Price Transparency

Know your out-of-pocket cost for care.

All Charges

Charge

Type

Setting

Price

PENICILLIN V POTASSIUM 250 MG TABLET [6092]

Facility

IP

$0.10

Service Code	NDC 57237-040-01
Hospital Charge Code	1711259
Hospital Revenue Code	259
Min. Negotiated Rate	$0.06
Max. Negotiated Rate	$0.08
Rate for Payer: Cash Price	$0.05
Rate for Payer: Cigna of CA HMO/PPO	$0.08
Rate for Payer: Health Smart Auto/Commercial	$0.06
Rate for Payer: LLUH Dept of Risk Management WC	$0.06
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$0.08

PENICILLIN V POTASSIUM 250 MG TABLET [6092]

Facility

IP

$0.22

Service Code	NDC 0093-1172-10
Hospital Charge Code	1711259
Hospital Revenue Code	259
Min. Negotiated Rate	$0.12
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	$0.13
Rate for Payer: LLUH Dept of Risk Management WC	$0.12
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$0.17

PENICILLIN V POTASSIUM 250 MG TABLET [6092]

Facility

OP

$0.66

Service Code	NDC 0781-1205-01
Hospital Charge Code	1711259
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

PENICILLIN V POTASSIUM 250 MG TABLET [6092]

Facility

IP

$0.10

Service Code	NDC 0143-9837-01
Hospital Charge Code	1711259
Hospital Revenue Code	259
Min. Negotiated Rate	$0.06
Max. Negotiated Rate	$0.08
Rate for Payer: Cash Price	$0.05
Rate for Payer: Cigna of CA HMO/PPO	$0.08
Rate for Payer: Health Smart Auto/Commercial	$0.06
Rate for Payer: LLUH Dept of Risk Management WC	$0.06
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$0.08

PENICILLIN V POTASSIUM 250 MG TABLET [6092]

Facility

OP

$0.10

Service Code	NDC 57237-040-01
Hospital Charge Code	1711259
Hospital Revenue Code	259
Min. Negotiated Rate	$0.06
Max. Negotiated Rate	$0.08
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$0.06
Rate for Payer: Aetna of CA Government/Medicare	$0.06
Rate for Payer: Cash Price	$0.05
Rate for Payer: Health Smart Auto/Commercial	$0.06
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$0.06
Rate for Payer: LLUH Dept of Risk Management WC	$0.06
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$0.08

PENICILLIN V POTASSIUM 250 MG TABLET [6092]

Facility

IP

$0.66

Service Code	NDC 0781-1205-01
Hospital Charge Code	1711259
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

PENICILLIN V POTASSIUM 250 MG TABLET [6092]

Facility

OP

$0.22

Service Code	NDC 0093-1172-10
Hospital Charge Code	1711259
Hospital Revenue Code	259
Min. Negotiated Rate	$0.12
Max. Negotiated Rate	$0.17
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	$0.10
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 Beech St/Commercial/PHCS	$0.17

PENICILLIN V POTASSIUM 250 MG TABLET [6092]

Facility

OP

$0.10

Service Code	NDC 0143-9837-01
Hospital Charge Code	1711259
Hospital Revenue Code	259
Min. Negotiated Rate	$0.06
Max. Negotiated Rate	$0.08
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$0.06
Rate for Payer: Aetna of CA Government/Medicare	$0.06
Rate for Payer: Cash Price	$0.05
Rate for Payer: Health Smart Auto/Commercial	$0.06
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$0.06
Rate for Payer: LLUH Dept of Risk Management WC	$0.06
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$0.08

PENICILLIN V POTASSIUM 50 MG/ML ORAL SOLUTION FOR DESENSITIZATION [40803012]

Facility

IP

$0.08

Service Code	NDC 0093-4127-74
Hospital Charge Code	NDG6091
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

PENICILLIN V POTASSIUM 50 MG/ML ORAL SOLUTION FOR DESENSITIZATION [40803012]

Facility

OP

$0.08

Service Code	NDC 0093-4127-74
Hospital Charge Code	NDG6091
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

PENICILLIN V POTASSIUM 5 MG/ML ORAL SOLUTION FOR DESENSITIZATION [40803010]

Facility

OP

$0.01

Service Code	NDC 9994-3000-09
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

PENICILLIN V POTASSIUM 5 MG/ML ORAL SOLUTION FOR DESENSITIZATION [40803010]

Facility

IP

$0.01

Service Code	NDC 9994-3000-09
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

PENICILLIN V POTASSIUM 6.25 MG/ML (10,000 UNITS/ML) ORAL SOLN [4081500]

Facility

IP

$0.08

Service Code	NDC 9994-0815-00
Hospital Charge Code	NDC4081500
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

PENICILLIN V POTASSIUM 6.25 MG/ML (10,000 UNITS/ML) ORAL SOLN [4081500]

Facility

OP

$0.08

Service Code	NDC 9994-0815-00
Hospital Charge Code	NDC4081500
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

PENTAMIDINE 300 MG SOLUTION FOR INHALATION [28235]

Facility

IP

$173.40

Service Code	NDC 13925-522-01
Hospital Charge Code	1744057
Hospital Revenue Code	259
Min. Negotiated Rate	$95.37
Max. Negotiated Rate	$138.72
Rate for Payer: Cash Price	$78.03
Rate for Payer: Cigna of CA HMO/PPO	$138.72
Rate for Payer: Health Smart Auto/Commercial	$104.04
Rate for Payer: LLUH Dept of Risk Management WC	$95.37
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$130.05

PENTAMIDINE 300 MG SOLUTION FOR INHALATION [28235]

Facility

OP

$173.40

Service Code	NDC 13925-522-01
Hospital Charge Code	1744057
Hospital Revenue Code	259
Min. Negotiated Rate	$95.37
Max. Negotiated Rate	$130.05
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$104.04
Rate for Payer: Aetna of CA Government/Medicare	$104.04
Rate for Payer: Cash Price	$78.03
Rate for Payer: Health Smart Auto/Commercial	$104.04
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$104.04
Rate for Payer: LLUH Dept of Risk Management WC	$95.37
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$130.05

PENTAMIDINE 300 MG SOLUTION FOR INHALATION [28235]

Facility

IP

$200.27

Service Code	NDC 63323-877-15
Hospital Charge Code	1744057
Hospital Revenue Code	259
Min. Negotiated Rate	$110.15
Max. Negotiated Rate	$160.22
Rate for Payer: Cash Price	$90.12
Rate for Payer: Cigna of CA HMO/PPO	$160.22
Rate for Payer: Health Smart Auto/Commercial	$120.16
Rate for Payer: LLUH Dept of Risk Management WC	$110.15
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$150.20

PENTAMIDINE 300 MG SOLUTION FOR INHALATION [28235]

Facility

OP

$200.27

Service Code	NDC 63323-877-15
Hospital Charge Code	1744057
Hospital Revenue Code	259
Min. Negotiated Rate	$110.15
Max. Negotiated Rate	$150.20
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$120.16
Rate for Payer: Aetna of CA Government/Medicare	$120.16
Rate for Payer: Cash Price	$90.12
Rate for Payer: Health Smart Auto/Commercial	$120.16
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$120.16
Rate for Payer: LLUH Dept of Risk Management WC	$110.15
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$150.20

PENTAMIDINE 300 MG SOLUTION FOR INJECTION [27430]

Facility

OP

$117.24

Service Code	CPT J3490
Hospital Charge Code	1720550
Hospital Revenue Code	636
Min. Negotiated Rate	$64.48
Max. Negotiated Rate	$87.93
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$70.34
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$104.04
Rate for Payer: Aetna of CA Government/Medicare	$104.04
Rate for Payer: Aetna of CA Government/Medicare	$70.34
Rate for Payer: Cash Price	$52.76
Rate for Payer: Cash Price	$78.03
Rate for Payer: Health Smart Auto/Commercial	$104.04
Rate for Payer: Health Smart Auto/Commercial	$70.34
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$70.34
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$104.04
Rate for Payer: LLUH Dept of Risk Management WC	$95.37
Rate for Payer: LLUH Dept of Risk Management WC	$64.48
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$130.05
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$87.93

PENTAMIDINE 300 MG SOLUTION FOR INJECTION [27430]

Facility

IP

$117.24

Service Code	CPT J3490
Hospital Charge Code	1720550
Hospital Revenue Code	636
Min. Negotiated Rate	$64.48
Max. Negotiated Rate	$93.79
Rate for Payer: Cash Price	$52.76
Rate for Payer: Cash Price	$78.03
Rate for Payer: Cigna of CA HMO/PPO	$93.79
Rate for Payer: Cigna of CA HMO/PPO	$138.72
Rate for Payer: Health Smart Auto/Commercial	$70.34
Rate for Payer: Health Smart Auto/Commercial	$104.04
Rate for Payer: LLUH Dept of Risk Management WC	$95.37
Rate for Payer: LLUH Dept of Risk Management WC	$64.48
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$87.93
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$130.05

PENTOSAN POLYSULFATE SODIUM 100 MG CAPSULE [12912]

Facility

OP

$13.10

Service Code	NDC 50458-098-01
Hospital Charge Code	1710932
Hospital Revenue Code	259
Min. Negotiated Rate	$7.20
Max. Negotiated Rate	$9.82
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$7.86
Rate for Payer: Aetna of CA Government/Medicare	$7.86
Rate for Payer: Cash Price	$5.90
Rate for Payer: Health Smart Auto/Commercial	$7.86
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$7.86
Rate for Payer: LLUH Dept of Risk Management WC	$7.20
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$9.82

PENTOSAN POLYSULFATE SODIUM 100 MG CAPSULE [12912]

Facility

IP

$13.10

Service Code	NDC 50458-098-01
Hospital Charge Code	1710932
Hospital Revenue Code	259
Min. Negotiated Rate	$7.20
Max. Negotiated Rate	$10.48
Rate for Payer: Cash Price	$5.90
Rate for Payer: Cigna of CA HMO/PPO	$10.48
Rate for Payer: Health Smart Auto/Commercial	$7.86
Rate for Payer: LLUH Dept of Risk Management WC	$7.20
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$9.82

PENTOSTATIN 10 MG INTRAVENOUS SOLUTION [10910]

Facility

OP

$2,926.88

Service Code	CPT J9268
Hospital Charge Code	1755684
Hospital Revenue Code	636
Min. Negotiated Rate	$1,609.78
Max. Negotiated Rate	$2,195.16
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$1,756.13
Rate for Payer: Aetna of CA Government/Medicare	$1,756.13
Rate for Payer: Cash Price	$1,317.10
Rate for Payer: Health Smart Auto/Commercial	$1,756.13
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$1,756.13
Rate for Payer: LLUH Dept of Risk Management WC	$1,609.78
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$2,195.16

PENTOSTATIN 10 MG INTRAVENOUS SOLUTION [10910]

Facility

IP

$2,926.88

Service Code	CPT J9268
Hospital Charge Code	1755684
Hospital Revenue Code	636
Min. Negotiated Rate	$1,609.78
Max. Negotiated Rate	$2,341.50
Rate for Payer: Cash Price	$1,317.10
Rate for Payer: Cigna of CA HMO/PPO	$2,341.50
Rate for Payer: Health Smart Auto/Commercial	$1,756.13
Rate for Payer: LLUH Dept of Risk Management WC	$1,609.78
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$2,195.16

PENTOXIFYLLINE ER 400 MG TABLET,EXTENDED RELEASE [10911]

Facility

IP

$0.51

Service Code	NDC 60505-0033-6
Hospital Charge Code	1711410
Hospital Revenue Code	259
Min. Negotiated Rate	$0.28
Max. Negotiated Rate	$0.41
Rate for Payer: Cash Price	$0.23
Rate for Payer: Cigna of CA HMO/PPO	$0.41
Rate for Payer: Health Smart Auto/Commercial	$0.31
Rate for Payer: LLUH Dept of Risk Management WC	$0.28
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$0.38

<<
<
611
612
613
614
615
616
617
618
619
620
>
>>