Price Transparency

Know your out-of-pocket cost for care.

All Charges

Charge

Type

Setting

Price

WHITE PETROLATUM 41 % TOPICAL OINTMENT [115556]

Facility

OP

$0.04

Service Code	NDC 7214063386
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

WHITE PETROLATUM 41 % TOPICAL OINTMENT [115556]

Facility

IP

$0.04

Service Code	NDC 7214063608
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

WHITE PETROLATUM 41 % TOPICAL OINTMENT [115556]

Facility

IP

$0.12

Service Code	NDC 7214045231
Hospital Charge Code	901700029
Hospital Revenue Code	259
Min. Negotiated Rate	$0.07
Max. Negotiated Rate	$0.10
Rate for Payer: Cash Price	$0.06
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$0.10
Rate for Payer: Health Smart Auto/Commercial	$0.07
Rate for Payer: LLUH Dept of Risk Management WC	$0.07
Rate for Payer: Multiplan Commercial	$0.09

WHITE PETROLATUM 41 % TOPICAL OINTMENT [115556]

Facility

OP

$0.04

Service Code	NDC 7214003147
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

WHITE PETROLATUM 41 % TOPICAL OINTMENT [115556]

Facility

IP

$0.04

Service Code	NDC 7214003147
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

WHITE PETROLATUM 41 % TOPICAL OINTMENT [115556]

Facility

IP

$0.04

Service Code	NDC 7214063386
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

WHITE PETROLATUM 41 % TOPICAL OINTMENT [115556]

Facility

OP

$0.04

Service Code	NDC 7214063608
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

WHITE PETROLATUM-MINERAL OIL 56.8 %-42.5 % EYE OINTMENT [119525]

Facility

IP

$3.35

Service Code	NDC 0023-0312-04
Hospital Charge Code	901700029
Hospital Revenue Code	259
Min. Negotiated Rate	$1.84
Max. Negotiated Rate	$2.68
Rate for Payer: Cash Price	$1.84
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$2.68
Rate for Payer: Health Smart Auto/Commercial	$2.01
Rate for Payer: LLUH Dept of Risk Management WC	$1.84
Rate for Payer: Multiplan Commercial	$2.51

WHITE PETROLATUM-MINERAL OIL 56.8 %-42.5 % EYE OINTMENT [119525]

Facility

OP

$3.35

Service Code	NDC 0023-0312-04
Hospital Charge Code	901700029
Hospital Revenue Code	259
Min. Negotiated Rate	$1.84
Max. Negotiated Rate	$2.68
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$2.01
Rate for Payer: Aetna of CA Government/Medicare	$2.01
Rate for Payer: Cash Price	$1.84
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$2.68
Rate for Payer: Health Smart Auto/Commercial	$2.01
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$2.01
Rate for Payer: LLUH Dept of Risk Management WC	$1.84
Rate for Payer: Multiplan Commercial	$2.51

WHITE PETROLATUM-MINERAL OIL 80 %-20 % EYE OINTMENT [119541]

Facility

IP

$2.34

Service Code	NDC 9999-9022-39
Hospital Charge Code	901700029
Hospital Revenue Code	259
Min. Negotiated Rate	$1.29
Max. Negotiated Rate	$1.87
Rate for Payer: Cash Price	$1.29
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$1.87
Rate for Payer: Health Smart Auto/Commercial	$1.40
Rate for Payer: LLUH Dept of Risk Management WC	$1.29
Rate for Payer: Multiplan Commercial	$1.75

WHITE PETROLATUM-MINERAL OIL 80 %-20 % EYE OINTMENT [119541]

Facility

IP

$2.52

Service Code	NDC 1011902239
Hospital Charge Code	901700029
Hospital Revenue Code	259
Min. Negotiated Rate	$1.39
Max. Negotiated Rate	$2.02
Rate for Payer: Cash Price	$1.38
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$2.02
Rate for Payer: Health Smart Auto/Commercial	$1.51
Rate for Payer: LLUH Dept of Risk Management WC	$1.39
Rate for Payer: Multiplan Commercial	$1.89

WHITE PETROLATUM-MINERAL OIL 80 %-20 % EYE OINTMENT [119541]

Facility

OP

$2.52

Service Code	NDC 1011902239
Hospital Charge Code	901700029
Hospital Revenue Code	259
Min. Negotiated Rate	$1.39
Max. Negotiated Rate	$2.02
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$1.51
Rate for Payer: Aetna of CA Government/Medicare	$1.51
Rate for Payer: Cash Price	$1.38
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$2.02
Rate for Payer: Health Smart Auto/Commercial	$1.51
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$1.51
Rate for Payer: LLUH Dept of Risk Management WC	$1.39
Rate for Payer: Multiplan Commercial	$1.89

WHITE PETROLATUM-MINERAL OIL 80 %-20 % EYE OINTMENT [119541]

Facility

OP

$2.34

Service Code	NDC 9999-9022-39
Hospital Charge Code	901700029
Hospital Revenue Code	259
Min. Negotiated Rate	$1.29
Max. Negotiated Rate	$1.87
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$1.40
Rate for Payer: Aetna of CA Government/Medicare	$1.40
Rate for Payer: Cash Price	$1.29
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$1.87
Rate for Payer: Health Smart Auto/Commercial	$1.40
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$1.40
Rate for Payer: LLUH Dept of Risk Management WC	$1.29
Rate for Payer: Multiplan Commercial	$1.75

WHITE PETROLATUM-MINERAL OIL 83 %-15 % EYE OINTMENT [119339]

Facility

IP

$1.85

Service Code	NDC 0904-6488-38
Hospital Charge Code	901700029
Hospital Revenue Code	259
Min. Negotiated Rate	$1.02
Max. Negotiated Rate	$1.48
Rate for Payer: Cash Price	$1.02
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$1.48
Rate for Payer: Health Smart Auto/Commercial	$1.11
Rate for Payer: LLUH Dept of Risk Management WC	$1.02
Rate for Payer: Multiplan Commercial	$1.39

WHITE PETROLATUM-MINERAL OIL 83 %-15 % EYE OINTMENT [119339]

Facility

OP

$1.85

Service Code	NDC 0904-6488-38
Hospital Charge Code	901700029
Hospital Revenue Code	259
Min. Negotiated Rate	$1.02
Max. Negotiated Rate	$1.48
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$1.11
Rate for Payer: Aetna of CA Government/Medicare	$1.11
Rate for Payer: Cash Price	$1.02
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$1.48
Rate for Payer: Health Smart Auto/Commercial	$1.11
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$1.11
Rate for Payer: LLUH Dept of Risk Management WC	$1.02
Rate for Payer: Multiplan Commercial	$1.39

WHITE PETROLATUM-MINERAL OIL 94 %-3 % EYE OINTMENT [119919]

Facility

IP

$2.45

Service Code	NDC 0065-0518-01
Hospital Charge Code	901700029
Hospital Revenue Code	259
Min. Negotiated Rate	$1.35
Max. Negotiated Rate	$1.96
Rate for Payer: Cash Price	$1.35
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$1.96
Rate for Payer: Health Smart Auto/Commercial	$1.47
Rate for Payer: LLUH Dept of Risk Management WC	$1.35
Rate for Payer: Multiplan Commercial	$1.84

WHITE PETROLATUM-MINERAL OIL 94 %-3 % EYE OINTMENT [119919]

Facility

OP

$2.45

Service Code	NDC 0065-0518-01
Hospital Charge Code	901700029
Hospital Revenue Code	259
Min. Negotiated Rate	$1.35
Max. Negotiated Rate	$1.96
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$1.47
Rate for Payer: Aetna of CA Government/Medicare	$1.47
Rate for Payer: Cash Price	$1.35
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$1.96
Rate for Payer: Health Smart Auto/Commercial	$1.47
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$1.47
Rate for Payer: LLUH Dept of Risk Management WC	$1.35
Rate for Payer: Multiplan Commercial	$1.84

WHITE PETROLATUM-MINERAL OIL TOPICAL OINTMENT [115913]

Facility

IP

$0.10

Service Code	NDC 4628750704
Hospital Charge Code	901700029
Hospital Revenue Code	259
Min. Negotiated Rate	$0.06
Max. Negotiated Rate	$0.08
Rate for Payer: Cash Price	$0.06
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO 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 Commercial	$0.08

WHITE PETROLATUM-MINERAL OIL TOPICAL OINTMENT [115913]

Facility

OP

$0.10

Service Code	NDC 4628750704
Hospital Charge Code	901700029
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	$0.06
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$0.08
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 Commercial	$0.08

ZIDOVUDINE 10 MG/ML ORAL SYRUP [11693]

Facility

IP

$0.18

Service Code	HCPCS S0104
Hospital Charge Code	901700029
Hospital Revenue Code	259
Min. Negotiated Rate	$0.10
Max. Negotiated Rate	$0.14
Rate for Payer: Cash Price	$0.10
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$0.14
Rate for Payer: Health Smart Auto/Commercial	$0.11
Rate for Payer: LLUH Dept of Risk Management WC	$0.10
Rate for Payer: Multiplan Commercial	$0.14

ZIDOVUDINE 10 MG/ML ORAL SYRUP [11693]

Facility

OP

$0.18

Service Code	HCPCS S0104
Hospital Charge Code	901700029
Hospital Revenue Code	259
Min. Negotiated Rate	$0.10
Max. Negotiated Rate	$0.14
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$0.11
Rate for Payer: Aetna of CA Government/Medicare	$0.11
Rate for Payer: Cash Price	$0.10
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$0.14
Rate for Payer: Health Smart Auto/Commercial	$0.11
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$0.11
Rate for Payer: LLUH Dept of Risk Management WC	$0.10
Rate for Payer: Multiplan Commercial	$0.14

ZINC CHLORIDE 1 MG/ML INTRAVENOUS SOLUTION [8865]

Facility

IP

$2.84

Service Code	NDC 51754-0102-4
Hospital Charge Code	901700004
Hospital Revenue Code	250
Min. Negotiated Rate	$1.56
Max. Negotiated Rate	$2.27
Rate for Payer: Cash Price	$1.56
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$2.27
Rate for Payer: Health Smart Auto/Commercial	$1.70
Rate for Payer: LLUH Dept of Risk Management WC	$1.56
Rate for Payer: Multiplan Commercial	$2.13

ZINC CHLORIDE 1 MG/ML INTRAVENOUS SOLUTION [8865]

Facility

OP

$2.84

Service Code	NDC 51754-0102-4
Hospital Charge Code	901700004
Hospital Revenue Code	250
Min. Negotiated Rate	$1.56
Max. Negotiated Rate	$2.27
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$1.70
Rate for Payer: Aetna of CA Government/Medicare	$1.70
Rate for Payer: Cash Price	$1.56
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$2.27
Rate for Payer: Health Smart Auto/Commercial	$1.70
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$1.70
Rate for Payer: LLUH Dept of Risk Management WC	$1.56
Rate for Payer: Multiplan Commercial	$2.13

ZINC CHLORIDE 1 MG/ML INTRAVENOUS SOLUTION [8865]

Facility

OP

$2.84

Service Code	NDC 51754-0102-1
Hospital Charge Code	901700004
Hospital Revenue Code	250
Min. Negotiated Rate	$1.56
Max. Negotiated Rate	$2.27
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$1.70
Rate for Payer: Aetna of CA Government/Medicare	$1.70
Rate for Payer: Cash Price	$1.56
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$2.27
Rate for Payer: Health Smart Auto/Commercial	$1.70
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$1.70
Rate for Payer: LLUH Dept of Risk Management WC	$1.56
Rate for Payer: Multiplan Commercial	$2.13

ZINC CHLORIDE 1 MG/ML INTRAVENOUS SOLUTION [8865]

Facility

OP

$2.84

Service Code	NDC 0409-4090-11
Hospital Charge Code	901700004
Hospital Revenue Code	250
Min. Negotiated Rate	$1.56
Max. Negotiated Rate	$2.27
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$1.70
Rate for Payer: Aetna of CA Government/Medicare	$1.70
Rate for Payer: Cash Price	$1.56
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$2.27
Rate for Payer: Health Smart Auto/Commercial	$1.70
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$1.70
Rate for Payer: LLUH Dept of Risk Management WC	$1.56
Rate for Payer: Multiplan Commercial	$2.13

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