Price Transparency

Know your out-of-pocket cost for care.

All Charges

Charge

Type

Setting

Price

ITRACONAZOLE 100 MG CAPSULE [10364]

Facility

OP

$15.10

Service Code	NDC 0378-5100-93
Hospital Charge Code	1712171
Hospital Revenue Code	259
Min. Negotiated Rate	$8.30
Max. Negotiated Rate	$11.32
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$9.06
Rate for Payer: Aetna of CA Government/Medicare	$9.06
Rate for Payer: Cash Price	$6.80
Rate for Payer: Health Smart Auto/Commercial	$9.06
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$9.06
Rate for Payer: LLUH Dept of Risk Management WC	$8.30
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$11.32

ITRACONAZOLE 100 MG CAPSULE [10364]

Facility

IP

$2.00

Service Code	NDC 49884-239-11
Hospital Charge Code	1712171
Hospital Revenue Code	259
Min. Negotiated Rate	$1.10
Max. Negotiated Rate	$1.60
Rate for Payer: Cash Price	$0.90
Rate for Payer: Cigna of CA 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 Beech St/Commercial/PHCS	$1.50

ITRACONAZOLE 100 MG CAPSULE [10364]

Facility

IP

$2.00

Service Code	NDC 65162-630-03
Hospital Charge Code	1712171
Hospital Revenue Code	259
Min. Negotiated Rate	$1.10
Max. Negotiated Rate	$1.60
Rate for Payer: Cash Price	$0.90
Rate for Payer: Cigna of CA 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 Beech St/Commercial/PHCS	$1.50

ITRACONAZOLE 100 MG CAPSULE [10364]

Facility

OP

$33.78

Service Code	NDC 50458-290-01
Hospital Charge Code	1712171
Hospital Revenue Code	259
Min. Negotiated Rate	$18.58
Max. Negotiated Rate	$25.34
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$20.27
Rate for Payer: Aetna of CA Government/Medicare	$20.27
Rate for Payer: Cash Price	$15.20
Rate for Payer: Health Smart Auto/Commercial	$20.27
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$20.27
Rate for Payer: LLUH Dept of Risk Management WC	$18.58
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$25.34

ITRACONAZOLE 100 MG CAPSULE [10364]

Facility

OP

$2.00

Service Code	NDC 67877-454-30
Hospital Charge Code	1712171
Hospital Revenue Code	259
Min. Negotiated Rate	$1.10
Max. Negotiated Rate	$1.50
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	$0.90
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 Beech St/Commercial/PHCS	$1.50

ITRACONAZOLE 100 MG CAPSULE [10364]

Facility

IP

$8.93

Service Code	NDC 10147-1700-7
Hospital Charge Code	1712171
Hospital Revenue Code	259
Min. Negotiated Rate	$4.91
Max. Negotiated Rate	$7.14
Rate for Payer: Cash Price	$4.02
Rate for Payer: Cigna of CA HMO/PPO	$7.14
Rate for Payer: Health Smart Auto/Commercial	$5.36
Rate for Payer: LLUH Dept of Risk Management WC	$4.91
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$6.70

ITRACONAZOLE 100 MG CAPSULE [10364]

Facility

IP

$33.78

Service Code	NDC 50458-290-01
Hospital Charge Code	1712171
Hospital Revenue Code	259
Min. Negotiated Rate	$18.58
Max. Negotiated Rate	$27.02
Rate for Payer: Cash Price	$15.20
Rate for Payer: Cigna of CA HMO/PPO	$27.02
Rate for Payer: Health Smart Auto/Commercial	$20.27
Rate for Payer: LLUH Dept of Risk Management WC	$18.58
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$25.34

ITRACONAZOLE 100 MG CAPSULE [10364]

Facility

IP

$2.00

Service Code	NDC 67877-454-30
Hospital Charge Code	1712171
Hospital Revenue Code	259
Min. Negotiated Rate	$1.10
Max. Negotiated Rate	$1.60
Rate for Payer: Cash Price	$0.90
Rate for Payer: Cigna of CA 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 Beech St/Commercial/PHCS	$1.50

ITRACONAZOLE 10 MG/ML ORAL SOLUTION [19928]

Facility

IP

$2.00

Service Code	NDC 31722-006-31
Hospital Charge Code	1715991
Hospital Revenue Code	259
Min. Negotiated Rate	$1.10
Max. Negotiated Rate	$1.60
Rate for Payer: Cash Price	$0.90
Rate for Payer: Cigna of CA 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 Beech St/Commercial/PHCS	$1.50

ITRACONAZOLE 10 MG/ML ORAL SOLUTION [19928]

Facility

IP

$2.35

Service Code	NDC 65162-087-74
Hospital Charge Code	1715991
Hospital Revenue Code	259
Min. Negotiated Rate	$1.29
Max. Negotiated Rate	$1.88
Rate for Payer: Cash Price	$1.06
Rate for Payer: Cigna of CA HMO/PPO	$1.88
Rate for Payer: Health Smart Auto/Commercial	$1.41
Rate for Payer: LLUH Dept of Risk Management WC	$1.29
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$1.76

ITRACONAZOLE 10 MG/ML ORAL SOLUTION [19928]

Facility

OP

$2.35

Service Code	NDC 65162-087-74
Hospital Charge Code	1715991
Hospital Revenue Code	259
Min. Negotiated Rate	$1.29
Max. Negotiated Rate	$1.76
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$1.41
Rate for Payer: Aetna of CA Government/Medicare	$1.41
Rate for Payer: Cash Price	$1.06
Rate for Payer: Health Smart Auto/Commercial	$1.41
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$1.41
Rate for Payer: LLUH Dept of Risk Management WC	$1.29
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$1.76

ITRACONAZOLE 10 MG/ML ORAL SOLUTION [19928]

Facility

OP

$2.00

Service Code	NDC 31722-006-31
Hospital Charge Code	1715991
Hospital Revenue Code	259
Min. Negotiated Rate	$1.10
Max. Negotiated Rate	$1.50
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	$0.90
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 Beech St/Commercial/PHCS	$1.50

IVABRADINE 5 MG TABLET [204605]

Facility

OP

$11.36

Service Code	NDC 55513-800-60
Hospital Charge Code	ERX204605
Hospital Revenue Code	259
Min. Negotiated Rate	$6.25
Max. Negotiated Rate	$8.52
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$6.82
Rate for Payer: Aetna of CA Government/Medicare	$6.82
Rate for Payer: Cash Price	$5.11
Rate for Payer: Health Smart Auto/Commercial	$6.82
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$6.82
Rate for Payer: LLUH Dept of Risk Management WC	$6.25
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$8.52

IVABRADINE 5 MG TABLET [204605]

Facility

IP

$11.36

Service Code	NDC 55513-800-60
Hospital Charge Code	ERX204605
Hospital Revenue Code	259
Min. Negotiated Rate	$6.25
Max. Negotiated Rate	$9.09
Rate for Payer: Cash Price	$5.11
Rate for Payer: Cigna of CA HMO/PPO	$9.09
Rate for Payer: Health Smart Auto/Commercial	$6.82
Rate for Payer: LLUH Dept of Risk Management WC	$6.25
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$8.52

IVABRADINE 7.5 MG TABLET [204608]

Facility

IP

$11.36

Service Code	NDC 55513-810-60
Hospital Charge Code	ERX204608
Hospital Revenue Code	259
Min. Negotiated Rate	$6.25
Max. Negotiated Rate	$9.09
Rate for Payer: Cash Price	$5.11
Rate for Payer: Cigna of CA HMO/PPO	$9.09
Rate for Payer: Health Smart Auto/Commercial	$6.82
Rate for Payer: LLUH Dept of Risk Management WC	$6.25
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$8.52

IVABRADINE 7.5 MG TABLET [204608]

Facility

OP

$11.36

Service Code	NDC 55513-810-60
Hospital Charge Code	ERX204608
Hospital Revenue Code	259
Min. Negotiated Rate	$6.25
Max. Negotiated Rate	$8.52
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$6.82
Rate for Payer: Aetna of CA Government/Medicare	$6.82
Rate for Payer: Cash Price	$5.11
Rate for Payer: Health Smart Auto/Commercial	$6.82
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$6.82
Rate for Payer: LLUH Dept of Risk Management WC	$6.25
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$8.52

IVERMECTIN 0.5 % LOTION [196318]

Facility

OP

$2.79

Service Code	NDC 24338-183-04
Hospital Charge Code	NDG196318
Hospital Revenue Code	259
Min. Negotiated Rate	$1.53
Max. Negotiated Rate	$2.09
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$1.67
Rate for Payer: Aetna of CA Government/Medicare	$1.67
Rate for Payer: Cash Price	$1.26
Rate for Payer: Health Smart Auto/Commercial	$1.67
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$1.67
Rate for Payer: LLUH Dept of Risk Management WC	$1.53
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$2.09

IVERMECTIN 0.5 % LOTION [196318]

Facility

IP

$2.79

Service Code	NDC 24338-183-04
Hospital Charge Code	NDG196318
Hospital Revenue Code	259
Min. Negotiated Rate	$1.53
Max. Negotiated Rate	$2.23
Rate for Payer: Cash Price	$1.26
Rate for Payer: Cigna of CA HMO/PPO	$2.23
Rate for Payer: Health Smart Auto/Commercial	$1.67
Rate for Payer: LLUH Dept of Risk Management WC	$1.53
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$2.09

IVERMECTIN 3 MG TABLET [25820]

Facility

IP

$4.97

Service Code	NDC 42799-806-01
Hospital Charge Code	1712490
Hospital Revenue Code	259
Min. Negotiated Rate	$2.73
Max. Negotiated Rate	$3.98
Rate for Payer: Cash Price	$2.24
Rate for Payer: Cigna of CA 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 Beech St/Commercial/PHCS	$3.73

IVERMECTIN 3 MG TABLET [25820]

Facility

OP

$4.97

Service Code	NDC 42799-806-01
Hospital Charge Code	1712490
Hospital Revenue Code	259
Min. Negotiated Rate	$2.73
Max. Negotiated Rate	$3.73
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	$2.24
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 Beech St/Commercial/PHCS	$3.73

IXABEPILONE 45 MG INTRAVENOUS SOLUTION [88653]

Facility

OP

$6,645.17

Service Code	CPT J9207
Hospital Charge Code	1755731
Hospital Revenue Code	636
Min. Negotiated Rate	$3,654.84
Max. Negotiated Rate	$4,983.88
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$3,987.10
Rate for Payer: Aetna of CA Government/Medicare	$3,987.10
Rate for Payer: Cash Price	$2,990.33
Rate for Payer: Health Smart Auto/Commercial	$3,987.10
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$3,987.10
Rate for Payer: LLUH Dept of Risk Management WC	$3,654.84
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$4,983.88

IXABEPILONE 45 MG INTRAVENOUS SOLUTION [88653]

Facility

IP

$6,645.17

Service Code	CPT J9207
Hospital Charge Code	1755731
Hospital Revenue Code	636
Min. Negotiated Rate	$3,654.84
Max. Negotiated Rate	$5,316.14
Rate for Payer: Cash Price	$2,990.33
Rate for Payer: Cigna of CA HMO/PPO	$5,316.14
Rate for Payer: Health Smart Auto/Commercial	$3,987.10
Rate for Payer: LLUH Dept of Risk Management WC	$3,654.84
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$4,983.88

KARAYA GUM TOPICAL POWDER [111957]

Facility

IP

$0.18

Service Code	NDC 8380007905
Hospital Charge Code	NDG111957
Hospital Revenue Code	259
Min. Negotiated Rate	$0.10
Max. Negotiated Rate	$0.14
Rate for Payer: Cash Price	$0.08
Rate for Payer: Cigna of CA 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 Beech St/Commercial/PHCS	$0.14

KARAYA GUM TOPICAL POWDER [111957]

Facility

OP

$0.18

Service Code	NDC 8380007905
Hospital Charge Code	NDG111957
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	$0.08
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 Beech St/Commercial/PHCS	$0.14

KETAMINE 100 MG/ML INJECTION SOLUTION [4237]

Facility

OP

$2.00

Service Code	NDC 0409-2051-05
Hospital Charge Code	1720437
Hospital Revenue Code	250
Min. Negotiated Rate	$1.10
Max. Negotiated Rate	$1.50
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	$0.90
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 Beech St/Commercial/PHCS	$1.50

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