Price Transparency

Know your out-of-pocket cost for care.

All Charges

Charge

Type

Setting

Price

EMOLLIENT COMBINATION NO.69 TOPICAL CREAM [196535]

Facility

IP

$0.03

Service Code	NDC 7214063378
Hospital Charge Code	901700029
Hospital Revenue Code	259
Min. Negotiated Rate	$0.02
Max. Negotiated Rate	$0.02
Rate for Payer: Cash Price	$0.02
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$0.02
Rate for Payer: Health Smart Auto/Commercial	$0.02
Rate for Payer: LLUH Dept of Risk Management WC	$0.02
Rate for Payer: Multiplan Commercial	$0.02

EMOLLIENT COMBINATION NO.69 TOPICAL CREAM [196535]

Facility

OP

$0.03

Service Code	NDC 7214063378
Hospital Charge Code	901700029
Hospital Revenue Code	259
Min. Negotiated Rate	$0.02
Max. Negotiated Rate	$0.02
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$0.02
Rate for Payer: Aetna of CA Government/Medicare	$0.02
Rate for Payer: Cash Price	$0.02
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$0.02
Rate for Payer: Health Smart Auto/Commercial	$0.02
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$0.02
Rate for Payer: LLUH Dept of Risk Management WC	$0.02
Rate for Payer: Multiplan Commercial	$0.02

EMOLLIENTS BAG BALM OINTMENT [4080770]

Facility

OP

$35.74

Service Code	NDC 98193-000-17
Hospital Charge Code	901700029
Hospital Revenue Code	259
Min. Negotiated Rate	$19.66
Max. Negotiated Rate	$28.59
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$21.44
Rate for Payer: Aetna of CA Government/Medicare	$21.44
Rate for Payer: Cash Price	$19.66
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$28.59
Rate for Payer: Health Smart Auto/Commercial	$21.44
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$21.44
Rate for Payer: LLUH Dept of Risk Management WC	$19.66
Rate for Payer: Multiplan Commercial	$26.80

EMOLLIENTS BAG BALM OINTMENT [4080770]

Facility

OP

$5.11

Service Code	NDC 99408-770-02
Hospital Charge Code	901700029
Hospital Revenue Code	259
Min. Negotiated Rate	$2.81
Max. Negotiated Rate	$4.09
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$3.07
Rate for Payer: Aetna of CA Government/Medicare	$3.07
Rate for Payer: Cash Price	$2.81
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$4.09
Rate for Payer: Health Smart Auto/Commercial	$3.07
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$3.07
Rate for Payer: LLUH Dept of Risk Management WC	$2.81
Rate for Payer: Multiplan Commercial	$3.83

EMOLLIENTS BAG BALM OINTMENT [4080770]

Facility

IP

$5.11

Service Code	NDC 99408-770-02
Hospital Charge Code	901700029
Hospital Revenue Code	259
Min. Negotiated Rate	$2.81
Max. Negotiated Rate	$4.09
Rate for Payer: Cash Price	$2.81
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$4.09
Rate for Payer: Health Smart Auto/Commercial	$3.07
Rate for Payer: LLUH Dept of Risk Management WC	$2.81
Rate for Payer: Multiplan Commercial	$3.83

EMOLLIENTS BAG BALM OINTMENT [4080770]

Facility

OP

$3.36

Service Code	NDC 9994-0807-70
Hospital Charge Code	901700029
Hospital Revenue Code	259
Min. Negotiated Rate	$1.85
Max. Negotiated Rate	$2.69
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$2.02
Rate for Payer: Aetna of CA Government/Medicare	$2.02
Rate for Payer: Cash Price	$1.85
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$2.69
Rate for Payer: Health Smart Auto/Commercial	$2.02
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$2.02
Rate for Payer: LLUH Dept of Risk Management WC	$1.85
Rate for Payer: Multiplan Commercial	$2.52

EMOLLIENTS BAG BALM OINTMENT [4080770]

Facility

IP

$35.74

Service Code	NDC 98193-000-17
Hospital Charge Code	901700029
Hospital Revenue Code	259
Min. Negotiated Rate	$19.66
Max. Negotiated Rate	$28.59
Rate for Payer: Cash Price	$19.66
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$28.59
Rate for Payer: Health Smart Auto/Commercial	$21.44
Rate for Payer: LLUH Dept of Risk Management WC	$19.66
Rate for Payer: Multiplan Commercial	$26.80

EMOLLIENTS BAG BALM OINTMENT [4080770]

Facility

IP

$3.36

Service Code	NDC 9994-0807-70
Hospital Charge Code	901700029
Hospital Revenue Code	259
Min. Negotiated Rate	$1.85
Max. Negotiated Rate	$2.69
Rate for Payer: Cash Price	$1.85
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$2.69
Rate for Payer: Health Smart Auto/Commercial	$2.02
Rate for Payer: LLUH Dept of Risk Management WC	$1.85
Rate for Payer: Multiplan Commercial	$2.52

EMOLLIENTS BAG BALM OINTMENT [4080770]

Facility

IP

$4.73

Service Code	NDC 98193-00005
Hospital Charge Code	901700029
Hospital Revenue Code	259
Min. Negotiated Rate	$2.60
Max. Negotiated Rate	$3.78
Rate for Payer: Cash Price	$2.60
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$3.78
Rate for Payer: Health Smart Auto/Commercial	$2.84
Rate for Payer: LLUH Dept of Risk Management WC	$2.60
Rate for Payer: Multiplan Commercial	$3.55

EMOLLIENTS BAG BALM OINTMENT [4080770]

Facility

OP

$4.73

Service Code	NDC 98193-00005
Hospital Charge Code	901700029
Hospital Revenue Code	259
Min. Negotiated Rate	$2.60
Max. Negotiated Rate	$3.78
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$2.84
Rate for Payer: Aetna of CA Government/Medicare	$2.84
Rate for Payer: Cash Price	$2.60
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$3.78
Rate for Payer: Health Smart Auto/Commercial	$2.84
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$2.84
Rate for Payer: LLUH Dept of Risk Management WC	$2.60
Rate for Payer: Multiplan Commercial	$3.55

EMTRICITABINE 200 MG CAPSULE [36252]

Facility

IP

$18.54

Service Code	NDC 69097-642-02
Hospital Charge Code	901700029
Hospital Revenue Code	259
Min. Negotiated Rate	$10.20
Max. Negotiated Rate	$14.83
Rate for Payer: Cash Price	$10.20
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$14.83
Rate for Payer: Health Smart Auto/Commercial	$11.12
Rate for Payer: LLUH Dept of Risk Management WC	$10.20
Rate for Payer: Multiplan Commercial	$13.90

EMTRICITABINE 200 MG CAPSULE [36252]

Facility

IP

$19.28

Service Code	NDC 65862-301-30
Hospital Charge Code	901700029
Hospital Revenue Code	259
Min. Negotiated Rate	$10.60
Max. Negotiated Rate	$15.42
Rate for Payer: Cash Price	$10.60
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$15.42
Rate for Payer: Health Smart Auto/Commercial	$11.57
Rate for Payer: LLUH Dept of Risk Management WC	$10.60
Rate for Payer: Multiplan Commercial	$14.46

EMTRICITABINE 200 MG CAPSULE [36252]

Facility

OP

$18.54

Service Code	NDC 69097-642-02
Hospital Charge Code	901700029
Hospital Revenue Code	259
Min. Negotiated Rate	$10.20
Max. Negotiated Rate	$14.83
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$11.12
Rate for Payer: Aetna of CA Government/Medicare	$11.12
Rate for Payer: Cash Price	$10.20
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$14.83
Rate for Payer: Health Smart Auto/Commercial	$11.12
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$11.12
Rate for Payer: LLUH Dept of Risk Management WC	$10.20
Rate for Payer: Multiplan Commercial	$13.90

EMTRICITABINE 200 MG CAPSULE [36252]

Facility

OP

$19.28

Service Code	NDC 65862-301-30
Hospital Charge Code	901700029
Hospital Revenue Code	259
Min. Negotiated Rate	$10.60
Max. Negotiated Rate	$15.42
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$11.57
Rate for Payer: Aetna of CA Government/Medicare	$11.57
Rate for Payer: Cash Price	$10.60
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$15.42
Rate for Payer: Health Smart Auto/Commercial	$11.57
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$11.57
Rate for Payer: LLUH Dept of Risk Management WC	$10.60
Rate for Payer: Multiplan Commercial	$14.46

EMTRICITABINE 200 MG-TENOFOVIR ALAFENAMIDE FUMARATE 25 MG TABLET [214124]

Facility

OP

$88.09

Service Code	NDC 61958-2002-1
Hospital Charge Code	901700029
Hospital Revenue Code	259
Min. Negotiated Rate	$48.45
Max. Negotiated Rate	$70.47
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$52.85
Rate for Payer: Aetna of CA Government/Medicare	$52.85
Rate for Payer: Cash Price	$48.45
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$70.47
Rate for Payer: Health Smart Auto/Commercial	$52.85
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$52.85
Rate for Payer: LLUH Dept of Risk Management WC	$48.45
Rate for Payer: Multiplan Commercial	$66.07

EMTRICITABINE 200 MG-TENOFOVIR ALAFENAMIDE FUMARATE 25 MG TABLET [214124]

Facility

IP

$88.09

Service Code	NDC 61958-2002-1
Hospital Charge Code	901700029
Hospital Revenue Code	259
Min. Negotiated Rate	$48.45
Max. Negotiated Rate	$70.47
Rate for Payer: Cash Price	$48.45
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$70.47
Rate for Payer: Health Smart Auto/Commercial	$52.85
Rate for Payer: LLUH Dept of Risk Management WC	$48.45
Rate for Payer: Multiplan Commercial	$66.07

EMTRICITABINE 200 MG-TENOFOVIR DISOPROXIL FUMARATE 300 MG TABLET [39255]

Facility

OP

$1.00

Service Code	HCPCS J0750
Hospital Charge Code	901700025
Hospital Revenue Code	636
Min. Negotiated Rate	$0.55
Max. Negotiated Rate	$0.80
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$0.60
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$0.72
Rate for Payer: Aetna of CA Government/Medicare	$0.60
Rate for Payer: Aetna of CA Government/Medicare	$0.72
Rate for Payer: Cash Price	$0.55
Rate for Payer: Cash Price	$0.66
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$0.80
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$0.96
Rate for Payer: Health Smart Auto/Commercial	$0.60
Rate for Payer: Health Smart Auto/Commercial	$0.72
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$0.60
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$0.72
Rate for Payer: LLUH Dept of Risk Management WC	$0.66
Rate for Payer: LLUH Dept of Risk Management WC	$0.55
Rate for Payer: Multiplan Commercial	$0.75
Rate for Payer: Multiplan Commercial	$0.90

EMTRICITABINE 200 MG-TENOFOVIR DISOPROXIL FUMARATE 300 MG TABLET [39255]

Facility

IP

$1.00

Service Code	HCPCS J0750
Hospital Charge Code	901700025
Hospital Revenue Code	636
Min. Negotiated Rate	$0.55
Max. Negotiated Rate	$0.80
Rate for Payer: Cash Price	$0.55
Rate for Payer: Cash Price	$0.66
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$0.80
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$0.96
Rate for Payer: Health Smart Auto/Commercial	$0.60
Rate for Payer: Health Smart Auto/Commercial	$0.72
Rate for Payer: LLUH Dept of Risk Management WC	$0.66
Rate for Payer: LLUH Dept of Risk Management WC	$0.55
Rate for Payer: Multiplan Commercial	$0.75
Rate for Payer: Multiplan Commercial	$0.90

ENALAPRILAT 1.25 MG/ML INTRAVENOUS SOLUTION [9929]

Facility

IP

$6.37

Service Code	NDC 0143-9787-10
Hospital Charge Code	901700004
Hospital Revenue Code	250
Min. Negotiated Rate	$3.50
Max. Negotiated Rate	$5.10
Rate for Payer: Cash Price	$3.50
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$5.10
Rate for Payer: Health Smart Auto/Commercial	$3.82
Rate for Payer: LLUH Dept of Risk Management WC	$3.50
Rate for Payer: Multiplan Commercial	$4.78

ENALAPRILAT 1.25 MG/ML INTRAVENOUS SOLUTION [9929]

Facility

OP

$5.69

Service Code	NDC 43598-169-11
Hospital Charge Code	901700004
Hospital Revenue Code	250
Min. Negotiated Rate	$3.13
Max. Negotiated Rate	$4.55
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$3.41
Rate for Payer: Aetna of CA Government/Medicare	$3.41
Rate for Payer: Cash Price	$3.13
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$4.55
Rate for Payer: Health Smart Auto/Commercial	$3.41
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$3.41
Rate for Payer: LLUH Dept of Risk Management WC	$3.13
Rate for Payer: Multiplan Commercial	$4.27

ENALAPRILAT 1.25 MG/ML INTRAVENOUS SOLUTION [9929]

Facility

OP

$5.69

Service Code	NDC 0143-9786-01
Hospital Charge Code	901700004
Hospital Revenue Code	250
Min. Negotiated Rate	$3.13
Max. Negotiated Rate	$4.55
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$3.41
Rate for Payer: Aetna of CA Government/Medicare	$3.41
Rate for Payer: Cash Price	$3.13
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$4.55
Rate for Payer: Health Smart Auto/Commercial	$3.41
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$3.41
Rate for Payer: LLUH Dept of Risk Management WC	$3.13
Rate for Payer: Multiplan Commercial	$4.27

ENALAPRILAT 1.25 MG/ML INTRAVENOUS SOLUTION [9929]

Facility

IP

$5.69

Service Code	NDC 0143-9786-01
Hospital Charge Code	901700004
Hospital Revenue Code	250
Min. Negotiated Rate	$3.13
Max. Negotiated Rate	$4.55
Rate for Payer: Cash Price	$3.13
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$4.55
Rate for Payer: Health Smart Auto/Commercial	$3.41
Rate for Payer: LLUH Dept of Risk Management WC	$3.13
Rate for Payer: Multiplan Commercial	$4.27

ENALAPRILAT 1.25 MG/ML INTRAVENOUS SOLUTION [9929]

Facility

IP

$5.69

Service Code	NDC 43598-169-58
Hospital Charge Code	901700004
Hospital Revenue Code	250
Min. Negotiated Rate	$3.13
Max. Negotiated Rate	$4.55
Rate for Payer: Cash Price	$3.13
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$4.55
Rate for Payer: Health Smart Auto/Commercial	$3.41
Rate for Payer: LLUH Dept of Risk Management WC	$3.13
Rate for Payer: Multiplan Commercial	$4.27

ENALAPRILAT 1.25 MG/ML INTRAVENOUS SOLUTION [9929]

Facility

IP

$5.69

Service Code	NDC 0143-9786-10
Hospital Charge Code	901700004
Hospital Revenue Code	250
Min. Negotiated Rate	$3.13
Max. Negotiated Rate	$4.55
Rate for Payer: Cash Price	$3.13
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$4.55
Rate for Payer: Health Smart Auto/Commercial	$3.41
Rate for Payer: LLUH Dept of Risk Management WC	$3.13
Rate for Payer: Multiplan Commercial	$4.27

ENALAPRILAT 1.25 MG/ML INTRAVENOUS SOLUTION [9929]

Facility

OP

$5.69

Service Code	NDC 43598-169-58
Hospital Charge Code	901700004
Hospital Revenue Code	250
Min. Negotiated Rate	$3.13
Max. Negotiated Rate	$4.55
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$3.41
Rate for Payer: Aetna of CA Government/Medicare	$3.41
Rate for Payer: Cash Price	$3.13
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$4.55
Rate for Payer: Health Smart Auto/Commercial	$3.41
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$3.41
Rate for Payer: LLUH Dept of Risk Management WC	$3.13
Rate for Payer: Multiplan Commercial	$4.27

<<
<
167
168
169
170
171
172
173
174
175
176
>
>>