Loma Linda University Behavioral Medicine Center (BMC)

All Charges

Charge

Type

Setting

Price

ENALAPRIL MALEATE 10 MG TABLET [9924]

Facility

$0.60

Service Code	NDC 64679-925-02
Hospital Charge Code	1711458
Hospital Revenue Code	259
Min. Negotiated Rate	$0.33
Max. Negotiated Rate	$0.48
Rate for Payer: Cash Price	$0.27
Rate for Payer: Cigna of CA 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 Beech St/Commercial/PHCS	$0.45

ENALAPRIL MALEATE 1 MG/ML ORAL SOLUTION [216253]

Facility

$4.72

Service Code	NDC 52652-4001-1
Hospital Charge Code	1715986
Hospital Revenue Code	259
Min. Negotiated Rate	$2.60
Max. Negotiated Rate	$3.78
Rate for Payer: Cash Price	$2.12
Rate for Payer: Cigna of CA HMO/PPO	$3.78
Rate for Payer: Health Smart Auto/Commercial	$2.83
Rate for Payer: LLUH Dept of Risk Management WC	$2.60
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$3.54

ENALAPRIL MALEATE 1 MG/ML ORAL SOLUTION [216253]

Facility

$4.72

Service Code	NDC 52652-4001-1
Hospital Charge Code	1715986
Hospital Revenue Code	259
Min. Negotiated Rate	$2.60
Max. Negotiated Rate	$3.54
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$2.83
Rate for Payer: Aetna of CA Government/Medicare	$2.83
Rate for Payer: Cash Price	$2.12
Rate for Payer: Health Smart Auto/Commercial	$2.83
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$2.83
Rate for Payer: LLUH Dept of Risk Management WC	$2.60
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$3.54

ENALAPRIL MALEATE 20 MG TABLET [9926]

Facility

$0.85

Service Code	NDC 64679-926-02
Hospital Charge Code	1711459
Hospital Revenue Code	259
Min. Negotiated Rate	$0.47
Max. Negotiated Rate	$0.68
Rate for Payer: Cash Price	$0.38
Rate for Payer: Cigna of CA 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 Beech St/Commercial/PHCS	$0.64

ENALAPRIL MALEATE 20 MG TABLET [9926]

Facility

$0.88

Service Code	NDC 68084-392-11
Hospital Charge Code	1711459
Hospital Revenue Code	259
Min. Negotiated Rate	$0.48
Max. Negotiated Rate	$0.70
Rate for Payer: Cash Price	$0.40
Rate for Payer: Cigna of CA 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 Beech St/Commercial/PHCS	$0.66

ENALAPRIL MALEATE 20 MG TABLET [9926]

Facility

$0.88

Service Code	NDC 68084-392-11
Hospital Charge Code	1711459
Hospital Revenue Code	259
Min. Negotiated Rate	$0.48
Max. Negotiated Rate	$0.66
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	$0.40
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 Beech St/Commercial/PHCS	$0.66

ENALAPRIL MALEATE 20 MG TABLET [9926]

Facility

$0.88

Service Code	NDC 68084-392-01
Hospital Charge Code	1711459
Hospital Revenue Code	259
Min. Negotiated Rate	$0.48
Max. Negotiated Rate	$0.66
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	$0.40
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 Beech St/Commercial/PHCS	$0.66

ENALAPRIL MALEATE 20 MG TABLET [9926]

Facility

$0.85

Service Code	NDC 64679-926-02
Hospital Charge Code	1711459
Hospital Revenue Code	259
Min. Negotiated Rate	$0.47
Max. Negotiated Rate	$0.64
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	$0.38
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 Beech St/Commercial/PHCS	$0.64

ENALAPRIL MALEATE 20 MG TABLET [9926]

Facility

$1.00

Service Code	NDC 68682-713-01
Hospital Charge Code	1711459
Hospital Revenue Code	259
Min. Negotiated Rate	$0.55
Max. Negotiated Rate	$0.75
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$0.60
Rate for Payer: Aetna of CA Government/Medicare	$0.60
Rate for Payer: Cash Price	$0.45
Rate for Payer: Health Smart Auto/Commercial	$0.60
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$0.60
Rate for Payer: LLUH Dept of Risk Management WC	$0.55
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$0.75

ENALAPRIL MALEATE 20 MG TABLET [9926]

Facility

$1.00

Service Code	NDC 68682-713-01
Hospital Charge Code	1711459
Hospital Revenue Code	259
Min. Negotiated Rate	$0.55
Max. Negotiated Rate	$0.80
Rate for Payer: Cash Price	$0.45
Rate for Payer: Cigna of CA HMO/PPO	$0.80
Rate for Payer: Health Smart Auto/Commercial	$0.60
Rate for Payer: LLUH Dept of Risk Management WC	$0.55
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$0.75

ENALAPRIL MALEATE 20 MG TABLET [9926]

Facility

$0.88

Service Code	NDC 68084-392-01
Hospital Charge Code	1711459
Hospital Revenue Code	259
Min. Negotiated Rate	$0.48
Max. Negotiated Rate	$0.70
Rate for Payer: Cash Price	$0.40
Rate for Payer: Cigna of CA 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 Beech St/Commercial/PHCS	$0.66

ENALAPRIL MALEATE 2.5 MG TABLET [9925]

Facility

$0.45

Service Code	NDC 64679-923-02
Hospital Charge Code	1711355
Hospital Revenue Code	259
Min. Negotiated Rate	$0.25
Max. Negotiated Rate	$0.34
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	$0.20
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 Beech St/Commercial/PHCS	$0.34

ENALAPRIL MALEATE 2.5 MG TABLET [9925]

Facility

$0.56

Service Code	NDC 0904-5609-61
Hospital Charge Code	1711355
Hospital Revenue Code	259
Min. Negotiated Rate	$0.31
Max. Negotiated Rate	$0.45
Rate for Payer: Cash Price	$0.25
Rate for Payer: Cigna of CA HMO/PPO	$0.45
Rate for Payer: Health Smart Auto/Commercial	$0.34
Rate for Payer: LLUH Dept of Risk Management WC	$0.31
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$0.42

ENALAPRIL MALEATE 2.5 MG TABLET [9925]

Facility

$0.45

Service Code	NDC 64679-923-02
Hospital Charge Code	1711355
Hospital Revenue Code	259
Min. Negotiated Rate	$0.25
Max. Negotiated Rate	$0.36
Rate for Payer: Cash Price	$0.20
Rate for Payer: Cigna of CA 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 Beech St/Commercial/PHCS	$0.34

ENALAPRIL MALEATE 2.5 MG TABLET [9925]

Facility

$0.56

Service Code	NDC 0904-5609-61
Hospital Charge Code	1711355
Hospital Revenue Code	259
Min. Negotiated Rate	$0.31
Max. Negotiated Rate	$0.42
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$0.34
Rate for Payer: Aetna of CA Government/Medicare	$0.34
Rate for Payer: Cash Price	$0.25
Rate for Payer: Health Smart Auto/Commercial	$0.34
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$0.34
Rate for Payer: LLUH Dept of Risk Management WC	$0.31
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$0.42

ENALAPRIL MALEATE 2.5 MG TABLET [9925]

Facility

$0.53

Service Code	NDC 68682-710-01
Hospital Charge Code	1711355
Hospital Revenue Code	259
Min. Negotiated Rate	$0.29
Max. Negotiated Rate	$0.40
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$0.32
Rate for Payer: Aetna of CA Government/Medicare	$0.32
Rate for Payer: Cash Price	$0.24
Rate for Payer: Health Smart Auto/Commercial	$0.32
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$0.32
Rate for Payer: LLUH Dept of Risk Management WC	$0.29
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$0.40

ENALAPRIL MALEATE 2.5 MG TABLET [9925]

Facility

$0.53

Service Code	NDC 68682-710-01
Hospital Charge Code	1711355
Hospital Revenue Code	259
Min. Negotiated Rate	$0.29
Max. Negotiated Rate	$0.42
Rate for Payer: Cash Price	$0.24
Rate for Payer: Cigna of CA HMO/PPO	$0.42
Rate for Payer: Health Smart Auto/Commercial	$0.32
Rate for Payer: LLUH Dept of Risk Management WC	$0.29
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$0.40

ENALAPRIL MALEATE 5 MG TABLET [9927]

Facility

$0.25

Service Code	NDC 43547-546-10
Hospital Charge Code	1711457
Hospital Revenue Code	259
Min. Negotiated Rate	$0.14
Max. Negotiated Rate	$0.20
Rate for Payer: Cash Price	$0.11
Rate for Payer: Cigna of CA HMO/PPO	$0.20
Rate for Payer: Health Smart Auto/Commercial	$0.15
Rate for Payer: LLUH Dept of Risk Management WC	$0.14
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$0.19

ENALAPRIL MALEATE 5 MG TABLET [9927]

Facility

$0.25

Service Code	NDC 43547-546-10
Hospital Charge Code	1711457
Hospital Revenue Code	259
Min. Negotiated Rate	$0.14
Max. Negotiated Rate	$0.19
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$0.15
Rate for Payer: Aetna of CA Government/Medicare	$0.15
Rate for Payer: Cash Price	$0.11
Rate for Payer: Health Smart Auto/Commercial	$0.15
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$0.15
Rate for Payer: LLUH Dept of Risk Management WC	$0.14
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$0.19

ENALAPRIL MALEATE 5 MG TABLET [9927]

Facility

$0.57

Service Code	NDC 0904-5502-61
Hospital Charge Code	1711457
Hospital Revenue Code	259
Min. Negotiated Rate	$0.31
Max. Negotiated Rate	$0.46
Rate for Payer: Cash Price	$0.26
Rate for Payer: Cigna of CA HMO/PPO	$0.46
Rate for Payer: Health Smart Auto/Commercial	$0.34
Rate for Payer: LLUH Dept of Risk Management WC	$0.31
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$0.43

ENALAPRIL MALEATE 5 MG TABLET [9927]

Facility

$0.67

Service Code	NDC 68682-711-01
Hospital Charge Code	1711457
Hospital Revenue Code	259
Min. Negotiated Rate	$0.37
Max. Negotiated Rate	$0.54
Rate for Payer: Cash Price	$0.30
Rate for Payer: Cigna of CA HMO/PPO	$0.54
Rate for Payer: Health Smart Auto/Commercial	$0.40
Rate for Payer: LLUH Dept of Risk Management WC	$0.37
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$0.50

ENALAPRIL MALEATE 5 MG TABLET [9927]

Facility

$0.57

Service Code	NDC 0904-5502-61
Hospital Charge Code	1711457
Hospital Revenue Code	259
Min. Negotiated Rate	$0.31
Max. Negotiated Rate	$0.43
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$0.34
Rate for Payer: Aetna of CA Government/Medicare	$0.34
Rate for Payer: Cash Price	$0.26
Rate for Payer: Health Smart Auto/Commercial	$0.34
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$0.34
Rate for Payer: LLUH Dept of Risk Management WC	$0.31
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$0.43

ENALAPRIL MALEATE 5 MG TABLET [9927]

Facility

$0.67

Service Code	NDC 68682-711-01
Hospital Charge Code	1711457
Hospital Revenue Code	259
Min. Negotiated Rate	$0.37
Max. Negotiated Rate	$0.50
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$0.40
Rate for Payer: Aetna of CA Government/Medicare	$0.40
Rate for Payer: Cash Price	$0.30
Rate for Payer: Health Smart Auto/Commercial	$0.40
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$0.40
Rate for Payer: LLUH Dept of Risk Management WC	$0.37
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$0.50

ENFORTUMAB VEDOTIN-EJFV 20 MG INTRAVENOUS SOLUTION [226724]

Facility

$3,181.20

Service Code	NDC 51144-020-01
Hospital Charge Code	ERX226724
Hospital Revenue Code	636
Min. Negotiated Rate	$1,749.66
Max. Negotiated Rate	$2,385.90
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$1,908.72
Rate for Payer: Aetna of CA Government/Medicare	$1,908.72
Rate for Payer: Cash Price	$1,431.54
Rate for Payer: Health Smart Auto/Commercial	$1,908.72
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$1,908.72
Rate for Payer: LLUH Dept of Risk Management WC	$1,749.66
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$2,385.90

ENFORTUMAB VEDOTIN-EJFV 20 MG INTRAVENOUS SOLUTION [226724]

Facility

$3,181.20

Service Code	NDC 51144-020-01
Hospital Charge Code	ERX226724
Hospital Revenue Code	636
Min. Negotiated Rate	$1,749.66
Max. Negotiated Rate	$2,544.96
Rate for Payer: Cash Price	$1,431.54
Rate for Payer: Cigna of CA HMO/PPO	$2,544.96
Rate for Payer: Health Smart Auto/Commercial	$1,908.72
Rate for Payer: LLUH Dept of Risk Management WC	$1,749.66
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$2,385.90

Know your out-of-pocket cost for care.

All Charges