Price Transparency

Know your out-of-pocket cost for care.

All Charges

Charge

Type

Setting

Price

METAXALONE 800 MG TABLET [33963]

Facility

OP

$1.80

Service Code	NDC 55111-650-01
Hospital Charge Code	1712374
Hospital Revenue Code	259
Min. Negotiated Rate	$0.99
Max. Negotiated Rate	$1.35
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$1.08
Rate for Payer: Aetna of CA Government/Medicare	$1.08
Rate for Payer: Cash Price	$0.81
Rate for Payer: Health Smart Auto/Commercial	$1.08
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$1.08
Rate for Payer: LLUH Dept of Risk Management WC	$0.99
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$1.35

METFORMIN 500 MG/5 ML ORAL SOLUTION [37125]

Facility

OP

$1.69

Service Code	NDC 10631-206-01
Hospital Charge Code	NDG37125
Hospital Revenue Code	259
Min. Negotiated Rate	$0.93
Max. Negotiated Rate	$1.27
Rate for Payer: Health Smart Auto/Commercial	$1.01
Rate for Payer: Cash Price	$0.76
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$1.01
Rate for Payer: Aetna of CA Government/Medicare	$1.01
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$1.01
Rate for Payer: LLUH Dept of Risk Management WC	$0.93
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$1.27

METFORMIN 500 MG/5 ML ORAL SOLUTION [37125]

Facility

IP

$1.69

Service Code	NDC 10631-206-01
Hospital Charge Code	NDG37125
Hospital Revenue Code	259
Min. Negotiated Rate	$0.93
Max. Negotiated Rate	$1.35
Rate for Payer: Cash Price	$0.76
Rate for Payer: Cigna of CA HMO/PPO	$1.35
Rate for Payer: Health Smart Auto/Commercial	$1.01
Rate for Payer: LLUH Dept of Risk Management WC	$0.93
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$1.27

METFORMIN 500 MG TABLET [10544]

Facility

IP

$0.05

Service Code	NDC 23155-102-01
Hospital Charge Code	1712181
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

METFORMIN 500 MG TABLET [10544]

Facility

IP

$0.03

Service Code	NDC 70010-063-01
Hospital Charge Code	1712181
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

METFORMIN 500 MG TABLET [10544]

Facility

OP

$0.05

Service Code	NDC 23155-102-01
Hospital Charge Code	1712181
Hospital Revenue Code	259
Min. Negotiated Rate	$0.03
Max. Negotiated Rate	$0.04
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$0.03
Rate for Payer: Aetna of CA Government/Medicare	$0.03
Rate for Payer: Cash Price	$0.02
Rate for Payer: Health Smart Auto/Commercial	$0.03
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$0.03
Rate for Payer: LLUH Dept of Risk Management WC	$0.03
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$0.04

METFORMIN 500 MG TABLET [10544]

Facility

IP

$0.08

Service Code	NDC 0904-6689-61
Hospital Charge Code	1712181
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

METFORMIN 500 MG TABLET [10544]

Facility

OP

$0.03

Service Code	NDC 70010-063-01
Hospital Charge Code	1712181
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

METFORMIN 500 MG TABLET [10544]

Facility

OP

$0.08

Service Code	NDC 0904-6689-61
Hospital Charge Code	1712181
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

METFORMIN 850 MG TABLET [14719]

Facility

OP

$0.26

Service Code	NDC 60687-143-11
Hospital Charge Code	1712182
Hospital Revenue Code	259
Min. Negotiated Rate	$0.14
Max. Negotiated Rate	$0.20
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$0.16
Rate for Payer: Aetna of CA Government/Medicare	$0.16
Rate for Payer: Cash Price	$0.12
Rate for Payer: Health Smart Auto/Commercial	$0.16
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$0.16
Rate for Payer: LLUH Dept of Risk Management WC	$0.14
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$0.20

METFORMIN 850 MG TABLET [14719]

Facility

OP

$0.26

Service Code	NDC 60687-143-01
Hospital Charge Code	1712182
Hospital Revenue Code	259
Min. Negotiated Rate	$0.14
Max. Negotiated Rate	$0.20
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$0.16
Rate for Payer: Aetna of CA Government/Medicare	$0.16
Rate for Payer: Cash Price	$0.12
Rate for Payer: Health Smart Auto/Commercial	$0.16
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$0.16
Rate for Payer: LLUH Dept of Risk Management WC	$0.14
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$0.20

METFORMIN 850 MG TABLET [14719]

Facility

IP

$0.26

Service Code	NDC 60687-143-01
Hospital Charge Code	1712182
Hospital Revenue Code	259
Min. Negotiated Rate	$0.14
Max. Negotiated Rate	$0.21
Rate for Payer: Cash Price	$0.12
Rate for Payer: Cigna of CA HMO/PPO	$0.21
Rate for Payer: Health Smart Auto/Commercial	$0.16
Rate for Payer: LLUH Dept of Risk Management WC	$0.14
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$0.20

METFORMIN 850 MG TABLET [14719]

Facility

IP

$0.26

Service Code	NDC 60687-143-11
Hospital Charge Code	1712182
Hospital Revenue Code	259
Min. Negotiated Rate	$0.14
Max. Negotiated Rate	$0.21
Rate for Payer: Cash Price	$0.12
Rate for Payer: Cigna of CA HMO/PPO	$0.21
Rate for Payer: Health Smart Auto/Commercial	$0.16
Rate for Payer: LLUH Dept of Risk Management WC	$0.14
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$0.20

METFORMIN ER 500 MG TABLET,EXTENDED RELEASE 24 HR [28995]

Facility

OP

$0.06

Service Code	NDC 70010-491-01
Hospital Charge Code	1712246
Hospital Revenue Code	259
Min. Negotiated Rate	$0.03
Max. Negotiated Rate	$0.05
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$0.04
Rate for Payer: Aetna of CA Government/Medicare	$0.04
Rate for Payer: Cash Price	$0.03
Rate for Payer: Health Smart Auto/Commercial	$0.04
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: Multiplan Beech St/Commercial/PHCS	$0.05

METFORMIN ER 500 MG TABLET,EXTENDED RELEASE 24 HR [28995]

Facility

IP

$0.06

Service Code	NDC 70010-491-01
Hospital Charge Code	1712246
Hospital Revenue Code	259
Min. Negotiated Rate	$0.03
Max. Negotiated Rate	$0.05
Rate for Payer: Cash Price	$0.03
Rate for Payer: Cigna of CA HMO/PPO	$0.05
Rate for Payer: Health Smart Auto/Commercial	$0.04
Rate for Payer: LLUH Dept of Risk Management WC	$0.03
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$0.05

METFORMIN ER 750 MG TABLET,EXTENDED RELEASE 24 HR [35771]

Facility

IP

$0.26

Service Code	NDC 76385-129-01
Hospital Charge Code	ERX35771
Hospital Revenue Code	259
Min. Negotiated Rate	$0.14
Max. Negotiated Rate	$0.21
Rate for Payer: Cash Price	$0.12
Rate for Payer: Cigna of CA HMO/PPO	$0.21
Rate for Payer: Health Smart Auto/Commercial	$0.16
Rate for Payer: LLUH Dept of Risk Management WC	$0.14
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$0.20

METFORMIN ER 750 MG TABLET,EXTENDED RELEASE 24 HR [35771]

Facility

OP

$0.26

Service Code	NDC 76385-129-01
Hospital Charge Code	ERX35771
Hospital Revenue Code	259
Min. Negotiated Rate	$0.14
Max. Negotiated Rate	$0.20
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$0.16
Rate for Payer: Aetna of CA Government/Medicare	$0.16
Rate for Payer: Cash Price	$0.12
Rate for Payer: Health Smart Auto/Commercial	$0.16
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$0.16
Rate for Payer: LLUH Dept of Risk Management WC	$0.14
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$0.20

METHACHOLINE CHLORIDE 100 MG SOLUTION FOR INHALATION [27032]

Facility

OP

$99.60

Service Code	CPT J7674
Hospital Charge Code	ERX27032
Hospital Revenue Code	259
Min. Negotiated Rate	$54.78
Max. Negotiated Rate	$74.70
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$59.76
Rate for Payer: Aetna of CA Government/Medicare	$59.76
Rate for Payer: Cash Price	$44.82
Rate for Payer: Health Smart Auto/Commercial	$59.76
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$59.76
Rate for Payer: LLUH Dept of Risk Management WC	$54.78
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$74.70

METHACHOLINE CHLORIDE 100 MG SOLUTION FOR INHALATION [27032]

Facility

IP

$99.60

Service Code	CPT J7674
Hospital Charge Code	ERX27032
Hospital Revenue Code	259
Min. Negotiated Rate	$54.78
Max. Negotiated Rate	$79.68
Rate for Payer: Cash Price	$44.82
Rate for Payer: Cigna of CA HMO/PPO	$79.68
Rate for Payer: Health Smart Auto/Commercial	$59.76
Rate for Payer: LLUH Dept of Risk Management WC	$54.78
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$74.70

METHADONE 10 MG/ML INJECTION. [4081195]

Facility

IP

$21.60

Service Code	CPT J1230
Hospital Charge Code	1730057
Hospital Revenue Code	636
Min. Negotiated Rate	$11.88
Max. Negotiated Rate	$17.28
Rate for Payer: Cash Price	$9.72
Rate for Payer: Cigna of CA HMO/PPO	$17.28
Rate for Payer: Health Smart Auto/Commercial	$12.96
Rate for Payer: LLUH Dept of Risk Management WC	$11.88
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$16.20

METHADONE 10 MG/ML INJECTION. [4081195]

Facility

OP

$21.60

Service Code	CPT J1230
Hospital Charge Code	1730057
Hospital Revenue Code	636
Min. Negotiated Rate	$11.88
Max. Negotiated Rate	$16.20
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$12.96
Rate for Payer: Aetna of CA Government/Medicare	$12.96
Rate for Payer: Cash Price	$9.72
Rate for Payer: Health Smart Auto/Commercial	$12.96
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$12.96
Rate for Payer: LLUH Dept of Risk Management WC	$11.88
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$16.20

METHADONE 10 MG/ML INJECTION. [4081195]

Facility

OP

$21.60

Service Code	CPT J1230
Hospital Charge Code	NDG10546
Hospital Revenue Code	636
Min. Negotiated Rate	$11.88
Max. Negotiated Rate	$16.20
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$12.96
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$14.00
Rate for Payer: Aetna of CA Government/Medicare	$12.96
Rate for Payer: Aetna of CA Government/Medicare	$14.00
Rate for Payer: Cash Price	$9.72
Rate for Payer: Cash Price	$10.50
Rate for Payer: Health Smart Auto/Commercial	$12.96
Rate for Payer: Health Smart Auto/Commercial	$14.00
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$12.96
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$14.00
Rate for Payer: LLUH Dept of Risk Management WC	$12.84
Rate for Payer: LLUH Dept of Risk Management WC	$11.88
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$17.50
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$16.20

METHADONE 10 MG/ML INJECTION. [4081195]

Facility

IP

$21.60

Service Code	CPT J1230
Hospital Charge Code	NDG10546
Hospital Revenue Code	636
Min. Negotiated Rate	$11.88
Max. Negotiated Rate	$17.28
Rate for Payer: Cash Price	$9.72
Rate for Payer: Cash Price	$10.50
Rate for Payer: Cigna of CA HMO/PPO	$18.67
Rate for Payer: Cigna of CA HMO/PPO	$17.28
Rate for Payer: Health Smart Auto/Commercial	$14.00
Rate for Payer: Health Smart Auto/Commercial	$12.96
Rate for Payer: LLUH Dept of Risk Management WC	$12.84
Rate for Payer: LLUH Dept of Risk Management WC	$11.88
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$17.50
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$16.20

METHADONE 10 MG/ML INJECTION SOLUTION [10546]

Facility

IP

$21.60

Service Code	NDC 17478-380-20
Hospital Charge Code	NDG10546
Hospital Revenue Code	636
Min. Negotiated Rate	$11.88
Max. Negotiated Rate	$17.28
Rate for Payer: Cash Price	$9.72
Rate for Payer: Cigna of CA HMO/PPO	$17.28
Rate for Payer: Health Smart Auto/Commercial	$12.96
Rate for Payer: LLUH Dept of Risk Management WC	$11.88
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$16.20

METHADONE 10 MG/ML INJECTION SOLUTION [10546]

Facility

OP

$21.60

Service Code	NDC 17478-380-20
Hospital Charge Code	NDG10546
Hospital Revenue Code	636
Min. Negotiated Rate	$11.88
Max. Negotiated Rate	$16.20
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$12.96
Rate for Payer: Aetna of CA Government/Medicare	$12.96
Rate for Payer: Cash Price	$9.72
Rate for Payer: Health Smart Auto/Commercial	$12.96
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$12.96
Rate for Payer: LLUH Dept of Risk Management WC	$11.88
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$16.20

<<
<
530
531
532
533
534
535
536
537
538
539
>
>>