Price Transparency

Know your out-of-pocket cost for care.

All Charges

Charge

Type

Setting

Price

ENTECAVIR 0.5 MG TABLET [41147]

Facility

IP

$1.60

Service Code	NDC 31722-833-30
Hospital Charge Code	1711886
Hospital Revenue Code	259
Min. Negotiated Rate	$0.88
Max. Negotiated Rate	$1.28
Rate for Payer: Cash Price	$0.72
Rate for Payer: Cigna of CA HMO/PPO	$1.28
Rate for Payer: Health Smart Auto/Commercial	$0.96
Rate for Payer: LLUH Dept of Risk Management WC	$0.88
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$1.20

ENTECAVIR 0.5 MG TABLET [41147]

Facility

OP

$3.14

Service Code	NDC 42806-658-30
Hospital Charge Code	1711886
Hospital Revenue Code	259
Min. Negotiated Rate	$1.73
Max. Negotiated Rate	$2.36
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$1.88
Rate for Payer: Aetna of CA Government/Medicare	$1.88
Rate for Payer: Cash Price	$1.41
Rate for Payer: Health Smart Auto/Commercial	$1.88
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$1.88
Rate for Payer: LLUH Dept of Risk Management WC	$1.73
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$2.36

ENTECAVIR 0.5 MG TABLET [41147]

Facility

IP

$2.56

Service Code	NDC 69097-426-02
Hospital Charge Code	1711886
Hospital Revenue Code	259
Min. Negotiated Rate	$1.41
Max. Negotiated Rate	$2.05
Rate for Payer: Cash Price	$1.15
Rate for Payer: Cigna of CA HMO/PPO	$2.05
Rate for Payer: Health Smart Auto/Commercial	$1.54
Rate for Payer: LLUH Dept of Risk Management WC	$1.41
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$1.92

ENTECAVIR 0.5 MG TABLET [41147]

Facility

IP

$3.14

Service Code	NDC 42806-658-30
Hospital Charge Code	1711886
Hospital Revenue Code	259
Min. Negotiated Rate	$1.73
Max. Negotiated Rate	$2.51
Rate for Payer: Cash Price	$1.41
Rate for Payer: Cigna of CA HMO/PPO	$2.51
Rate for Payer: Health Smart Auto/Commercial	$1.88
Rate for Payer: LLUH Dept of Risk Management WC	$1.73
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$2.36

ENTECAVIR 0.5 MG TABLET [41147]

Facility

OP

$2.56

Service Code	NDC 69097-426-02
Hospital Charge Code	1711886
Hospital Revenue Code	259
Min. Negotiated Rate	$1.41
Max. Negotiated Rate	$1.92
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$1.54
Rate for Payer: Aetna of CA Government/Medicare	$1.54
Rate for Payer: Cash Price	$1.15
Rate for Payer: Health Smart Auto/Commercial	$1.54
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$1.54
Rate for Payer: LLUH Dept of Risk Management WC	$1.41
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$1.92

ENTRECTINIB 100 MG CAPSULE [225690]

Facility

IP

$254.51

Service Code	NDC 50242-091-30
Hospital Revenue Code	636
Min. Negotiated Rate	$139.98
Max. Negotiated Rate	$203.61
Rate for Payer: Cash Price	$114.53
Rate for Payer: Cigna of CA HMO/PPO	$203.61
Rate for Payer: Health Smart Auto/Commercial	$152.71
Rate for Payer: LLUH Dept of Risk Management WC	$139.98
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$190.88

ENTRECTINIB 100 MG CAPSULE [225690]

Facility

OP

$254.51

Service Code	NDC 50242-091-30
Hospital Revenue Code	636
Min. Negotiated Rate	$139.98
Max. Negotiated Rate	$190.88
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$152.71
Rate for Payer: Aetna of CA Government/Medicare	$152.71
Rate for Payer: Cash Price	$114.53
Rate for Payer: Health Smart Auto/Commercial	$152.71
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$152.71
Rate for Payer: LLUH Dept of Risk Management WC	$139.98
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$190.88

ENTRECTINIB 200 MG CAPSULE [225691]

Facility

IP

$254.51

Service Code	NDC 50242-094-90
Hospital Revenue Code	636
Min. Negotiated Rate	$139.98
Max. Negotiated Rate	$203.61
Rate for Payer: Cash Price	$114.53
Rate for Payer: Cigna of CA HMO/PPO	$203.61
Rate for Payer: Health Smart Auto/Commercial	$152.71
Rate for Payer: LLUH Dept of Risk Management WC	$139.98
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$190.88

ENTRECTINIB 200 MG CAPSULE [225691]

Facility

OP

$254.51

Service Code	NDC 50242-094-90
Hospital Revenue Code	636
Min. Negotiated Rate	$139.98
Max. Negotiated Rate	$190.88
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$152.71
Rate for Payer: Aetna of CA Government/Medicare	$152.71
Rate for Payer: Cash Price	$114.53
Rate for Payer: Health Smart Auto/Commercial	$152.71
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$152.71
Rate for Payer: LLUH Dept of Risk Management WC	$139.98
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$190.88

EPCORITAMAB-BYSP 48 MG/0.8 ML SUBCUTANEOUS SOLUTION [238112]

Facility

OP

$22,838.34

Service Code	CPT C9155
Hospital Charge Code	ERX238112
Hospital Revenue Code	636
Min. Negotiated Rate	$12,561.09
Max. Negotiated Rate	$17,128.76
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$13,703.00
Rate for Payer: Aetna of CA Government/Medicare	$13,703.00
Rate for Payer: Cash Price	$10,277.25
Rate for Payer: Health Smart Auto/Commercial	$13,703.00
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$13,703.00
Rate for Payer: LLUH Dept of Risk Management WC	$12,561.09
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$17,128.76

EPCORITAMAB-BYSP 48 MG/0.8 ML SUBCUTANEOUS SOLUTION [238112]

Facility

IP

$22,838.34

Service Code	CPT C9155
Hospital Charge Code	ERX238112
Hospital Revenue Code	636
Min. Negotiated Rate	$12,561.09
Max. Negotiated Rate	$18,270.67
Rate for Payer: Cash Price	$10,277.25
Rate for Payer: Cigna of CA HMO/PPO	$18,270.67
Rate for Payer: Health Smart Auto/Commercial	$13,703.00
Rate for Payer: LLUH Dept of Risk Management WC	$12,561.09
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$17,128.76

EPCORITAMAB-BYSP 4 MG/0.8 ML SUBCUTANEOUS SOLUTION (MUST DILUTE) [238113]

Facility

OP

$1,903.20

Service Code	CPT C9155
Hospital Charge Code	ERX238113
Hospital Revenue Code	636
Min. Negotiated Rate	$1,046.76
Max. Negotiated Rate	$1,427.40
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$1,141.92
Rate for Payer: Aetna of CA Government/Medicare	$1,141.92
Rate for Payer: Cash Price	$856.44
Rate for Payer: Health Smart Auto/Commercial	$1,141.92
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$1,141.92
Rate for Payer: LLUH Dept of Risk Management WC	$1,046.76
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$1,427.40

EPCORITAMAB-BYSP 4 MG/0.8 ML SUBCUTANEOUS SOLUTION (MUST DILUTE) [238113]

Facility

IP

$1,903.20

Service Code	CPT C9155
Hospital Charge Code	ERX238113
Hospital Revenue Code	636
Min. Negotiated Rate	$1,046.76
Max. Negotiated Rate	$1,522.56
Rate for Payer: Cash Price	$856.44
Rate for Payer: Cigna of CA HMO/PPO	$1,522.56
Rate for Payer: Health Smart Auto/Commercial	$1,141.92
Rate for Payer: LLUH Dept of Risk Management WC	$1,046.76
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$1,427.40

EPHEDRINE (PF) 25 MG/5 ML (5 MG/ML) IN 0.9% SODIUM CHLORIDE IV SYRINGE [120232]

Facility

OP

$4.76

Service Code	NDC 70092-1478-44
Hospital Charge Code	1722051
Hospital Revenue Code	250
Min. Negotiated Rate	$2.62
Max. Negotiated Rate	$3.57
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$2.86
Rate for Payer: Aetna of CA Government/Medicare	$2.86
Rate for Payer: Cash Price	$2.14
Rate for Payer: Health Smart Auto/Commercial	$2.86
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$2.86
Rate for Payer: LLUH Dept of Risk Management WC	$2.62
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$3.57

EPHEDRINE (PF) 25 MG/5 ML (5 MG/ML) IN 0.9% SODIUM CHLORIDE IV SYRINGE [120232]

Facility

IP

$4.76

Service Code	NDC 70092-1478-44
Hospital Charge Code	1722051
Hospital Revenue Code	250
Min. Negotiated Rate	$2.62
Max. Negotiated Rate	$3.81
Rate for Payer: Cash Price	$2.14
Rate for Payer: Cigna of CA HMO/PPO	$3.81
Rate for Payer: Health Smart Auto/Commercial	$2.86
Rate for Payer: LLUH Dept of Risk Management WC	$2.62
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$3.57

EPHEDRINE (PF) 25 MG/5 ML (5 MG/ML) IN 0.9% SODIUM CHLORIDE IV SYRINGE [120232]

Facility

IP

$6.00

Service Code	NDC 70004-604-09
Hospital Charge Code	1722051
Hospital Revenue Code	250
Min. Negotiated Rate	$3.30
Max. Negotiated Rate	$4.80
Rate for Payer: Cash Price	$2.70
Rate for Payer: Cigna of CA HMO/PPO	$4.80
Rate for Payer: Health Smart Auto/Commercial	$3.60
Rate for Payer: LLUH Dept of Risk Management WC	$3.30
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$4.50

EPHEDRINE (PF) 25 MG/5 ML (5 MG/ML) IN 0.9% SODIUM CHLORIDE IV SYRINGE [120232]

Facility

OP

$6.00

Service Code	NDC 70004-604-09
Hospital Charge Code	1722051
Hospital Revenue Code	250
Min. Negotiated Rate	$3.30
Max. Negotiated Rate	$4.50
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$3.60
Rate for Payer: Aetna of CA Government/Medicare	$3.60
Rate for Payer: Cash Price	$2.70
Rate for Payer: Health Smart Auto/Commercial	$3.60
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$3.60
Rate for Payer: LLUH Dept of Risk Management WC	$3.30
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$4.50

EPHEDRINE SULFATE 25 MG/5 ML (5 MG/ML) INTRAVENOUS SYRINGE [233841]

Facility

OP

$2.96

Service Code	NDC 51754-4250-1
Hospital Charge Code	NDG233841
Hospital Revenue Code	250
Min. Negotiated Rate	$1.63
Max. Negotiated Rate	$2.22
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$1.78
Rate for Payer: Aetna of CA Government/Medicare	$1.78
Rate for Payer: Cash Price	$1.33
Rate for Payer: Health Smart Auto/Commercial	$1.78
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$1.78
Rate for Payer: LLUH Dept of Risk Management WC	$1.63
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$2.22

EPHEDRINE SULFATE 25 MG/5 ML (5 MG/ML) INTRAVENOUS SYRINGE [233841]

Facility

IP

$2.96

Service Code	NDC 51754-4250-1
Hospital Charge Code	NDG233841
Hospital Revenue Code	250
Min. Negotiated Rate	$1.63
Max. Negotiated Rate	$2.37
Rate for Payer: Cash Price	$1.33
Rate for Payer: Cigna of CA HMO/PPO	$2.37
Rate for Payer: Health Smart Auto/Commercial	$1.78
Rate for Payer: LLUH Dept of Risk Management WC	$1.63
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$2.22

EPHEDRINE SULFATE 25 MG/5 ML (5 MG/ML) INTRAVENOUS SYRINGE [233841]

Facility

IP

$2.96

Service Code	NDC 51754-4250-3
Hospital Charge Code	NDG233841
Hospital Revenue Code	250
Min. Negotiated Rate	$1.63
Max. Negotiated Rate	$2.37
Rate for Payer: Cash Price	$1.33
Rate for Payer: Cigna of CA HMO/PPO	$2.37
Rate for Payer: Health Smart Auto/Commercial	$1.78
Rate for Payer: LLUH Dept of Risk Management WC	$1.63
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$2.22

EPHEDRINE SULFATE 25 MG/5 ML (5 MG/ML) INTRAVENOUS SYRINGE [233841]

Facility

OP

$2.96

Service Code	NDC 51754-4250-3
Hospital Charge Code	NDG233841
Hospital Revenue Code	250
Min. Negotiated Rate	$1.63
Max. Negotiated Rate	$2.22
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$1.78
Rate for Payer: Aetna of CA Government/Medicare	$1.78
Rate for Payer: Cash Price	$1.33
Rate for Payer: Health Smart Auto/Commercial	$1.78
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$1.78
Rate for Payer: LLUH Dept of Risk Management WC	$1.63
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$2.22

EPHEDRINE SULFATE 50 MG/ML INTRAVENOUS SOLUTION [214342]

Facility

IP

$34.85

Service Code	NDC 70121-1637-1
Hospital Charge Code	1720234
Hospital Revenue Code	250
Min. Negotiated Rate	$19.17
Max. Negotiated Rate	$27.88
Rate for Payer: Cash Price	$15.68
Rate for Payer: Cigna of CA HMO/PPO	$27.88
Rate for Payer: Health Smart Auto/Commercial	$20.91
Rate for Payer: LLUH Dept of Risk Management WC	$19.17
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$26.14

EPHEDRINE SULFATE 50 MG/ML INTRAVENOUS SOLUTION [214342]

Facility

OP

$34.85

Service Code	NDC 70121-1637-1
Hospital Charge Code	1720234
Hospital Revenue Code	250
Min. Negotiated Rate	$19.17
Max. Negotiated Rate	$26.14
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$20.91
Rate for Payer: Aetna of CA Government/Medicare	$20.91
Rate for Payer: Cash Price	$15.68
Rate for Payer: Health Smart Auto/Commercial	$20.91
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$20.91
Rate for Payer: LLUH Dept of Risk Management WC	$19.17
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$26.14

EPHEDRINE SULFATE 50 MG/ML INTRAVENOUS SOLUTION [214342]

Facility

OP

$56.75

Service Code	NDC 70121-1637-7
Hospital Charge Code	1720234
Hospital Revenue Code	250
Min. Negotiated Rate	$31.21
Max. Negotiated Rate	$42.56
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$34.05
Rate for Payer: Aetna of CA Government/Medicare	$34.05
Rate for Payer: Cash Price	$25.54
Rate for Payer: Health Smart Auto/Commercial	$34.05
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$34.05
Rate for Payer: LLUH Dept of Risk Management WC	$31.21
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$42.56

EPHEDRINE SULFATE 50 MG/ML INTRAVENOUS SOLUTION [214342]

Facility

OP

$34.05

Service Code	NDC 0781-3269-95
Hospital Charge Code	1720234
Hospital Revenue Code	250
Min. Negotiated Rate	$18.73
Max. Negotiated Rate	$25.54
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$20.43
Rate for Payer: Aetna of CA Government/Medicare	$20.43
Rate for Payer: Cash Price	$15.32
Rate for Payer: Health Smart Auto/Commercial	$20.43
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$20.43
Rate for Payer: LLUH Dept of Risk Management WC	$18.73
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$25.54

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