Price Transparency

Know your out-of-pocket cost for care.

All Charges

Charge

Type

Setting

Price

EPHEDRINE SULFATE 5 MG/ML INTRAVENOUS SOLUTION [227763]

Facility

IP

$3.48

Service Code	NDC 42023-243-01
Hospital Charge Code	901700004
Hospital Revenue Code	250
Min. Negotiated Rate	$1.91
Max. Negotiated Rate	$2.78
Rate for Payer: Cash Price	$1.91
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$2.78
Rate for Payer: Health Smart Auto/Commercial	$2.09
Rate for Payer: LLUH Dept of Risk Management WC	$1.91
Rate for Payer: Multiplan Commercial	$2.61

EPHEDRINE SULFATE 5 MG/ML INTRAVENOUS SOLUTION [227763]

Facility

IP

$3.48

Service Code	NDC 14789-250-07
Hospital Charge Code	901700004
Hospital Revenue Code	250
Min. Negotiated Rate	$1.91
Max. Negotiated Rate	$2.78
Rate for Payer: Cash Price	$1.91
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$2.78
Rate for Payer: Health Smart Auto/Commercial	$2.09
Rate for Payer: LLUH Dept of Risk Management WC	$1.91
Rate for Payer: Multiplan Commercial	$2.61

EPHEDRINE SULFATE 5 MG/ML INTRAVENOUS SOLUTION [227763]

Facility

OP

$3.48

Service Code	NDC 42023-243-01
Hospital Charge Code	901700004
Hospital Revenue Code	250
Min. Negotiated Rate	$1.91
Max. Negotiated Rate	$2.78
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$2.09
Rate for Payer: Aetna of CA Government/Medicare	$2.09
Rate for Payer: Cash Price	$1.91
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$2.78
Rate for Payer: Health Smart Auto/Commercial	$2.09
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$2.09
Rate for Payer: LLUH Dept of Risk Management WC	$1.91
Rate for Payer: Multiplan Commercial	$2.61

EPHEDRINE SULFATE 5 MG/ML INTRAVENOUS SOLUTION [227763]

Facility

OP

$3.48

Service Code	NDC 14789-250-07
Hospital Charge Code	901700004
Hospital Revenue Code	250
Min. Negotiated Rate	$1.91
Max. Negotiated Rate	$2.78
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$2.09
Rate for Payer: Aetna of CA Government/Medicare	$2.09
Rate for Payer: Cash Price	$1.91
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$2.78
Rate for Payer: Health Smart Auto/Commercial	$2.09
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$2.09
Rate for Payer: LLUH Dept of Risk Management WC	$1.91
Rate for Payer: Multiplan Commercial	$2.61

EPHEDRINE SULFATE 5 MG/ML INTRAVENOUS SOLUTION [227763]

Facility

IP

$3.48

Service Code	NDC 14789-250-10
Hospital Charge Code	901700004
Hospital Revenue Code	250
Min. Negotiated Rate	$1.91
Max. Negotiated Rate	$2.78
Rate for Payer: Cash Price	$1.91
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$2.78
Rate for Payer: Health Smart Auto/Commercial	$2.09
Rate for Payer: LLUH Dept of Risk Management WC	$1.91
Rate for Payer: Multiplan Commercial	$2.61

EPHEDRINE SULFATE 5 MG/ML INTRAVENOUS SOLUTION [227763]

Facility

OP

$3.48

Service Code	NDC 14789-250-10
Hospital Charge Code	901700004
Hospital Revenue Code	250
Min. Negotiated Rate	$1.91
Max. Negotiated Rate	$2.78
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$2.09
Rate for Payer: Aetna of CA Government/Medicare	$2.09
Rate for Payer: Cash Price	$1.91
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$2.78
Rate for Payer: Health Smart Auto/Commercial	$2.09
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$2.09
Rate for Payer: LLUH Dept of Risk Management WC	$1.91
Rate for Payer: Multiplan Commercial	$2.61

EPINEPHRINE 0.1 MG/ML INJECTION SYRINGE (10 ML) [2848]

Facility

IP

$1.65

Service Code	HCPCS J0168
Hospital Charge Code	901700025
Hospital Revenue Code	636
Min. Negotiated Rate	$0.91
Max. Negotiated Rate	$1.32
Rate for Payer: Cash Price	$0.91
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$1.32
Rate for Payer: Health Smart Auto/Commercial	$0.99
Rate for Payer: LLUH Dept of Risk Management WC	$0.91
Rate for Payer: Multiplan Commercial	$1.24

EPINEPHRINE 0.1 MG/ML INJECTION SYRINGE (10 ML) [2848]

Facility

OP

$1.65

Service Code	HCPCS J0168
Hospital Charge Code	901700025
Hospital Revenue Code	636
Min. Negotiated Rate	$0.91
Max. Negotiated Rate	$1.32
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$0.99
Rate for Payer: Aetna of CA Government/Medicare	$0.99
Rate for Payer: Cash Price	$0.91
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$1.32
Rate for Payer: Health Smart Auto/Commercial	$0.99
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$0.99
Rate for Payer: LLUH Dept of Risk Management WC	$0.91
Rate for Payer: Multiplan Commercial	$1.24

EPINEPHRINE 0.3 MG/0.3 ML INJECTION, AUTO-INJECTOR [100491]

Facility

IP

$180.00

Service Code	HCPCS J0165
Hospital Charge Code	901700025
Hospital Revenue Code	636
Min. Negotiated Rate	$99.00
Max. Negotiated Rate	$144.00
Rate for Payer: Cash Price	$99.00
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$144.00
Rate for Payer: Health Smart Auto/Commercial	$108.00
Rate for Payer: LLUH Dept of Risk Management WC	$99.00
Rate for Payer: Multiplan Commercial	$135.00

EPINEPHRINE 0.3 MG/0.3 ML INJECTION, AUTO-INJECTOR [100491]

Facility

OP

$180.00

Service Code	HCPCS J0165
Hospital Charge Code	901700025
Hospital Revenue Code	636
Min. Negotiated Rate	$99.00
Max. Negotiated Rate	$144.00
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$108.00
Rate for Payer: Aetna of CA Government/Medicare	$108.00
Rate for Payer: Cash Price	$99.00
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$144.00
Rate for Payer: Health Smart Auto/Commercial	$108.00
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$108.00
Rate for Payer: LLUH Dept of Risk Management WC	$99.00
Rate for Payer: Multiplan Commercial	$135.00

EPINEPHRINE 1.25 MG/50 ML NS SYRINGE [4080665]

Facility

IP

$15.00

Service Code	HCPCS J0165
Hospital Charge Code	901700025
Hospital Revenue Code	636
Min. Negotiated Rate	$8.25
Max. Negotiated Rate	$12.00
Rate for Payer: Cash Price	$8.25
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$12.00
Rate for Payer: Health Smart Auto/Commercial	$9.00
Rate for Payer: LLUH Dept of Risk Management WC	$8.25
Rate for Payer: Multiplan Commercial	$11.25

EPINEPHRINE 1.25 MG/50 ML NS SYRINGE [4080665]

Facility

OP

$15.00

Service Code	HCPCS J0165
Hospital Charge Code	901700025
Hospital Revenue Code	636
Min. Negotiated Rate	$8.25
Max. Negotiated Rate	$12.00
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$9.00
Rate for Payer: Aetna of CA Government/Medicare	$9.00
Rate for Payer: Cash Price	$8.25
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$12.00
Rate for Payer: Health Smart Auto/Commercial	$9.00
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$9.00
Rate for Payer: LLUH Dept of Risk Management WC	$8.25
Rate for Payer: Multiplan Commercial	$11.25

EPINEPHRINE 1 MG/10 ML (100 MCG/ML) IN SODIUM CHLOR,ISO-OSM IV SYRINGE [224815]

Facility

OP

$0.55

Service Code	HCPCS J0165
Hospital Charge Code	901700025
Hospital Revenue Code	636
Min. Negotiated Rate	$0.30
Max. Negotiated Rate	$0.44
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$0.33
Rate for Payer: Aetna of CA Government/Medicare	$0.33
Rate for Payer: Cash Price	$0.30
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$0.44
Rate for Payer: Health Smart Auto/Commercial	$0.33
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$0.33
Rate for Payer: LLUH Dept of Risk Management WC	$0.30
Rate for Payer: Multiplan Commercial	$0.41

EPINEPHRINE 1 MG/10 ML (100 MCG/ML) IN SODIUM CHLOR,ISO-OSM IV SYRINGE [224815]

Facility

IP

$0.55

Service Code	HCPCS J0165
Hospital Charge Code	901700025
Hospital Revenue Code	636
Min. Negotiated Rate	$0.30
Max. Negotiated Rate	$0.44
Rate for Payer: Cash Price	$0.30
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$0.44
Rate for Payer: Health Smart Auto/Commercial	$0.33
Rate for Payer: LLUH Dept of Risk Management WC	$0.30
Rate for Payer: Multiplan Commercial	$0.41

EPINEPHRINE 1 MG/ML (1 ML) INJECTION SOLUTION WRAP [408187508]

Facility

IP

$13.20

Service Code	HCPCS J0166
Hospital Charge Code	901700025
Hospital Revenue Code	636
Min. Negotiated Rate	$7.26
Max. Negotiated Rate	$10.56
Rate for Payer: Cash Price	$7.26
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$10.56
Rate for Payer: Health Smart Auto/Commercial	$7.92
Rate for Payer: LLUH Dept of Risk Management WC	$7.26
Rate for Payer: Multiplan Commercial	$9.90

EPINEPHRINE 1 MG/ML (1 ML) INJECTION SOLUTION WRAP [408187508]

Facility

OP

$13.20

Service Code	HCPCS J0166
Hospital Charge Code	901700025
Hospital Revenue Code	636
Min. Negotiated Rate	$7.26
Max. Negotiated Rate	$10.56
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$7.92
Rate for Payer: Aetna of CA Government/Medicare	$7.92
Rate for Payer: Cash Price	$7.26
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$10.56
Rate for Payer: Health Smart Auto/Commercial	$7.92
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$7.92
Rate for Payer: LLUH Dept of Risk Management WC	$7.26
Rate for Payer: Multiplan Commercial	$9.90

EPINEPHRINE 1 MG/ML (1 ML) INJECTION SOLUTION WRAP [408187508]

Facility

IP

$13.20

Service Code	HCPCS J0165
Hospital Charge Code	901700025
Hospital Revenue Code	636
Min. Negotiated Rate	$7.26
Max. Negotiated Rate	$10.56
Rate for Payer: Cash Price	$7.26
Rate for Payer: Cash Price	$4.94
Rate for Payer: Cash Price	$536.42
Rate for Payer: Cash Price	$9.87
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$14.36
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$7.19
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$10.56
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$780.24
Rate for Payer: Health Smart Auto/Commercial	$7.92
Rate for Payer: Health Smart Auto/Commercial	$10.77
Rate for Payer: Health Smart Auto/Commercial	$5.39
Rate for Payer: Health Smart Auto/Commercial	$585.18
Rate for Payer: LLUH Dept of Risk Management WC	$7.26
Rate for Payer: LLUH Dept of Risk Management WC	$4.94
Rate for Payer: LLUH Dept of Risk Management WC	$536.41
Rate for Payer: LLUH Dept of Risk Management WC	$9.87
Rate for Payer: Multiplan Commercial	$731.48
Rate for Payer: Multiplan Commercial	$6.74
Rate for Payer: Multiplan Commercial	$13.46
Rate for Payer: Multiplan Commercial	$9.90

EPINEPHRINE 1 MG/ML (1 ML) INJECTION SOLUTION WRAP [408187508]

Facility

OP

$17.95

Service Code	HCPCS J0169
Hospital Charge Code	901700025
Hospital Revenue Code	636
Min. Negotiated Rate	$9.87
Max. Negotiated Rate	$14.36
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$10.77
Rate for Payer: Aetna of CA Government/Medicare	$10.77
Rate for Payer: Cash Price	$9.87
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$14.36
Rate for Payer: Health Smart Auto/Commercial	$10.77
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$10.77
Rate for Payer: LLUH Dept of Risk Management WC	$9.87
Rate for Payer: Multiplan Commercial	$13.46

EPINEPHRINE 1 MG/ML (1 ML) INJECTION SOLUTION WRAP [408187508]

Facility

OP

$17.95

Service Code	HCPCS J0165
Hospital Charge Code	901700025
Hospital Revenue Code	636
Min. Negotiated Rate	$9.87
Max. Negotiated Rate	$14.36
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$10.77
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$7.92
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$5.39
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$585.18
Rate for Payer: Aetna of CA Government/Medicare	$10.77
Rate for Payer: Aetna of CA Government/Medicare	$585.18
Rate for Payer: Aetna of CA Government/Medicare	$7.92
Rate for Payer: Aetna of CA Government/Medicare	$5.39
Rate for Payer: Cash Price	$7.26
Rate for Payer: Cash Price	$4.94
Rate for Payer: Cash Price	$9.87
Rate for Payer: Cash Price	$536.42
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$7.19
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$10.56
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$14.36
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$780.24
Rate for Payer: Health Smart Auto/Commercial	$585.18
Rate for Payer: Health Smart Auto/Commercial	$7.92
Rate for Payer: Health Smart Auto/Commercial	$5.39
Rate for Payer: Health Smart Auto/Commercial	$10.77
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$10.77
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$7.92
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$5.39
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$585.18
Rate for Payer: LLUH Dept of Risk Management WC	$9.87
Rate for Payer: LLUH Dept of Risk Management WC	$4.94
Rate for Payer: LLUH Dept of Risk Management WC	$7.26
Rate for Payer: LLUH Dept of Risk Management WC	$536.41
Rate for Payer: Multiplan Commercial	$6.74
Rate for Payer: Multiplan Commercial	$9.90
Rate for Payer: Multiplan Commercial	$13.46
Rate for Payer: Multiplan Commercial	$731.48

EPINEPHRINE 1 MG/ML (1 ML) INJECTION SOLUTION WRAP [408187508]

Facility

IP

$17.95

Service Code	HCPCS J0169
Hospital Charge Code	901700025
Hospital Revenue Code	636
Min. Negotiated Rate	$9.87
Max. Negotiated Rate	$14.36
Rate for Payer: Cash Price	$9.87
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$14.36
Rate for Payer: Health Smart Auto/Commercial	$10.77
Rate for Payer: LLUH Dept of Risk Management WC	$9.87
Rate for Payer: Multiplan Commercial	$13.46

EPINEPHRINE 1 MG/ML INJECTION SOLUTION [2850]

Facility

OP

$10.02

Service Code	HCPCS J0169
Hospital Charge Code	901700025
Hospital Revenue Code	636
Min. Negotiated Rate	$5.51
Max. Negotiated Rate	$8.02
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$6.01
Rate for Payer: Aetna of CA Government/Medicare	$6.01
Rate for Payer: Cash Price	$5.51
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$8.02
Rate for Payer: Health Smart Auto/Commercial	$6.01
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$6.01
Rate for Payer: LLUH Dept of Risk Management WC	$5.51
Rate for Payer: Multiplan Commercial	$7.51

EPINEPHRINE 1 MG/ML INJECTION SOLUTION [2850]

Facility

IP

$10.02

Service Code	HCPCS J0169
Hospital Charge Code	901700025
Hospital Revenue Code	636
Min. Negotiated Rate	$5.51
Max. Negotiated Rate	$8.02
Rate for Payer: Cash Price	$5.51
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$8.02
Rate for Payer: Health Smart Auto/Commercial	$6.01
Rate for Payer: LLUH Dept of Risk Management WC	$5.51
Rate for Payer: Multiplan Commercial	$7.51

EPINEPHRINE 1 MG/ML INJECTION SOLUTION [2850]

Facility

IP

$10.80

Service Code	HCPCS J0166
Hospital Charge Code	901700025
Hospital Revenue Code	636
Min. Negotiated Rate	$5.94
Max. Negotiated Rate	$8.64
Rate for Payer: Cash Price	$5.94
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$8.64
Rate for Payer: Health Smart Auto/Commercial	$6.48
Rate for Payer: LLUH Dept of Risk Management WC	$5.94
Rate for Payer: Multiplan Commercial	$8.10

EPINEPHRINE 1 MG/ML INJECTION SOLUTION [2850]

Facility

OP

$9.00

Service Code	HCPCS J0168
Hospital Charge Code	901700025
Hospital Revenue Code	636
Min. Negotiated Rate	$4.95
Max. Negotiated Rate	$7.20
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$5.40
Rate for Payer: Aetna of CA Government/Medicare	$5.40
Rate for Payer: Cash Price	$4.95
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$7.20
Rate for Payer: Health Smart Auto/Commercial	$5.40
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$5.40
Rate for Payer: LLUH Dept of Risk Management WC	$4.95
Rate for Payer: Multiplan Commercial	$6.75

EPINEPHRINE 1 MG/ML INJECTION SOLUTION [2850]

Facility

IP

$9.00

Service Code	HCPCS J0168
Hospital Charge Code	901700025
Hospital Revenue Code	636
Min. Negotiated Rate	$4.95
Max. Negotiated Rate	$7.20
Rate for Payer: Cash Price	$4.95
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$7.20
Rate for Payer: Health Smart Auto/Commercial	$5.40
Rate for Payer: LLUH Dept of Risk Management WC	$4.95
Rate for Payer: Multiplan Commercial	$6.75

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