Price Transparency

Know your out-of-pocket cost for care.

All Charges

Charge

Type

Setting

Price

B-COMPLEX WITH VITAMIN C 1/2 TABLET [408807]

Facility

IP

$0.03

Service Code	NDC 9999-9998-07
Hospital Charge Code	NDC408807
Hospital Revenue Code	259
Min. Negotiated Rate	$0.02
Max. Negotiated Rate	$0.02
Rate for Payer: Cash Price	$0.01
Rate for Payer: Cigna of CA HMO/PPO	$0.02
Rate for Payer: Health Smart Auto/Commercial	$0.02
Rate for Payer: LLUH Dept of Risk Management WC	$0.02
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$0.02

B-COMPLEX WITH VITAMIN C TABLET [807]

Facility

IP

$0.03

Service Code	NDC 9999-9998-07
Hospital Charge Code	NDC408807
Hospital Revenue Code	259
Min. Negotiated Rate	$0.02
Max. Negotiated Rate	$0.02
Rate for Payer: Cash Price	$0.01
Rate for Payer: Cigna of CA HMO/PPO	$0.02
Rate for Payer: Health Smart Auto/Commercial	$0.02
Rate for Payer: LLUH Dept of Risk Management WC	$0.02
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$0.02

B-COMPLEX WITH VITAMIN C TABLET [807]

Facility

OP

$0.08

Service Code	NDC 3160401338
Hospital Charge Code	1711835
Hospital Revenue Code	259
Min. Negotiated Rate	$0.04
Max. Negotiated Rate	$0.06
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$0.05
Rate for Payer: Aetna of CA Government/Medicare	$0.05
Rate for Payer: Cash Price	$0.04
Rate for Payer: Health Smart Auto/Commercial	$0.05
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$0.05
Rate for Payer: LLUH Dept of Risk Management WC	$0.04
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$0.06

B-COMPLEX WITH VITAMIN C TABLET [807]

Facility

IP

$0.08

Service Code	NDC 3160401338
Hospital Charge Code	1711835
Hospital Revenue Code	259
Min. Negotiated Rate	$0.04
Max. Negotiated Rate	$0.06
Rate for Payer: Cash Price	$0.04
Rate for Payer: Cigna of CA HMO/PPO	$0.06
Rate for Payer: Health Smart Auto/Commercial	$0.05
Rate for Payer: LLUH Dept of Risk Management WC	$0.04
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$0.06

B-COMPLEX WITH VITAMIN C TABLET [807]

Facility

OP

$0.03

Service Code	NDC 9999-9998-07
Hospital Charge Code	NDC408807
Hospital Revenue Code	259
Min. Negotiated Rate	$0.02
Max. Negotiated Rate	$0.02
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$0.02
Rate for Payer: Aetna of CA Government/Medicare	$0.02
Rate for Payer: Cash Price	$0.01
Rate for Payer: Health Smart Auto/Commercial	$0.02
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$0.02
Rate for Payer: LLUH Dept of Risk Management WC	$0.02
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$0.02

B-COMPLEX WITH VITAMIN C TABLET [807]

Facility

IP

$0.03

Service Code	NDC 8068112600
Hospital Charge Code	1711835
Hospital Revenue Code	259
Min. Negotiated Rate	$0.02
Max. Negotiated Rate	$0.02
Rate for Payer: Cash Price	$0.01
Rate for Payer: Cigna of CA HMO/PPO	$0.02
Rate for Payer: Health Smart Auto/Commercial	$0.02
Rate for Payer: LLUH Dept of Risk Management WC	$0.02
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$0.02

B-COMPLEX WITH VITAMIN C TABLET [807]

Facility

OP

$0.03

Service Code	NDC 8068112600
Hospital Charge Code	1711835
Hospital Revenue Code	259
Min. Negotiated Rate	$0.02
Max. Negotiated Rate	$0.02
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$0.02
Rate for Payer: Aetna of CA Government/Medicare	$0.02
Rate for Payer: Cash Price	$0.01
Rate for Payer: Health Smart Auto/Commercial	$0.02
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$0.02
Rate for Payer: LLUH Dept of Risk Management WC	$0.02
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$0.02

BEBTELOVIMAB 175 MG/2 ML (87.5 MG/ML) INTRAVENOUS SOLUTION (UNAPP) [233528]

Facility

IP

$1,260.00

Service Code	CPT Q0222
Hospital Charge Code	NDG233528
Hospital Revenue Code	636
Min. Negotiated Rate	$693.00
Max. Negotiated Rate	$1,008.00
Rate for Payer: Cash Price	$567.00
Rate for Payer: Cigna of CA HMO/PPO	$1,008.00
Rate for Payer: Health Smart Auto/Commercial	$756.00
Rate for Payer: LLUH Dept of Risk Management WC	$693.00
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$945.00

BEBTELOVIMAB 175 MG/2 ML (87.5 MG/ML) INTRAVENOUS SOLUTION (UNAPP) [233528]

Facility

OP

$1,260.00

Service Code	CPT Q0222
Hospital Charge Code	NDG233528
Hospital Revenue Code	636
Min. Negotiated Rate	$693.00
Max. Negotiated Rate	$945.00
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$756.00
Rate for Payer: Aetna of CA Government/Medicare	$756.00
Rate for Payer: Cash Price	$567.00
Rate for Payer: Health Smart Auto/Commercial	$756.00
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$756.00
Rate for Payer: LLUH Dept of Risk Management WC	$693.00
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$945.00

BECLOMETHASONE ORAL EMULSION COMPOUND 1 MG/ML [4080247]

Facility

IP

$0.09

Service Code	NDC 9994-0802-47
Hospital Charge Code	1715210
Hospital Revenue Code	259
Min. Negotiated Rate	$0.05
Max. Negotiated Rate	$0.07
Rate for Payer: Cash Price	$0.04
Rate for Payer: Cigna of CA HMO/PPO	$0.07
Rate for Payer: Health Smart Auto/Commercial	$0.05
Rate for Payer: LLUH Dept of Risk Management WC	$0.05
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$0.07

BECLOMETHASONE ORAL EMULSION COMPOUND 1 MG/ML [4080247]

Facility

OP

$0.09

Service Code	NDC 9994-0802-47
Hospital Charge Code	1715210
Hospital Revenue Code	259
Min. Negotiated Rate	$0.05
Max. Negotiated Rate	$0.07
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$0.05
Rate for Payer: Aetna of CA Government/Medicare	$0.05
Rate for Payer: Cash Price	$0.04
Rate for Payer: Health Smart Auto/Commercial	$0.05
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$0.05
Rate for Payer: LLUH Dept of Risk Management WC	$0.05
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$0.07

BEER [4080757]

Facility

IP

$1.43

Service Code	NDC 9994-0807-57
Hospital Charge Code	ERX4080757
Hospital Revenue Code	250
Min. Negotiated Rate	$0.79
Max. Negotiated Rate	$1.14
Rate for Payer: Cash Price	$0.64
Rate for Payer: Cigna of CA HMO/PPO	$1.14
Rate for Payer: Health Smart Auto/Commercial	$0.86
Rate for Payer: LLUH Dept of Risk Management WC	$0.79
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$1.07

BEER [4080757]

Facility

OP

$1.43

Service Code	NDC 9994-0807-57
Hospital Charge Code	ERX4080757
Hospital Revenue Code	250
Min. Negotiated Rate	$0.79
Max. Negotiated Rate	$1.07
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$0.86
Rate for Payer: Aetna of CA Government/Medicare	$0.86
Rate for Payer: Cash Price	$0.64
Rate for Payer: Health Smart Auto/Commercial	$0.86
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$0.86
Rate for Payer: LLUH Dept of Risk Management WC	$0.79
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$1.07

BELANTAMAB MAFODOTIN-BLMF 100 MG INTRAVENOUS SOLUTION [229004]

Facility

OP

$10,591.76

Service Code	CPT J9037
Hospital Charge Code	ERX229004
Hospital Revenue Code	636
Min. Negotiated Rate	$5,825.47
Max. Negotiated Rate	$7,943.82
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$6,355.06
Rate for Payer: Aetna of CA Government/Medicare	$6,355.06
Rate for Payer: Cash Price	$4,766.29
Rate for Payer: Health Smart Auto/Commercial	$6,355.06
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$6,355.06
Rate for Payer: LLUH Dept of Risk Management WC	$5,825.47
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$7,943.82

BELANTAMAB MAFODOTIN-BLMF 100 MG INTRAVENOUS SOLUTION [229004]

Facility

IP

$10,591.76

Service Code	CPT J9037
Hospital Charge Code	ERX229004
Hospital Revenue Code	636
Min. Negotiated Rate	$5,825.47
Max. Negotiated Rate	$8,473.41
Rate for Payer: Cash Price	$4,766.29
Rate for Payer: Cigna of CA HMO/PPO	$8,473.41
Rate for Payer: Health Smart Auto/Commercial	$6,355.06
Rate for Payer: LLUH Dept of Risk Management WC	$5,825.47
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$7,943.82

BELATACEPT 250 MG INTRAVENOUS SOLUTION [153042]

Facility

IP

$1,163.86

Service Code	CPT J0485
Hospital Charge Code	ERX153042
Hospital Revenue Code	636
Min. Negotiated Rate	$640.12
Max. Negotiated Rate	$931.09
Rate for Payer: Cash Price	$523.74
Rate for Payer: Cigna of CA HMO/PPO	$931.09
Rate for Payer: Health Smart Auto/Commercial	$698.32
Rate for Payer: LLUH Dept of Risk Management WC	$640.12
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$872.90

BELATACEPT 250 MG INTRAVENOUS SOLUTION [153042]

Facility

OP

$1,163.86

Service Code	CPT J0485
Hospital Charge Code	ERX153042
Hospital Revenue Code	636
Min. Negotiated Rate	$640.12
Max. Negotiated Rate	$872.90
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$698.32
Rate for Payer: Aetna of CA Government/Medicare	$698.32
Rate for Payer: Cash Price	$523.74
Rate for Payer: Health Smart Auto/Commercial	$698.32
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$698.32
Rate for Payer: LLUH Dept of Risk Management WC	$640.12
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$872.90

BELIMUMAB 120 MG INTRAVENOUS SOLUTION [108842]

Facility

OP

$707.42

Service Code	CPT J0490
Hospital Charge Code	1755787
Hospital Revenue Code	636
Min. Negotiated Rate	$389.08
Max. Negotiated Rate	$530.56
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$424.45
Rate for Payer: Aetna of CA Government/Medicare	$424.45
Rate for Payer: Cash Price	$318.34
Rate for Payer: Health Smart Auto/Commercial	$424.45
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$424.45
Rate for Payer: LLUH Dept of Risk Management WC	$389.08
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$530.56

BELIMUMAB 120 MG INTRAVENOUS SOLUTION [108842]

Facility

IP

$707.42

Service Code	CPT J0490
Hospital Charge Code	1755787
Hospital Revenue Code	636
Min. Negotiated Rate	$389.08
Max. Negotiated Rate	$565.94
Rate for Payer: Cash Price	$318.34
Rate for Payer: Cigna of CA HMO/PPO	$565.94
Rate for Payer: Health Smart Auto/Commercial	$424.45
Rate for Payer: LLUH Dept of Risk Management WC	$389.08
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$530.56

BELIMUMAB 400 MG INTRAVENOUS SOLUTION [108843]

Facility

IP

$2,357.96

Service Code	CPT J0490
Hospital Charge Code	1755788
Hospital Revenue Code	636
Min. Negotiated Rate	$1,296.88
Max. Negotiated Rate	$1,886.37
Rate for Payer: Cash Price	$1,061.08
Rate for Payer: Cigna of CA HMO/PPO	$1,886.37
Rate for Payer: Health Smart Auto/Commercial	$1,414.78
Rate for Payer: LLUH Dept of Risk Management WC	$1,296.88
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$1,768.47

BELIMUMAB 400 MG INTRAVENOUS SOLUTION [108843]

Facility

OP

$2,357.96

Service Code	CPT J0490
Hospital Charge Code	1755788
Hospital Revenue Code	636
Min. Negotiated Rate	$1,296.88
Max. Negotiated Rate	$1,768.47
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$1,414.78
Rate for Payer: Aetna of CA Government/Medicare	$1,414.78
Rate for Payer: Cash Price	$1,061.08
Rate for Payer: Health Smart Auto/Commercial	$1,414.78
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$1,414.78
Rate for Payer: LLUH Dept of Risk Management WC	$1,296.88
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$1,768.47

BELLADONNA ALKALOIDS-OPIUM 16.2 MG-30 MG RECTAL SUPPOSITORY [111311]

Facility

OP

$26.42

Service Code	NDC 0574-7045-12
Hospital Charge Code	ERX111311
Hospital Revenue Code	259
Min. Negotiated Rate	$14.53
Max. Negotiated Rate	$19.82
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$15.85
Rate for Payer: Aetna of CA Government/Medicare	$15.85
Rate for Payer: Cash Price	$11.89
Rate for Payer: Health Smart Auto/Commercial	$15.85
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$15.85
Rate for Payer: LLUH Dept of Risk Management WC	$14.53
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$19.82

BELLADONNA ALKALOIDS-OPIUM 16.2 MG-30 MG RECTAL SUPPOSITORY [111311]

Facility

IP

$26.42

Service Code	NDC 0574-7045-01
Hospital Charge Code	ERX111311
Hospital Revenue Code	259
Min. Negotiated Rate	$14.53
Max. Negotiated Rate	$21.14
Rate for Payer: Cash Price	$11.89
Rate for Payer: Cigna of CA HMO/PPO	$21.14
Rate for Payer: Health Smart Auto/Commercial	$15.85
Rate for Payer: LLUH Dept of Risk Management WC	$14.53
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$19.82

BELLADONNA ALKALOIDS-OPIUM 16.2 MG-30 MG RECTAL SUPPOSITORY [111311]

Facility

OP

$26.42

Service Code	NDC 0574-7045-01
Hospital Charge Code	ERX111311
Hospital Revenue Code	259
Min. Negotiated Rate	$14.53
Max. Negotiated Rate	$19.82
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$15.85
Rate for Payer: Aetna of CA Government/Medicare	$15.85
Rate for Payer: Cash Price	$11.89
Rate for Payer: Health Smart Auto/Commercial	$15.85
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$15.85
Rate for Payer: LLUH Dept of Risk Management WC	$14.53
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$19.82

BELLADONNA ALKALOIDS-OPIUM 16.2 MG-30 MG RECTAL SUPPOSITORY [111311]

Facility

IP

$26.42

Service Code	NDC 0574-7045-12
Hospital Charge Code	ERX111311
Hospital Revenue Code	259
Min. Negotiated Rate	$14.53
Max. Negotiated Rate	$21.14
Rate for Payer: Cash Price	$11.89
Rate for Payer: Cigna of CA HMO/PPO	$21.14
Rate for Payer: Health Smart Auto/Commercial	$15.85
Rate for Payer: LLUH Dept of Risk Management WC	$14.53
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$19.82

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