Price Transparency

Know your out-of-pocket cost for care.

All Charges

Charge

Type

Setting

Price

HEPARIN, PORCINE (PF) 100 UNIT/ML INTRAVENOUS SOLUTION [408117967]

Facility

IP

$0.16

Service Code	NDC 9994-0819-20
Hospital Charge Code	901700017
Hospital Revenue Code	272
Min. Negotiated Rate	$0.09
Max. Negotiated Rate	$0.13
Rate for Payer: Cash Price	$0.09
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$0.13
Rate for Payer: Health Smart Auto/Commercial	$0.10
Rate for Payer: LLUH Dept of Risk Management WC	$0.09
Rate for Payer: Multiplan Commercial	$0.12

HEPARIN, PORCINE (PF) 100 UNIT/ML INTRAVENOUS SOLUTION [408117967]

Facility

OP

$0.16

Service Code	NDC 9994-0819-20
Hospital Charge Code	901700017
Hospital Revenue Code	272
Min. Negotiated Rate	$0.09
Max. Negotiated Rate	$0.13
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$0.10
Rate for Payer: Aetna of CA Government/Medicare	$0.10
Rate for Payer: Cash Price	$0.09
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$0.13
Rate for Payer: Health Smart Auto/Commercial	$0.10
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$0.10
Rate for Payer: LLUH Dept of Risk Management WC	$0.09
Rate for Payer: Multiplan Commercial	$0.12

HEPARIN, PORCINE (PF) 100 UNIT/ML INTRAVENOUS SOLUTION [408117967]

Facility

IP

$0.27

Service Code	NDC 6425333323
Hospital Charge Code	901700017
Hospital Revenue Code	272
Min. Negotiated Rate	$0.15
Max. Negotiated Rate	$0.22
Rate for Payer: Cash Price	$0.15
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$0.22
Rate for Payer: Health Smart Auto/Commercial	$0.16
Rate for Payer: LLUH Dept of Risk Management WC	$0.15
Rate for Payer: Multiplan Commercial	$0.20

HEPARIN, PORCINE (PF) 100 UNIT/ML INTRAVENOUS SOLUTION [408117967]

Facility

OP

$3.37

Service Code	NDC 6332354901
Hospital Charge Code	901700017
Hospital Revenue Code	272
Min. Negotiated Rate	$1.85
Max. Negotiated Rate	$2.70
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$2.02
Rate for Payer: Aetna of CA Government/Medicare	$2.02
Rate for Payer: Cash Price	$1.85
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$2.70
Rate for Payer: Health Smart Auto/Commercial	$2.02
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$2.02
Rate for Payer: LLUH Dept of Risk Management WC	$1.85
Rate for Payer: Multiplan Commercial	$2.53

HEPARIN, PORCINE (PF) 100 UNIT/ML INTRAVENOUS SOLUTION [408117967]

Facility

OP

$0.16

Service Code	NDC 6425333335
Hospital Charge Code	901700017
Hospital Revenue Code	272
Min. Negotiated Rate	$0.09
Max. Negotiated Rate	$0.13
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$0.10
Rate for Payer: Aetna of CA Government/Medicare	$0.10
Rate for Payer: Cash Price	$0.09
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$0.13
Rate for Payer: Health Smart Auto/Commercial	$0.10
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$0.10
Rate for Payer: LLUH Dept of Risk Management WC	$0.09
Rate for Payer: Multiplan Commercial	$0.12

HEPARIN, PORCINE (PF) 100 UNIT/ML INTRAVENOUS SOLUTION [408117967]

Facility

IP

$0.17

Service Code	NDC 8290306424
Hospital Charge Code	901700017
Hospital Revenue Code	272
Min. Negotiated Rate	$0.09
Max. Negotiated Rate	$0.14
Rate for Payer: Cash Price	$0.09
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$0.14
Rate for Payer: Health Smart Auto/Commercial	$0.10
Rate for Payer: LLUH Dept of Risk Management WC	$0.09
Rate for Payer: Multiplan Commercial	$0.13

HEPARIN, PORCINE (PF) 100 UNIT/ML INTRAVENOUS SOLUTION [408117967]

Facility

IP

$3.37

Service Code	NDC 6332354901
Hospital Charge Code	901700017
Hospital Revenue Code	272
Min. Negotiated Rate	$1.85
Max. Negotiated Rate	$2.70
Rate for Payer: Cash Price	$1.85
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$2.70
Rate for Payer: Health Smart Auto/Commercial	$2.02
Rate for Payer: LLUH Dept of Risk Management WC	$1.85
Rate for Payer: Multiplan Commercial	$2.53

HEPARIN, PORCINE (PF) 100 UNIT/ML INTRAVENOUS SOLUTION [408117967]

Facility

IP

$0.16

Service Code	NDC 6425333335
Hospital Charge Code	901700017
Hospital Revenue Code	272
Min. Negotiated Rate	$0.09
Max. Negotiated Rate	$0.13
Rate for Payer: Cash Price	$0.09
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$0.13
Rate for Payer: Health Smart Auto/Commercial	$0.10
Rate for Payer: LLUH Dept of Risk Management WC	$0.09
Rate for Payer: Multiplan Commercial	$0.12

HEPARIN, PORCINE (PF) 100 UNIT/ML INTRAVENOUS SYRINGE [117963]

Facility

IP

$0.17

Service Code	NDC 8290306424
Hospital Charge Code	901700017
Hospital Revenue Code	272
Min. Negotiated Rate	$0.09
Max. Negotiated Rate	$0.14
Rate for Payer: Cash Price	$0.09
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$0.14
Rate for Payer: Health Smart Auto/Commercial	$0.10
Rate for Payer: LLUH Dept of Risk Management WC	$0.09
Rate for Payer: Multiplan Commercial	$0.13

HEPARIN, PORCINE (PF) 100 UNIT/ML INTRAVENOUS SYRINGE [117963]

Facility

OP

$0.24

Service Code	NDC 6380760005
Hospital Charge Code	901700017
Hospital Revenue Code	272
Min. Negotiated Rate	$0.13
Max. Negotiated Rate	$0.19
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$0.14
Rate for Payer: Aetna of CA Government/Medicare	$0.14
Rate for Payer: Cash Price	$0.13
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$0.19
Rate for Payer: Health Smart Auto/Commercial	$0.14
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$0.14
Rate for Payer: LLUH Dept of Risk Management WC	$0.13
Rate for Payer: Multiplan Commercial	$0.18

HEPARIN, PORCINE (PF) 100 UNIT/ML INTRAVENOUS SYRINGE [117963]

Facility

OP

$0.17

Service Code	NDC 8290306424
Hospital Charge Code	901700017
Hospital Revenue Code	272
Min. Negotiated Rate	$0.09
Max. Negotiated Rate	$0.14
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$0.10
Rate for Payer: Aetna of CA Government/Medicare	$0.10
Rate for Payer: Cash Price	$0.09
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$0.14
Rate for Payer: Health Smart Auto/Commercial	$0.10
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$0.10
Rate for Payer: LLUH Dept of Risk Management WC	$0.09
Rate for Payer: Multiplan Commercial	$0.13

HEPARIN, PORCINE (PF) 100 UNIT/ML INTRAVENOUS SYRINGE [117963]

Facility

IP

$0.24

Service Code	NDC 6380760005
Hospital Charge Code	901700017
Hospital Revenue Code	272
Min. Negotiated Rate	$0.13
Max. Negotiated Rate	$0.19
Rate for Payer: Cash Price	$0.13
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$0.19
Rate for Payer: Health Smart Auto/Commercial	$0.14
Rate for Payer: LLUH Dept of Risk Management WC	$0.13
Rate for Payer: Multiplan Commercial	$0.18

HEPARIN, PORCINE (PF) 10 UNIT/ML INTRAVENOUS SYRINGE [105460]

Facility

IP

$0.24

Service Code	HCPCS J1642
Hospital Charge Code	901700025
Hospital Revenue Code	636
Min. Negotiated Rate	$0.13
Max. Negotiated Rate	$0.19
Rate for Payer: Cash Price	$0.13
Rate for Payer: Cash Price	$0.15
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$0.22
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$0.19
Rate for Payer: Health Smart Auto/Commercial	$0.14
Rate for Payer: Health Smart Auto/Commercial	$0.17
Rate for Payer: LLUH Dept of Risk Management WC	$0.13
Rate for Payer: LLUH Dept of Risk Management WC	$0.15
Rate for Payer: Multiplan Commercial	$0.18
Rate for Payer: Multiplan Commercial	$0.21

HEPARIN, PORCINE (PF) 10 UNIT/ML INTRAVENOUS SYRINGE [105460]

Facility

OP

$0.28

Service Code	HCPCS J1642
Hospital Charge Code	901700025
Hospital Revenue Code	636
Min. Negotiated Rate	$0.15
Max. Negotiated Rate	$0.22
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$0.17
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$0.14
Rate for Payer: Aetna of CA Government/Medicare	$0.14
Rate for Payer: Aetna of CA Government/Medicare	$0.17
Rate for Payer: Cash Price	$0.13
Rate for Payer: Cash Price	$0.15
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$0.22
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$0.19
Rate for Payer: Health Smart Auto/Commercial	$0.17
Rate for Payer: Health Smart Auto/Commercial	$0.14
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$0.14
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$0.17
Rate for Payer: LLUH Dept of Risk Management WC	$0.13
Rate for Payer: LLUH Dept of Risk Management WC	$0.15
Rate for Payer: Multiplan Commercial	$0.21
Rate for Payer: Multiplan Commercial	$0.18

HEPARIN, PORCINE (PF) 5,000 UNIT/0.5 ML INJECTION SOLUTION [121687]

Facility

OP

$9.60

Service Code	HCPCS J1644
Hospital Charge Code	901700025
Hospital Revenue Code	636
Min. Negotiated Rate	$5.28
Max. Negotiated Rate	$7.68
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$5.76
Rate for Payer: Aetna of CA Government/Medicare	$5.76
Rate for Payer: Cash Price	$5.28
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$7.68
Rate for Payer: Health Smart Auto/Commercial	$5.76
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$5.76
Rate for Payer: LLUH Dept of Risk Management WC	$5.28
Rate for Payer: Multiplan Commercial	$7.20

HEPARIN, PORCINE (PF) 5,000 UNIT/0.5 ML INJECTION SOLUTION [121687]

Facility

IP

$9.60

Service Code	HCPCS J1644
Hospital Charge Code	901700025
Hospital Revenue Code	636
Min. Negotiated Rate	$5.28
Max. Negotiated Rate	$7.68
Rate for Payer: Cash Price	$5.28
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$7.68
Rate for Payer: Health Smart Auto/Commercial	$5.76
Rate for Payer: LLUH Dept of Risk Management WC	$5.28
Rate for Payer: Multiplan Commercial	$7.20

HEPARIN, PORCINE (PF) 5,000 UNIT/0.5 ML INJECTION SYRINGE [117969]

Facility

IP

$7.96

Service Code	HCPCS J1644
Hospital Charge Code	901700025
Hospital Revenue Code	636
Min. Negotiated Rate	$4.38
Max. Negotiated Rate	$6.37
Rate for Payer: Cash Price	$4.38
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$6.37
Rate for Payer: Health Smart Auto/Commercial	$4.78
Rate for Payer: LLUH Dept of Risk Management WC	$4.38
Rate for Payer: Multiplan Commercial	$5.97

HEPARIN, PORCINE (PF) 5,000 UNIT/0.5 ML INJECTION SYRINGE [117969]

Facility

OP

$7.96

Service Code	HCPCS J1644
Hospital Charge Code	901700025
Hospital Revenue Code	636
Min. Negotiated Rate	$4.38
Max. Negotiated Rate	$6.37
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$4.78
Rate for Payer: Aetna of CA Government/Medicare	$4.78
Rate for Payer: Cash Price	$4.38
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$6.37
Rate for Payer: Health Smart Auto/Commercial	$4.78
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$4.78
Rate for Payer: LLUH Dept of Risk Management WC	$4.38
Rate for Payer: Multiplan Commercial	$5.97

HEPARIN, PORCINE (PF) 5,000 UNIT/0.5 ML SUBCUTANEOUS SYRINGE [224551]

Facility

OP

$14.40

Service Code	HCPCS J1644
Hospital Charge Code	901700025
Hospital Revenue Code	636
Min. Negotiated Rate	$7.92
Max. Negotiated Rate	$11.52
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$8.64
Rate for Payer: Aetna of CA Government/Medicare	$8.64
Rate for Payer: Cash Price	$7.92
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$11.52
Rate for Payer: Health Smart Auto/Commercial	$8.64
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$8.64
Rate for Payer: LLUH Dept of Risk Management WC	$7.92
Rate for Payer: Multiplan Commercial	$10.80

HEPARIN, PORCINE (PF) 5,000 UNIT/0.5 ML SUBCUTANEOUS SYRINGE [224551]

Facility

IP

$14.40

Service Code	HCPCS J1644
Hospital Charge Code	901700025
Hospital Revenue Code	636
Min. Negotiated Rate	$7.92
Max. Negotiated Rate	$11.52
Rate for Payer: Cash Price	$7.92
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$11.52
Rate for Payer: Health Smart Auto/Commercial	$8.64
Rate for Payer: LLUH Dept of Risk Management WC	$7.92
Rate for Payer: Multiplan Commercial	$10.80

HEPATITIS A AND B VIRUS VACCINE(PF)720 ELISA UNIT-20 MCG/ML IM SYRINGE [118915]

Facility

IP

$157.12

Service Code	HCPCS 90636
Hospital Charge Code	901700025
Hospital Revenue Code	636
Min. Negotiated Rate	$86.42
Max. Negotiated Rate	$125.70
Rate for Payer: Cash Price	$86.41
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$125.70
Rate for Payer: Health Smart Auto/Commercial	$94.27
Rate for Payer: LLUH Dept of Risk Management WC	$86.42
Rate for Payer: Multiplan Commercial	$117.84

HEPATITIS A AND B VIRUS VACCINE(PF)720 ELISA UNIT-20 MCG/ML IM SYRINGE [118915]

Facility

OP

$157.12

Service Code	HCPCS 90636
Hospital Charge Code	901700025
Hospital Revenue Code	636
Min. Negotiated Rate	$86.42
Max. Negotiated Rate	$125.70
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$94.27
Rate for Payer: Aetna of CA Government/Medicare	$94.27
Rate for Payer: Cash Price	$86.41
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$125.70
Rate for Payer: Health Smart Auto/Commercial	$94.27
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$94.27
Rate for Payer: LLUH Dept of Risk Management WC	$86.42
Rate for Payer: Multiplan Commercial	$117.84

HEPATITIS A VACCINE (PF) 1,440 ELISA UNIT/ML INTRAMUSCULAR SYRINGE [118741]

Facility

IP

$102.48

Service Code	HCPCS 90632
Hospital Charge Code	901700025
Hospital Revenue Code	636
Min. Negotiated Rate	$56.36
Max. Negotiated Rate	$81.98
Rate for Payer: Cash Price	$56.36
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$81.98
Rate for Payer: Health Smart Auto/Commercial	$61.49
Rate for Payer: LLUH Dept of Risk Management WC	$56.36
Rate for Payer: Multiplan Commercial	$76.86

HEPATITIS A VACCINE (PF) 1,440 ELISA UNIT/ML INTRAMUSCULAR SYRINGE [118741]

Facility

OP

$102.48

Service Code	HCPCS 90632
Hospital Charge Code	901700025
Hospital Revenue Code	636
Min. Negotiated Rate	$56.36
Max. Negotiated Rate	$81.98
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$61.49
Rate for Payer: Aetna of CA Government/Medicare	$61.49
Rate for Payer: Cash Price	$56.36
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$81.98
Rate for Payer: Health Smart Auto/Commercial	$61.49
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$61.49
Rate for Payer: LLUH Dept of Risk Management WC	$56.36
Rate for Payer: Multiplan Commercial	$76.86

HEPATITIS B IMMUNE GLOBULIN > 1,560 UNIT/5 ML INTRAMUSCULAR SOLUTION [91047]

Facility

IP

$189.69

Service Code	HCPCS 90371
Hospital Charge Code	901700025
Hospital Revenue Code	636
Min. Negotiated Rate	$104.33
Max. Negotiated Rate	$151.75
Rate for Payer: Cash Price	$104.33
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$151.75
Rate for Payer: Health Smart Auto/Commercial	$113.81
Rate for Payer: LLUH Dept of Risk Management WC	$104.33
Rate for Payer: Multiplan Commercial	$142.27

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