Price Transparency

Know your out-of-pocket cost for care.

All Charges

Charge

Type

Setting

Price

MELOXICAM 7.5 MG TABLET [20566]

Facility

IP

$0.20

Service Code	NDC 50268-525-15
Hospital Charge Code	1711947
Hospital Revenue Code	259
Min. Negotiated Rate	$0.11
Max. Negotiated Rate	$0.16
Rate for Payer: Cash Price	$0.09
Rate for Payer: Cigna of CA HMO/PPO	$0.16
Rate for Payer: Health Smart Auto/Commercial	$0.12
Rate for Payer: LLUH Dept of Risk Management WC	$0.11
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$0.15

MELOXICAM 7.5 MG TABLET [20566]

Facility

IP

$0.05

Service Code	NDC 68382-050-01
Hospital Charge Code	1711947
Hospital Revenue Code	259
Min. Negotiated Rate	$0.03
Max. Negotiated Rate	$0.04
Rate for Payer: Cash Price	$0.02
Rate for Payer: Cigna of CA HMO/PPO	$0.04
Rate for Payer: Health Smart Auto/Commercial	$0.03
Rate for Payer: LLUH Dept of Risk Management WC	$0.03
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$0.04

MELOXICAM 7.5 MG TABLET [20566]

Facility

IP

$0.20

Service Code	NDC 50268-525-11
Hospital Charge Code	1711947
Hospital Revenue Code	259
Min. Negotiated Rate	$0.11
Max. Negotiated Rate	$0.16
Rate for Payer: Cash Price	$0.09
Rate for Payer: Cigna of CA HMO/PPO	$0.16
Rate for Payer: Health Smart Auto/Commercial	$0.12
Rate for Payer: LLUH Dept of Risk Management WC	$0.11
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$0.15

MELOXICAM 7.5 MG TABLET [20566]

Facility

OP

$0.20

Service Code	NDC 50268-525-15
Hospital Charge Code	1711947
Hospital Revenue Code	259
Min. Negotiated Rate	$0.11
Max. Negotiated Rate	$0.15
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$0.12
Rate for Payer: Aetna of CA Government/Medicare	$0.12
Rate for Payer: Cash Price	$0.09
Rate for Payer: Health Smart Auto/Commercial	$0.12
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$0.12
Rate for Payer: LLUH Dept of Risk Management WC	$0.11
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$0.15

MELPHALAN FLUFENAMIDE 20 MG INTRAVENOUS SOLUTION [230897]

Facility

OP

$11,400.00

Service Code	CPT J9247
Hospital Revenue Code	636
Min. Negotiated Rate	$6,270.00
Max. Negotiated Rate	$8,550.00
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$6,840.00
Rate for Payer: Aetna of CA Government/Medicare	$6,840.00
Rate for Payer: Cash Price	$5,130.00
Rate for Payer: Health Smart Auto/Commercial	$6,840.00
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$6,840.00
Rate for Payer: LLUH Dept of Risk Management WC	$6,270.00
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$8,550.00

MELPHALAN FLUFENAMIDE 20 MG INTRAVENOUS SOLUTION [230897]

Facility

IP

$11,400.00

Service Code	CPT J9247
Hospital Revenue Code	636
Min. Negotiated Rate	$6,270.00
Max. Negotiated Rate	$9,120.00
Rate for Payer: Cash Price	$5,130.00
Rate for Payer: Cigna of CA HMO/PPO	$9,120.00
Rate for Payer: Health Smart Auto/Commercial	$6,840.00
Rate for Payer: LLUH Dept of Risk Management WC	$6,270.00
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$8,550.00

MELPHALAN HCL 50 MG INTRAVENOUS POWDER FOR SOLUTION [10522]

Facility

OP

$240.00

Service Code	NDC 71288-132-90
Hospital Charge Code	1755553
Hospital Revenue Code	636
Min. Negotiated Rate	$132.00
Max. Negotiated Rate	$180.00
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$144.00
Rate for Payer: Aetna of CA Government/Medicare	$144.00
Rate for Payer: Cash Price	$108.00
Rate for Payer: Health Smart Auto/Commercial	$144.00
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$144.00
Rate for Payer: LLUH Dept of Risk Management WC	$132.00
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$180.00

MELPHALAN HCL 50 MG INTRAVENOUS POWDER FOR SOLUTION [10522]

Facility

IP

$240.00

Service Code	NDC 54288-109-02
Hospital Charge Code	1755553
Hospital Revenue Code	636
Min. Negotiated Rate	$132.00
Max. Negotiated Rate	$192.00
Rate for Payer: Cash Price	$108.00
Rate for Payer: Cigna of CA HMO/PPO	$192.00
Rate for Payer: Health Smart Auto/Commercial	$144.00
Rate for Payer: LLUH Dept of Risk Management WC	$132.00
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$180.00

MELPHALAN HCL 50 MG INTRAVENOUS POWDER FOR SOLUTION [10522]

Facility

IP

$240.00

Service Code	NDC 71288-132-90
Hospital Charge Code	1755553
Hospital Revenue Code	636
Min. Negotiated Rate	$132.00
Max. Negotiated Rate	$192.00
Rate for Payer: Cash Price	$108.00
Rate for Payer: Cigna of CA HMO/PPO	$192.00
Rate for Payer: Health Smart Auto/Commercial	$144.00
Rate for Payer: LLUH Dept of Risk Management WC	$132.00
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$180.00

MELPHALAN HCL 50 MG INTRAVENOUS POWDER FOR SOLUTION [10522]

Facility

OP

$538.80

Service Code	NDC 43598-392-48
Hospital Charge Code	1755553
Hospital Revenue Code	636
Min. Negotiated Rate	$296.34
Max. Negotiated Rate	$404.10
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$323.28
Rate for Payer: Aetna of CA Government/Medicare	$323.28
Rate for Payer: Cash Price	$242.46
Rate for Payer: Health Smart Auto/Commercial	$323.28
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$323.28
Rate for Payer: LLUH Dept of Risk Management WC	$296.34
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$404.10

MELPHALAN HCL 50 MG INTRAVENOUS POWDER FOR SOLUTION [10522]

Facility

IP

$240.00

Service Code	NDC 71288-130-15
Hospital Charge Code	1755553
Hospital Revenue Code	636
Min. Negotiated Rate	$132.00
Max. Negotiated Rate	$192.00
Rate for Payer: Cash Price	$108.00
Rate for Payer: Cigna of CA HMO/PPO	$192.00
Rate for Payer: Health Smart Auto/Commercial	$144.00
Rate for Payer: LLUH Dept of Risk Management WC	$132.00
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$180.00

MELPHALAN HCL 50 MG INTRAVENOUS POWDER FOR SOLUTION [10522]

Facility

OP

$538.80

Service Code	NDC 43598-391-50
Hospital Charge Code	1755553
Hospital Revenue Code	636
Min. Negotiated Rate	$296.34
Max. Negotiated Rate	$404.10
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$323.28
Rate for Payer: Aetna of CA Government/Medicare	$323.28
Rate for Payer: Cash Price	$242.46
Rate for Payer: Health Smart Auto/Commercial	$323.28
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$323.28
Rate for Payer: LLUH Dept of Risk Management WC	$296.34
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$404.10

MELPHALAN HCL 50 MG INTRAVENOUS POWDER FOR SOLUTION [10522]

Facility

OP

$240.00

Service Code	NDC 71288-130-15
Hospital Charge Code	1755553
Hospital Revenue Code	636
Min. Negotiated Rate	$132.00
Max. Negotiated Rate	$180.00
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$144.00
Rate for Payer: Aetna of CA Government/Medicare	$144.00
Rate for Payer: Cash Price	$108.00
Rate for Payer: Health Smart Auto/Commercial	$144.00
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$144.00
Rate for Payer: LLUH Dept of Risk Management WC	$132.00
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$180.00

MELPHALAN HCL 50 MG INTRAVENOUS POWDER FOR SOLUTION [10522]

Facility

OP

$240.00

Service Code	NDC 54288-106-01
Hospital Charge Code	1755553
Hospital Revenue Code	636
Min. Negotiated Rate	$132.00
Max. Negotiated Rate	$180.00
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$144.00
Rate for Payer: Aetna of CA Government/Medicare	$144.00
Rate for Payer: Cash Price	$108.00
Rate for Payer: Health Smart Auto/Commercial	$144.00
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$144.00
Rate for Payer: LLUH Dept of Risk Management WC	$132.00
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$180.00

MELPHALAN HCL 50 MG INTRAVENOUS POWDER FOR SOLUTION [10522]

Facility

IP

$538.80

Service Code	NDC 43598-392-48
Hospital Charge Code	1755553
Hospital Revenue Code	636
Min. Negotiated Rate	$296.34
Max. Negotiated Rate	$431.04
Rate for Payer: Cash Price	$242.46
Rate for Payer: Cigna of CA HMO/PPO	$431.04
Rate for Payer: Health Smart Auto/Commercial	$323.28
Rate for Payer: LLUH Dept of Risk Management WC	$296.34
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$404.10

MELPHALAN HCL 50 MG INTRAVENOUS POWDER FOR SOLUTION [10522]

Facility

IP

$538.80

Service Code	NDC 43598-391-50
Hospital Charge Code	1755553
Hospital Revenue Code	636
Min. Negotiated Rate	$296.34
Max. Negotiated Rate	$431.04
Rate for Payer: Cash Price	$242.46
Rate for Payer: Cigna of CA HMO/PPO	$431.04
Rate for Payer: Health Smart Auto/Commercial	$323.28
Rate for Payer: LLUH Dept of Risk Management WC	$296.34
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$404.10

MELPHALAN HCL 50 MG INTRAVENOUS POWDER FOR SOLUTION [10522]

Facility

IP

$240.00

Service Code	NDC 54288-106-01
Hospital Charge Code	1755553
Hospital Revenue Code	636
Min. Negotiated Rate	$132.00
Max. Negotiated Rate	$192.00
Rate for Payer: Cash Price	$108.00
Rate for Payer: Cigna of CA HMO/PPO	$192.00
Rate for Payer: Health Smart Auto/Commercial	$144.00
Rate for Payer: LLUH Dept of Risk Management WC	$132.00
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$180.00

MELPHALAN HCL 50 MG INTRAVENOUS POWDER FOR SOLUTION [10522]

Facility

OP

$240.00

Service Code	NDC 54288-109-02
Hospital Charge Code	1755553
Hospital Revenue Code	636
Min. Negotiated Rate	$132.00
Max. Negotiated Rate	$180.00
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$144.00
Rate for Payer: Aetna of CA Government/Medicare	$144.00
Rate for Payer: Cash Price	$108.00
Rate for Payer: Health Smart Auto/Commercial	$144.00
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$144.00
Rate for Payer: LLUH Dept of Risk Management WC	$132.00
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$180.00

MEMANTINE 10 MG TABLET [36966]

Facility

IP

$0.80

Service Code	NDC 60687-184-11
Hospital Charge Code	1711859
Hospital Revenue Code	259
Min. Negotiated Rate	$0.44
Max. Negotiated Rate	$0.64
Rate for Payer: Cash Price	$0.36
Rate for Payer: Cigna of CA HMO/PPO	$0.64
Rate for Payer: Health Smart Auto/Commercial	$0.48
Rate for Payer: LLUH Dept of Risk Management WC	$0.44
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$0.60

MEMANTINE 10 MG TABLET [36966]

Facility

IP

$0.43

Service Code	NDC 33342-298-09
Hospital Charge Code	1711859
Hospital Revenue Code	259
Min. Negotiated Rate	$0.24
Max. Negotiated Rate	$0.34
Rate for Payer: Cash Price	$0.19
Rate for Payer: Cigna of CA HMO/PPO	$0.34
Rate for Payer: Health Smart Auto/Commercial	$0.26
Rate for Payer: LLUH Dept of Risk Management WC	$0.24
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$0.32

MEMANTINE 10 MG TABLET [36966]

Facility

OP

$0.22

Service Code	NDC 0832-1113-60
Hospital Charge Code	1711859
Hospital Revenue Code	259
Min. Negotiated Rate	$0.12
Max. Negotiated Rate	$0.17
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$0.13
Rate for Payer: Aetna of CA Government/Medicare	$0.13
Rate for Payer: Cash Price	$0.10
Rate for Payer: Health Smart Auto/Commercial	$0.13
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$0.13
Rate for Payer: LLUH Dept of Risk Management WC	$0.12
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$0.17

MEMANTINE 10 MG TABLET [36966]

Facility

IP

$0.22

Service Code	NDC 0832-1113-60
Hospital Charge Code	1711859
Hospital Revenue Code	259
Min. Negotiated Rate	$0.12
Max. Negotiated Rate	$0.18
Rate for Payer: Cash Price	$0.10
Rate for Payer: Cigna of CA HMO/PPO	$0.18
Rate for Payer: Health Smart Auto/Commercial	$0.13
Rate for Payer: LLUH Dept of Risk Management WC	$0.12
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$0.17

MEMANTINE 10 MG TABLET [36966]

Facility

OP

$0.43

Service Code	NDC 33342-298-09
Hospital Charge Code	1711859
Hospital Revenue Code	259
Min. Negotiated Rate	$0.24
Max. Negotiated Rate	$0.32
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$0.26
Rate for Payer: Aetna of CA Government/Medicare	$0.26
Rate for Payer: Cash Price	$0.19
Rate for Payer: Health Smart Auto/Commercial	$0.26
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$0.26
Rate for Payer: LLUH Dept of Risk Management WC	$0.24
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$0.32

MEMANTINE 10 MG TABLET [36966]

Facility

OP

$0.80

Service Code	NDC 60687-184-11
Hospital Charge Code	1711859
Hospital Revenue Code	259
Min. Negotiated Rate	$0.44
Max. Negotiated Rate	$0.60
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$0.48
Rate for Payer: Aetna of CA Government/Medicare	$0.48
Rate for Payer: Cash Price	$0.36
Rate for Payer: Health Smart Auto/Commercial	$0.48
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$0.48
Rate for Payer: LLUH Dept of Risk Management WC	$0.44
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$0.60

MEMANTINE 10 MG TABLET [36966]

Facility

OP

$0.80

Service Code	NDC 60687-184-57
Hospital Charge Code	1711859
Hospital Revenue Code	259
Min. Negotiated Rate	$0.44
Max. Negotiated Rate	$0.60
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$0.48
Rate for Payer: Aetna of CA Government/Medicare	$0.48
Rate for Payer: Cash Price	$0.36
Rate for Payer: Health Smart Auto/Commercial	$0.48
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$0.48
Rate for Payer: LLUH Dept of Risk Management WC	$0.44
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$0.60

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