Price Transparency

Know your out-of-pocket cost for care.

All Charges

Charge

Type

Setting

Price

ISONIAZID 300 MG TABLET [4027]

Facility

OP

$1.24

Service Code	NDC 51079-083-01
Hospital Charge Code	1710467
Hospital Revenue Code	259
Min. Negotiated Rate	$0.68
Max. Negotiated Rate	$0.93
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	$0.56
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	$0.93

ISONIAZID 300 MG TABLET [4027]

Facility

IP

$0.49

Service Code	NDC 0555-0071-01
Hospital Charge Code	1710467
Hospital Revenue Code	259
Min. Negotiated Rate	$0.27
Max. Negotiated Rate	$0.39
Rate for Payer: Cash Price	$0.22
Rate for Payer: Cigna of CA HMO/PPO	$0.39
Rate for Payer: Health Smart Auto/Commercial	$0.29
Rate for Payer: LLUH Dept of Risk Management WC	$0.27
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$0.37

ISONIAZID 50 MG/5 ML ORAL SOLUTION [4025]

Facility

IP

$0.74

Service Code	NDC 46287-009-01
Hospital Charge Code	1715021
Hospital Revenue Code	259
Min. Negotiated Rate	$0.41
Max. Negotiated Rate	$0.59
Rate for Payer: Cash Price	$0.33
Rate for Payer: Cigna of CA HMO/PPO	$0.59
Rate for Payer: Health Smart Auto/Commercial	$0.44
Rate for Payer: LLUH Dept of Risk Management WC	$0.41
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$0.56

ISONIAZID 50 MG/5 ML ORAL SOLUTION [4025]

Facility

OP

$0.74

Service Code	NDC 46287-009-01
Hospital Charge Code	1715021
Hospital Revenue Code	259
Min. Negotiated Rate	$0.41
Max. Negotiated Rate	$0.56
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$0.44
Rate for Payer: Aetna of CA Government/Medicare	$0.44
Rate for Payer: Cash Price	$0.33
Rate for Payer: Health Smart Auto/Commercial	$0.44
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$0.44
Rate for Payer: LLUH Dept of Risk Management WC	$0.41
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$0.56

ISOPROTERENOL 0.2 MG/ML INJECTION SOLUTION [110292]

Facility

IP

$33.60

Service Code	NDC 23155-661-42
Hospital Charge Code	1720174
Hospital Revenue Code	250
Min. Negotiated Rate	$18.48
Max. Negotiated Rate	$26.88
Rate for Payer: Cash Price	$15.12
Rate for Payer: Cigna of CA HMO/PPO	$26.88
Rate for Payer: Health Smart Auto/Commercial	$20.16
Rate for Payer: LLUH Dept of Risk Management WC	$18.48
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$25.20

ISOPROTERENOL 0.2 MG/ML INJECTION SOLUTION [110292]

Facility

IP

$48.00

Service Code	NDC 0548-9502-00
Hospital Charge Code	1720174
Hospital Revenue Code	250
Min. Negotiated Rate	$26.40
Max. Negotiated Rate	$38.40
Rate for Payer: Cash Price	$21.60
Rate for Payer: Cigna of CA HMO/PPO	$38.40
Rate for Payer: Health Smart Auto/Commercial	$28.80
Rate for Payer: LLUH Dept of Risk Management WC	$26.40
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$36.00

ISOPROTERENOL 0.2 MG/ML INJECTION SOLUTION [110292]

Facility

IP

$33.60

Service Code	NDC 23155-661-31
Hospital Charge Code	1720174
Hospital Revenue Code	250
Min. Negotiated Rate	$18.48
Max. Negotiated Rate	$26.88
Rate for Payer: Cash Price	$15.12
Rate for Payer: Cigna of CA HMO/PPO	$26.88
Rate for Payer: Health Smart Auto/Commercial	$20.16
Rate for Payer: LLUH Dept of Risk Management WC	$18.48
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$25.20

ISOPROTERENOL 0.2 MG/ML INJECTION SOLUTION [110292]

Facility

OP

$48.00

Service Code	NDC 0548-9502-00
Hospital Charge Code	1720174
Hospital Revenue Code	250
Min. Negotiated Rate	$26.40
Max. Negotiated Rate	$36.00
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$28.80
Rate for Payer: Aetna of CA Government/Medicare	$28.80
Rate for Payer: Cash Price	$21.60
Rate for Payer: Health Smart Auto/Commercial	$28.80
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$28.80
Rate for Payer: LLUH Dept of Risk Management WC	$26.40
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$36.00

ISOPROTERENOL 0.2 MG/ML INJECTION SOLUTION [110292]

Facility

IP

$40.80

Service Code	NDC 72485-113-10
Hospital Charge Code	1720174
Hospital Revenue Code	250
Min. Negotiated Rate	$22.44
Max. Negotiated Rate	$32.64
Rate for Payer: Cash Price	$18.36
Rate for Payer: Cigna of CA HMO/PPO	$32.64
Rate for Payer: Health Smart Auto/Commercial	$24.48
Rate for Payer: LLUH Dept of Risk Management WC	$22.44
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$30.60

ISOPROTERENOL 0.2 MG/ML INJECTION SOLUTION [110292]

Facility

IP

$40.80

Service Code	NDC 72485-113-01
Hospital Charge Code	1720174
Hospital Revenue Code	250
Min. Negotiated Rate	$22.44
Max. Negotiated Rate	$32.64
Rate for Payer: Cash Price	$18.36
Rate for Payer: Cigna of CA HMO/PPO	$32.64
Rate for Payer: Health Smart Auto/Commercial	$24.48
Rate for Payer: LLUH Dept of Risk Management WC	$22.44
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$30.60

ISOPROTERENOL 0.2 MG/ML INJECTION SOLUTION [110292]

Facility

OP

$33.60

Service Code	NDC 23155-661-42
Hospital Charge Code	1720174
Hospital Revenue Code	250
Min. Negotiated Rate	$18.48
Max. Negotiated Rate	$25.20
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$20.16
Rate for Payer: Aetna of CA Government/Medicare	$20.16
Rate for Payer: Cash Price	$15.12
Rate for Payer: Health Smart Auto/Commercial	$20.16
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$20.16
Rate for Payer: LLUH Dept of Risk Management WC	$18.48
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$25.20

ISOPROTERENOL 0.2 MG/ML INJECTION SOLUTION [110292]

Facility

OP

$40.80

Service Code	NDC 72485-113-01
Hospital Charge Code	1720174
Hospital Revenue Code	250
Min. Negotiated Rate	$22.44
Max. Negotiated Rate	$30.60
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$24.48
Rate for Payer: Aetna of CA Government/Medicare	$24.48
Rate for Payer: Cash Price	$18.36
Rate for Payer: Health Smart Auto/Commercial	$24.48
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$24.48
Rate for Payer: LLUH Dept of Risk Management WC	$22.44
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$30.60

ISOPROTERENOL 0.2 MG/ML INJECTION SOLUTION [110292]

Facility

OP

$40.80

Service Code	NDC 72485-113-10
Hospital Charge Code	1720174
Hospital Revenue Code	250
Min. Negotiated Rate	$22.44
Max. Negotiated Rate	$30.60
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$24.48
Rate for Payer: Aetna of CA Government/Medicare	$24.48
Rate for Payer: Cash Price	$18.36
Rate for Payer: Health Smart Auto/Commercial	$24.48
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$24.48
Rate for Payer: LLUH Dept of Risk Management WC	$22.44
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$30.60

ISOPROTERENOL 0.2 MG/ML INJECTION SOLUTION [110292]

Facility

OP

$33.60

Service Code	NDC 23155-661-31
Hospital Charge Code	1720174
Hospital Revenue Code	250
Min. Negotiated Rate	$18.48
Max. Negotiated Rate	$25.20
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$20.16
Rate for Payer: Aetna of CA Government/Medicare	$20.16
Rate for Payer: Cash Price	$15.12
Rate for Payer: Health Smart Auto/Commercial	$20.16
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$20.16
Rate for Payer: LLUH Dept of Risk Management WC	$18.48
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$25.20

ISOPROTERENOL 0.2 MG/ML INJECTION SOLUTION FOR DRIPS [48110292]

Facility

IP

$48.00

Service Code	NDC 0548-9502-00
Hospital Charge Code	1720174
Hospital Revenue Code	250
Min. Negotiated Rate	$26.40
Max. Negotiated Rate	$38.40
Rate for Payer: Cash Price	$21.60
Rate for Payer: Cigna of CA HMO/PPO	$38.40
Rate for Payer: Health Smart Auto/Commercial	$28.80
Rate for Payer: LLUH Dept of Risk Management WC	$26.40
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$36.00

ISOPROTERENOL 0.2 MG/ML INJECTION SOLUTION FOR DRIPS [48110292]

Facility

OP

$48.00

Service Code	NDC 0548-9502-00
Hospital Charge Code	1720174
Hospital Revenue Code	250
Min. Negotiated Rate	$26.40
Max. Negotiated Rate	$36.00
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$28.80
Rate for Payer: Aetna of CA Government/Medicare	$28.80
Rate for Payer: Cash Price	$21.60
Rate for Payer: Health Smart Auto/Commercial	$28.80
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$28.80
Rate for Payer: LLUH Dept of Risk Management WC	$26.40
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$36.00

ISOSORBIDE 20 MG-HYDRALAZINE 37.5 MG TABLET [41893]

Facility

IP

$5.21

Service Code	NDC 24338-010-09
Hospital Charge Code	1711911
Hospital Revenue Code	259
Min. Negotiated Rate	$2.87
Max. Negotiated Rate	$4.17
Rate for Payer: Cash Price	$2.34
Rate for Payer: Cigna of CA HMO/PPO	$4.17
Rate for Payer: Health Smart Auto/Commercial	$3.13
Rate for Payer: LLUH Dept of Risk Management WC	$2.87
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$3.91

ISOSORBIDE 20 MG-HYDRALAZINE 37.5 MG TABLET [41893]

Facility

IP

$3.33

Service Code	NDC 52536-006-09
Hospital Charge Code	1711911
Hospital Revenue Code	259
Min. Negotiated Rate	$1.83
Max. Negotiated Rate	$2.66
Rate for Payer: Cash Price	$1.50
Rate for Payer: Cigna of CA HMO/PPO	$2.66
Rate for Payer: Health Smart Auto/Commercial	$2.00
Rate for Payer: LLUH Dept of Risk Management WC	$1.83
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$2.50

ISOSORBIDE 20 MG-HYDRALAZINE 37.5 MG TABLET [41893]

Facility

OP

$5.21

Service Code	NDC 24338-010-09
Hospital Charge Code	1711911
Hospital Revenue Code	259
Min. Negotiated Rate	$2.87
Max. Negotiated Rate	$3.91
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$3.13
Rate for Payer: Aetna of CA Government/Medicare	$3.13
Rate for Payer: Cash Price	$2.34
Rate for Payer: Health Smart Auto/Commercial	$3.13
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$3.13
Rate for Payer: LLUH Dept of Risk Management WC	$2.87
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$3.91

ISOSORBIDE 20 MG-HYDRALAZINE 37.5 MG TABLET [41893]

Facility

OP

$3.33

Service Code	NDC 52536-006-09
Hospital Charge Code	1711911
Hospital Revenue Code	259
Min. Negotiated Rate	$1.83
Max. Negotiated Rate	$2.50
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$2.00
Rate for Payer: Aetna of CA Government/Medicare	$2.00
Rate for Payer: Cash Price	$1.50
Rate for Payer: Health Smart Auto/Commercial	$2.00
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$2.00
Rate for Payer: LLUH Dept of Risk Management WC	$1.83
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$2.50

ISOSORBIDE DINITRATE 10 MG TABLET [4064]

Facility

IP

$1.04

Service Code	NDC 68001-374-00
Hospital Charge Code	1710141
Hospital Revenue Code	259
Min. Negotiated Rate	$0.57
Max. Negotiated Rate	$0.83
Rate for Payer: Cash Price	$0.47
Rate for Payer: Cigna of CA HMO/PPO	$0.83
Rate for Payer: Health Smart Auto/Commercial	$0.62
Rate for Payer: LLUH Dept of Risk Management WC	$0.57
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$0.78

ISOSORBIDE DINITRATE 10 MG TABLET [4064]

Facility

IP

$1.12

Service Code	NDC 68084-082-01
Hospital Charge Code	1710141
Hospital Revenue Code	259
Min. Negotiated Rate	$0.62
Max. Negotiated Rate	$0.90
Rate for Payer: Cash Price	$0.50
Rate for Payer: Cigna of CA HMO/PPO	$0.90
Rate for Payer: Health Smart Auto/Commercial	$0.67
Rate for Payer: LLUH Dept of Risk Management WC	$0.62
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$0.84

ISOSORBIDE DINITRATE 10 MG TABLET [4064]

Facility

OP

$1.04

Service Code	NDC 68001-374-00
Hospital Charge Code	1710141
Hospital Revenue Code	259
Min. Negotiated Rate	$0.57
Max. Negotiated Rate	$0.78
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$0.62
Rate for Payer: Aetna of CA Government/Medicare	$0.62
Rate for Payer: Cash Price	$0.47
Rate for Payer: Health Smart Auto/Commercial	$0.62
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$0.62
Rate for Payer: LLUH Dept of Risk Management WC	$0.57
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$0.78

ISOSORBIDE DINITRATE 10 MG TABLET [4064]

Facility

IP

$1.12

Service Code	NDC 68084-082-11
Hospital Charge Code	1710141
Hospital Revenue Code	259
Min. Negotiated Rate	$0.62
Max. Negotiated Rate	$0.90
Rate for Payer: Cash Price	$0.50
Rate for Payer: Cigna of CA HMO/PPO	$0.90
Rate for Payer: Health Smart Auto/Commercial	$0.67
Rate for Payer: LLUH Dept of Risk Management WC	$0.62
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$0.84

ISOSORBIDE DINITRATE 10 MG TABLET [4064]

Facility

IP

$0.69

Service Code	NDC 0143-1771-01
Hospital Charge Code	1710141
Hospital Revenue Code	259
Min. Negotiated Rate	$0.38
Max. Negotiated Rate	$0.55
Rate for Payer: Cash Price	$0.31
Rate for Payer: Cigna of CA HMO/PPO	$0.55
Rate for Payer: Health Smart Auto/Commercial	$0.41
Rate for Payer: LLUH Dept of Risk Management WC	$0.38
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$0.52

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