Price Transparency

Know your out-of-pocket cost for care.

All Charges

Charge

Type

Setting

Price

NITROGLYCERIN 0.2 MG/HR TRANSDERMAL 24 HOUR PATCH [27472]

Facility

OP

$0.85

Service Code	NDC 0378-9104-16
Hospital Charge Code	1743506
Hospital Revenue Code	259
Min. Negotiated Rate	$0.47
Max. Negotiated Rate	$0.64
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$0.51
Rate for Payer: Aetna of CA Government/Medicare	$0.51
Rate for Payer: Cash Price	$0.38
Rate for Payer: Health Smart Auto/Commercial	$0.51
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$0.51
Rate for Payer: LLUH Dept of Risk Management WC	$0.47
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$0.64

NITROGLYCERIN 0.4 MG/HR TRANSDERMAL 24 HOUR PATCH [27474]

Facility

IP

$0.98

Service Code	NDC 0378-9112-16
Hospital Charge Code	1743508
Hospital Revenue Code	259
Min. Negotiated Rate	$0.54
Max. Negotiated Rate	$0.78
Rate for Payer: Cash Price	$0.44
Rate for Payer: Cigna of CA HMO/PPO	$0.78
Rate for Payer: Health Smart Auto/Commercial	$0.59
Rate for Payer: LLUH Dept of Risk Management WC	$0.54
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$0.74

NITROGLYCERIN 0.4 MG/HR TRANSDERMAL 24 HOUR PATCH [27474]

Facility

IP

$0.98

Service Code	NDC 0378-9112-93
Hospital Charge Code	1743508
Hospital Revenue Code	259
Min. Negotiated Rate	$0.54
Max. Negotiated Rate	$0.78
Rate for Payer: Cash Price	$0.44
Rate for Payer: Cigna of CA HMO/PPO	$0.78
Rate for Payer: Health Smart Auto/Commercial	$0.59
Rate for Payer: LLUH Dept of Risk Management WC	$0.54
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$0.74

NITROGLYCERIN 0.4 MG/HR TRANSDERMAL 24 HOUR PATCH [27474]

Facility

OP

$0.98

Service Code	NDC 0378-9112-93
Hospital Charge Code	1743508
Hospital Revenue Code	259
Min. Negotiated Rate	$0.54
Max. Negotiated Rate	$0.74
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$0.59
Rate for Payer: Aetna of CA Government/Medicare	$0.59
Rate for Payer: Cash Price	$0.44
Rate for Payer: Health Smart Auto/Commercial	$0.59
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$0.59
Rate for Payer: LLUH Dept of Risk Management WC	$0.54
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$0.74

NITROGLYCERIN 0.4 MG/HR TRANSDERMAL 24 HOUR PATCH [27474]

Facility

OP

$0.98

Service Code	NDC 0378-9112-16
Hospital Charge Code	1743508
Hospital Revenue Code	259
Min. Negotiated Rate	$0.54
Max. Negotiated Rate	$0.74
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$0.59
Rate for Payer: Aetna of CA Government/Medicare	$0.59
Rate for Payer: Cash Price	$0.44
Rate for Payer: Health Smart Auto/Commercial	$0.59
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$0.59
Rate for Payer: LLUH Dept of Risk Management WC	$0.54
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$0.74

NITROGLYCERIN 0.4 MG SUBLINGUAL TABLET [5604]

Facility

IP

$1.02

Service Code	NDC 43598-436-11
Hospital Charge Code	1711158
Hospital Revenue Code	259
Min. Negotiated Rate	$0.56
Max. Negotiated Rate	$0.82
Rate for Payer: Cash Price	$0.46
Rate for Payer: Cigna of CA HMO/PPO	$0.82
Rate for Payer: Health Smart Auto/Commercial	$0.61
Rate for Payer: LLUH Dept of Risk Management WC	$0.56
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$0.77

NITROGLYCERIN 0.4 MG SUBLINGUAL TABLET [5604]

Facility

IP

$0.99

Service Code	NDC 68462-639-25
Hospital Charge Code	1711158
Hospital Revenue Code	259
Min. Negotiated Rate	$0.54
Max. Negotiated Rate	$0.79
Rate for Payer: Cash Price	$0.45
Rate for Payer: Cigna of CA HMO/PPO	$0.79
Rate for Payer: Health Smart Auto/Commercial	$0.59
Rate for Payer: LLUH Dept of Risk Management WC	$0.54
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$0.74

NITROGLYCERIN 0.4 MG SUBLINGUAL TABLET [5604]

Facility

OP

$0.99

Service Code	NDC 68462-639-25
Hospital Charge Code	1711158
Hospital Revenue Code	259
Min. Negotiated Rate	$0.54
Max. Negotiated Rate	$0.74
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$0.59
Rate for Payer: Aetna of CA Government/Medicare	$0.59
Rate for Payer: Cash Price	$0.45
Rate for Payer: Health Smart Auto/Commercial	$0.59
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$0.59
Rate for Payer: LLUH Dept of Risk Management WC	$0.54
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$0.74

NITROGLYCERIN 0.4 MG SUBLINGUAL TABLET [5604]

Facility

IP

$1.02

Service Code	NDC 43598-436-35
Hospital Charge Code	1711158
Hospital Revenue Code	259
Min. Negotiated Rate	$0.56
Max. Negotiated Rate	$0.82
Rate for Payer: Cash Price	$0.46
Rate for Payer: Cigna of CA HMO/PPO	$0.82
Rate for Payer: Health Smart Auto/Commercial	$0.61
Rate for Payer: LLUH Dept of Risk Management WC	$0.56
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$0.77

NITROGLYCERIN 0.4 MG SUBLINGUAL TABLET [5604]

Facility

OP

$1.02

Service Code	NDC 43598-436-35
Hospital Charge Code	1711158
Hospital Revenue Code	259
Min. Negotiated Rate	$0.56
Max. Negotiated Rate	$0.77
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$0.61
Rate for Payer: Aetna of CA Government/Medicare	$0.61
Rate for Payer: Cash Price	$0.46
Rate for Payer: Health Smart Auto/Commercial	$0.61
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$0.61
Rate for Payer: LLUH Dept of Risk Management WC	$0.56
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$0.77

NITROGLYCERIN 0.4 MG SUBLINGUAL TABLET [5604]

Facility

OP

$1.02

Service Code	NDC 43598-436-11
Hospital Charge Code	1711158
Hospital Revenue Code	259
Min. Negotiated Rate	$0.56
Max. Negotiated Rate	$0.77
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$0.61
Rate for Payer: Aetna of CA Government/Medicare	$0.61
Rate for Payer: Cash Price	$0.46
Rate for Payer: Health Smart Auto/Commercial	$0.61
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$0.61
Rate for Payer: LLUH Dept of Risk Management WC	$0.56
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$0.77

NITROGLYCERIN 0.4 MG SUBLINGUAL TABLET [5604]

Facility

IP

$0.99

Service Code	NDC 68462-639-45
Hospital Charge Code	1711158
Hospital Revenue Code	259
Min. Negotiated Rate	$0.54
Max. Negotiated Rate	$0.79
Rate for Payer: Cash Price	$0.45
Rate for Payer: Cigna of CA HMO/PPO	$0.79
Rate for Payer: Health Smart Auto/Commercial	$0.59
Rate for Payer: LLUH Dept of Risk Management WC	$0.54
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$0.74

NITROGLYCERIN 0.4 MG SUBLINGUAL TABLET [5604]

Facility

OP

$0.99

Service Code	NDC 68462-639-45
Hospital Charge Code	1711158
Hospital Revenue Code	259
Min. Negotiated Rate	$0.54
Max. Negotiated Rate	$0.74
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$0.59
Rate for Payer: Aetna of CA Government/Medicare	$0.59
Rate for Payer: Cash Price	$0.45
Rate for Payer: Health Smart Auto/Commercial	$0.59
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$0.59
Rate for Payer: LLUH Dept of Risk Management WC	$0.54
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$0.74

NITROGLYCERIN 0.6 MG/HR TRANSDERMAL 24 HOUR PATCH [27475]

Facility

OP

$1.13

Service Code	NDC 49730-113-30
Hospital Charge Code	1743509
Hospital Revenue Code	259
Min. Negotiated Rate	$0.62
Max. Negotiated Rate	$0.85
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$0.68
Rate for Payer: Aetna of CA Government/Medicare	$0.68
Rate for Payer: Cash Price	$0.51
Rate for Payer: Health Smart Auto/Commercial	$0.68
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$0.68
Rate for Payer: LLUH Dept of Risk Management WC	$0.62
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$0.85

NITROGLYCERIN 0.6 MG/HR TRANSDERMAL 24 HOUR PATCH [27475]

Facility

IP

$1.13

Service Code	NDC 49730-113-30
Hospital Charge Code	1743509
Hospital Revenue Code	259
Min. Negotiated Rate	$0.62
Max. Negotiated Rate	$0.90
Rate for Payer: Cash Price	$0.51
Rate for Payer: Cigna of CA HMO/PPO	$0.90
Rate for Payer: Health Smart Auto/Commercial	$0.68
Rate for Payer: LLUH Dept of Risk Management WC	$0.62
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$0.85

NITROGLYCERIN 100 MG/250 ML (400 MCG/ML) IN 5 % DEXTROSE INTRAVENOUS [14895]

Facility

IP

$0.12

Service Code	CPT J2305
Hospital Charge Code	1771301
Hospital Revenue Code	636
Min. Negotiated Rate	$0.07
Max. Negotiated Rate	$0.10
Rate for Payer: Cash Price	$0.05
Rate for Payer: Cash Price	$0.02
Rate for Payer: Cigna of CA HMO/PPO	$0.03
Rate for Payer: Cigna of CA HMO/PPO	$0.10
Rate for Payer: Health Smart Auto/Commercial	$0.07
Rate for Payer: Health Smart Auto/Commercial	$0.02
Rate for Payer: LLUH Dept of Risk Management WC	$0.07
Rate for Payer: LLUH Dept of Risk Management WC	$0.02
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$0.09
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$0.03

NITROGLYCERIN 100 MG/250 ML (400 MCG/ML) IN 5 % DEXTROSE INTRAVENOUS [14895]

Facility

OP

$0.12

Service Code	CPT J2305
Hospital Charge Code	1771301
Hospital Revenue Code	636
Min. Negotiated Rate	$0.07
Max. Negotiated Rate	$0.09
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$0.07
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: Aetna of CA Government/Medicare	$0.07
Rate for Payer: Cash Price	$0.05
Rate for Payer: Cash Price	$0.02
Rate for Payer: Health Smart Auto/Commercial	$0.02
Rate for Payer: Health Smart Auto/Commercial	$0.07
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$0.07
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: LLUH Dept of Risk Management WC	$0.07
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$0.09
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$0.03

NITROGLYCERIN 10 MG/50 ML D5.2NS SYRINGE [4080694]

Facility

IP

$0.88

Service Code	NDC 9994-0806-94
Hospital Charge Code	NDC4080694
Hospital Revenue Code	250
Min. Negotiated Rate	$0.48
Max. Negotiated Rate	$0.70
Rate for Payer: Cash Price	$0.40
Rate for Payer: Cigna of CA HMO/PPO	$0.70
Rate for Payer: Health Smart Auto/Commercial	$0.53
Rate for Payer: LLUH Dept of Risk Management WC	$0.48
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$0.66

NITROGLYCERIN 10 MG/50 ML D5.2NS SYRINGE [4080694]

Facility

OP

$0.88

Service Code	NDC 9994-0806-94
Hospital Charge Code	NDC4080694
Hospital Revenue Code	250
Min. Negotiated Rate	$0.48
Max. Negotiated Rate	$0.66
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$0.53
Rate for Payer: Aetna of CA Government/Medicare	$0.53
Rate for Payer: Cash Price	$0.40
Rate for Payer: Health Smart Auto/Commercial	$0.53
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$0.53
Rate for Payer: LLUH Dept of Risk Management WC	$0.48
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$0.66

NITROGLYCERIN 25 MG/250 ML (100 MCG/ML) IN 5 % DEXTROSE INTRAVENOUS [15858]

Facility

IP

$0.03

Service Code	NDC 0409-1483-02
Hospital Charge Code	1771214
Hospital Revenue Code	250
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

NITROGLYCERIN 25 MG/250 ML (100 MCG/ML) IN 5 % DEXTROSE INTRAVENOUS [15858]

Facility

OP

$0.03

Service Code	NDC 0409-1483-02
Hospital Charge Code	1771214
Hospital Revenue Code	250
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

NITROGLYCERIN 2 % TRANSDERMAL OINTMENT [5606]

Facility

OP

$2.65

Service Code	NDC 0281-0326-08
Hospital Charge Code	1743605
Hospital Revenue Code	259
Min. Negotiated Rate	$1.46
Max. Negotiated Rate	$1.99
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$1.59
Rate for Payer: Aetna of CA Government/Medicare	$1.59
Rate for Payer: Cash Price	$1.19
Rate for Payer: Health Smart Auto/Commercial	$1.59
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$1.59
Rate for Payer: LLUH Dept of Risk Management WC	$1.46
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$1.99

NITROGLYCERIN 2 % TRANSDERMAL OINTMENT [5606]

Facility

IP

$2.65

Service Code	NDC 0281-0326-08
Hospital Charge Code	1743605
Hospital Revenue Code	259
Min. Negotiated Rate	$1.46
Max. Negotiated Rate	$2.12
Rate for Payer: Cash Price	$1.19
Rate for Payer: Cigna of CA HMO/PPO	$2.12
Rate for Payer: Health Smart Auto/Commercial	$1.59
Rate for Payer: LLUH Dept of Risk Management WC	$1.46
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$1.99

NITROGLYCERIN 2 % TRANSDERMAL OINTMENT BULK TUBE [4081590]

Facility

IP

$1.36

Service Code	NDC 0281-0326-30
Hospital Charge Code	NDG5606
Hospital Revenue Code	259
Min. Negotiated Rate	$0.75
Max. Negotiated Rate	$1.09
Rate for Payer: Cash Price	$0.61
Rate for Payer: Cigna of CA HMO/PPO	$1.09
Rate for Payer: Health Smart Auto/Commercial	$0.82
Rate for Payer: LLUH Dept of Risk Management WC	$0.75
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$1.02

NITROGLYCERIN 2 % TRANSDERMAL OINTMENT BULK TUBE [4081590]

Facility

OP

$1.36

Service Code	NDC 0281-0326-30
Hospital Charge Code	NDG5606
Hospital Revenue Code	259
Min. Negotiated Rate	$0.75
Max. Negotiated Rate	$1.02
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$0.82
Rate for Payer: Aetna of CA Government/Medicare	$0.82
Rate for Payer: Cash Price	$0.61
Rate for Payer: Health Smart Auto/Commercial	$0.82
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$0.82
Rate for Payer: LLUH Dept of Risk Management WC	$0.75
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$1.02

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