Price Transparency

Know your out-of-pocket cost for care.

All Charges

Charge

Type

Setting

Price

CANDESARTAN 32 MG TABLET [23232]

Facility

OP

$3.82

Service Code	NDC 49884-661-09
Hospital Charge Code	901700029
Hospital Revenue Code	259
Min. Negotiated Rate	$2.10
Max. Negotiated Rate	$3.06
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$2.29
Rate for Payer: Aetna of CA Government/Medicare	$2.29
Rate for Payer: Cash Price	$2.10
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$3.06
Rate for Payer: Health Smart Auto/Commercial	$2.29
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$2.29
Rate for Payer: LLUH Dept of Risk Management WC	$2.10
Rate for Payer: Multiplan Commercial	$2.87

CANDESARTAN 32 MG TABLET [23232]

Facility

IP

$3.82

Service Code	NDC 49884-661-09
Hospital Charge Code	901700029
Hospital Revenue Code	259
Min. Negotiated Rate	$2.10
Max. Negotiated Rate	$3.06
Rate for Payer: Cash Price	$2.10
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$3.06
Rate for Payer: Health Smart Auto/Commercial	$2.29
Rate for Payer: LLUH Dept of Risk Management WC	$2.10
Rate for Payer: Multiplan Commercial	$2.87

CANDESARTAN 32 MG TABLET [23232]

Facility

IP

$2.04

Service Code	NDC 33342-117-07
Hospital Charge Code	901700029
Hospital Revenue Code	259
Min. Negotiated Rate	$1.12
Max. Negotiated Rate	$1.63
Rate for Payer: Cash Price	$1.12
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$1.63
Rate for Payer: Health Smart Auto/Commercial	$1.22
Rate for Payer: LLUH Dept of Risk Management WC	$1.12
Rate for Payer: Multiplan Commercial	$1.53

CANDESARTAN 32 MG TABLET [23232]

Facility

OP

$2.04

Service Code	NDC 0378-3232-93
Hospital Charge Code	901700029
Hospital Revenue Code	259
Min. Negotiated Rate	$1.12
Max. Negotiated Rate	$1.63
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$1.22
Rate for Payer: Aetna of CA Government/Medicare	$1.22
Rate for Payer: Cash Price	$1.12
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$1.63
Rate for Payer: Health Smart Auto/Commercial	$1.22
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$1.22
Rate for Payer: LLUH Dept of Risk Management WC	$1.12
Rate for Payer: Multiplan Commercial	$1.53

CANDESARTAN 32 MG TABLET [23232]

Facility

IP

$2.04

Service Code	NDC 0378-3232-93
Hospital Charge Code	901700029
Hospital Revenue Code	259
Min. Negotiated Rate	$1.12
Max. Negotiated Rate	$1.63
Rate for Payer: Cash Price	$1.12
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$1.63
Rate for Payer: Health Smart Auto/Commercial	$1.22
Rate for Payer: LLUH Dept of Risk Management WC	$1.12
Rate for Payer: Multiplan Commercial	$1.53

CANDESARTAN 32 MG TABLET [23232]

Facility

OP

$2.04

Service Code	NDC 33342-117-07
Hospital Charge Code	901700029
Hospital Revenue Code	259
Min. Negotiated Rate	$1.12
Max. Negotiated Rate	$1.63
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$1.22
Rate for Payer: Aetna of CA Government/Medicare	$1.22
Rate for Payer: Cash Price	$1.12
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$1.63
Rate for Payer: Health Smart Auto/Commercial	$1.22
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$1.22
Rate for Payer: LLUH Dept of Risk Management WC	$1.12
Rate for Payer: Multiplan Commercial	$1.53

CANDESARTAN 8 MG TABLET [23230]

Facility

OP

$1.60

Service Code	NDC 0378-3225-93
Hospital Charge Code	901700029
Hospital Revenue Code	259
Min. Negotiated Rate	$0.88
Max. Negotiated Rate	$1.28
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$0.96
Rate for Payer: Aetna of CA Government/Medicare	$0.96
Rate for Payer: Cash Price	$0.88
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$1.28
Rate for Payer: Health Smart Auto/Commercial	$0.96
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$0.96
Rate for Payer: LLUH Dept of Risk Management WC	$0.88
Rate for Payer: Multiplan Commercial	$1.20

CANDESARTAN 8 MG TABLET [23230]

Facility

IP

$1.60

Service Code	NDC 0378-3225-93
Hospital Charge Code	901700029
Hospital Revenue Code	259
Min. Negotiated Rate	$0.88
Max. Negotiated Rate	$1.28
Rate for Payer: Cash Price	$0.88
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO 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 Commercial	$1.20

CANNABIDIOL 100 MG/ML ORAL SOLUTION [222792]

Facility

OP

$20.52

Service Code	NDC 70127-100-10
Hospital Charge Code	901700029
Hospital Revenue Code	259
Min. Negotiated Rate	$11.29
Max. Negotiated Rate	$16.42
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$12.31
Rate for Payer: Aetna of CA Government/Medicare	$12.31
Rate for Payer: Cash Price	$11.29
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$16.42
Rate for Payer: Health Smart Auto/Commercial	$12.31
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$12.31
Rate for Payer: LLUH Dept of Risk Management WC	$11.29
Rate for Payer: Multiplan Commercial	$15.39

CANNABIDIOL 100 MG/ML ORAL SOLUTION [222792]

Facility

IP

$20.52

Service Code	NDC 70127-100-10
Hospital Charge Code	901700029
Hospital Revenue Code	259
Min. Negotiated Rate	$11.29
Max. Negotiated Rate	$16.42
Rate for Payer: Cash Price	$11.29
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$16.42
Rate for Payer: Health Smart Auto/Commercial	$12.31
Rate for Payer: LLUH Dept of Risk Management WC	$11.29
Rate for Payer: Multiplan Commercial	$15.39

CANNABIDIOL 100 MG/ML ORAL SOLUTION [222792]

Facility

OP

$20.52

Service Code	NDC 70127-100-01
Hospital Charge Code	901700029
Hospital Revenue Code	259
Min. Negotiated Rate	$11.29
Max. Negotiated Rate	$16.42
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$12.31
Rate for Payer: Aetna of CA Government/Medicare	$12.31
Rate for Payer: Cash Price	$11.29
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$16.42
Rate for Payer: Health Smart Auto/Commercial	$12.31
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$12.31
Rate for Payer: LLUH Dept of Risk Management WC	$11.29
Rate for Payer: Multiplan Commercial	$15.39

CANNABIDIOL 100 MG/ML ORAL SOLUTION [222792]

Facility

IP

$20.52

Service Code	NDC 70127-100-01
Hospital Charge Code	901700029
Hospital Revenue Code	259
Min. Negotiated Rate	$11.29
Max. Negotiated Rate	$16.42
Rate for Payer: Cash Price	$11.29
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$16.42
Rate for Payer: Health Smart Auto/Commercial	$12.31
Rate for Payer: LLUH Dept of Risk Management WC	$11.29
Rate for Payer: Multiplan Commercial	$15.39

CAPMATINIB 150 MG TABLET [228060]

Facility

IP

$250.00

Service Code	NDC 0078-0709-56
Hospital Charge Code	901700029
Hospital Revenue Code	259
Min. Negotiated Rate	$137.50
Max. Negotiated Rate	$200.00
Rate for Payer: Cash Price	$137.50
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$200.00
Rate for Payer: Health Smart Auto/Commercial	$150.00
Rate for Payer: LLUH Dept of Risk Management WC	$137.50
Rate for Payer: Multiplan Commercial	$187.50

CAPMATINIB 150 MG TABLET [228060]

Facility

OP

$250.00

Service Code	NDC 0078-0709-56
Hospital Charge Code	901700029
Hospital Revenue Code	259
Min. Negotiated Rate	$137.50
Max. Negotiated Rate	$200.00
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$150.00
Rate for Payer: Aetna of CA Government/Medicare	$150.00
Rate for Payer: Cash Price	$137.50
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$200.00
Rate for Payer: Health Smart Auto/Commercial	$150.00
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$150.00
Rate for Payer: LLUH Dept of Risk Management WC	$137.50
Rate for Payer: Multiplan Commercial	$187.50

CAPMATINIB 200 MG TABLET [228061]

Facility

IP

$250.00

Service Code	NDC 0078-0716-56
Hospital Charge Code	901700029
Hospital Revenue Code	259
Min. Negotiated Rate	$137.50
Max. Negotiated Rate	$200.00
Rate for Payer: Cash Price	$137.50
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$200.00
Rate for Payer: Health Smart Auto/Commercial	$150.00
Rate for Payer: LLUH Dept of Risk Management WC	$137.50
Rate for Payer: Multiplan Commercial	$187.50

CAPMATINIB 200 MG TABLET [228061]

Facility

OP

$250.00

Service Code	NDC 0078-0716-56
Hospital Charge Code	901700029
Hospital Revenue Code	259
Min. Negotiated Rate	$137.50
Max. Negotiated Rate	$200.00
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$150.00
Rate for Payer: Aetna of CA Government/Medicare	$150.00
Rate for Payer: Cash Price	$137.50
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$200.00
Rate for Payer: Health Smart Auto/Commercial	$150.00
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$150.00
Rate for Payer: LLUH Dept of Risk Management WC	$137.50
Rate for Payer: Multiplan Commercial	$187.50

CAPSAICIN 0.025 % TOPICAL CREAM [1350]

Facility

OP

$0.14

Service Code	NDC 0536-2525-25
Hospital Charge Code	901700029
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	$0.08
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$0.11
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 Commercial	$0.11

CAPSAICIN 0.025 % TOPICAL CREAM [1350]

Facility

IP

$0.14

Service Code	NDC 0536-2525-25
Hospital Charge Code	901700029
Hospital Revenue Code	259
Min. Negotiated Rate	$0.08
Max. Negotiated Rate	$0.11
Rate for Payer: Cash Price	$0.08
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO 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 Commercial	$0.11

CAPSAICIN 0.075 % TOPICAL CREAM [9399]

Facility

OP

$0.10

Service Code	NDC 0536-1118-25
Hospital Charge Code	901700029
Hospital Revenue Code	259
Min. Negotiated Rate	$0.06
Max. Negotiated Rate	$0.08
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$0.06
Rate for Payer: Aetna of CA Government/Medicare	$0.06
Rate for Payer: Cash Price	$0.05
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$0.08
Rate for Payer: Health Smart Auto/Commercial	$0.06
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$0.06
Rate for Payer: LLUH Dept of Risk Management WC	$0.06
Rate for Payer: Multiplan Commercial	$0.08

CAPSAICIN 0.075 % TOPICAL CREAM [9399]

Facility

IP

$0.10

Service Code	NDC 0536-1118-25
Hospital Charge Code	901700029
Hospital Revenue Code	259
Min. Negotiated Rate	$0.06
Max. Negotiated Rate	$0.08
Rate for Payer: Cash Price	$0.05
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$0.08
Rate for Payer: Health Smart Auto/Commercial	$0.06
Rate for Payer: LLUH Dept of Risk Management WC	$0.06
Rate for Payer: Multiplan Commercial	$0.08

CAPSAICIN 0.1 % TOPICAL CREAM [70403]

Facility

IP

$0.29

Service Code	NDC 6056944302
Hospital Charge Code	901700029
Hospital Revenue Code	259
Min. Negotiated Rate	$0.16
Max. Negotiated Rate	$0.23
Rate for Payer: Cash Price	$0.16
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$0.23
Rate for Payer: Health Smart Auto/Commercial	$0.17
Rate for Payer: LLUH Dept of Risk Management WC	$0.16
Rate for Payer: Multiplan Commercial	$0.22

CAPSAICIN 0.1 % TOPICAL CREAM [70403]

Facility

OP

$0.29

Service Code	NDC 6056944302
Hospital Charge Code	901700029
Hospital Revenue Code	259
Min. Negotiated Rate	$0.16
Max. Negotiated Rate	$0.23
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$0.17
Rate for Payer: Aetna of CA Government/Medicare	$0.17
Rate for Payer: Cash Price	$0.16
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$0.23
Rate for Payer: Health Smart Auto/Commercial	$0.17
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$0.17
Rate for Payer: LLUH Dept of Risk Management WC	$0.16
Rate for Payer: Multiplan Commercial	$0.22

CAPTOPRIL 12.5 MG TABLET [9401]

Facility

OP

$1.70

Service Code	NDC 60687-304-11
Hospital Charge Code	901700029
Hospital Revenue Code	259
Min. Negotiated Rate	$0.94
Max. Negotiated Rate	$1.36
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$1.02
Rate for Payer: Aetna of CA Government/Medicare	$1.02
Rate for Payer: Cash Price	$0.93
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$1.36
Rate for Payer: Health Smart Auto/Commercial	$1.02
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$1.02
Rate for Payer: LLUH Dept of Risk Management WC	$0.94
Rate for Payer: Multiplan Commercial	$1.27

CAPTOPRIL 12.5 MG TABLET [9401]

Facility

OP

$1.20

Service Code	NDC 69292-522-01
Hospital Charge Code	901700029
Hospital Revenue Code	259
Min. Negotiated Rate	$0.66
Max. Negotiated Rate	$0.96
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$0.72
Rate for Payer: Aetna of CA Government/Medicare	$0.72
Rate for Payer: Cash Price	$0.66
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$0.96
Rate for Payer: Health Smart Auto/Commercial	$0.72
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$0.72
Rate for Payer: LLUH Dept of Risk Management WC	$0.66
Rate for Payer: Multiplan Commercial	$0.90

CAPTOPRIL 12.5 MG TABLET [9401]

Facility

IP

$1.70

Service Code	NDC 60687-304-21
Hospital Charge Code	901700029
Hospital Revenue Code	259
Min. Negotiated Rate	$0.94
Max. Negotiated Rate	$1.36
Rate for Payer: Cash Price	$0.93
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$1.36
Rate for Payer: Health Smart Auto/Commercial	$1.02
Rate for Payer: LLUH Dept of Risk Management WC	$0.94
Rate for Payer: Multiplan Commercial	$1.27

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