Price Transparency

Know your out-of-pocket cost for care.

All Charges

Charge

Type

Setting

Price

PAROXETINE 30 MG TABLET [10856]

Facility

OP

$0.55

Service Code	NDC 50268-642-11
Hospital Charge Code	1713111
Hospital Revenue Code	259
Min. Negotiated Rate	$0.30
Max. Negotiated Rate	$0.41
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	$0.25
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 Beech St/Commercial/PHCS	$0.41

PAROXETINE 30 MG TABLET [10856]

Facility

IP

$0.23

Service Code	NDC 68382-099-06
Hospital Charge Code	1713111
Hospital Revenue Code	259
Min. Negotiated Rate	$0.13
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	$0.14
Rate for Payer: LLUH Dept of Risk Management WC	$0.13
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$0.17

PAROXETINE 30 MG TABLET [10856]

Facility

OP

$0.32

Service Code	NDC 43547-349-03
Hospital Charge Code	1713111
Hospital Revenue Code	259
Min. Negotiated Rate	$0.18
Max. Negotiated Rate	$0.24
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$0.19
Rate for Payer: Aetna of CA Government/Medicare	$0.19
Rate for Payer: Cash Price	$0.14
Rate for Payer: Health Smart Auto/Commercial	$0.19
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$0.19
Rate for Payer: LLUH Dept of Risk Management WC	$0.18
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$0.24

PAROXETINE 30 MG TABLET [10856]

Facility

OP

$0.23

Service Code	NDC 68382-099-06
Hospital Charge Code	1713111
Hospital Revenue Code	259
Min. Negotiated Rate	$0.13
Max. Negotiated Rate	$0.17
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	$0.10
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 Beech St/Commercial/PHCS	$0.17

PAROXETINE 30 MG TABLET [10856]

Facility

IP

$0.32

Service Code	NDC 43547-349-03
Hospital Charge Code	1713111
Hospital Revenue Code	259
Min. Negotiated Rate	$0.18
Max. Negotiated Rate	$0.26
Rate for Payer: Cash Price	$0.14
Rate for Payer: Cigna of CA HMO/PPO	$0.26
Rate for Payer: Health Smart Auto/Commercial	$0.19
Rate for Payer: LLUH Dept of Risk Management WC	$0.18
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$0.24

PAROXETINE 30 MG TABLET [10856]

Facility

IP

$1.14

Service Code	NDC 68084-046-11
Hospital Charge Code	1713111
Hospital Revenue Code	259
Min. Negotiated Rate	$0.63
Max. Negotiated Rate	$0.91
Rate for Payer: Cash Price	$0.51
Rate for Payer: Cigna of CA HMO/PPO	$0.91
Rate for Payer: Health Smart Auto/Commercial	$0.68
Rate for Payer: LLUH Dept of Risk Management WC	$0.63
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$0.86

PAROXETINE 30 MG TABLET [10856]

Facility

IP

$0.55

Service Code	NDC 50268-642-15
Hospital Charge Code	1713111
Hospital Revenue Code	259
Min. Negotiated Rate	$0.30
Max. Negotiated Rate	$0.44
Rate for Payer: Cash Price	$0.25
Rate for Payer: Cigna of CA 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 Beech St/Commercial/PHCS	$0.41

PAROXETINE 30 MG TABLET [10856]

Facility

OP

$0.55

Service Code	NDC 50268-642-15
Hospital Charge Code	1713111
Hospital Revenue Code	259
Min. Negotiated Rate	$0.30
Max. Negotiated Rate	$0.41
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	$0.25
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 Beech St/Commercial/PHCS	$0.41

PATIROMER CALCIUM SORBITEX 16.8 GRAM ORAL POWDER PACKET [211786]

Facility

OP

$39.60

Service Code	NDC 53436-168-01
Hospital Charge Code	ERX211786
Hospital Revenue Code	259
Min. Negotiated Rate	$21.78
Max. Negotiated Rate	$29.70
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$23.76
Rate for Payer: Aetna of CA Government/Medicare	$23.76
Rate for Payer: Cash Price	$17.82
Rate for Payer: Health Smart Auto/Commercial	$23.76
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$23.76
Rate for Payer: LLUH Dept of Risk Management WC	$21.78
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$29.70

PATIROMER CALCIUM SORBITEX 16.8 GRAM ORAL POWDER PACKET [211786]

Facility

OP

$39.60

Service Code	NDC 53436-168-30
Hospital Charge Code	ERX211786
Hospital Revenue Code	259
Min. Negotiated Rate	$21.78
Max. Negotiated Rate	$29.70
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$23.76
Rate for Payer: Aetna of CA Government/Medicare	$23.76
Rate for Payer: Cash Price	$17.82
Rate for Payer: Health Smart Auto/Commercial	$23.76
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$23.76
Rate for Payer: LLUH Dept of Risk Management WC	$21.78
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$29.70

PATIROMER CALCIUM SORBITEX 16.8 GRAM ORAL POWDER PACKET [211786]

Facility

IP

$39.60

Service Code	NDC 53436-168-01
Hospital Charge Code	ERX211786
Hospital Revenue Code	259
Min. Negotiated Rate	$21.78
Max. Negotiated Rate	$31.68
Rate for Payer: Cash Price	$17.82
Rate for Payer: Cigna of CA HMO/PPO	$31.68
Rate for Payer: Health Smart Auto/Commercial	$23.76
Rate for Payer: LLUH Dept of Risk Management WC	$21.78
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$29.70

PATIROMER CALCIUM SORBITEX 16.8 GRAM ORAL POWDER PACKET [211786]

Facility

IP

$39.60

Service Code	NDC 53436-168-30
Hospital Charge Code	ERX211786
Hospital Revenue Code	259
Min. Negotiated Rate	$21.78
Max. Negotiated Rate	$31.68
Rate for Payer: Cash Price	$17.82
Rate for Payer: Cigna of CA HMO/PPO	$31.68
Rate for Payer: Health Smart Auto/Commercial	$23.76
Rate for Payer: LLUH Dept of Risk Management WC	$21.78
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$29.70

PATIROMER CALCIUM SORBITEX 8.4 GRAM ORAL POWDER PACKET [211785]

Facility

OP

$39.60

Service Code	NDC 53436-084-01
Hospital Charge Code	ERX211785
Hospital Revenue Code	259
Min. Negotiated Rate	$21.78
Max. Negotiated Rate	$29.70
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$23.76
Rate for Payer: Aetna of CA Government/Medicare	$23.76
Rate for Payer: Cash Price	$17.82
Rate for Payer: Health Smart Auto/Commercial	$23.76
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$23.76
Rate for Payer: LLUH Dept of Risk Management WC	$21.78
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$29.70

PATIROMER CALCIUM SORBITEX 8.4 GRAM ORAL POWDER PACKET [211785]

Facility

OP

$39.60

Service Code	NDC 53436-084-30
Hospital Charge Code	ERX211785
Hospital Revenue Code	259
Min. Negotiated Rate	$21.78
Max. Negotiated Rate	$29.70
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$23.76
Rate for Payer: Aetna of CA Government/Medicare	$23.76
Rate for Payer: Cash Price	$17.82
Rate for Payer: Health Smart Auto/Commercial	$23.76
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$23.76
Rate for Payer: LLUH Dept of Risk Management WC	$21.78
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$29.70

PATIROMER CALCIUM SORBITEX 8.4 GRAM ORAL POWDER PACKET [211785]

Facility

IP

$39.60

Service Code	NDC 53436-084-30
Hospital Charge Code	ERX211785
Hospital Revenue Code	259
Min. Negotiated Rate	$21.78
Max. Negotiated Rate	$31.68
Rate for Payer: Cash Price	$17.82
Rate for Payer: Cigna of CA HMO/PPO	$31.68
Rate for Payer: Health Smart Auto/Commercial	$23.76
Rate for Payer: LLUH Dept of Risk Management WC	$21.78
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$29.70

PATIROMER CALCIUM SORBITEX 8.4 GRAM ORAL POWDER PACKET [211785]

Facility

IP

$39.60

Service Code	NDC 53436-084-01
Hospital Charge Code	ERX211785
Hospital Revenue Code	259
Min. Negotiated Rate	$21.78
Max. Negotiated Rate	$31.68
Rate for Payer: Cash Price	$17.82
Rate for Payer: Cigna of CA HMO/PPO	$31.68
Rate for Payer: Health Smart Auto/Commercial	$23.76
Rate for Payer: LLUH Dept of Risk Management WC	$21.78
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$29.70

PEDIATRIC MULTIVITAMIN NO.192 250 MCG-50 MG-10 MCG/ML ORAL DROPS [228315]

Facility

IP

$0.20

Service Code	NDC 87040203
Hospital Charge Code	1715260
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

PEDIATRIC MULTIVITAMIN NO.192 250 MCG-50 MG-10 MCG/ML ORAL DROPS [228315]

Facility

OP

$0.20

Service Code	NDC 87040203
Hospital Charge Code	1715260
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

PEDIATRIC MULTIVITAMIN NO.40-PHYTONADIONE 400 MCG/ML ORAL DROPS [118399]

Facility

OP

$0.42

Service Code	NDC 5891421460
Hospital Charge Code	NDG118399
Hospital Revenue Code	259
Min. Negotiated Rate	$0.23
Max. Negotiated Rate	$0.32
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$0.25
Rate for Payer: Aetna of CA Government/Medicare	$0.25
Rate for Payer: Cash Price	$0.19
Rate for Payer: Health Smart Auto/Commercial	$0.25
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$0.25
Rate for Payer: LLUH Dept of Risk Management WC	$0.23
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$0.32

PEDIATRIC MULTIVITAMIN NO.40-PHYTONADIONE 400 MCG/ML ORAL DROPS [118399]

Facility

IP

$0.42

Service Code	NDC 5891421460
Hospital Charge Code	NDG118399
Hospital Revenue Code	259
Min. Negotiated Rate	$0.23
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	$0.25
Rate for Payer: LLUH Dept of Risk Management WC	$0.23
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$0.32

PEDIATRIC MULTIVITAMIN NO.61-VIT D3 3,000 UNIT-VIT K 800 MCG CAPSULE [206186]

Facility

OP

$0.66

Service Code	NDC 5820400406
Hospital Charge Code	ERX206186
Hospital Revenue Code	259
Min. Negotiated Rate	$0.36
Max. Negotiated Rate	$0.50
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$0.40
Rate for Payer: Aetna of CA Government/Medicare	$0.40
Rate for Payer: Cash Price	$0.30
Rate for Payer: Health Smart Auto/Commercial	$0.40
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$0.40
Rate for Payer: LLUH Dept of Risk Management WC	$0.36
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$0.50

PEDIATRIC MULTIVITAMIN NO.61-VIT D3 3,000 UNIT-VIT K 800 MCG CAPSULE [206186]

Facility

IP

$0.66

Service Code	NDC 5820400406
Hospital Charge Code	ERX206186
Hospital Revenue Code	259
Min. Negotiated Rate	$0.36
Max. Negotiated Rate	$0.53
Rate for Payer: Cash Price	$0.30
Rate for Payer: Cigna of CA HMO/PPO	$0.53
Rate for Payer: Health Smart Auto/Commercial	$0.40
Rate for Payer: LLUH Dept of Risk Management WC	$0.36
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$0.50

PEDI NUTRITION WITH IRON LACTOSE-FREE 0.03 GRAM-1 KCAL/ML ORAL LIQUID [120893]

Facility

IP

$0.01

Service Code	NDC 4390033511
Hospital Charge Code	NDG120893
Hospital Revenue Code	259
Min. Negotiated Rate	$0.01
Max. Negotiated Rate	$0.01
Rate for Payer: Cigna of CA HMO/PPO	$0.01
Rate for Payer: Health Smart Auto/Commercial	$0.01
Rate for Payer: LLUH Dept of Risk Management WC	$0.01
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$0.01

PEDI NUTRITION WITH IRON LACTOSE-FREE 0.03 GRAM-1 KCAL/ML ORAL LIQUID [120893]

Facility

OP

$0.01

Service Code	NDC 4390033511
Hospital Charge Code	NDG120893
Hospital Revenue Code	259
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: 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 Beech St/Commercial/PHCS	$0.01

PEG 3350-ELECTROLYTES 236 GRAM-22.74 GRAM-6.74 GRAM-5.86 GRAM SOLUTION [10839]

Facility

IP

$0.02

Service Code	NDC 64380-766-21
Hospital Charge Code	1713013
Hospital Revenue Code	259
Min. Negotiated Rate	$0.01
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	$0.01
Rate for Payer: LLUH Dept of Risk Management WC	$0.01
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$0.02

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