Price Transparency

Know your out-of-pocket cost for care.

All Charges

Charge

Type

Setting

Price

ITRACONAZOLE 10 MG/ML ORAL SOLUTION [19928]

Facility

OP

$2.00

Service Code	NDC 31722-006-31
Hospital Charge Code	901700029
Hospital Revenue Code	259
Min. Negotiated Rate	$1.10
Max. Negotiated Rate	$1.60
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$1.20
Rate for Payer: Aetna of CA Government/Medicare	$1.20
Rate for Payer: Cash Price	$1.10
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$1.60
Rate for Payer: Health Smart Auto/Commercial	$1.20
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$1.20
Rate for Payer: LLUH Dept of Risk Management WC	$1.10
Rate for Payer: Multiplan Commercial	$1.50

ITRACONAZOLE 10 MG/ML ORAL SOLUTION [19928]

Facility

IP

$2.00

Service Code	NDC 31722-006-31
Hospital Charge Code	901700029
Hospital Revenue Code	259
Min. Negotiated Rate	$1.10
Max. Negotiated Rate	$1.60
Rate for Payer: Cash Price	$1.10
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$1.60
Rate for Payer: Health Smart Auto/Commercial	$1.20
Rate for Payer: LLUH Dept of Risk Management WC	$1.10
Rate for Payer: Multiplan Commercial	$1.50

IVABRADINE 2.5 MG PARTIAL TABLET [4082315]

Facility

OP

$6.26

Service Code	NDC 9994-0823-15
Hospital Charge Code	901700029
Hospital Revenue Code	259
Min. Negotiated Rate	$3.44
Max. Negotiated Rate	$5.01
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$3.76
Rate for Payer: Aetna of CA Government/Medicare	$3.76
Rate for Payer: Cash Price	$3.44
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$5.01
Rate for Payer: Health Smart Auto/Commercial	$3.76
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$3.76
Rate for Payer: LLUH Dept of Risk Management WC	$3.44
Rate for Payer: Multiplan Commercial	$4.70

IVABRADINE 2.5 MG PARTIAL TABLET [4082315]

Facility

IP

$6.26

Service Code	NDC 9994-0823-15
Hospital Charge Code	901700029
Hospital Revenue Code	259
Min. Negotiated Rate	$3.44
Max. Negotiated Rate	$5.01
Rate for Payer: Cash Price	$3.44
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$5.01
Rate for Payer: Health Smart Auto/Commercial	$3.76
Rate for Payer: LLUH Dept of Risk Management WC	$3.44
Rate for Payer: Multiplan Commercial	$4.70

IVABRADINE 5 MG TABLET [204605]

Facility

OP

$2.70

Service Code	NDC 62332-679-60
Hospital Charge Code	901700029
Hospital Revenue Code	259
Min. Negotiated Rate	$1.49
Max. Negotiated Rate	$2.16
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$1.62
Rate for Payer: Aetna of CA Government/Medicare	$1.62
Rate for Payer: Cash Price	$1.49
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$2.16
Rate for Payer: Health Smart Auto/Commercial	$1.62
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$1.62
Rate for Payer: LLUH Dept of Risk Management WC	$1.49
Rate for Payer: Multiplan Commercial	$2.02

IVABRADINE 5 MG TABLET [204605]

Facility

IP

$12.65

Service Code	NDC 60687-862-21
Hospital Charge Code	901700029
Hospital Revenue Code	259
Min. Negotiated Rate	$6.96
Max. Negotiated Rate	$10.12
Rate for Payer: Cash Price	$6.96
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$10.12
Rate for Payer: Health Smart Auto/Commercial	$7.59
Rate for Payer: LLUH Dept of Risk Management WC	$6.96
Rate for Payer: Multiplan Commercial	$9.49

IVABRADINE 5 MG TABLET [204605]

Facility

IP

$2.70

Service Code	NDC 62332-679-60
Hospital Charge Code	901700029
Hospital Revenue Code	259
Min. Negotiated Rate	$1.49
Max. Negotiated Rate	$2.16
Rate for Payer: Cash Price	$1.49
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$2.16
Rate for Payer: Health Smart Auto/Commercial	$1.62
Rate for Payer: LLUH Dept of Risk Management WC	$1.49
Rate for Payer: Multiplan Commercial	$2.02

IVABRADINE 5 MG TABLET [204605]

Facility

OP

$0.90

Service Code	NDC 50742-362-60
Hospital Charge Code	901700029
Hospital Revenue Code	259
Min. Negotiated Rate	$0.50
Max. Negotiated Rate	$0.72
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$0.54
Rate for Payer: Aetna of CA Government/Medicare	$0.54
Rate for Payer: Cash Price	$0.50
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$0.72
Rate for Payer: Health Smart Auto/Commercial	$0.54
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$0.54
Rate for Payer: LLUH Dept of Risk Management WC	$0.50
Rate for Payer: Multiplan Commercial	$0.68

IVABRADINE 5 MG TABLET [204605]

Facility

OP

$12.65

Service Code	NDC 60687-862-11
Hospital Charge Code	901700029
Hospital Revenue Code	259
Min. Negotiated Rate	$6.96
Max. Negotiated Rate	$10.12
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$7.59
Rate for Payer: Aetna of CA Government/Medicare	$7.59
Rate for Payer: Cash Price	$6.96
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$10.12
Rate for Payer: Health Smart Auto/Commercial	$7.59
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$7.59
Rate for Payer: LLUH Dept of Risk Management WC	$6.96
Rate for Payer: Multiplan Commercial	$9.49

IVABRADINE 5 MG TABLET [204605]

Facility

IP

$12.65

Service Code	NDC 60687-862-11
Hospital Charge Code	901700029
Hospital Revenue Code	259
Min. Negotiated Rate	$6.96
Max. Negotiated Rate	$10.12
Rate for Payer: Cash Price	$6.96
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$10.12
Rate for Payer: Health Smart Auto/Commercial	$7.59
Rate for Payer: LLUH Dept of Risk Management WC	$6.96
Rate for Payer: Multiplan Commercial	$9.49

IVABRADINE 5 MG TABLET [204605]

Facility

IP

$0.90

Service Code	NDC 50742-362-60
Hospital Charge Code	901700029
Hospital Revenue Code	259
Min. Negotiated Rate	$0.50
Max. Negotiated Rate	$0.72
Rate for Payer: Cash Price	$0.50
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$0.72
Rate for Payer: Health Smart Auto/Commercial	$0.54
Rate for Payer: LLUH Dept of Risk Management WC	$0.50
Rate for Payer: Multiplan Commercial	$0.68

IVABRADINE 5 MG TABLET [204605]

Facility

OP

$12.65

Service Code	NDC 60687-862-21
Hospital Charge Code	901700029
Hospital Revenue Code	259
Min. Negotiated Rate	$6.96
Max. Negotiated Rate	$10.12
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$7.59
Rate for Payer: Aetna of CA Government/Medicare	$7.59
Rate for Payer: Cash Price	$6.96
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$10.12
Rate for Payer: Health Smart Auto/Commercial	$7.59
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$7.59
Rate for Payer: LLUH Dept of Risk Management WC	$6.96
Rate for Payer: Multiplan Commercial	$9.49

IVABRADINE 7.5 MG TABLET [204608]

Facility

IP

$12.52

Service Code	NDC 55513-810-60
Hospital Charge Code	901700029
Hospital Revenue Code	259
Min. Negotiated Rate	$6.89
Max. Negotiated Rate	$10.02
Rate for Payer: Cash Price	$6.89
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$10.02
Rate for Payer: Health Smart Auto/Commercial	$7.51
Rate for Payer: LLUH Dept of Risk Management WC	$6.89
Rate for Payer: Multiplan Commercial	$9.39

IVABRADINE 7.5 MG TABLET [204608]

Facility

OP

$12.52

Service Code	NDC 55513-810-60
Hospital Charge Code	901700029
Hospital Revenue Code	259
Min. Negotiated Rate	$6.89
Max. Negotiated Rate	$10.02
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$7.51
Rate for Payer: Aetna of CA Government/Medicare	$7.51
Rate for Payer: Cash Price	$6.89
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$10.02
Rate for Payer: Health Smart Auto/Commercial	$7.51
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$7.51
Rate for Payer: LLUH Dept of Risk Management WC	$6.89
Rate for Payer: Multiplan Commercial	$9.39

IVERMECTIN 3 MG TABLET [25820]

Facility

IP

$4.97

Service Code	NDC 42799-806-01
Hospital Charge Code	901700029
Hospital Revenue Code	259
Min. Negotiated Rate	$2.73
Max. Negotiated Rate	$3.98
Rate for Payer: Cash Price	$2.73
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$3.98
Rate for Payer: Health Smart Auto/Commercial	$2.98
Rate for Payer: LLUH Dept of Risk Management WC	$2.73
Rate for Payer: Multiplan Commercial	$3.73

IVERMECTIN 3 MG TABLET [25820]

Facility

OP

$4.97

Service Code	NDC 42799-806-01
Hospital Charge Code	901700029
Hospital Revenue Code	259
Min. Negotiated Rate	$2.73
Max. Negotiated Rate	$3.98
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$2.98
Rate for Payer: Aetna of CA Government/Medicare	$2.98
Rate for Payer: Cash Price	$2.73
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$3.98
Rate for Payer: Health Smart Auto/Commercial	$2.98
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$2.98
Rate for Payer: LLUH Dept of Risk Management WC	$2.73
Rate for Payer: Multiplan Commercial	$3.73

KARAYA GUM TOPICAL POWDER [111957]

Facility

IP

$0.18

Service Code	NDC 8380007905
Hospital Charge Code	901700029
Hospital Revenue Code	259
Min. Negotiated Rate	$0.10
Max. Negotiated Rate	$0.14
Rate for Payer: Cash Price	$0.10
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$0.14
Rate for Payer: Health Smart Auto/Commercial	$0.11
Rate for Payer: LLUH Dept of Risk Management WC	$0.10
Rate for Payer: Multiplan Commercial	$0.14

KARAYA GUM TOPICAL POWDER [111957]

Facility

OP

$0.18

Service Code	NDC 8380007905
Hospital Charge Code	901700029
Hospital Revenue Code	259
Min. Negotiated Rate	$0.10
Max. Negotiated Rate	$0.14
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$0.11
Rate for Payer: Aetna of CA Government/Medicare	$0.11
Rate for Payer: Cash Price	$0.10
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$0.14
Rate for Payer: Health Smart Auto/Commercial	$0.11
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$0.11
Rate for Payer: LLUH Dept of Risk Management WC	$0.10
Rate for Payer: Multiplan Commercial	$0.14

KETAMINE 100 MG/ML INJECTION SOLUTION [4237]

Facility

IP

$3.06

Service Code	NDC 0143-9509-10
Hospital Charge Code	901700004
Hospital Revenue Code	250
Min. Negotiated Rate	$1.68
Max. Negotiated Rate	$2.45
Rate for Payer: Cash Price	$1.68
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$2.45
Rate for Payer: Health Smart Auto/Commercial	$1.84
Rate for Payer: LLUH Dept of Risk Management WC	$1.68
Rate for Payer: Multiplan Commercial	$2.29

KETAMINE 100 MG/ML INJECTION SOLUTION [4237]

Facility

OP

$2.00

Service Code	NDC 0409-2051-05
Hospital Charge Code	901700004
Hospital Revenue Code	250
Min. Negotiated Rate	$1.10
Max. Negotiated Rate	$1.60
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$1.20
Rate for Payer: Aetna of CA Government/Medicare	$1.20
Rate for Payer: Cash Price	$1.10
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$1.60
Rate for Payer: Health Smart Auto/Commercial	$1.20
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$1.20
Rate for Payer: LLUH Dept of Risk Management WC	$1.10
Rate for Payer: Multiplan Commercial	$1.50

KETAMINE 100 MG/ML INJECTION SOLUTION [4237]

Facility

OP

$2.00

Service Code	NDC 0409-2051-15
Hospital Charge Code	901700004
Hospital Revenue Code	250
Min. Negotiated Rate	$1.10
Max. Negotiated Rate	$1.60
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$1.20
Rate for Payer: Aetna of CA Government/Medicare	$1.20
Rate for Payer: Cash Price	$1.10
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$1.60
Rate for Payer: Health Smart Auto/Commercial	$1.20
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$1.20
Rate for Payer: LLUH Dept of Risk Management WC	$1.10
Rate for Payer: Multiplan Commercial	$1.50

KETAMINE 100 MG/ML INJECTION SOLUTION [4237]

Facility

IP

$2.00

Service Code	NDC 0409-2051-15
Hospital Charge Code	901700004
Hospital Revenue Code	250
Min. Negotiated Rate	$1.10
Max. Negotiated Rate	$1.60
Rate for Payer: Cash Price	$1.10
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$1.60
Rate for Payer: Health Smart Auto/Commercial	$1.20
Rate for Payer: LLUH Dept of Risk Management WC	$1.10
Rate for Payer: Multiplan Commercial	$1.50

KETAMINE 100 MG/ML INJECTION SOLUTION [4237]

Facility

IP

$2.46

Service Code	NDC 65219-186-05
Hospital Charge Code	901700004
Hospital Revenue Code	250
Min. Negotiated Rate	$1.35
Max. Negotiated Rate	$1.97
Rate for Payer: Cash Price	$1.35
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO 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 Commercial	$1.84

KETAMINE 100 MG/ML INJECTION SOLUTION [4237]

Facility

OP

$3.06

Service Code	NDC 0143-9509-01
Hospital Charge Code	901700004
Hospital Revenue Code	250
Min. Negotiated Rate	$1.68
Max. Negotiated Rate	$2.45
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$1.84
Rate for Payer: Aetna of CA Government/Medicare	$1.84
Rate for Payer: Cash Price	$1.68
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$2.45
Rate for Payer: Health Smart Auto/Commercial	$1.84
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$1.84
Rate for Payer: LLUH Dept of Risk Management WC	$1.68
Rate for Payer: Multiplan Commercial	$2.29

KETAMINE 100 MG/ML INJECTION SOLUTION [4237]

Facility

IP

$2.46

Service Code	NDC 65219-186-01
Hospital Charge Code	901700004
Hospital Revenue Code	250
Min. Negotiated Rate	$1.35
Max. Negotiated Rate	$1.97
Rate for Payer: Cash Price	$1.35
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO 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 Commercial	$1.84

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