Price Transparency

Know your out-of-pocket cost for care.

All Charges

Charge

Type

Setting

Price

ETHAMBUTOL 100 MG TABLET [9982]

Facility

OP

$0.58

Service Code	NDC 54879-001-00
Hospital Charge Code	1711051
Hospital Revenue Code	259
Min. Negotiated Rate	$0.32
Max. Negotiated Rate	$0.44
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$0.35
Rate for Payer: Aetna of CA Government/Medicare	$0.35
Rate for Payer: Cash Price	$0.26
Rate for Payer: Health Smart Auto/Commercial	$0.35
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$0.35
Rate for Payer: LLUH Dept of Risk Management WC	$0.32
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$0.44

ETHAMBUTOL 100 MG TABLET [9982]

Facility

IP

$0.55

Service Code	NDC 68180-280-01
Hospital Charge Code	1711051
Hospital Revenue Code	259
Min. Negotiated Rate	$0.30
Max. Negotiated Rate	$0.44
Rate for Payer: Cash Price	$0.25
Rate for Payer: Cigna of CA 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 Beech St/Commercial/PHCS	$0.41

ETHAMBUTOL 100 MG TABLET [9982]

Facility

OP

$0.55

Service Code	NDC 68180-280-01
Hospital Charge Code	1711051
Hospital Revenue Code	259
Min. Negotiated Rate	$0.30
Max. Negotiated Rate	$0.41
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	$0.25
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 Beech St/Commercial/PHCS	$0.41

ETHAMBUTOL 400 MG TABLET [9983]

Facility

IP

$1.30

Service Code	NDC 68084-280-01
Hospital Charge Code	1711060
Hospital Revenue Code	259
Min. Negotiated Rate	$0.72
Max. Negotiated Rate	$1.04
Rate for Payer: Cash Price	$0.59
Rate for Payer: Cigna of CA HMO/PPO	$1.04
Rate for Payer: Health Smart Auto/Commercial	$0.78
Rate for Payer: LLUH Dept of Risk Management WC	$0.72
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$0.98

ETHAMBUTOL 400 MG TABLET [9983]

Facility

OP

$0.94

Service Code	NDC 68850-012-02
Hospital Charge Code	1711060
Hospital Revenue Code	259
Min. Negotiated Rate	$0.52
Max. Negotiated Rate	$0.71
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$0.56
Rate for Payer: Aetna of CA Government/Medicare	$0.56
Rate for Payer: Cash Price	$0.42
Rate for Payer: Health Smart Auto/Commercial	$0.56
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$0.56
Rate for Payer: LLUH Dept of Risk Management WC	$0.52
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$0.71

ETHAMBUTOL 400 MG TABLET [9983]

Facility

IP

$0.94

Service Code	NDC 68850-012-01
Hospital Charge Code	1711060
Hospital Revenue Code	259
Min. Negotiated Rate	$0.52
Max. Negotiated Rate	$0.75
Rate for Payer: Cash Price	$0.42
Rate for Payer: Cigna of CA HMO/PPO	$0.75
Rate for Payer: Health Smart Auto/Commercial	$0.56
Rate for Payer: LLUH Dept of Risk Management WC	$0.52
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$0.71

ETHAMBUTOL 400 MG TABLET [9983]

Facility

IP

$1.53

Service Code	NDC 68180-281-01
Hospital Charge Code	1711060
Hospital Revenue Code	259
Min. Negotiated Rate	$0.84
Max. Negotiated Rate	$1.22
Rate for Payer: Cash Price	$0.69
Rate for Payer: Cigna of CA HMO/PPO	$1.22
Rate for Payer: Health Smart Auto/Commercial	$0.92
Rate for Payer: LLUH Dept of Risk Management WC	$0.84
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$1.15

ETHAMBUTOL 400 MG TABLET [9983]

Facility

OP

$1.30

Service Code	NDC 68084-280-11
Hospital Charge Code	1711060
Hospital Revenue Code	259
Min. Negotiated Rate	$0.72
Max. Negotiated Rate	$0.98
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$0.78
Rate for Payer: Aetna of CA Government/Medicare	$0.78
Rate for Payer: Cash Price	$0.59
Rate for Payer: Health Smart Auto/Commercial	$0.78
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$0.78
Rate for Payer: LLUH Dept of Risk Management WC	$0.72
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$0.98

ETHAMBUTOL 400 MG TABLET [9983]

Facility

OP

$0.94

Service Code	NDC 68850-012-01
Hospital Charge Code	1711060
Hospital Revenue Code	259
Min. Negotiated Rate	$0.52
Max. Negotiated Rate	$0.71
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$0.56
Rate for Payer: Aetna of CA Government/Medicare	$0.56
Rate for Payer: Cash Price	$0.42
Rate for Payer: Health Smart Auto/Commercial	$0.56
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$0.56
Rate for Payer: LLUH Dept of Risk Management WC	$0.52
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$0.71

ETHAMBUTOL 400 MG TABLET [9983]

Facility

OP

$1.53

Service Code	NDC 68180-281-01
Hospital Charge Code	1711060
Hospital Revenue Code	259
Min. Negotiated Rate	$0.84
Max. Negotiated Rate	$1.15
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$0.92
Rate for Payer: Aetna of CA Government/Medicare	$0.92
Rate for Payer: Cash Price	$0.69
Rate for Payer: Health Smart Auto/Commercial	$0.92
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$0.92
Rate for Payer: LLUH Dept of Risk Management WC	$0.84
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$1.15

ETHAMBUTOL 400 MG TABLET [9983]

Facility

IP

$1.30

Service Code	NDC 68084-280-11
Hospital Charge Code	1711060
Hospital Revenue Code	259
Min. Negotiated Rate	$0.72
Max. Negotiated Rate	$1.04
Rate for Payer: Cash Price	$0.59
Rate for Payer: Cigna of CA HMO/PPO	$1.04
Rate for Payer: Health Smart Auto/Commercial	$0.78
Rate for Payer: LLUH Dept of Risk Management WC	$0.72
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$0.98

ETHAMBUTOL 400 MG TABLET [9983]

Facility

IP

$0.94

Service Code	NDC 68850-012-02
Hospital Charge Code	1711060
Hospital Revenue Code	259
Min. Negotiated Rate	$0.52
Max. Negotiated Rate	$0.75
Rate for Payer: Cash Price	$0.42
Rate for Payer: Cigna of CA HMO/PPO	$0.75
Rate for Payer: Health Smart Auto/Commercial	$0.56
Rate for Payer: LLUH Dept of Risk Management WC	$0.52
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$0.71

ETHAMBUTOL 400 MG TABLET [9983]

Facility

OP

$1.30

Service Code	NDC 68084-280-01
Hospital Charge Code	1711060
Hospital Revenue Code	259
Min. Negotiated Rate	$0.72
Max. Negotiated Rate	$0.98
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$0.78
Rate for Payer: Aetna of CA Government/Medicare	$0.78
Rate for Payer: Cash Price	$0.59
Rate for Payer: Health Smart Auto/Commercial	$0.78
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$0.78
Rate for Payer: LLUH Dept of Risk Management WC	$0.72
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$0.98

ETHAMBUTOL ORAL SUSPENSION COMPOUND 50 MG/ML [4080271]

Facility

IP

$0.22

Service Code	NDC 9994-0802-71
Hospital Charge Code	1715128
Hospital Revenue Code	259
Min. Negotiated Rate	$0.12
Max. Negotiated Rate	$0.18
Rate for Payer: Cash Price	$0.10
Rate for Payer: Cigna of CA HMO/PPO	$0.18
Rate for Payer: Health Smart Auto/Commercial	$0.13
Rate for Payer: LLUH Dept of Risk Management WC	$0.12
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$0.17

ETHAMBUTOL ORAL SUSPENSION COMPOUND 50 MG/ML [4080271]

Facility

OP

$0.22

Service Code	NDC 9994-0802-71
Hospital Charge Code	1715128
Hospital Revenue Code	259
Min. Negotiated Rate	$0.12
Max. Negotiated Rate	$0.17
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$0.13
Rate for Payer: Aetna of CA Government/Medicare	$0.13
Rate for Payer: Cash Price	$0.10
Rate for Payer: Health Smart Auto/Commercial	$0.13
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$0.13
Rate for Payer: LLUH Dept of Risk Management WC	$0.12
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$0.17

ETHANOLAMINE OLEATE 5 % INTRAVENOUS SOLUTION [9984]

Facility

OP

$274.77

Service Code	CPT J1430
Hospital Charge Code	1721070
Hospital Revenue Code	636
Min. Negotiated Rate	$151.12
Max. Negotiated Rate	$206.08
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$164.86
Rate for Payer: Aetna of CA Government/Medicare	$164.86
Rate for Payer: Cash Price	$123.65
Rate for Payer: Health Smart Auto/Commercial	$164.86
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$164.86
Rate for Payer: LLUH Dept of Risk Management WC	$151.12
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$206.08

ETHANOLAMINE OLEATE 5 % INTRAVENOUS SOLUTION [9984]

Facility

IP

$274.77

Service Code	CPT J1430
Hospital Charge Code	1721070
Hospital Revenue Code	636
Min. Negotiated Rate	$151.12
Max. Negotiated Rate	$219.82
Rate for Payer: Cash Price	$123.65
Rate for Payer: Cigna of CA HMO/PPO	$219.82
Rate for Payer: Health Smart Auto/Commercial	$164.86
Rate for Payer: LLUH Dept of Risk Management WC	$151.12
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$206.08

ETHIODIZED OIL 480 MG IODINE/ML FOR INJECTION [205424]

Facility

IP

$146.88

Service Code	NDC 67684-1901-2
Hospital Charge Code	NDG205424
Hospital Revenue Code	250
Min. Negotiated Rate	$80.78
Max. Negotiated Rate	$117.50
Rate for Payer: Cash Price	$66.10
Rate for Payer: Cigna of CA HMO/PPO	$117.50
Rate for Payer: Health Smart Auto/Commercial	$88.13
Rate for Payer: LLUH Dept of Risk Management WC	$80.78
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$110.16

ETHIODIZED OIL 480 MG IODINE/ML FOR INJECTION [205424]

Facility

OP

$146.88

Service Code	NDC 67684-1901-2
Hospital Charge Code	NDG205424
Hospital Revenue Code	250
Min. Negotiated Rate	$80.78
Max. Negotiated Rate	$110.16
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$88.13
Rate for Payer: Aetna of CA Government/Medicare	$88.13
Rate for Payer: Cash Price	$66.10
Rate for Payer: Health Smart Auto/Commercial	$88.13
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$88.13
Rate for Payer: LLUH Dept of Risk Management WC	$80.78
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$110.16

ETHOSUXIMIDE 250 MG/5 ML ORAL SOLUTION [38489]

Facility

IP

$0.14

Service Code	NDC 59762-2350-6
Hospital Charge Code	1715734
Hospital Revenue Code	259
Min. Negotiated Rate	$0.08
Max. Negotiated Rate	$0.11
Rate for Payer: Cash Price	$0.06
Rate for Payer: Cigna of CA HMO/PPO	$0.11
Rate for Payer: Health Smart Auto/Commercial	$0.08
Rate for Payer: LLUH Dept of Risk Management WC	$0.08
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$0.11

ETHOSUXIMIDE 250 MG/5 ML ORAL SOLUTION [38489]

Facility

IP

$0.14

Service Code	NDC 0121-0670-16
Hospital Charge Code	1715734
Hospital Revenue Code	259
Min. Negotiated Rate	$0.08
Max. Negotiated Rate	$0.11
Rate for Payer: Cash Price	$0.06
Rate for Payer: Cigna of CA HMO/PPO	$0.11
Rate for Payer: Health Smart Auto/Commercial	$0.08
Rate for Payer: LLUH Dept of Risk Management WC	$0.08
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$0.11

ETHOSUXIMIDE 250 MG/5 ML ORAL SOLUTION [38489]

Facility

OP

$0.14

Service Code	NDC 0121-0670-16
Hospital Charge Code	1715734
Hospital Revenue Code	259
Min. Negotiated Rate	$0.08
Max. Negotiated Rate	$0.11
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$0.08
Rate for Payer: Aetna of CA Government/Medicare	$0.08
Rate for Payer: Cash Price	$0.06
Rate for Payer: Health Smart Auto/Commercial	$0.08
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$0.08
Rate for Payer: LLUH Dept of Risk Management WC	$0.08
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$0.11

ETHOSUXIMIDE 250 MG/5 ML ORAL SOLUTION [38489]

Facility

OP

$0.14

Service Code	NDC 59762-2350-6
Hospital Charge Code	1715734
Hospital Revenue Code	259
Min. Negotiated Rate	$0.08
Max. Negotiated Rate	$0.11
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$0.08
Rate for Payer: Aetna of CA Government/Medicare	$0.08
Rate for Payer: Cash Price	$0.06
Rate for Payer: Health Smart Auto/Commercial	$0.08
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$0.08
Rate for Payer: LLUH Dept of Risk Management WC	$0.08
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$0.11

ETHOSUXIMIDE 250 MG CAPSULE [9989]

Facility

OP

$0.50

Service Code	NDC 64380-878-06
Hospital Charge Code	1711238
Hospital Revenue Code	259
Min. Negotiated Rate	$0.28
Max. Negotiated Rate	$0.38
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$0.30
Rate for Payer: Aetna of CA Government/Medicare	$0.30
Rate for Payer: Cash Price	$0.23
Rate for Payer: Health Smart Auto/Commercial	$0.30
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$0.30
Rate for Payer: LLUH Dept of Risk Management WC	$0.28
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$0.38

ETHOSUXIMIDE 250 MG CAPSULE [9989]

Facility

IP

$0.50

Service Code	NDC 64380-878-06
Hospital Charge Code	1711238
Hospital Revenue Code	259
Min. Negotiated Rate	$0.28
Max. Negotiated Rate	$0.40
Rate for Payer: Cash Price	$0.23
Rate for Payer: Cigna of CA HMO/PPO	$0.40
Rate for Payer: Health Smart Auto/Commercial	$0.30
Rate for Payer: LLUH Dept of Risk Management WC	$0.28
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$0.38

<<
<
196
197
198
199
200
201
202
203
204
205
>
>>