Price Transparency

Know your out-of-pocket cost for care.

All Charges

Charge

Type

Setting

Price

VITAMINS A AND D-WHITE PETROLATUM-LANOLIN TOPICAL OINTMENT [120259]

Facility

IP

$0.07

Service Code	NDC 4110081163
Hospital Charge Code	901700029
Hospital Revenue Code	259
Min. Negotiated Rate	$0.04
Max. Negotiated Rate	$0.06
Rate for Payer: Cash Price	$0.04
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$0.06
Rate for Payer: Health Smart Auto/Commercial	$0.04
Rate for Payer: LLUH Dept of Risk Management WC	$0.04
Rate for Payer: Multiplan Commercial	$0.05

VITAMINS A AND D-WHITE PETROLATUM-LANOLIN TOPICAL OINTMENT [120259]

Facility

IP

$0.07

Service Code	NDC 65197-400-10
Hospital Charge Code	901700029
Hospital Revenue Code	259
Min. Negotiated Rate	$0.04
Max. Negotiated Rate	$0.06
Rate for Payer: Cash Price	$0.04
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$0.06
Rate for Payer: Health Smart Auto/Commercial	$0.04
Rate for Payer: LLUH Dept of Risk Management WC	$0.04
Rate for Payer: Multiplan Commercial	$0.05

VITAMINS A AND D-WHITE PETROLATUM-LANOLIN TOPICAL OINTMENT [120259]

Facility

OP

$0.03

Service Code	NDC 24385-070-26
Hospital Charge Code	901700029
Hospital Revenue Code	259
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	$0.02
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$0.02
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	$0.02

VITAMINS A AND D-WHITE PETROLATUM-LANOLIN TOPICAL OINTMENT [120259]

Facility

OP

$0.06

Service Code	NDC 4110081122
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

VITAMINS A AND D-WHITE PETROLATUM-LANOLIN TOPICAL OINTMENT [120259]

Facility

OP

$0.07

Service Code	NDC 4110081163
Hospital Charge Code	901700029
Hospital Revenue Code	259
Min. Negotiated Rate	$0.04
Max. Negotiated Rate	$0.06
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$0.04
Rate for Payer: Aetna of CA Government/Medicare	$0.04
Rate for Payer: Cash Price	$0.04
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$0.06
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	$0.04
Rate for Payer: Multiplan Commercial	$0.05

VITAMINS A AND D-WHITE PETROLATUM-LANOLIN TOPICAL OINTMENT [120259]

Facility

OP

$0.04

Service Code	NDC 65197-401-01
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

VITAMINS A AND D-WHITE PETROLATUM-LANOLIN TOPICAL OINTMENT [120259]

Facility

IP

$0.04

Service Code	NDC 65197-401-01
Hospital Charge Code	901700029
Hospital Revenue Code	259
Min. Negotiated Rate	$0.02
Max. Negotiated Rate	$0.03
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: LLUH Dept of Risk Management WC	$0.02
Rate for Payer: Multiplan Commercial	$0.03

VITAMINS A AND D-WHITE PETROLATUM-LANOLIN TOPICAL OINTMENT [120259]

Facility

IP

$0.03

Service Code	NDC 24385-070-26
Hospital Charge Code	901700029
Hospital Revenue Code	259
Min. Negotiated Rate	$0.02
Max. Negotiated Rate	$0.02
Rate for Payer: Cash Price	$0.02
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO 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 Commercial	$0.02

VITAMINS A AND D-WHITE PETROLATUM-LANOLIN TOPICAL OINTMENT [120259]

Facility

IP

$0.04

Service Code	NDC 71399-0122-4
Hospital Charge Code	901700029
Hospital Revenue Code	259
Min. Negotiated Rate	$0.02
Max. Negotiated Rate	$0.03
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: LLUH Dept of Risk Management WC	$0.02
Rate for Payer: Multiplan Commercial	$0.03

VITAMINS A AND D-WHITE PETROLATUM-LANOLIN TOPICAL OINTMENT [120259]

Facility

OP

$0.04

Service Code	NDC 71399-0122-4
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

VITAMINS A AND D-WHITE PETROLATUM-LANOLIN TOPICAL OINTMENT [120259]

Facility

IP

$0.03

Service Code	NDC 8770140663
Hospital Charge Code	901700029
Hospital Revenue Code	259
Min. Negotiated Rate	$0.02
Max. Negotiated Rate	$0.02
Rate for Payer: Cash Price	$0.02
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO 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 Commercial	$0.02

VITAMINS A AND D-WHITE PETROLATUM-LANOLIN TOPICAL OINTMENT [120259]

Facility

OP

$0.03

Service Code	NDC 8770140663
Hospital Charge Code	901700029
Hospital Revenue Code	259
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	$0.02
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$0.02
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	$0.02

VIT E-GLYCERIN-DIMETHICONE LOTION [115875]

Facility

IP

$0.03

Service Code	NDC 0299391808
Hospital Charge Code	901700029
Hospital Revenue Code	259
Min. Negotiated Rate	$0.02
Max. Negotiated Rate	$0.02
Rate for Payer: Cash Price	$0.02
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO 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 Commercial	$0.02

VIT E-GLYCERIN-DIMETHICONE LOTION [115875]

Facility

OP

$0.03

Service Code	NDC 0299391808
Hospital Charge Code	901700029
Hospital Revenue Code	259
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	$0.02
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$0.02
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	$0.02

VORICONAZOLE 200 MG/5 ML (40 MG/ML) ORAL SUSPENSION [38103]

Facility

OP

$9.82

Service Code	NDC 0049-3160-44
Hospital Charge Code	901700029
Hospital Revenue Code	259
Min. Negotiated Rate	$5.40
Max. Negotiated Rate	$7.86
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$5.89
Rate for Payer: Aetna of CA Government/Medicare	$5.89
Rate for Payer: Cash Price	$5.40
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$7.86
Rate for Payer: Health Smart Auto/Commercial	$5.89
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$5.89
Rate for Payer: LLUH Dept of Risk Management WC	$5.40
Rate for Payer: Multiplan Commercial	$7.37

VORICONAZOLE 200 MG/5 ML (40 MG/ML) ORAL SUSPENSION [38103]

Facility

IP

$9.82

Service Code	NDC 0049-3160-44
Hospital Charge Code	901700029
Hospital Revenue Code	259
Min. Negotiated Rate	$5.40
Max. Negotiated Rate	$7.86
Rate for Payer: Cash Price	$5.40
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$7.86
Rate for Payer: Health Smart Auto/Commercial	$5.89
Rate for Payer: LLUH Dept of Risk Management WC	$5.40
Rate for Payer: Multiplan Commercial	$7.37

VORICONAZOLE 200 MG/5 ML (40 MG/ML) ORAL SUSPENSION [38103]

Facility

OP

$12.83

Service Code	NDC 65162-913-22
Hospital Charge Code	901700029
Hospital Revenue Code	259
Min. Negotiated Rate	$7.06
Max. Negotiated Rate	$10.26
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$7.70
Rate for Payer: Aetna of CA Government/Medicare	$7.70
Rate for Payer: Cash Price	$7.06
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$10.26
Rate for Payer: Health Smart Auto/Commercial	$7.70
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$7.70
Rate for Payer: LLUH Dept of Risk Management WC	$7.06
Rate for Payer: Multiplan Commercial	$9.62

VORICONAZOLE 200 MG/5 ML (40 MG/ML) ORAL SUSPENSION [38103]

Facility

IP

$12.83

Service Code	NDC 65162-913-22
Hospital Charge Code	901700029
Hospital Revenue Code	259
Min. Negotiated Rate	$7.06
Max. Negotiated Rate	$10.26
Rate for Payer: Cash Price	$7.06
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$10.26
Rate for Payer: Health Smart Auto/Commercial	$7.70
Rate for Payer: LLUH Dept of Risk Management WC	$7.06
Rate for Payer: Multiplan Commercial	$9.62

VORICONAZOLE 200 MG INTRAVENOUS SOLUTION [33010]

Facility

OP

$72.36

Service Code	HCPCS J3465
Hospital Charge Code	901700025
Hospital Revenue Code	636
Min. Negotiated Rate	$39.80
Max. Negotiated Rate	$57.89
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$43.42
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$52.73
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$43.20
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$28.80
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$25.20
Rate for Payer: Aetna of CA Government/Medicare	$43.42
Rate for Payer: Aetna of CA Government/Medicare	$25.20
Rate for Payer: Aetna of CA Government/Medicare	$43.20
Rate for Payer: Aetna of CA Government/Medicare	$28.80
Rate for Payer: Aetna of CA Government/Medicare	$52.73
Rate for Payer: Cash Price	$26.40
Rate for Payer: Cash Price	$39.60
Rate for Payer: Cash Price	$39.80
Rate for Payer: Cash Price	$23.10
Rate for Payer: Cash Price	$48.34
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$57.89
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$33.60
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$38.40
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$57.60
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$70.31
Rate for Payer: Health Smart Auto/Commercial	$43.20
Rate for Payer: Health Smart Auto/Commercial	$28.80
Rate for Payer: Health Smart Auto/Commercial	$52.73
Rate for Payer: Health Smart Auto/Commercial	$43.42
Rate for Payer: Health Smart Auto/Commercial	$25.20
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$25.20
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$43.20
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$43.42
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$28.80
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$52.73
Rate for Payer: LLUH Dept of Risk Management WC	$39.80
Rate for Payer: LLUH Dept of Risk Management WC	$48.34
Rate for Payer: LLUH Dept of Risk Management WC	$26.40
Rate for Payer: LLUH Dept of Risk Management WC	$23.10
Rate for Payer: LLUH Dept of Risk Management WC	$39.60
Rate for Payer: Multiplan Commercial	$65.92
Rate for Payer: Multiplan Commercial	$31.50
Rate for Payer: Multiplan Commercial	$36.00
Rate for Payer: Multiplan Commercial	$54.00
Rate for Payer: Multiplan Commercial	$54.27

VORICONAZOLE 200 MG INTRAVENOUS SOLUTION [33010]

Facility

IP

$72.36

Service Code	HCPCS J3465
Hospital Charge Code	901700025
Hospital Revenue Code	636
Min. Negotiated Rate	$39.80
Max. Negotiated Rate	$57.89
Rate for Payer: Cash Price	$39.80
Rate for Payer: Cash Price	$48.34
Rate for Payer: Cash Price	$23.10
Rate for Payer: Cash Price	$26.40
Rate for Payer: Cash Price	$39.60
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$57.89
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$57.60
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$70.31
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$38.40
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$33.60
Rate for Payer: Health Smart Auto/Commercial	$25.20
Rate for Payer: Health Smart Auto/Commercial	$28.80
Rate for Payer: Health Smart Auto/Commercial	$43.20
Rate for Payer: Health Smart Auto/Commercial	$43.42
Rate for Payer: Health Smart Auto/Commercial	$52.73
Rate for Payer: LLUH Dept of Risk Management WC	$39.60
Rate for Payer: LLUH Dept of Risk Management WC	$48.34
Rate for Payer: LLUH Dept of Risk Management WC	$23.10
Rate for Payer: LLUH Dept of Risk Management WC	$39.80
Rate for Payer: LLUH Dept of Risk Management WC	$26.40
Rate for Payer: Multiplan Commercial	$36.00
Rate for Payer: Multiplan Commercial	$54.27
Rate for Payer: Multiplan Commercial	$65.92
Rate for Payer: Multiplan Commercial	$31.50
Rate for Payer: Multiplan Commercial	$54.00

VORICONAZOLE 200 MG TABLET [33009]

Facility

IP

$21.43

Service Code	NDC 50268-803-11
Hospital Charge Code	901700029
Hospital Revenue Code	259
Min. Negotiated Rate	$11.79
Max. Negotiated Rate	$17.14
Rate for Payer: Cash Price	$11.79
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$17.14
Rate for Payer: Health Smart Auto/Commercial	$12.86
Rate for Payer: LLUH Dept of Risk Management WC	$11.79
Rate for Payer: Multiplan Commercial	$16.07

VORICONAZOLE 200 MG TABLET [33009]

Facility

OP

$21.43

Service Code	NDC 50268-803-11
Hospital Charge Code	901700029
Hospital Revenue Code	259
Min. Negotiated Rate	$11.79
Max. Negotiated Rate	$17.14
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$12.86
Rate for Payer: Aetna of CA Government/Medicare	$12.86
Rate for Payer: Cash Price	$11.79
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$17.14
Rate for Payer: Health Smart Auto/Commercial	$12.86
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$12.86
Rate for Payer: LLUH Dept of Risk Management WC	$11.79
Rate for Payer: Multiplan Commercial	$16.07

VORICONAZOLE 200 MG TABLET [33009]

Facility

OP

$21.43

Service Code	NDC 50268-803-12
Hospital Charge Code	901700029
Hospital Revenue Code	259
Min. Negotiated Rate	$11.79
Max. Negotiated Rate	$17.14
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$12.86
Rate for Payer: Aetna of CA Government/Medicare	$12.86
Rate for Payer: Cash Price	$11.79
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$17.14
Rate for Payer: Health Smart Auto/Commercial	$12.86
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$12.86
Rate for Payer: LLUH Dept of Risk Management WC	$11.79
Rate for Payer: Multiplan Commercial	$16.07

VORICONAZOLE 200 MG TABLET [33009]

Facility

IP

$9.00

Service Code	NDC 65862-892-30
Hospital Charge Code	901700029
Hospital Revenue Code	259
Min. Negotiated Rate	$4.95
Max. Negotiated Rate	$7.20
Rate for Payer: Cash Price	$4.95
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$7.20
Rate for Payer: Health Smart Auto/Commercial	$5.40
Rate for Payer: LLUH Dept of Risk Management WC	$4.95
Rate for Payer: Multiplan Commercial	$6.75

VORICONAZOLE 200 MG TABLET [33009]

Facility

OP

$9.00

Service Code	NDC 65862-892-30
Hospital Charge Code	901700029
Hospital Revenue Code	259
Min. Negotiated Rate	$4.95
Max. Negotiated Rate	$7.20
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$5.40
Rate for Payer: Aetna of CA Government/Medicare	$5.40
Rate for Payer: Cash Price	$4.95
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$7.20
Rate for Payer: Health Smart Auto/Commercial	$5.40
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$5.40
Rate for Payer: LLUH Dept of Risk Management WC	$4.95
Rate for Payer: Multiplan Commercial	$6.75

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