Price Transparency

Know your out-of-pocket cost for care.

All Charges

Charge

Type

Setting

Price

CHOLECALCIFEROL (VITAMIN D3) 50 MCG (2,000 UNIT) TABLET [94284]

Facility

OP

$0.03

Service Code	NDC 904615760
Hospital Charge Code	1712537
Hospital Revenue Code	259
Min. Negotiated Rate	$0.02
Max. Negotiated Rate	$0.02
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$0.02
Rate for Payer: Aetna of CA Government/Medicare	$0.02
Rate for Payer: Cash Price	$0.01
Rate for Payer: Health Smart Auto/Commercial	$0.02
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$0.02
Rate for Payer: LLUH Dept of Risk Management WC	$0.02
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$0.02

CHOLESTYRAMINE (WITH SUGAR) 4 GRAM POWDER FOR SUSP IN A PACKET [9588]

Facility

IP

$2.46

Service Code	NDC 49884-465-64
Hospital Charge Code	1713081
Hospital Revenue Code	259
Min. Negotiated Rate	$1.35
Max. Negotiated Rate	$1.97
Rate for Payer: Cash Price	$1.11
Rate for Payer: Cigna of CA HMO/PPO	$1.97
Rate for Payer: Health Smart Auto/Commercial	$1.48
Rate for Payer: LLUH Dept of Risk Management WC	$1.35
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$1.84

CHOLESTYRAMINE (WITH SUGAR) 4 GRAM POWDER FOR SUSP IN A PACKET [9588]

Facility

IP

$1.16

Service Code	NDC 67877-298-60
Hospital Charge Code	1713081
Hospital Revenue Code	259
Min. Negotiated Rate	$0.64
Max. Negotiated Rate	$0.93
Rate for Payer: Cash Price	$0.52
Rate for Payer: Cigna of CA HMO/PPO	$0.93
Rate for Payer: Health Smart Auto/Commercial	$0.70
Rate for Payer: LLUH Dept of Risk Management WC	$0.64
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$0.87

CHOLESTYRAMINE (WITH SUGAR) 4 GRAM POWDER FOR SUSP IN A PACKET [9588]

Facility

OP

$2.46

Service Code	NDC 49884-465-64
Hospital Charge Code	1713081
Hospital Revenue Code	259
Min. Negotiated Rate	$1.35
Max. Negotiated Rate	$1.84
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$1.48
Rate for Payer: Aetna of CA Government/Medicare	$1.48
Rate for Payer: Cash Price	$1.11
Rate for Payer: Health Smart Auto/Commercial	$1.48
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$1.48
Rate for Payer: LLUH Dept of Risk Management WC	$1.35
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$1.84

CHOLESTYRAMINE (WITH SUGAR) 4 GRAM POWDER FOR SUSP IN A PACKET [9588]

Facility

OP

$1.16

Service Code	NDC 67877-298-09
Hospital Charge Code	1713081
Hospital Revenue Code	259
Min. Negotiated Rate	$0.64
Max. Negotiated Rate	$0.87
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$0.70
Rate for Payer: Aetna of CA Government/Medicare	$0.70
Rate for Payer: Cash Price	$0.52
Rate for Payer: Health Smart Auto/Commercial	$0.70
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$0.70
Rate for Payer: LLUH Dept of Risk Management WC	$0.64
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$0.87

CHOLESTYRAMINE (WITH SUGAR) 4 GRAM POWDER FOR SUSP IN A PACKET [9588]

Facility

OP

$1.16

Service Code	NDC 67877-298-60
Hospital Charge Code	1713081
Hospital Revenue Code	259
Min. Negotiated Rate	$0.64
Max. Negotiated Rate	$0.87
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$0.70
Rate for Payer: Aetna of CA Government/Medicare	$0.70
Rate for Payer: Cash Price	$0.52
Rate for Payer: Health Smart Auto/Commercial	$0.70
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$0.70
Rate for Payer: LLUH Dept of Risk Management WC	$0.64
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$0.87

CHOLESTYRAMINE (WITH SUGAR) 4 GRAM POWDER FOR SUSP IN A PACKET [9588]

Facility

IP

$1.16

Service Code	NDC 67877-298-09
Hospital Charge Code	1713081
Hospital Revenue Code	259
Min. Negotiated Rate	$0.64
Max. Negotiated Rate	$0.93
Rate for Payer: Cash Price	$0.52
Rate for Payer: Cigna of CA HMO/PPO	$0.93
Rate for Payer: Health Smart Auto/Commercial	$0.70
Rate for Payer: LLUH Dept of Risk Management WC	$0.64
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$0.87

CHOLESTYRAMINE (WITH SUGAR) 4 GRAM POWDER FOR SUSP IN A PACKET [9588]

Facility

IP

$2.46

Service Code	NDC 49884-465-65
Hospital Charge Code	1713081
Hospital Revenue Code	259
Min. Negotiated Rate	$1.35
Max. Negotiated Rate	$1.97
Rate for Payer: Cash Price	$1.11
Rate for Payer: Cigna of CA HMO/PPO	$1.97
Rate for Payer: Health Smart Auto/Commercial	$1.48
Rate for Payer: LLUH Dept of Risk Management WC	$1.35
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$1.84

CHOLESTYRAMINE (WITH SUGAR) 4 GRAM POWDER FOR SUSP IN A PACKET [9588]

Facility

OP

$2.46

Service Code	NDC 49884-465-65
Hospital Charge Code	1713081
Hospital Revenue Code	259
Min. Negotiated Rate	$1.35
Max. Negotiated Rate	$1.84
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$1.48
Rate for Payer: Aetna of CA Government/Medicare	$1.48
Rate for Payer: Cash Price	$1.11
Rate for Payer: Health Smart Auto/Commercial	$1.48
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$1.48
Rate for Payer: LLUH Dept of Risk Management WC	$1.35
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$1.84

CHONDROITIN-SOD HYALURON 3 %-4 %(0.35 ML)1 %(0.4 ML)INTRAOCULAR SYRING [28916]

Facility

IP

$378.13

Service Code	NDC 8065183135
Hospital Charge Code	NDG28916
Hospital Revenue Code	250
Min. Negotiated Rate	$207.97
Max. Negotiated Rate	$302.50
Rate for Payer: Cash Price	$170.16
Rate for Payer: Cigna of CA HMO/PPO	$302.50
Rate for Payer: Health Smart Auto/Commercial	$226.88
Rate for Payer: LLUH Dept of Risk Management WC	$207.97
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$283.60

CHONDROITIN-SOD HYALURON 3 %-4 %(0.35 ML)1 %(0.4 ML)INTRAOCULAR SYRING [28916]

Facility

OP

$378.13

Service Code	NDC 8065183135
Hospital Charge Code	NDG28916
Hospital Revenue Code	250
Min. Negotiated Rate	$207.97
Max. Negotiated Rate	$283.60
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$226.88
Rate for Payer: Aetna of CA Government/Medicare	$226.88
Rate for Payer: Cash Price	$170.16
Rate for Payer: Health Smart Auto/Commercial	$226.88
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$226.88
Rate for Payer: LLUH Dept of Risk Management WC	$207.97
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$283.60

CHONDROITIN-SOD HYALURON 4 %-3 % (40 MG-30 MG/ML) INTRAOCULAR SYRINGE [28923]

Facility

OP

$431.64

Service Code	NDC 8065183905
Hospital Charge Code	1720965
Hospital Revenue Code	272
Min. Negotiated Rate	$237.40
Max. Negotiated Rate	$323.73
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$258.98
Rate for Payer: Aetna of CA Government/Medicare	$258.98
Rate for Payer: Cash Price	$194.24
Rate for Payer: Health Smart Auto/Commercial	$258.98
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$258.98
Rate for Payer: LLUH Dept of Risk Management WC	$237.40
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$323.73

CHONDROITIN-SOD HYALURON 4 %-3 % (40 MG-30 MG/ML) INTRAOCULAR SYRINGE [28923]

Facility

IP

$431.64

Service Code	NDC 8065183905
Hospital Charge Code	1720965
Hospital Revenue Code	272
Min. Negotiated Rate	$237.40
Max. Negotiated Rate	$345.31
Rate for Payer: Cash Price	$194.24
Rate for Payer: Cigna of CA HMO/PPO	$345.31
Rate for Payer: Health Smart Auto/Commercial	$258.98
Rate for Payer: LLUH Dept of Risk Management WC	$237.40
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$323.73

CHROMIUM CHLORIDE 4 MCG/ML INTRAVENOUS SOLUTION [1685]

Facility

OP

$2.38

Service Code	NDC 0409-4093-01
Hospital Charge Code	1757538
Hospital Revenue Code	250
Min. Negotiated Rate	$1.31
Max. Negotiated Rate	$1.78
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$1.43
Rate for Payer: Aetna of CA Government/Medicare	$1.43
Rate for Payer: Cash Price	$1.07
Rate for Payer: Health Smart Auto/Commercial	$1.43
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$1.43
Rate for Payer: LLUH Dept of Risk Management WC	$1.31
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$1.78

CHROMIUM CHLORIDE 4 MCG/ML INTRAVENOUS SOLUTION [1685]

Facility

IP

$2.38

Service Code	NDC 0409-4093-01
Hospital Charge Code	1757538
Hospital Revenue Code	250
Min. Negotiated Rate	$1.31
Max. Negotiated Rate	$1.90
Rate for Payer: Cash Price	$1.07
Rate for Payer: Cigna of CA HMO/PPO	$1.90
Rate for Payer: Health Smart Auto/Commercial	$1.43
Rate for Payer: LLUH Dept of Risk Management WC	$1.31
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$1.78

C.I. ACID BLUE 90 0.025 % INTRAOCULAR SYRINGE [227971]

Facility

IP

$352.80

Service Code	CPT J3490
Hospital Charge Code	ERX227971
Hospital Revenue Code	636
Min. Negotiated Rate	$194.04
Max. Negotiated Rate	$282.24
Rate for Payer: Cash Price	$158.76
Rate for Payer: Cigna of CA HMO/PPO	$282.24
Rate for Payer: Health Smart Auto/Commercial	$211.68
Rate for Payer: LLUH Dept of Risk Management WC	$194.04
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$264.60

C.I. ACID BLUE 90 0.025 % INTRAOCULAR SYRINGE [227971]

Facility

OP

$352.80

Service Code	CPT J3490
Hospital Charge Code	ERX227971
Hospital Revenue Code	636
Min. Negotiated Rate	$194.04
Max. Negotiated Rate	$264.60
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$211.68
Rate for Payer: Aetna of CA Government/Medicare	$211.68
Rate for Payer: Cash Price	$158.76
Rate for Payer: Health Smart Auto/Commercial	$211.68
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$211.68
Rate for Payer: LLUH Dept of Risk Management WC	$194.04
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$264.60

CICLOPIROX 0.77 % TOPICAL CREAM [9598]

Facility

IP

$1.49

Service Code	NDC 51672-1318-1
Hospital Charge Code	NDG9598
Hospital Revenue Code	259
Min. Negotiated Rate	$0.82
Max. Negotiated Rate	$1.19
Rate for Payer: Cash Price	$0.67
Rate for Payer: Cigna of CA HMO/PPO	$1.19
Rate for Payer: Health Smart Auto/Commercial	$0.89
Rate for Payer: LLUH Dept of Risk Management WC	$0.82
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$1.12

CICLOPIROX 0.77 % TOPICAL CREAM [9598]

Facility

OP

$1.23

Service Code	NDC 68462-297-17
Hospital Charge Code	NDG9598
Hospital Revenue Code	259
Min. Negotiated Rate	$0.68
Max. Negotiated Rate	$0.92
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$0.74
Rate for Payer: Aetna of CA Government/Medicare	$0.74
Rate for Payer: Cash Price	$0.55
Rate for Payer: Health Smart Auto/Commercial	$0.74
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$0.74
Rate for Payer: LLUH Dept of Risk Management WC	$0.68
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$0.92

CICLOPIROX 0.77 % TOPICAL CREAM [9598]

Facility

OP

$1.08

Service Code	NDC 45802-138-11
Hospital Charge Code	1743680
Hospital Revenue Code	259
Min. Negotiated Rate	$0.59
Max. Negotiated Rate	$0.81
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$0.65
Rate for Payer: Aetna of CA Government/Medicare	$0.65
Rate for Payer: Cash Price	$0.49
Rate for Payer: Health Smart Auto/Commercial	$0.65
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$0.65
Rate for Payer: LLUH Dept of Risk Management WC	$0.59
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$0.81

CICLOPIROX 0.77 % TOPICAL CREAM [9598]

Facility

IP

$1.23

Service Code	NDC 68462-297-17
Hospital Charge Code	NDG9598
Hospital Revenue Code	259
Min. Negotiated Rate	$0.68
Max. Negotiated Rate	$0.98
Rate for Payer: Cash Price	$0.55
Rate for Payer: Cigna of CA HMO/PPO	$0.98
Rate for Payer: Health Smart Auto/Commercial	$0.74
Rate for Payer: LLUH Dept of Risk Management WC	$0.68
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$0.92

CICLOPIROX 0.77 % TOPICAL CREAM [9598]

Facility

OP

$1.49

Service Code	NDC 51672-1318-1
Hospital Charge Code	NDG9598
Hospital Revenue Code	259
Min. Negotiated Rate	$0.82
Max. Negotiated Rate	$1.12
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$0.89
Rate for Payer: Aetna of CA Government/Medicare	$0.89
Rate for Payer: Cash Price	$0.67
Rate for Payer: Health Smart Auto/Commercial	$0.89
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$0.89
Rate for Payer: LLUH Dept of Risk Management WC	$0.82
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$1.12

CICLOPIROX 0.77 % TOPICAL CREAM [9598]

Facility

IP

$1.08

Service Code	NDC 45802-138-11
Hospital Charge Code	1743680
Hospital Revenue Code	259
Min. Negotiated Rate	$0.59
Max. Negotiated Rate	$0.86
Rate for Payer: Cash Price	$0.49
Rate for Payer: Cigna of CA HMO/PPO	$0.86
Rate for Payer: Health Smart Auto/Commercial	$0.65
Rate for Payer: LLUH Dept of Risk Management WC	$0.59
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$0.81

CICLOPIROX 8 % TOPICAL SOLUTION [27158]

Facility

IP

$6.76

Service Code	NDC 50383-419-06
Hospital Charge Code	1743748
Hospital Revenue Code	259
Min. Negotiated Rate	$3.72
Max. Negotiated Rate	$5.41
Rate for Payer: Cash Price	$3.04
Rate for Payer: Cigna of CA HMO/PPO	$5.41
Rate for Payer: Health Smart Auto/Commercial	$4.06
Rate for Payer: LLUH Dept of Risk Management WC	$3.72
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$5.07

CICLOPIROX 8 % TOPICAL SOLUTION [27158]

Facility

OP

$5.82

Service Code	NDC 0713-0317-88
Hospital Charge Code	1743748
Hospital Revenue Code	259
Min. Negotiated Rate	$3.20
Max. Negotiated Rate	$4.36
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$3.49
Rate for Payer: Aetna of CA Government/Medicare	$3.49
Rate for Payer: Cash Price	$2.62
Rate for Payer: Health Smart Auto/Commercial	$3.49
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$3.49
Rate for Payer: LLUH Dept of Risk Management WC	$3.20
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$4.36

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