	$0.08

ALBUTEROL SULFATE 2 MG TABLET [253]

Facility

IP

$7.47

Service Code	NDC 68084-949-95
Hospital Charge Code	901700029
Hospital Revenue Code	259
Min. Negotiated Rate	$4.11
Max. Negotiated Rate	$5.98
Rate for Payer: Cash Price	$4.11
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$5.98
Rate for Payer: Health Smart Auto/Commercial	$4.48
Rate for Payer: LLUH Dept of Risk Management WC	$4.11
Rate for Payer: Multiplan Commercial	$5.60

ALBUTEROL SULFATE 2 MG TABLET [253]

Facility

OP

$7.47

Service Code	NDC 68084-949-95
Hospital Charge Code	901700029
Hospital Revenue Code	259
Min. Negotiated Rate	$4.11
Max. Negotiated Rate	$5.98
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$4.48
Rate for Payer: Aetna of CA Government/Medicare	$4.48
Rate for Payer: Cash Price	$4.11
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$5.98
Rate for Payer: Health Smart Auto/Commercial	$4.48
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$4.48
Rate for Payer: LLUH Dept of Risk Management WC	$4.11
Rate for Payer: Multiplan Commercial	$5.60

ALBUTEROL SULFATE 2 MG TABLET [253]

Facility

IP

$7.47

Service Code	NDC 68084-949-25
Hospital Charge Code	901700029
Hospital Revenue Code	259
Min. Negotiated Rate	$4.11
Max. Negotiated Rate	$5.98
Rate for Payer: Cash Price	$4.11
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$5.98
Rate for Payer: Health Smart Auto/Commercial	$4.48
Rate for Payer: LLUH Dept of Risk Management WC	$4.11
Rate for Payer: Multiplan Commercial	$5.60

ALBUTEROL SULFATE 2 MG TABLET [253]

Facility

OP

$7.47

Service Code	NDC 68084-949-25
Hospital Charge Code	901700029
Hospital Revenue Code	259
Min. Negotiated Rate	$4.11
Max. Negotiated Rate	$5.98
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$4.48
Rate for Payer: Aetna of CA Government/Medicare	$4.48
Rate for Payer: Cash Price	$4.11
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$5.98
Rate for Payer: Health Smart Auto/Commercial	$4.48
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$4.48
Rate for Payer: LLUH Dept of Risk Management WC	$4.11
Rate for Payer: Multiplan Commercial	$5.60

ALBUTEROL SULFATE 2 MG TABLET [253]

Facility

IP

$0.72

Service Code	NDC 69238-1344-1
Hospital Charge Code	901700029
Hospital Revenue Code	259
Min. Negotiated Rate	$0.40
Max. Negotiated Rate	$0.58
Rate for Payer: Cash Price	$0.40
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO 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 Commercial	$0.54

ALBUTEROL SULFATE 2 MG TABLET [253]

Facility

OP

$0.72

Service Code	NDC 69238-1344-1
Hospital Charge Code	901700029
Hospital Revenue Code	259
Min. Negotiated Rate	$0.40
Max. Negotiated Rate	$0.58
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	$0.40
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$0.58
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 Commercial	$0.54

ALBUTEROL SULFATE CONCENTRATE 2.5 MG/0.5 ML SOLN FOR NEBULIZATION FOR STATUS ASTHMATICUS [4081891]

Facility

OP

$4.32

Service Code	NDC 0487-9901-30
Hospital Charge Code	901700029
Hospital Revenue Code	259
Min. Negotiated Rate	$2.38
Max. Negotiated Rate	$3.46
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$2.59
Rate for Payer: Aetna of CA Government/Medicare	$2.59
Rate for Payer: Cash Price	$2.38
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$3.46
Rate for Payer: Health Smart Auto/Commercial	$2.59
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$2.59
Rate for Payer: LLUH Dept of Risk Management WC	$2.38
Rate for Payer: Multiplan Commercial	$3.24

ALBUTEROL SULFATE CONCENTRATE 2.5 MG/0.5 ML SOLN FOR NEBULIZATION FOR STATUS ASTHMATICUS [4081891]

Facility

IP

$4.32

Service Code	NDC 0487-9901-30
Hospital Charge Code	901700029
Hospital Revenue Code	259
Min. Negotiated Rate	$2.38
Max. Negotiated Rate	$3.46
Rate for Payer: Cash Price	$2.38
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$3.46
Rate for Payer: Health Smart Auto/Commercial	$2.59
Rate for Payer: LLUH Dept of Risk Management WC	$2.38
Rate for Payer: Multiplan Commercial	$3.24

ALBUTEROL SULFATE CONCENTRATE 2.5 MG/0.5 ML SOLUTION FOR NEBULIZATION [116907]

Facility

IP

$4.32

Service Code	NDC 0487-9901-30
Hospital Charge Code	901700029
Hospital Revenue Code	259
Min. Negotiated Rate	$2.38
Max. Negotiated Rate	$3.46
Rate for Payer: Cash Price	$2.38
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$3.46
Rate for Payer: Health Smart Auto/Commercial	$2.59
Rate for Payer: LLUH Dept of Risk Management WC	$2.38
Rate for Payer: Multiplan Commercial	$3.24

ALBUTEROL SULFATE CONCENTRATE 2.5 MG/0.5 ML SOLUTION FOR NEBULIZATION [116907]

Facility

OP

$4.32

Service Code	NDC 0487-9901-30
Hospital Charge Code	901700029
Hospital Revenue Code	259
Min. Negotiated Rate	$2.38
Max. Negotiated Rate	$3.46
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$2.59
Rate for Payer: Aetna of CA Government/Medicare	$2.59
Rate for Payer: Cash Price	$2.38
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$3.46
Rate for Payer: Health Smart Auto/Commercial	$2.59
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$2.59
Rate for Payer: LLUH Dept of Risk Management WC	$2.38
Rate for Payer: Multiplan Commercial	$3.24

ALBUTEROL SULFATE CONCENTRATE 5 MG/ML(0.5 %) SOLUTION FOR NEBULIZATION [251]

Facility

IP

$3.00

Service Code	NDC 73177-146-33
Hospital Charge Code	901700029
Hospital Revenue Code	259
Min. Negotiated Rate	$1.65
Max. Negotiated Rate	$2.40
Rate for Payer: Cash Price	$1.65
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$2.40
Rate for Payer: Health Smart Auto/Commercial	$1.80
Rate for Payer: LLUH Dept of Risk Management WC	$1.65
Rate for Payer: Multiplan Commercial	$2.25

ALBUTEROL SULFATE CONCENTRATE 5 MG/ML(0.5 %) SOLUTION FOR NEBULIZATION [251]

Facility

OP

$3.00

Service Code	NDC 73177-146-33
Hospital Charge Code	901700029
Hospital Revenue Code	259
Min. Negotiated Rate	$1.65
Max. Negotiated Rate	$2.40
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$1.80
Rate for Payer: Aetna of CA Government/Medicare	$1.80
Rate for Payer: Cash Price	$1.65
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$2.40
Rate for Payer: Health Smart Auto/Commercial	$1.80
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$1.80
Rate for Payer: LLUH Dept of Risk Management WC	$1.65
Rate for Payer: Multiplan Commercial	$2.25

ALBUTEROL SULFATE HFA 90 MCG/ACTUATION AEROSOL INHALER [17837]

Facility

OP

$3.41

Service Code	NDC 0173-0682-24
Hospital Charge Code	901700029
Hospital Revenue Code	259
Min. Negotiated Rate	$1.88
Max. Negotiated Rate	$2.73
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$2.05
Rate for Payer: Aetna of CA Government/Medicare	$2.05
Rate for Payer: Cash Price	$1.87
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$2.73
Rate for Payer: Health Smart Auto/Commercial	$2.05
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$2.05
Rate for Payer: LLUH Dept of Risk Management WC	$1.88
Rate for Payer: Multiplan Commercial	$2.56

ALBUTEROL SULFATE HFA 90 MCG/ACTUATION AEROSOL INHALER [17837]

Facility

IP

$3.67

Service Code	NDC 68180-963-01
Hospital Charge Code	901700029
Hospital Revenue Code	259
Min. Negotiated Rate	$2.02
Max. Negotiated Rate	$2.94
Rate for Payer: Cash Price	$2.02
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$2.94
Rate for Payer: Health Smart Auto/Commercial	$2.20
Rate for Payer: LLUH Dept of Risk Management WC	$2.02
Rate for Payer: Multiplan Commercial	$2.75

ALBUTEROL SULFATE HFA 90 MCG/ACTUATION AEROSOL INHALER [17837]

Facility

IP

$3.41

Service Code	NDC 0173-0682-24
Hospital Charge Code	901700029
Hospital Revenue Code	259
Min. Negotiated Rate	$1.88
Max. Negotiated Rate	$2.73
Rate for Payer: Cash Price	$1.87
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$2.73
Rate for Payer: Health Smart Auto/Commercial	$2.05
Rate for Payer: LLUH Dept of Risk Management WC	$1.88
Rate for Payer: Multiplan Commercial	$2.56

ALBUTEROL SULFATE HFA 90 MCG/ACTUATION AEROSOL INHALER [17837]

Facility

OP

$3.67

Service Code	NDC 68180-963-01
Hospital Charge Code	901700029
Hospital Revenue Code	259
Min. Negotiated Rate	$2.02
Max. Negotiated Rate	$2.94
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$2.20
Rate for Payer: Aetna of CA Government/Medicare	$2.20
Rate for Payer: Cash Price	$2.02
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$2.94
Rate for Payer: Health Smart Auto/Commercial	$2.20
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$2.20
Rate for Payer: LLUH Dept of Risk Management WC	$2.02
Rate for Payer: Multiplan Commercial	$2.75

ALECTINIB 150 MG CAPSULE [212384]

Facility

IP

$97.33

Service Code	NDC 50242-130-01
Hospital Charge Code	901700029
Hospital Revenue Code	259
Min. Negotiated Rate	$53.53
Max. Negotiated Rate	$77.86
Rate for Payer: Cash Price	$53.53
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$77.86
Rate for Payer: Health Smart Auto/Commercial	$58.40
Rate for Payer: LLUH Dept of Risk Management WC	$53.53
Rate for Payer: Multiplan Commercial	$73.00

ALECTINIB 150 MG CAPSULE [212384]

Facility

OP

$97.33

Service Code	NDC 50242-130-01
Hospital Charge Code	901700029
Hospital Revenue Code	259
Min. Negotiated Rate	$53.53
Max. Negotiated Rate	$77.86
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$58.40
Rate for Payer: Aetna of CA Government/Medicare	$58.40
Rate for Payer: Cash Price	$53.53
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$77.86
Rate for Payer: Health Smart Auto/Commercial	$58.40
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$58.40
Rate for Payer: LLUH Dept of Risk Management WC	$53.53
Rate for Payer: Multiplan Commercial	$73.00

ALENDRONATE 10 MG TABLET [15661]

Facility

IP

$0.24

Service Code	NDC 64980-340-03
Hospital Charge Code	901700029
Hospital Revenue Code	259
Min. Negotiated Rate	$0.13
Max. Negotiated Rate	$0.19
Rate for Payer: Cash Price	$0.13
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$0.19
Rate for Payer: Health Smart Auto/Commercial	$0.14
Rate for Payer: LLUH Dept of Risk Management WC	$0.13
Rate for Payer: Multiplan Commercial	$0.18

ALENDRONATE 10 MG TABLET [15661]

Facility

OP

$0.24

Service Code	NDC 64980-340-03
Hospital Charge Code	901700029
Hospital Revenue Code	259
Min. Negotiated Rate	$0.13
Max. Negotiated Rate	$0.19
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$0.14
Rate for Payer: Aetna of CA Government/Medicare	$0.14
Rate for Payer: Cash Price	$0.13
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$0.19
Rate for Payer: Health Smart Auto/Commercial	$0.14
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$0.14
Rate for Payer: LLUH Dept of Risk Management WC	$0.13
Rate for Payer: Multiplan Commercial	$0.18

ALENDRONATE 70 MG/75 ML ORAL SOLUTION [37640]

Facility

OP

$1.10

Service Code	NDC 0054-0282-59
Hospital Charge Code	901700029
Hospital Revenue Code	259
Min. Negotiated Rate	$0.61
Max. Negotiated Rate	$0.88
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	$0.61
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$0.88
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 Commercial	$0.83

ALENDRONATE 70 MG/75 ML ORAL SOLUTION [37640]

Facility

IP

$1.10

Service Code	NDC 0054-0282-59
Hospital Charge Code	901700029
Hospital Revenue Code	259
Min. Negotiated Rate	$0.61
Max. Negotiated Rate	$0.88
Rate for Payer: Cash Price	$0.61
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO 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 Commercial	$0.83

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