Price Transparency

Know your out-of-pocket cost for care.

All Charges

Charge

Type

Setting

Price

QUETIAPINE (SEROQUEL) CRUSHED TABLET IN WATER 2.5 MG/ML [40821823]

Facility

IP

$0.11

Service Code	NDC 29300-147-01
Hospital Charge Code	901700029
Hospital Revenue Code	259
Min. Negotiated Rate	$0.06
Max. Negotiated Rate	$0.09
Rate for Payer: Cash Price	$0.06
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$0.09
Rate for Payer: Health Smart Auto/Commercial	$0.07
Rate for Payer: LLUH Dept of Risk Management WC	$0.06
Rate for Payer: Multiplan Commercial	$0.08

QUETIAPINE (SEROQUEL) CRUSHED TABLET IN WATER 2.5 MG/ML [40821823]

Facility

OP

$0.06

Service Code	NDC 16729-145-01
Hospital Charge Code	901700029
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: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$0.05
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 Commercial	$0.05

QUETIAPINE (SEROQUEL) CRUSHED TABLET IN WATER 2.5 MG/ML [40821823]

Facility

IP

$0.06

Service Code	NDC 16729-145-01
Hospital Charge Code	901700029
Hospital Revenue Code	259
Min. Negotiated Rate	$0.03
Max. Negotiated Rate	$0.05
Rate for Payer: Cash Price	$0.03
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO 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 Commercial	$0.05

QUETIAPINE (SEROQUEL) CRUSHED TABLET IN WATER 2.5 MG/ML [40821823]

Facility

OP

$0.39

Service Code	NDC 60687-327-11
Hospital Charge Code	901700029
Hospital Revenue Code	259
Min. Negotiated Rate	$0.21
Max. Negotiated Rate	$0.31
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$0.23
Rate for Payer: Aetna of CA Government/Medicare	$0.23
Rate for Payer: Cash Price	$0.21
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$0.31
Rate for Payer: Health Smart Auto/Commercial	$0.23
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$0.23
Rate for Payer: LLUH Dept of Risk Management WC	$0.21
Rate for Payer: Multiplan Commercial	$0.29

QUETIAPINE (SEROQUEL) CRUSHED TABLET IN WATER 2.5 MG/ML [40821823]

Facility

IP

$0.39

Service Code	NDC 60687-327-11
Hospital Charge Code	901700029
Hospital Revenue Code	259
Min. Negotiated Rate	$0.21
Max. Negotiated Rate	$0.31
Rate for Payer: Cash Price	$0.21
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$0.31
Rate for Payer: Health Smart Auto/Commercial	$0.23
Rate for Payer: LLUH Dept of Risk Management WC	$0.21
Rate for Payer: Multiplan Commercial	$0.29

QUETIAPINE (SEROQUEL) CRUSHED TABLET IN WATER 2.5 MG/ML [40821823]

Facility

OP

$0.22

Service Code	NDC 47335-902-88
Hospital Charge Code	901700029
Hospital Revenue Code	259
Min. Negotiated Rate	$0.12
Max. Negotiated Rate	$0.18
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	$0.12
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$0.18
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 Commercial	$0.17

QUETIAPINE (SEROQUEL) CRUSHED TABLET IN WATER 2.5 MG/ML [40821823]

Facility

IP

$0.06

Service Code	NDC 68180-445-01
Hospital Charge Code	901700029
Hospital Revenue Code	259
Min. Negotiated Rate	$0.03
Max. Negotiated Rate	$0.05
Rate for Payer: Cash Price	$0.03
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO 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 Commercial	$0.05

QUETIAPINE (SEROQUEL) CRUSHED TABLET IN WATER 2.5 MG/ML [40821823]

Facility

IP

$0.22

Service Code	NDC 47335-902-88
Hospital Charge Code	901700029
Hospital Revenue Code	259
Min. Negotiated Rate	$0.12
Max. Negotiated Rate	$0.18
Rate for Payer: Cash Price	$0.12
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO 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 Commercial	$0.17

QUETIAPINE (SEROQUEL) CRUSHED TABLET IN WATER 2.5 MG/ML [40821823]

Facility

OP

$0.04

Service Code	NDC 67877-242-01
Hospital Charge Code	901700029
Hospital Revenue Code	259
Min. Negotiated Rate	$0.02
Max. Negotiated Rate	$0.03
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	$0.02
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$0.03
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 Commercial	$0.03

QUINIDINE GLUCONATE ER 324 MG TABLET,EXTENDED RELEASE [12197]

Facility

OP

$8.70

Service Code	NDC 53489-141-01
Hospital Charge Code	901700029
Hospital Revenue Code	259
Min. Negotiated Rate	$4.79
Max. Negotiated Rate	$6.96
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$5.22
Rate for Payer: Aetna of CA Government/Medicare	$5.22
Rate for Payer: Cash Price	$4.78
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$6.96
Rate for Payer: Health Smart Auto/Commercial	$5.22
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$5.22
Rate for Payer: LLUH Dept of Risk Management WC	$4.79
Rate for Payer: Multiplan Commercial	$6.53

QUINIDINE GLUCONATE ER 324 MG TABLET,EXTENDED RELEASE [12197]

Facility

IP

$8.70

Service Code	NDC 53489-141-01
Hospital Charge Code	901700029
Hospital Revenue Code	259
Min. Negotiated Rate	$4.79
Max. Negotiated Rate	$6.96
Rate for Payer: Cash Price	$4.78
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$6.96
Rate for Payer: Health Smart Auto/Commercial	$5.22
Rate for Payer: LLUH Dept of Risk Management WC	$4.79
Rate for Payer: Multiplan Commercial	$6.53

QUININE 324 MG CAPSULE [117183]

Facility

OP

$7.86

Service Code	NDC 13310-153-07
Hospital Charge Code	901700029
Hospital Revenue Code	259
Min. Negotiated Rate	$4.32
Max. Negotiated Rate	$6.29
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$4.72
Rate for Payer: Aetna of CA Government/Medicare	$4.72
Rate for Payer: Cash Price	$4.32
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$6.29
Rate for Payer: Health Smart Auto/Commercial	$4.72
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$4.72
Rate for Payer: LLUH Dept of Risk Management WC	$4.32
Rate for Payer: Multiplan Commercial	$5.89

QUININE 324 MG CAPSULE [117183]

Facility

IP

$7.86

Service Code	NDC 13310-153-07
Hospital Charge Code	901700029
Hospital Revenue Code	259
Min. Negotiated Rate	$4.32
Max. Negotiated Rate	$6.29
Rate for Payer: Cash Price	$4.32
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$6.29
Rate for Payer: Health Smart Auto/Commercial	$4.72
Rate for Payer: LLUH Dept of Risk Management WC	$4.32
Rate for Payer: Multiplan Commercial	$5.89

RABIES IMMUNE GLOBULIN (PF) 150 UNIT/ML INTRAMUSCULAR SOLUTION [111036]

Facility

OP

$447.37

Service Code	HCPCS 90377
Hospital Charge Code	901700025
Hospital Revenue Code	636
Min. Negotiated Rate	$246.05
Max. Negotiated Rate	$357.90
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$268.42
Rate for Payer: Aetna of CA Government/Medicare	$268.42
Rate for Payer: Cash Price	$246.05
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$357.90
Rate for Payer: Health Smart Auto/Commercial	$268.42
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$268.42
Rate for Payer: LLUH Dept of Risk Management WC	$246.05
Rate for Payer: Multiplan Commercial	$335.53

RABIES IMMUNE GLOBULIN (PF) 150 UNIT/ML INTRAMUSCULAR SOLUTION [111036]

Facility

IP

$447.37

Service Code	HCPCS 90377
Hospital Charge Code	901700025
Hospital Revenue Code	636
Min. Negotiated Rate	$246.05
Max. Negotiated Rate	$357.90
Rate for Payer: Cash Price	$246.05
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$357.90
Rate for Payer: Health Smart Auto/Commercial	$268.42
Rate for Payer: LLUH Dept of Risk Management WC	$246.05
Rate for Payer: Multiplan Commercial	$335.53

RABIES IMMUNE GLOBULIN (PF) 300 UNIT/ML INTRAMUSCULAR SOLUTION [221392]

Facility

IP

$816.60

Service Code	HCPCS 90375
Hospital Charge Code	901700025
Hospital Revenue Code	636
Min. Negotiated Rate	$449.13
Max. Negotiated Rate	$653.28
Rate for Payer: Cash Price	$449.13
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$653.28
Rate for Payer: Health Smart Auto/Commercial	$489.96
Rate for Payer: LLUH Dept of Risk Management WC	$449.13
Rate for Payer: Multiplan Commercial	$612.45

RABIES IMMUNE GLOBULIN (PF) 300 UNIT/ML INTRAMUSCULAR SOLUTION [221392]

Facility

OP

$816.60

Service Code	HCPCS 90375
Hospital Charge Code	901700025
Hospital Revenue Code	636
Min. Negotiated Rate	$449.13
Max. Negotiated Rate	$653.28
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$489.96
Rate for Payer: Aetna of CA Government/Medicare	$489.96
Rate for Payer: Cash Price	$449.13
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$653.28
Rate for Payer: Health Smart Auto/Commercial	$489.96
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$489.96
Rate for Payer: LLUH Dept of Risk Management WC	$449.13
Rate for Payer: Multiplan Commercial	$612.45

RABIES VACCINE,HUMAN DIPLOID (PF) 2.5 UNIT INTRAMUSCULAR SOLUTION [11257]

Facility

OP

$520.57

Service Code	HCPCS 90675
Hospital Charge Code	901700025
Hospital Revenue Code	636
Min. Negotiated Rate	$286.31
Max. Negotiated Rate	$416.46
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$312.34
Rate for Payer: Aetna of CA Government/Medicare	$312.34
Rate for Payer: Cash Price	$286.31
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$416.46
Rate for Payer: Health Smart Auto/Commercial	$312.34
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$312.34
Rate for Payer: LLUH Dept of Risk Management WC	$286.31
Rate for Payer: Multiplan Commercial	$390.43

RABIES VACCINE,HUMAN DIPLOID (PF) 2.5 UNIT INTRAMUSCULAR SOLUTION [11257]

Facility

IP

$520.57

Service Code	HCPCS 90675
Hospital Charge Code	901700025
Hospital Revenue Code	636
Min. Negotiated Rate	$286.31
Max. Negotiated Rate	$416.46
Rate for Payer: Cash Price	$286.31
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$416.46
Rate for Payer: Health Smart Auto/Commercial	$312.34
Rate for Payer: LLUH Dept of Risk Management WC	$286.31
Rate for Payer: Multiplan Commercial	$390.43

RABIES VACCINE, PURIFIED CHICKEN EMBRYO CELL (PF) 2.5 UNIT IM SUSP [22120]

Facility

IP

$521.53

Service Code	HCPCS 90675
Hospital Charge Code	901700025
Hospital Revenue Code	636
Min. Negotiated Rate	$286.84
Max. Negotiated Rate	$417.22
Rate for Payer: Cash Price	$286.84
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$417.22
Rate for Payer: Health Smart Auto/Commercial	$312.92
Rate for Payer: LLUH Dept of Risk Management WC	$286.84
Rate for Payer: Multiplan Commercial	$391.15

RABIES VACCINE, PURIFIED CHICKEN EMBRYO CELL (PF) 2.5 UNIT IM SUSP [22120]

Facility

OP

$521.53

Service Code	HCPCS 90675
Hospital Charge Code	901700025
Hospital Revenue Code	636
Min. Negotiated Rate	$286.84
Max. Negotiated Rate	$417.22
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$312.92
Rate for Payer: Aetna of CA Government/Medicare	$312.92
Rate for Payer: Cash Price	$286.84
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$417.22
Rate for Payer: Health Smart Auto/Commercial	$312.92
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$312.92
Rate for Payer: LLUH Dept of Risk Management WC	$286.84
Rate for Payer: Multiplan Commercial	$391.15

RACEPINEPHRINE 2.25 % SOLUTION FOR NEBULIZATION [2851]

Facility

IP

$1.68

Service Code	NDC 0487-5901-99
Hospital Charge Code	901700029
Hospital Revenue Code	259
Min. Negotiated Rate	$0.92
Max. Negotiated Rate	$1.34
Rate for Payer: Cash Price	$0.92
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$1.34
Rate for Payer: Health Smart Auto/Commercial	$1.01
Rate for Payer: LLUH Dept of Risk Management WC	$0.92
Rate for Payer: Multiplan Commercial	$1.26

RACEPINEPHRINE 2.25 % SOLUTION FOR NEBULIZATION [2851]

Facility

OP

$1.68

Service Code	NDC 0487-5901-99
Hospital Charge Code	901700029
Hospital Revenue Code	259
Min. Negotiated Rate	$0.92
Max. Negotiated Rate	$1.34
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: Cash Price	$0.92
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$1.34
Rate for Payer: Health Smart Auto/Commercial	$1.01
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$1.01
Rate for Payer: LLUH Dept of Risk Management WC	$0.92
Rate for Payer: Multiplan Commercial	$1.26

RADIOPAQUE PVC MARKERS-BARIUM SULFATE 24 MARKERS CAPSULE [21381]

Facility

IP

$119.88

Service Code	HCPCS A9698
Hospital Charge Code	901700042
Hospital Revenue Code	254
Min. Negotiated Rate	$65.93
Max. Negotiated Rate	$95.90
Rate for Payer: Cash Price	$65.93
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$95.90
Rate for Payer: Health Smart Auto/Commercial	$71.93
Rate for Payer: LLUH Dept of Risk Management WC	$65.93
Rate for Payer: Multiplan Commercial	$89.91

RADIOPAQUE PVC MARKERS-BARIUM SULFATE 24 MARKERS CAPSULE [21381]

Facility

OP

$119.88

Service Code	HCPCS A9698
Hospital Charge Code	901700042
Hospital Revenue Code	254
Min. Negotiated Rate	$65.93
Max. Negotiated Rate	$95.90
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$71.93
Rate for Payer: Aetna of CA Government/Medicare	$71.93
Rate for Payer: Cash Price	$65.93
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$95.90
Rate for Payer: Health Smart Auto/Commercial	$71.93
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$71.93
Rate for Payer: LLUH Dept of Risk Management WC	$65.93
Rate for Payer: Multiplan Commercial	$89.91

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