Price Transparency

Know your out-of-pocket cost for care.

All Charges

Charge

Type

Setting

Price

LINEZOLID 600 MG TABLET [28224]

Facility

IP

$4.20

Service Code	NDC 67877-419-84
Hospital Charge Code	901700029
Hospital Revenue Code	259
Min. Negotiated Rate	$2.31
Max. Negotiated Rate	$3.36
Rate for Payer: Cash Price	$2.31
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$3.36
Rate for Payer: Health Smart Auto/Commercial	$2.52
Rate for Payer: LLUH Dept of Risk Management WC	$2.31
Rate for Payer: Multiplan Commercial	$3.15

LINEZOLID 600 MG TABLET [28224]

Facility

IP

$7.40

Service Code	NDC 60687-309-21
Hospital Charge Code	901700029
Hospital Revenue Code	259
Min. Negotiated Rate	$4.07
Max. Negotiated Rate	$5.92
Rate for Payer: Cash Price	$4.07
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$5.92
Rate for Payer: Health Smart Auto/Commercial	$4.44
Rate for Payer: LLUH Dept of Risk Management WC	$4.07
Rate for Payer: Multiplan Commercial	$5.55

LINEZOLID 600 MG TABLET [28224]

Facility

IP

$4.20

Service Code	NDC 67877-419-33
Hospital Charge Code	901700029
Hospital Revenue Code	259
Min. Negotiated Rate	$2.31
Max. Negotiated Rate	$3.36
Rate for Payer: Cash Price	$2.31
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$3.36
Rate for Payer: Health Smart Auto/Commercial	$2.52
Rate for Payer: LLUH Dept of Risk Management WC	$2.31
Rate for Payer: Multiplan Commercial	$3.15

LINEZOLID 600 MG TABLET [28224]

Facility

OP

$7.40

Service Code	NDC 60687-309-11
Hospital Charge Code	901700029
Hospital Revenue Code	259
Min. Negotiated Rate	$4.07
Max. Negotiated Rate	$5.92
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$4.44
Rate for Payer: Aetna of CA Government/Medicare	$4.44
Rate for Payer: Cash Price	$4.07
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$5.92
Rate for Payer: Health Smart Auto/Commercial	$4.44
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$4.44
Rate for Payer: LLUH Dept of Risk Management WC	$4.07
Rate for Payer: Multiplan Commercial	$5.55

LINEZOLID 600 MG TABLET [28224]

Facility

OP

$4.20

Service Code	NDC 67877-419-33
Hospital Charge Code	901700029
Hospital Revenue Code	259
Min. Negotiated Rate	$2.31
Max. Negotiated Rate	$3.36
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$2.52
Rate for Payer: Aetna of CA Government/Medicare	$2.52
Rate for Payer: Cash Price	$2.31
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$3.36
Rate for Payer: Health Smart Auto/Commercial	$2.52
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$2.52
Rate for Payer: LLUH Dept of Risk Management WC	$2.31
Rate for Payer: Multiplan Commercial	$3.15

LINEZOLID 600 MG TABLET [28224]

Facility

OP

$7.40

Service Code	NDC 60687-309-21
Hospital Charge Code	901700029
Hospital Revenue Code	259
Min. Negotiated Rate	$4.07
Max. Negotiated Rate	$5.92
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$4.44
Rate for Payer: Aetna of CA Government/Medicare	$4.44
Rate for Payer: Cash Price	$4.07
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$5.92
Rate for Payer: Health Smart Auto/Commercial	$4.44
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$4.44
Rate for Payer: LLUH Dept of Risk Management WC	$4.07
Rate for Payer: Multiplan Commercial	$5.55

LINEZOLID IN 5% DEXTROSE IN WATER 600 MG/300 ML INTRAVENOUS PIGGYBACK [114051]

Facility

OP

$0.25

Service Code	HCPCS J2020
Hospital Charge Code	901700025
Hospital Revenue Code	636
Min. Negotiated Rate	$0.14
Max. Negotiated Rate	$0.20
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$0.15
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$0.04
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$0.06
Rate for Payer: Aetna of CA Government/Medicare	$0.04
Rate for Payer: Aetna of CA Government/Medicare	$0.06
Rate for Payer: Aetna of CA Government/Medicare	$0.15
Rate for Payer: Cash Price	$0.06
Rate for Payer: Cash Price	$0.03
Rate for Payer: Cash Price	$0.14
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$0.20
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$0.05
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$0.08
Rate for Payer: Health Smart Auto/Commercial	$0.15
Rate for Payer: Health Smart Auto/Commercial	$0.06
Rate for Payer: Health Smart Auto/Commercial	$0.04
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$0.15
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$0.06
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$0.04
Rate for Payer: LLUH Dept of Risk Management WC	$0.03
Rate for Payer: LLUH Dept of Risk Management WC	$0.06
Rate for Payer: LLUH Dept of Risk Management WC	$0.14
Rate for Payer: Multiplan Commercial	$0.08
Rate for Payer: Multiplan Commercial	$0.05
Rate for Payer: Multiplan Commercial	$0.19

LINEZOLID IN 5% DEXTROSE IN WATER 600 MG/300 ML INTRAVENOUS PIGGYBACK [114051]

Facility

IP

$0.06

Service Code	HCPCS J2020
Hospital Charge Code	901700025
Hospital Revenue Code	636
Min. Negotiated Rate	$0.03
Max. Negotiated Rate	$0.05
Rate for Payer: Cash Price	$0.03
Rate for Payer: Cash Price	$0.14
Rate for Payer: Cash Price	$0.06
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$0.20
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$0.05
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$0.08
Rate for Payer: Health Smart Auto/Commercial	$0.15
Rate for Payer: Health Smart Auto/Commercial	$0.06
Rate for Payer: Health Smart Auto/Commercial	$0.04
Rate for Payer: LLUH Dept of Risk Management WC	$0.14
Rate for Payer: LLUH Dept of Risk Management WC	$0.03
Rate for Payer: LLUH Dept of Risk Management WC	$0.06
Rate for Payer: Multiplan Commercial	$0.19
Rate for Payer: Multiplan Commercial	$0.08
Rate for Payer: Multiplan Commercial	$0.05

LIOTHYRONINE 25 MCG TABLET [4504]

Facility

OP

$1.06

Service Code	NDC 42794-019-12
Hospital Charge Code	901700029
Hospital Revenue Code	259
Min. Negotiated Rate	$0.58
Max. Negotiated Rate	$0.85
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$0.64
Rate for Payer: Aetna of CA Government/Medicare	$0.64
Rate for Payer: Cash Price	$0.58
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$0.85
Rate for Payer: Health Smart Auto/Commercial	$0.64
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$0.64
Rate for Payer: LLUH Dept of Risk Management WC	$0.58
Rate for Payer: Multiplan Commercial	$0.80

LIOTHYRONINE 25 MCG TABLET [4504]

Facility

IP

$1.06

Service Code	NDC 42794-019-12
Hospital Charge Code	901700029
Hospital Revenue Code	259
Min. Negotiated Rate	$0.58
Max. Negotiated Rate	$0.85
Rate for Payer: Cash Price	$0.58
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$0.85
Rate for Payer: Health Smart Auto/Commercial	$0.64
Rate for Payer: LLUH Dept of Risk Management WC	$0.58
Rate for Payer: Multiplan Commercial	$0.80

LIOTHYRONINE 25 MCG TABLET [4504]

Facility

OP

$0.87

Service Code	NDC 62756-590-88
Hospital Charge Code	901700029
Hospital Revenue Code	259
Min. Negotiated Rate	$0.48
Max. Negotiated Rate	$0.70
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$0.52
Rate for Payer: Aetna of CA Government/Medicare	$0.52
Rate for Payer: Cash Price	$0.48
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$0.70
Rate for Payer: Health Smart Auto/Commercial	$0.52
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$0.52
Rate for Payer: LLUH Dept of Risk Management WC	$0.48
Rate for Payer: Multiplan Commercial	$0.65

LIOTHYRONINE 25 MCG TABLET [4504]

Facility

IP

$0.87

Service Code	NDC 62756-590-88
Hospital Charge Code	901700029
Hospital Revenue Code	259
Min. Negotiated Rate	$0.48
Max. Negotiated Rate	$0.70
Rate for Payer: Cash Price	$0.48
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$0.70
Rate for Payer: Health Smart Auto/Commercial	$0.52
Rate for Payer: LLUH Dept of Risk Management WC	$0.48
Rate for Payer: Multiplan Commercial	$0.65

LIOTHYRONINE 5 MCG TABLET [10443]

Facility

OP

$0.82

Service Code	NDC 42794-018-12
Hospital Charge Code	901700029
Hospital Revenue Code	259
Min. Negotiated Rate	$0.45
Max. Negotiated Rate	$0.66
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$0.49
Rate for Payer: Aetna of CA Government/Medicare	$0.49
Rate for Payer: Cash Price	$0.45
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$0.66
Rate for Payer: Health Smart Auto/Commercial	$0.49
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$0.49
Rate for Payer: LLUH Dept of Risk Management WC	$0.45
Rate for Payer: Multiplan Commercial	$0.62

LIOTHYRONINE 5 MCG TABLET [10443]

Facility

IP

$0.82

Service Code	NDC 42794-018-12
Hospital Charge Code	901700029
Hospital Revenue Code	259
Min. Negotiated Rate	$0.45
Max. Negotiated Rate	$0.66
Rate for Payer: Cash Price	$0.45
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$0.66
Rate for Payer: Health Smart Auto/Commercial	$0.49
Rate for Payer: LLUH Dept of Risk Management WC	$0.45
Rate for Payer: Multiplan Commercial	$0.62

LIPASE-PROTEASE-AMYLASE 12,000-38,000-60,000 UNIT CAPSULE,DELAYED REL [98035]

Facility

IP

$5.15

Service Code	NDC 0032-0047-70
Hospital Charge Code	901700029
Hospital Revenue Code	259
Min. Negotiated Rate	$2.83
Max. Negotiated Rate	$4.12
Rate for Payer: Cash Price	$2.83
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$4.12
Rate for Payer: Health Smart Auto/Commercial	$3.09
Rate for Payer: LLUH Dept of Risk Management WC	$2.83
Rate for Payer: Multiplan Commercial	$3.86

LIPASE-PROTEASE-AMYLASE 12,000-38,000-60,000 UNIT CAPSULE,DELAYED REL [98035]

Facility

OP

$5.15

Service Code	NDC 0032-0047-70
Hospital Charge Code	901700029
Hospital Revenue Code	259
Min. Negotiated Rate	$2.83
Max. Negotiated Rate	$4.12
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$3.09
Rate for Payer: Aetna of CA Government/Medicare	$3.09
Rate for Payer: Cash Price	$2.83
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$4.12
Rate for Payer: Health Smart Auto/Commercial	$3.09
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$3.09
Rate for Payer: LLUH Dept of Risk Management WC	$2.83
Rate for Payer: Multiplan Commercial	$3.86

LIPASE-PROTEASE-AMYLASE 20,880-78,300-78,300 UNIT TABLET [196333]

Facility

IP

$10.00

Service Code	NDC 73562-208-10
Hospital Charge Code	901700029
Hospital Revenue Code	259
Min. Negotiated Rate	$5.50
Max. Negotiated Rate	$8.00
Rate for Payer: Cash Price	$5.50
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$8.00
Rate for Payer: Health Smart Auto/Commercial	$6.00
Rate for Payer: LLUH Dept of Risk Management WC	$5.50
Rate for Payer: Multiplan Commercial	$7.50

LIPASE-PROTEASE-AMYLASE 20,880-78,300-78,300 UNIT TABLET [196333]

Facility

OP

$10.00

Service Code	NDC 73562-208-10
Hospital Charge Code	901700029
Hospital Revenue Code	259
Min. Negotiated Rate	$5.50
Max. Negotiated Rate	$8.00
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$6.00
Rate for Payer: Aetna of CA Government/Medicare	$6.00
Rate for Payer: Cash Price	$5.50
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$8.00
Rate for Payer: Health Smart Auto/Commercial	$6.00
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$6.00
Rate for Payer: LLUH Dept of Risk Management WC	$5.50
Rate for Payer: Multiplan Commercial	$7.50

LIPASE-PROTEASE-AMYLASE 24,000-76,000-120,000 UNIT CAPSULE,DELAYED REL [98036]

Facility

OP

$10.20

Service Code	NDC 0032-1224-01
Hospital Charge Code	901700029
Hospital Revenue Code	259
Min. Negotiated Rate	$5.61
Max. Negotiated Rate	$8.16
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$6.12
Rate for Payer: Aetna of CA Government/Medicare	$6.12
Rate for Payer: Cash Price	$5.61
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$8.16
Rate for Payer: Health Smart Auto/Commercial	$6.12
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$6.12
Rate for Payer: LLUH Dept of Risk Management WC	$5.61
Rate for Payer: Multiplan Commercial	$7.65

LIPASE-PROTEASE-AMYLASE 24,000-76,000-120,000 UNIT CAPSULE,DELAYED REL [98036]

Facility

OP

$10.20

Service Code	NDC 0032-2636-01
Hospital Charge Code	901700029
Hospital Revenue Code	259
Min. Negotiated Rate	$5.61
Max. Negotiated Rate	$8.16
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$6.12
Rate for Payer: Aetna of CA Government/Medicare	$6.12
Rate for Payer: Cash Price	$5.61
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$8.16
Rate for Payer: Health Smart Auto/Commercial	$6.12
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$6.12
Rate for Payer: LLUH Dept of Risk Management WC	$5.61
Rate for Payer: Multiplan Commercial	$7.65

LIPASE-PROTEASE-AMYLASE 24,000-76,000-120,000 UNIT CAPSULE,DELAYED REL [98036]

Facility

IP

$10.20

Service Code	NDC 0032-2636-01
Hospital Charge Code	901700029
Hospital Revenue Code	259
Min. Negotiated Rate	$5.61
Max. Negotiated Rate	$8.16
Rate for Payer: Cash Price	$5.61
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$8.16
Rate for Payer: Health Smart Auto/Commercial	$6.12
Rate for Payer: LLUH Dept of Risk Management WC	$5.61
Rate for Payer: Multiplan Commercial	$7.65

LIPASE-PROTEASE-AMYLASE 24,000-76,000-120,000 UNIT CAPSULE,DELAYED REL [98036]

Facility

IP

$10.20

Service Code	NDC 0032-1224-01
Hospital Charge Code	901700029
Hospital Revenue Code	259
Min. Negotiated Rate	$5.61
Max. Negotiated Rate	$8.16
Rate for Payer: Cash Price	$5.61
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$8.16
Rate for Payer: Health Smart Auto/Commercial	$6.12
Rate for Payer: LLUH Dept of Risk Management WC	$5.61
Rate for Payer: Multiplan Commercial	$7.65

LIPASE-PROTEASE-AMYLASE 3,000-9,500-15,000 UNIT CAPSULE, DELAYED REL [187996]

Facility

IP

$2.17

Service Code	NDC 0032-1203-70
Hospital Charge Code	901700029
Hospital Revenue Code	259
Min. Negotiated Rate	$1.19
Max. Negotiated Rate	$1.74
Rate for Payer: Cash Price	$1.20
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$1.74
Rate for Payer: Health Smart Auto/Commercial	$1.30
Rate for Payer: LLUH Dept of Risk Management WC	$1.19
Rate for Payer: Multiplan Commercial	$1.63

LIPASE-PROTEASE-AMYLASE 3,000-9,500-15,000 UNIT CAPSULE, DELAYED REL [187996]

Facility

OP

$2.17

Service Code	NDC 0032-0045-70
Hospital Charge Code	901700029
Hospital Revenue Code	259
Min. Negotiated Rate	$1.19
Max. Negotiated Rate	$1.74
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$1.30
Rate for Payer: Aetna of CA Government/Medicare	$1.30
Rate for Payer: Cash Price	$1.20
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$1.74
Rate for Payer: Health Smart Auto/Commercial	$1.30
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$1.30
Rate for Payer: LLUH Dept of Risk Management WC	$1.19
Rate for Payer: Multiplan Commercial	$1.63

LIPASE-PROTEASE-AMYLASE 3,000-9,500-15,000 UNIT CAPSULE, DELAYED REL [187996]

Facility

OP

$2.17

Service Code	NDC 0032-1203-70
Hospital Charge Code	901700029
Hospital Revenue Code	259
Min. Negotiated Rate	$1.19
Max. Negotiated Rate	$1.74
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$1.30
Rate for Payer: Aetna of CA Government/Medicare	$1.30
Rate for Payer: Cash Price	$1.20
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$1.74
Rate for Payer: Health Smart Auto/Commercial	$1.30
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$1.30
Rate for Payer: LLUH Dept of Risk Management WC	$1.19
Rate for Payer: Multiplan Commercial	$1.63

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