Loma Linda University Behavioral Medicine Center (BMC)

All Charges

Charge

Type

Setting

Price

ENALAPRILAT 1.25 MG/ML INTRAVENOUS SOLUTION [9929]

Facility

$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: Aetna of CA EPO/HMO/POS/PPO	$3.82
Rate for Payer: Aetna of CA Government/Medicare	$3.82
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: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$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

$6.37

Service Code	NDC 0143-9787-01
Hospital Charge Code	901700004
Hospital Revenue Code	250
Min. Negotiated Rate	$3.50
Max. Negotiated Rate	$5.10
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$3.82
Rate for Payer: Aetna of CA Government/Medicare	$3.82
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: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$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

$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

ENALAPRILAT 1.25 MG/ML INTRAVENOUS SOLUTION [9929]

Facility

$6.37

Service Code	NDC 43598-078-11
Hospital Charge Code	901700004
Hospital Revenue Code	250
Min. Negotiated Rate	$3.50
Max. Negotiated Rate	$5.10
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$3.82
Rate for Payer: Aetna of CA Government/Medicare	$3.82
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: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$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

$6.37

Service Code	NDC 43598-078-58
Hospital Charge Code	901700004
Hospital Revenue Code	250
Min. Negotiated Rate	$3.50
Max. Negotiated Rate	$5.10
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$3.82
Rate for Payer: Aetna of CA Government/Medicare	$3.82
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: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$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

$6.37

Service Code	NDC 43598-078-58
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

$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: 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

$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: 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

$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

ENALAPRIL MALEATE 10 MG TABLET [9924]

Facility

$0.60

Service Code	NDC 64679-925-02
Hospital Charge Code	901700029
Hospital Revenue Code	259
Min. Negotiated Rate	$0.33
Max. Negotiated Rate	$0.48
Rate for Payer: Cash Price	$0.33
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$0.48
Rate for Payer: Health Smart Auto/Commercial	$0.36
Rate for Payer: LLUH Dept of Risk Management WC	$0.33
Rate for Payer: Multiplan Commercial	$0.45

ENALAPRIL MALEATE 10 MG TABLET [9924]

Facility

$0.60

Service Code	NDC 64679-925-02
Hospital Charge Code	901700029
Hospital Revenue Code	259
Min. Negotiated Rate	$0.33
Max. Negotiated Rate	$0.48
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$0.36
Rate for Payer: Aetna of CA Government/Medicare	$0.36
Rate for Payer: Cash Price	$0.33
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$0.48
Rate for Payer: Health Smart Auto/Commercial	$0.36
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$0.36
Rate for Payer: LLUH Dept of Risk Management WC	$0.33
Rate for Payer: Multiplan Commercial	$0.45

ENALAPRIL MALEATE 10 MG TABLET [9924]

Facility

$0.26

Service Code	NDC 43547-547-10
Hospital Charge Code	901700029
Hospital Revenue Code	259
Min. Negotiated Rate	$0.14
Max. Negotiated Rate	$0.21
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	$0.15
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$0.21
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	$0.14
Rate for Payer: Multiplan Commercial	$0.20

ENALAPRIL MALEATE 10 MG TABLET [9924]

Facility

$0.26

Service Code	NDC 43547-547-10
Hospital Charge Code	901700029
Hospital Revenue Code	259
Min. Negotiated Rate	$0.14
Max. Negotiated Rate	$0.21
Rate for Payer: Cash Price	$0.15
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$0.21
Rate for Payer: Health Smart Auto/Commercial	$0.16
Rate for Payer: LLUH Dept of Risk Management WC	$0.14
Rate for Payer: Multiplan Commercial	$0.20

ENALAPRIL MALEATE 1 MG/ML ORAL SOLUTION [216253]

Facility

$5.43

Service Code	NDC 52652-4001-1
Hospital Charge Code	901700029
Hospital Revenue Code	259
Min. Negotiated Rate	$2.99
Max. Negotiated Rate	$4.34
Rate for Payer: Cash Price	$2.99
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$4.34
Rate for Payer: Health Smart Auto/Commercial	$3.26
Rate for Payer: LLUH Dept of Risk Management WC	$2.99
Rate for Payer: Multiplan Commercial	$4.07

ENALAPRIL MALEATE 1 MG/ML ORAL SOLUTION [216253]

Facility

$5.43

Service Code	NDC 52652-4001-1
Hospital Charge Code	901700029
Hospital Revenue Code	259
Min. Negotiated Rate	$2.99
Max. Negotiated Rate	$4.34
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$3.26
Rate for Payer: Aetna of CA Government/Medicare	$3.26
Rate for Payer: Cash Price	$2.99
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$4.34
Rate for Payer: Health Smart Auto/Commercial	$3.26
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$3.26
Rate for Payer: LLUH Dept of Risk Management WC	$2.99
Rate for Payer: Multiplan Commercial	$4.07

ENALAPRIL MALEATE 20 MG TABLET [9926]

Facility

$0.85

Service Code	NDC 64679-926-02
Hospital Charge Code	901700029
Hospital Revenue Code	259
Min. Negotiated Rate	$0.47
Max. Negotiated Rate	$0.68
Rate for Payer: Cash Price	$0.47
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$0.68
Rate for Payer: Health Smart Auto/Commercial	$0.51
Rate for Payer: LLUH Dept of Risk Management WC	$0.47
Rate for Payer: Multiplan Commercial	$0.64

ENALAPRIL MALEATE 20 MG TABLET [9926]

Facility

$0.88

Service Code	NDC 68084-392-11
Hospital Charge Code	901700029
Hospital Revenue Code	259
Min. Negotiated Rate	$0.48
Max. Negotiated Rate	$0.70
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$0.53
Rate for Payer: Aetna of CA Government/Medicare	$0.53
Rate for Payer: Cash Price	$0.49
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$0.70
Rate for Payer: Health Smart Auto/Commercial	$0.53
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$0.53
Rate for Payer: LLUH Dept of Risk Management WC	$0.48
Rate for Payer: Multiplan Commercial	$0.66

ENALAPRIL MALEATE 20 MG TABLET [9926]

Facility

$0.88

Service Code	NDC 68084-392-01
Hospital Charge Code	901700029
Hospital Revenue Code	259
Min. Negotiated Rate	$0.48
Max. Negotiated Rate	$0.70
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$0.53
Rate for Payer: Aetna of CA Government/Medicare	$0.53
Rate for Payer: Cash Price	$0.49
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$0.70
Rate for Payer: Health Smart Auto/Commercial	$0.53
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$0.53
Rate for Payer: LLUH Dept of Risk Management WC	$0.48
Rate for Payer: Multiplan Commercial	$0.66

ENALAPRIL MALEATE 20 MG TABLET [9926]

Facility

$0.88

Service Code	NDC 68084-392-11
Hospital Charge Code	901700029
Hospital Revenue Code	259
Min. Negotiated Rate	$0.48
Max. Negotiated Rate	$0.70
Rate for Payer: Cash Price	$0.49
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$0.70
Rate for Payer: Health Smart Auto/Commercial	$0.53
Rate for Payer: LLUH Dept of Risk Management WC	$0.48
Rate for Payer: Multiplan Commercial	$0.66

ENALAPRIL MALEATE 20 MG TABLET [9926]

Facility

$0.88

Service Code	NDC 68084-392-01
Hospital Charge Code	901700029
Hospital Revenue Code	259
Min. Negotiated Rate	$0.48
Max. Negotiated Rate	$0.70
Rate for Payer: Cash Price	$0.49
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$0.70
Rate for Payer: Health Smart Auto/Commercial	$0.53
Rate for Payer: LLUH Dept of Risk Management WC	$0.48
Rate for Payer: Multiplan Commercial	$0.66

ENALAPRIL MALEATE 20 MG TABLET [9926]

Facility

$0.85

Service Code	NDC 64679-926-02
Hospital Charge Code	901700029
Hospital Revenue Code	259
Min. Negotiated Rate	$0.47
Max. Negotiated Rate	$0.68
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$0.51
Rate for Payer: Aetna of CA Government/Medicare	$0.51
Rate for Payer: Cash Price	$0.47
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$0.68
Rate for Payer: Health Smart Auto/Commercial	$0.51
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$0.51
Rate for Payer: LLUH Dept of Risk Management WC	$0.47
Rate for Payer: Multiplan Commercial	$0.64

ENALAPRIL MALEATE 2.5 MG TABLET [9925]

Facility

$0.20

Service Code	NDC 43547-545-10
Hospital Charge Code	901700029
Hospital Revenue Code	259
Min. Negotiated Rate	$0.11
Max. Negotiated Rate	$0.16
Rate for Payer: Cash Price	$0.11
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO 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 Commercial	$0.15

ENALAPRIL MALEATE 2.5 MG TABLET [9925]

Facility

$0.45

Service Code	NDC 64679-923-02
Hospital Charge Code	901700029
Hospital Revenue Code	259
Min. Negotiated Rate	$0.25
Max. Negotiated Rate	$0.36
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$0.27
Rate for Payer: Aetna of CA Government/Medicare	$0.27
Rate for Payer: Cash Price	$0.25
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$0.36
Rate for Payer: Health Smart Auto/Commercial	$0.27
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$0.27
Rate for Payer: LLUH Dept of Risk Management WC	$0.25
Rate for Payer: Multiplan Commercial	$0.34

ENALAPRIL MALEATE 2.5 MG TABLET [9925]

Facility

$0.45

Service Code	NDC 64679-923-02
Hospital Charge Code	901700029
Hospital Revenue Code	259
Min. Negotiated Rate	$0.25
Max. Negotiated Rate	$0.36
Rate for Payer: Cash Price	$0.25
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$0.36
Rate for Payer: Health Smart Auto/Commercial	$0.27
Rate for Payer: LLUH Dept of Risk Management WC	$0.25
Rate for Payer: Multiplan Commercial	$0.34

ENALAPRIL MALEATE 2.5 MG TABLET [9925]

Facility

$0.20

Service Code	NDC 43547-545-10
Hospital Charge Code	901700029
Hospital Revenue Code	259
Min. Negotiated Rate	$0.11
Max. Negotiated Rate	$0.16
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	$0.11
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$0.16
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 Commercial	$0.15

Know your out-of-pocket cost for care.

All Charges