Price Transparency

Know your out-of-pocket cost for care.

All Charges

Charge

Type

Setting

Price

RASAGILINE 0.5 MG TABLET [76480]

Facility

IP

$17.80

Service Code	NDC 47781-683-30
Hospital Charge Code	901700029
Hospital Revenue Code	259
Min. Negotiated Rate	$9.79
Max. Negotiated Rate	$14.24
Rate for Payer: Cash Price	$9.79
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$14.24
Rate for Payer: Health Smart Auto/Commercial	$10.68
Rate for Payer: LLUH Dept of Risk Management WC	$9.79
Rate for Payer: Multiplan Commercial	$13.35

RASAGILINE 1 MG TABLET [76481]

Facility

IP

$8.25

Service Code	NDC 0093-3061-56
Hospital Charge Code	901700029
Hospital Revenue Code	259
Min. Negotiated Rate	$4.54
Max. Negotiated Rate	$6.60
Rate for Payer: Cash Price	$4.54
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$6.60
Rate for Payer: Health Smart Auto/Commercial	$4.95
Rate for Payer: LLUH Dept of Risk Management WC	$4.54
Rate for Payer: Multiplan Commercial	$6.19

RASAGILINE 1 MG TABLET [76481]

Facility

OP

$17.80

Service Code	NDC 47781-690-30
Hospital Charge Code	901700029
Hospital Revenue Code	259
Min. Negotiated Rate	$9.79
Max. Negotiated Rate	$14.24
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$10.68
Rate for Payer: Aetna of CA Government/Medicare	$10.68
Rate for Payer: Cash Price	$9.79
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$14.24
Rate for Payer: Health Smart Auto/Commercial	$10.68
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$10.68
Rate for Payer: LLUH Dept of Risk Management WC	$9.79
Rate for Payer: Multiplan Commercial	$13.35

RASAGILINE 1 MG TABLET [76481]

Facility

OP

$8.25

Service Code	NDC 0093-3061-56
Hospital Charge Code	901700029
Hospital Revenue Code	259
Min. Negotiated Rate	$4.54
Max. Negotiated Rate	$6.60
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$4.95
Rate for Payer: Aetna of CA Government/Medicare	$4.95
Rate for Payer: Cash Price	$4.54
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$6.60
Rate for Payer: Health Smart Auto/Commercial	$4.95
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$4.95
Rate for Payer: LLUH Dept of Risk Management WC	$4.54
Rate for Payer: Multiplan Commercial	$6.19

RASAGILINE 1 MG TABLET [76481]

Facility

IP

$50.04

Service Code	NDC 68546-229-56
Hospital Charge Code	901700029
Hospital Revenue Code	259
Min. Negotiated Rate	$27.52
Max. Negotiated Rate	$40.03
Rate for Payer: Cash Price	$27.52
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$40.03
Rate for Payer: Health Smart Auto/Commercial	$30.02
Rate for Payer: LLUH Dept of Risk Management WC	$27.52
Rate for Payer: Multiplan Commercial	$37.53

RASAGILINE 1 MG TABLET [76481]

Facility

IP

$17.80

Service Code	NDC 47781-690-30
Hospital Charge Code	901700029
Hospital Revenue Code	259
Min. Negotiated Rate	$9.79
Max. Negotiated Rate	$14.24
Rate for Payer: Cash Price	$9.79
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$14.24
Rate for Payer: Health Smart Auto/Commercial	$10.68
Rate for Payer: LLUH Dept of Risk Management WC	$9.79
Rate for Payer: Multiplan Commercial	$13.35

RASAGILINE 1 MG TABLET [76481]

Facility

OP

$50.04

Service Code	NDC 68546-229-56
Hospital Charge Code	901700029
Hospital Revenue Code	259
Min. Negotiated Rate	$27.52
Max. Negotiated Rate	$40.03
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$30.02
Rate for Payer: Aetna of CA Government/Medicare	$30.02
Rate for Payer: Cash Price	$27.52
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$40.03
Rate for Payer: Health Smart Auto/Commercial	$30.02
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$30.02
Rate for Payer: LLUH Dept of Risk Management WC	$27.52
Rate for Payer: Multiplan Commercial	$37.53

RASAGILINE 1 MG TABLET [76481]

Facility

IP

$3.44

Service Code	NDC 23155-747-03
Hospital Charge Code	901700029
Hospital Revenue Code	259
Min. Negotiated Rate	$1.89
Max. Negotiated Rate	$2.75
Rate for Payer: Cash Price	$1.89
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$2.75
Rate for Payer: Health Smart Auto/Commercial	$2.06
Rate for Payer: LLUH Dept of Risk Management WC	$1.89
Rate for Payer: Multiplan Commercial	$2.58

RASAGILINE 1 MG TABLET [76481]

Facility

OP

$3.44

Service Code	NDC 23155-747-03
Hospital Charge Code	901700029
Hospital Revenue Code	259
Min. Negotiated Rate	$1.89
Max. Negotiated Rate	$2.75
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$2.06
Rate for Payer: Aetna of CA Government/Medicare	$2.06
Rate for Payer: Cash Price	$1.89
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$2.75
Rate for Payer: Health Smart Auto/Commercial	$2.06
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$2.06
Rate for Payer: LLUH Dept of Risk Management WC	$1.89
Rate for Payer: Multiplan Commercial	$2.58

REGADENOSON 0.4 MG/5 ML INTRAVENOUS SYRINGE [91408]

Facility

OP

$7.20

Service Code	HCPCS J2785
Hospital Charge Code	901700025
Hospital Revenue Code	636
Min. Negotiated Rate	$3.96
Max. Negotiated Rate	$5.76
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$4.32
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$2.88
Rate for Payer: Aetna of CA Government/Medicare	$4.32
Rate for Payer: Aetna of CA Government/Medicare	$2.88
Rate for Payer: Cash Price	$3.96
Rate for Payer: Cash Price	$2.64
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$5.76
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$3.84
Rate for Payer: Health Smart Auto/Commercial	$2.88
Rate for Payer: Health Smart Auto/Commercial	$4.32
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$4.32
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$2.88
Rate for Payer: LLUH Dept of Risk Management WC	$2.64
Rate for Payer: LLUH Dept of Risk Management WC	$3.96
Rate for Payer: Multiplan Commercial	$5.40
Rate for Payer: Multiplan Commercial	$3.60

REGADENOSON 0.4 MG/5 ML INTRAVENOUS SYRINGE [91408]

Facility

IP

$4.80

Service Code	HCPCS J2785
Hospital Charge Code	901700025
Hospital Revenue Code	636
Min. Negotiated Rate	$2.64
Max. Negotiated Rate	$3.84
Rate for Payer: Cash Price	$2.64
Rate for Payer: Cash Price	$3.96
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$5.76
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$3.84
Rate for Payer: Health Smart Auto/Commercial	$2.88
Rate for Payer: Health Smart Auto/Commercial	$4.32
Rate for Payer: LLUH Dept of Risk Management WC	$2.64
Rate for Payer: LLUH Dept of Risk Management WC	$3.96
Rate for Payer: Multiplan Commercial	$3.60
Rate for Payer: Multiplan Commercial	$5.40

RELUGOLIX 120 MG TABLET [229912]

Facility

OP

$110.49

Service Code	NDC 72974-120-01
Hospital Charge Code	901700029
Hospital Revenue Code	259
Min. Negotiated Rate	$60.77
Max. Negotiated Rate	$88.39
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$66.29
Rate for Payer: Aetna of CA Government/Medicare	$66.29
Rate for Payer: Cash Price	$60.77
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$88.39
Rate for Payer: Health Smart Auto/Commercial	$66.29
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$66.29
Rate for Payer: LLUH Dept of Risk Management WC	$60.77
Rate for Payer: Multiplan Commercial	$82.87

RELUGOLIX 120 MG TABLET [229912]

Facility

IP

$110.49

Service Code	NDC 72974-120-01
Hospital Charge Code	901700029
Hospital Revenue Code	259
Min. Negotiated Rate	$60.77
Max. Negotiated Rate	$88.39
Rate for Payer: Cash Price	$60.77
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$88.39
Rate for Payer: Health Smart Auto/Commercial	$66.29
Rate for Payer: LLUH Dept of Risk Management WC	$60.77
Rate for Payer: Multiplan Commercial	$82.87

REMDESIVIR 100 MG INTRAVENOUS POWDER FOR SOLUTION [227996]

Facility

IP

$780.86

Service Code	HCPCS J0248
Hospital Charge Code	901700025
Hospital Revenue Code	636
Min. Negotiated Rate	$429.47
Max. Negotiated Rate	$624.69
Rate for Payer: Cash Price	$429.48
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$624.69
Rate for Payer: Health Smart Auto/Commercial	$468.52
Rate for Payer: LLUH Dept of Risk Management WC	$429.47
Rate for Payer: Multiplan Commercial	$585.64

REMDESIVIR 100 MG INTRAVENOUS POWDER FOR SOLUTION [227996]

Facility

OP

$780.86

Service Code	HCPCS J0248
Hospital Charge Code	901700025
Hospital Revenue Code	636
Min. Negotiated Rate	$429.47
Max. Negotiated Rate	$624.69
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$468.52
Rate for Payer: Aetna of CA Government/Medicare	$468.52
Rate for Payer: Cash Price	$429.48
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$624.69
Rate for Payer: Health Smart Auto/Commercial	$468.52
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$468.52
Rate for Payer: LLUH Dept of Risk Management WC	$429.47
Rate for Payer: Multiplan Commercial	$585.64

REMDESIVIR 100 MG LYOPHILIZED POWDER FOR INJECTION - COMMERCIAL PRODUCT [4082058626]

Facility

OP

$780.86

Service Code	HCPCS J0248
Hospital Charge Code	901700025
Hospital Revenue Code	636
Min. Negotiated Rate	$429.47
Max. Negotiated Rate	$624.69
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$468.52
Rate for Payer: Aetna of CA Government/Medicare	$468.52
Rate for Payer: Cash Price	$429.48
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$624.69
Rate for Payer: Health Smart Auto/Commercial	$468.52
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$468.52
Rate for Payer: LLUH Dept of Risk Management WC	$429.47
Rate for Payer: Multiplan Commercial	$585.64

REMDESIVIR 100 MG LYOPHILIZED POWDER FOR INJECTION - COMMERCIAL PRODUCT [4082058626]

Facility

IP

$780.86

Service Code	HCPCS J0248
Hospital Charge Code	901700025
Hospital Revenue Code	636
Min. Negotiated Rate	$429.47
Max. Negotiated Rate	$624.69
Rate for Payer: Cash Price	$429.48
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$624.69
Rate for Payer: Health Smart Auto/Commercial	$468.52
Rate for Payer: LLUH Dept of Risk Management WC	$429.47
Rate for Payer: Multiplan Commercial	$585.64

REMIFENTANIL 1 MG INTRAVENOUS SOLUTION [18398]

Facility

IP

$87.97

Service Code	NDC 63323-723-03
Hospital Charge Code	901700004
Hospital Revenue Code	250
Min. Negotiated Rate	$48.38
Max. Negotiated Rate	$70.38
Rate for Payer: Cash Price	$48.38
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$70.38
Rate for Payer: Health Smart Auto/Commercial	$52.78
Rate for Payer: LLUH Dept of Risk Management WC	$48.38
Rate for Payer: Multiplan Commercial	$65.98

REMIFENTANIL 1 MG INTRAVENOUS SOLUTION [18398]

Facility

IP

$87.97

Service Code	NDC 63323-723-01
Hospital Charge Code	901700004
Hospital Revenue Code	250
Min. Negotiated Rate	$48.38
Max. Negotiated Rate	$70.38
Rate for Payer: Cash Price	$48.38
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$70.38
Rate for Payer: Health Smart Auto/Commercial	$52.78
Rate for Payer: LLUH Dept of Risk Management WC	$48.38
Rate for Payer: Multiplan Commercial	$65.98

REMIFENTANIL 1 MG INTRAVENOUS SOLUTION [18398]

Facility

IP

$80.83

Service Code	NDC 72078-034-01
Hospital Charge Code	901700004
Hospital Revenue Code	250
Min. Negotiated Rate	$44.46
Max. Negotiated Rate	$64.66
Rate for Payer: Cash Price	$44.46
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$64.66
Rate for Payer: Health Smart Auto/Commercial	$48.50
Rate for Payer: LLUH Dept of Risk Management WC	$44.46
Rate for Payer: Multiplan Commercial	$60.62

REMIFENTANIL 1 MG INTRAVENOUS SOLUTION [18398]

Facility

OP

$80.83

Service Code	NDC 72078-034-00
Hospital Charge Code	901700004
Hospital Revenue Code	250
Min. Negotiated Rate	$44.46
Max. Negotiated Rate	$64.66
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$48.50
Rate for Payer: Aetna of CA Government/Medicare	$48.50
Rate for Payer: Cash Price	$44.46
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$64.66
Rate for Payer: Health Smart Auto/Commercial	$48.50
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$48.50
Rate for Payer: LLUH Dept of Risk Management WC	$44.46
Rate for Payer: Multiplan Commercial	$60.62

REMIFENTANIL 1 MG INTRAVENOUS SOLUTION [18398]

Facility

OP

$87.97

Service Code	NDC 63323-723-01
Hospital Charge Code	901700004
Hospital Revenue Code	250
Min. Negotiated Rate	$48.38
Max. Negotiated Rate	$70.38
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$52.78
Rate for Payer: Aetna of CA Government/Medicare	$52.78
Rate for Payer: Cash Price	$48.38
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$70.38
Rate for Payer: Health Smart Auto/Commercial	$52.78
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$52.78
Rate for Payer: LLUH Dept of Risk Management WC	$48.38
Rate for Payer: Multiplan Commercial	$65.98

REMIFENTANIL 1 MG INTRAVENOUS SOLUTION [18398]

Facility

OP

$87.97

Service Code	NDC 63323-723-03
Hospital Charge Code	901700004
Hospital Revenue Code	250
Min. Negotiated Rate	$48.38
Max. Negotiated Rate	$70.38
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$52.78
Rate for Payer: Aetna of CA Government/Medicare	$52.78
Rate for Payer: Cash Price	$48.38
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$70.38
Rate for Payer: Health Smart Auto/Commercial	$52.78
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$52.78
Rate for Payer: LLUH Dept of Risk Management WC	$48.38
Rate for Payer: Multiplan Commercial	$65.98

REMIFENTANIL 1 MG INTRAVENOUS SOLUTION [18398]

Facility

OP

$80.83

Service Code	NDC 72078-034-01
Hospital Charge Code	901700004
Hospital Revenue Code	250
Min. Negotiated Rate	$44.46
Max. Negotiated Rate	$64.66
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$48.50
Rate for Payer: Aetna of CA Government/Medicare	$48.50
Rate for Payer: Cash Price	$44.46
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$64.66
Rate for Payer: Health Smart Auto/Commercial	$48.50
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$48.50
Rate for Payer: LLUH Dept of Risk Management WC	$44.46
Rate for Payer: Multiplan Commercial	$60.62

REMIFENTANIL 1 MG INTRAVENOUS SOLUTION [18398]

Facility

IP

$80.83

Service Code	NDC 72078-034-00
Hospital Charge Code	901700004
Hospital Revenue Code	250
Min. Negotiated Rate	$44.46
Max. Negotiated Rate	$64.66
Rate for Payer: Cash Price	$44.46
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$64.66
Rate for Payer: Health Smart Auto/Commercial	$48.50
Rate for Payer: LLUH Dept of Risk Management WC	$44.46
Rate for Payer: Multiplan Commercial	$60.62

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