Price Transparency

Know your out-of-pocket cost for care.

All Charges

Charge

Type

Setting

Price

SPIRONOLACTONE 25 MG TABLET [7437]

Facility

IP

$0.23

Service Code	NDC 60687-465-11
Hospital Charge Code	901700029
Hospital Revenue Code	259
Min. Negotiated Rate	$0.13
Max. Negotiated Rate	$0.18
Rate for Payer: Cash Price	$0.13
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$0.18
Rate for Payer: Health Smart Auto/Commercial	$0.14
Rate for Payer: LLUH Dept of Risk Management WC	$0.13
Rate for Payer: Multiplan Commercial	$0.17

SPIRONOLACTONE 25 MG TABLET [7437]

Facility

OP

$0.23

Service Code	NDC 60687-465-01
Hospital Charge Code	901700029
Hospital Revenue Code	259
Min. Negotiated Rate	$0.13
Max. Negotiated Rate	$0.18
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$0.14
Rate for Payer: Aetna of CA Government/Medicare	$0.14
Rate for Payer: Cash Price	$0.13
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$0.18
Rate for Payer: Health Smart Auto/Commercial	$0.14
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$0.14
Rate for Payer: LLUH Dept of Risk Management WC	$0.13
Rate for Payer: Multiplan Commercial	$0.17

SPIRONOLACTONE 25 MG TABLET [7437]

Facility

IP

$0.15

Service Code	NDC 59651-426-01
Hospital Charge Code	901700029
Hospital Revenue Code	259
Min. Negotiated Rate	$0.08
Max. Negotiated Rate	$0.12
Rate for Payer: Cash Price	$0.08
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$0.12
Rate for Payer: Health Smart Auto/Commercial	$0.09
Rate for Payer: LLUH Dept of Risk Management WC	$0.08
Rate for Payer: Multiplan Commercial	$0.11

SPIRONOLACTONE 25 MG TABLET [7437]

Facility

IP

$0.23

Service Code	NDC 60687-465-01
Hospital Charge Code	901700029
Hospital Revenue Code	259
Min. Negotiated Rate	$0.13
Max. Negotiated Rate	$0.18
Rate for Payer: Cash Price	$0.13
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$0.18
Rate for Payer: Health Smart Auto/Commercial	$0.14
Rate for Payer: LLUH Dept of Risk Management WC	$0.13
Rate for Payer: Multiplan Commercial	$0.17

SPIRONOLACTONE 50 MG TABLET [11426]

Facility

OP

$0.55

Service Code	NDC 60687-476-01
Hospital Charge Code	901700029
Hospital Revenue Code	259
Min. Negotiated Rate	$0.30
Max. Negotiated Rate	$0.44
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$0.33
Rate for Payer: Aetna of CA Government/Medicare	$0.33
Rate for Payer: Cash Price	$0.30
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$0.44
Rate for Payer: Health Smart Auto/Commercial	$0.33
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$0.33
Rate for Payer: LLUH Dept of Risk Management WC	$0.30
Rate for Payer: Multiplan Commercial	$0.41

SPIRONOLACTONE 50 MG TABLET [11426]

Facility

OP

$0.55

Service Code	NDC 60687-476-11
Hospital Charge Code	901700029
Hospital Revenue Code	259
Min. Negotiated Rate	$0.30
Max. Negotiated Rate	$0.44
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$0.33
Rate for Payer: Aetna of CA Government/Medicare	$0.33
Rate for Payer: Cash Price	$0.30
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$0.44
Rate for Payer: Health Smart Auto/Commercial	$0.33
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$0.33
Rate for Payer: LLUH Dept of Risk Management WC	$0.30
Rate for Payer: Multiplan Commercial	$0.41

SPIRONOLACTONE 50 MG TABLET [11426]

Facility

OP

$0.13

Service Code	NDC 16729-226-01
Hospital Charge Code	901700029
Hospital Revenue Code	259
Min. Negotiated Rate	$0.07
Max. Negotiated Rate	$0.10
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$0.08
Rate for Payer: Aetna of CA Government/Medicare	$0.08
Rate for Payer: Cash Price	$0.07
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$0.10
Rate for Payer: Health Smart Auto/Commercial	$0.08
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$0.08
Rate for Payer: LLUH Dept of Risk Management WC	$0.07
Rate for Payer: Multiplan Commercial	$0.10

SPIRONOLACTONE 50 MG TABLET [11426]

Facility

IP

$0.13

Service Code	NDC 16729-226-01
Hospital Charge Code	901700029
Hospital Revenue Code	259
Min. Negotiated Rate	$0.07
Max. Negotiated Rate	$0.10
Rate for Payer: Cash Price	$0.07
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$0.10
Rate for Payer: Health Smart Auto/Commercial	$0.08
Rate for Payer: LLUH Dept of Risk Management WC	$0.07
Rate for Payer: Multiplan Commercial	$0.10

SPIRONOLACTONE 50 MG TABLET [11426]

Facility

IP

$0.55

Service Code	NDC 60687-476-11
Hospital Charge Code	901700029
Hospital Revenue Code	259
Min. Negotiated Rate	$0.30
Max. Negotiated Rate	$0.44
Rate for Payer: Cash Price	$0.30
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$0.44
Rate for Payer: Health Smart Auto/Commercial	$0.33
Rate for Payer: LLUH Dept of Risk Management WC	$0.30
Rate for Payer: Multiplan Commercial	$0.41

SPIRONOLACTONE 50 MG TABLET [11426]

Facility

IP

$0.55

Service Code	NDC 60687-476-01
Hospital Charge Code	901700029
Hospital Revenue Code	259
Min. Negotiated Rate	$0.30
Max. Negotiated Rate	$0.44
Rate for Payer: Cash Price	$0.30
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$0.44
Rate for Payer: Health Smart Auto/Commercial	$0.33
Rate for Payer: LLUH Dept of Risk Management WC	$0.30
Rate for Payer: Multiplan Commercial	$0.41

SPIRONOLACTONE 50 MG TABLET [11426]

Facility

IP

$0.13

Service Code	NDC 69584-853-10
Hospital Charge Code	901700029
Hospital Revenue Code	259
Min. Negotiated Rate	$0.07
Max. Negotiated Rate	$0.10
Rate for Payer: Cash Price	$0.07
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$0.10
Rate for Payer: Health Smart Auto/Commercial	$0.08
Rate for Payer: LLUH Dept of Risk Management WC	$0.07
Rate for Payer: Multiplan Commercial	$0.10

SPIRONOLACTONE 50 MG TABLET [11426]

Facility

OP

$0.13

Service Code	NDC 69584-853-10
Hospital Charge Code	901700029
Hospital Revenue Code	259
Min. Negotiated Rate	$0.07
Max. Negotiated Rate	$0.10
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$0.08
Rate for Payer: Aetna of CA Government/Medicare	$0.08
Rate for Payer: Cash Price	$0.07
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$0.10
Rate for Payer: Health Smart Auto/Commercial	$0.08
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$0.08
Rate for Payer: LLUH Dept of Risk Management WC	$0.07
Rate for Payer: Multiplan Commercial	$0.10

SPIRONOLACTONE 50 MG TABLET [11426]

Facility

IP

$0.34

Service Code	NDC 53489-328-01
Hospital Charge Code	901700029
Hospital Revenue Code	259
Min. Negotiated Rate	$0.19
Max. Negotiated Rate	$0.27
Rate for Payer: Cash Price	$0.19
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$0.27
Rate for Payer: Health Smart Auto/Commercial	$0.20
Rate for Payer: LLUH Dept of Risk Management WC	$0.19
Rate for Payer: Multiplan Commercial	$0.26

SPIRONOLACTONE 50 MG TABLET [11426]

Facility

OP

$0.34

Service Code	NDC 53489-328-01
Hospital Charge Code	901700029
Hospital Revenue Code	259
Min. Negotiated Rate	$0.19
Max. Negotiated Rate	$0.27
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$0.20
Rate for Payer: Aetna of CA Government/Medicare	$0.20
Rate for Payer: Cash Price	$0.19
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$0.27
Rate for Payer: Health Smart Auto/Commercial	$0.20
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$0.20
Rate for Payer: LLUH Dept of Risk Management WC	$0.19
Rate for Payer: Multiplan Commercial	$0.26

SPIRONOLACTONE/HCTZ ORAL SUSP COMPOUND 5 MG/ML [4080340]

Facility

IP

$0.09

Service Code	NDC 9994-0803-40
Hospital Charge Code	901700029
Hospital Revenue Code	259
Min. Negotiated Rate	$0.05
Max. Negotiated Rate	$0.07
Rate for Payer: Cash Price	$0.05
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO 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 Commercial	$0.07

SPIRONOLACTONE/HCTZ ORAL SUSP COMPOUND 5 MG/ML [4080340]

Facility

OP

$0.09

Service Code	NDC 9994-0803-40
Hospital Charge Code	901700029
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	$0.05
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$0.07
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 Commercial	$0.07

SPIRONOLACTONE ORAL SUSPENSION COMPOUND 2.5 MG/ML [4080339]

Facility

IP

$0.47

Service Code	NDC 9994-0803-39
Hospital Charge Code	901700029
Hospital Revenue Code	259
Min. Negotiated Rate	$0.26
Max. Negotiated Rate	$0.38
Rate for Payer: Cash Price	$0.26
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$0.38
Rate for Payer: Health Smart Auto/Commercial	$0.28
Rate for Payer: LLUH Dept of Risk Management WC	$0.26
Rate for Payer: Multiplan Commercial	$0.35

SPIRONOLACTONE ORAL SUSPENSION COMPOUND 2.5 MG/ML [4080339]

Facility

OP

$0.47

Service Code	NDC 9994-0803-39
Hospital Charge Code	901700029
Hospital Revenue Code	259
Min. Negotiated Rate	$0.26
Max. Negotiated Rate	$0.38
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$0.28
Rate for Payer: Aetna of CA Government/Medicare	$0.28
Rate for Payer: Cash Price	$0.26
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$0.38
Rate for Payer: Health Smart Auto/Commercial	$0.28
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$0.28
Rate for Payer: LLUH Dept of Risk Management WC	$0.26
Rate for Payer: Multiplan Commercial	$0.35

STERILE TALC 4 GRAM INTRAPLEURAL SUSPENSION [221295]

Facility

OP

$234.60

Service Code	NDC 62327-444-44
Hospital Charge Code	901700004
Hospital Revenue Code	250
Min. Negotiated Rate	$129.03
Max. Negotiated Rate	$187.68
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$140.76
Rate for Payer: Aetna of CA Government/Medicare	$140.76
Rate for Payer: Cash Price	$129.03
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$187.68
Rate for Payer: Health Smart Auto/Commercial	$140.76
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$140.76
Rate for Payer: LLUH Dept of Risk Management WC	$129.03
Rate for Payer: Multiplan Commercial	$175.95

STERILE TALC 4 GRAM INTRAPLEURAL SUSPENSION [221295]

Facility

OP

$234.60

Service Code	NDC 62327-444-04
Hospital Charge Code	901700004
Hospital Revenue Code	250
Min. Negotiated Rate	$129.03
Max. Negotiated Rate	$187.68
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$140.76
Rate for Payer: Aetna of CA Government/Medicare	$140.76
Rate for Payer: Cash Price	$129.03
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$187.68
Rate for Payer: Health Smart Auto/Commercial	$140.76
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$140.76
Rate for Payer: LLUH Dept of Risk Management WC	$129.03
Rate for Payer: Multiplan Commercial	$175.95

STERILE TALC 4 GRAM INTRAPLEURAL SUSPENSION [221295]

Facility

IP

$234.60

Service Code	NDC 62327-444-44
Hospital Charge Code	901700004
Hospital Revenue Code	250
Min. Negotiated Rate	$129.03
Max. Negotiated Rate	$187.68
Rate for Payer: Cash Price	$129.03
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$187.68
Rate for Payer: Health Smart Auto/Commercial	$140.76
Rate for Payer: LLUH Dept of Risk Management WC	$129.03
Rate for Payer: Multiplan Commercial	$175.95

STERILE TALC 4 GRAM INTRAPLEURAL SUSPENSION [221295]

Facility

IP

$234.60

Service Code	NDC 62327-444-04
Hospital Charge Code	901700004
Hospital Revenue Code	250
Min. Negotiated Rate	$129.03
Max. Negotiated Rate	$187.68
Rate for Payer: Cash Price	$129.03
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$187.68
Rate for Payer: Health Smart Auto/Commercial	$140.76
Rate for Payer: LLUH Dept of Risk Management WC	$129.03
Rate for Payer: Multiplan Commercial	$175.95

STERILE TALC 5 GRAM INTRAPLEURAL SUSPENSION [37812]

Facility

OP

$119.40

Service Code	NDC 63256-200-05
Hospital Charge Code	901700004
Hospital Revenue Code	250
Min. Negotiated Rate	$65.67
Max. Negotiated Rate	$95.52
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$71.64
Rate for Payer: Aetna of CA Government/Medicare	$71.64
Rate for Payer: Cash Price	$65.67
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$95.52
Rate for Payer: Health Smart Auto/Commercial	$71.64
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$71.64
Rate for Payer: LLUH Dept of Risk Management WC	$65.67
Rate for Payer: Multiplan Commercial	$89.55

STERILE TALC 5 GRAM INTRAPLEURAL SUSPENSION [37812]

Facility

IP

$119.40

Service Code	NDC 63256-200-05
Hospital Charge Code	901700004
Hospital Revenue Code	250
Min. Negotiated Rate	$65.67
Max. Negotiated Rate	$95.52
Rate for Payer: Cash Price	$65.67
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$95.52
Rate for Payer: Health Smart Auto/Commercial	$71.64
Rate for Payer: LLUH Dept of Risk Management WC	$65.67
Rate for Payer: Multiplan Commercial	$89.55

STERILE WATER FOR INJECTION. [4081186]

Facility

OP

$0.01

Service Code	NDC 0264-7850-00
Hospital Charge Code	901700008
Hospital Revenue Code	258
Min. Negotiated Rate	$0.01
Max. Negotiated Rate	$0.01
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$0.01
Rate for Payer: Aetna of CA Government/Medicare	$0.01
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$0.01
Rate for Payer: Health Smart Auto/Commercial	$0.01
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$0.01
Rate for Payer: LLUH Dept of Risk Management WC	$0.01
Rate for Payer: Multiplan Commercial	$0.01

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