Price Transparency

Know your out-of-pocket cost for care.

All Charges

Charge

Type

Setting

Price

SPIRONOLACTONE 50 MG TABLET [11426]

Facility

IP

$0.34

Service Code	NDC 53489-328-01
Hospital Charge Code	1710103
Hospital Revenue Code	259
Min. Negotiated Rate	$0.19
Max. Negotiated Rate	$0.27
Rate for Payer: Cash Price	$0.15
Rate for Payer: Cigna of CA 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 Beech St/Commercial/PHCS	$0.26

SPIRONOLACTONE 50 MG TABLET [11426]

Facility

IP

$0.55

Service Code	NDC 60687-476-01
Hospital Charge Code	1710103
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

SPIRONOLACTONE 50 MG TABLET [11426]

Facility

OP

$0.55

Service Code	NDC 60687-476-11
Hospital Charge Code	1710103
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

SPIRONOLACTONE 50 MG TABLET [11426]

Facility

OP

$0.36

Service Code	NDC 16729-226-01
Hospital Charge Code	1710103
Hospital Revenue Code	259
Min. Negotiated Rate	$0.20
Max. Negotiated Rate	$0.27
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$0.22
Rate for Payer: Aetna of CA Government/Medicare	$0.22
Rate for Payer: Cash Price	$0.16
Rate for Payer: Health Smart Auto/Commercial	$0.22
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$0.22
Rate for Payer: LLUH Dept of Risk Management WC	$0.20
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$0.27

SPIRONOLACTONE 50 MG TABLET [11426]

Facility

IP

$0.55

Service Code	NDC 60687-476-11
Hospital Charge Code	1710103
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

SPIRONOLACTONE 50 MG TABLET [11426]

Facility

OP

$0.55

Service Code	NDC 60687-476-01
Hospital Charge Code	1710103
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

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

Facility

IP

$0.09

Service Code	NDC 9994-0803-40
Hospital Charge Code	1715090
Hospital Revenue Code	259
Min. Negotiated Rate	$0.05
Max. Negotiated Rate	$0.07
Rate for Payer: Cash Price	$0.04
Rate for Payer: Cigna of CA 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 Beech St/Commercial/PHCS	$0.07

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

Facility

OP

$0.09

Service Code	NDC 9994-0803-40
Hospital Charge Code	1715090
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	$0.04
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	$0.05
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$0.07

SPIRONOLACTONE ORAL SUSPENSION COMPOUND 2.5 MG/ML [4080339]

Facility

OP

$0.47

Service Code	NDC 9994-0803-39
Hospital Charge Code	1715003
Hospital Revenue Code	259
Min. Negotiated Rate	$0.26
Max. Negotiated Rate	$0.35
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	$0.21
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 Beech St/Commercial/PHCS	$0.35

SPIRONOLACTONE ORAL SUSPENSION COMPOUND 2.5 MG/ML [4080339]

Facility

IP

$0.47

Service Code	NDC 9994-0803-39
Hospital Charge Code	1715003
Hospital Revenue Code	259
Min. Negotiated Rate	$0.26
Max. Negotiated Rate	$0.38
Rate for Payer: Cash Price	$0.21
Rate for Payer: Cigna of CA 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 Beech St/Commercial/PHCS	$0.35

STERILE TALC 4 GRAM INTRAPLEURAL SUSPENSION [221295]

Facility

OP

$190.80

Service Code	NDC 62327-444-04
Hospital Charge Code	ERX221295
Hospital Revenue Code	250
Min. Negotiated Rate	$104.94
Max. Negotiated Rate	$143.10
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$114.48
Rate for Payer: Aetna of CA Government/Medicare	$114.48
Rate for Payer: Cash Price	$85.86
Rate for Payer: Health Smart Auto/Commercial	$114.48
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$114.48
Rate for Payer: LLUH Dept of Risk Management WC	$104.94
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$143.10

STERILE TALC 4 GRAM INTRAPLEURAL SUSPENSION [221295]

Facility

OP

$190.80

Service Code	NDC 62327-444-44
Hospital Charge Code	ERX221295
Hospital Revenue Code	250
Min. Negotiated Rate	$104.94
Max. Negotiated Rate	$143.10
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$114.48
Rate for Payer: Aetna of CA Government/Medicare	$114.48
Rate for Payer: Cash Price	$85.86
Rate for Payer: Health Smart Auto/Commercial	$114.48
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$114.48
Rate for Payer: LLUH Dept of Risk Management WC	$104.94
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$143.10

STERILE TALC 4 GRAM INTRAPLEURAL SUSPENSION [221295]

Facility

IP

$190.80

Service Code	NDC 62327-444-04
Hospital Charge Code	ERX221295
Hospital Revenue Code	250
Min. Negotiated Rate	$104.94
Max. Negotiated Rate	$152.64
Rate for Payer: Cash Price	$85.86
Rate for Payer: Cigna of CA HMO/PPO	$152.64
Rate for Payer: Health Smart Auto/Commercial	$114.48
Rate for Payer: LLUH Dept of Risk Management WC	$104.94
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$143.10

STERILE TALC 4 GRAM INTRAPLEURAL SUSPENSION [221295]

Facility

IP

$190.80

Service Code	NDC 62327-444-44
Hospital Charge Code	ERX221295
Hospital Revenue Code	250
Min. Negotiated Rate	$104.94
Max. Negotiated Rate	$152.64
Rate for Payer: Cash Price	$85.86
Rate for Payer: Cigna of CA HMO/PPO	$152.64
Rate for Payer: Health Smart Auto/Commercial	$114.48
Rate for Payer: LLUH Dept of Risk Management WC	$104.94
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$143.10

STERILE TALC 5 GRAM INTRAPLEURAL SUSPENSION [37812]

Facility

IP

$119.40

Service Code	NDC 63256-200-05
Hospital Charge Code	1756020
Hospital Revenue Code	250
Min. Negotiated Rate	$65.67
Max. Negotiated Rate	$95.52
Rate for Payer: Cash Price	$53.73
Rate for Payer: Cigna of CA 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 Beech St/Commercial/PHCS	$89.55

STERILE TALC 5 GRAM INTRAPLEURAL SUSPENSION [37812]

Facility

OP

$119.40

Service Code	NDC 63256-200-05
Hospital Charge Code	1756020
Hospital Revenue Code	250
Min. Negotiated Rate	$65.67
Max. Negotiated Rate	$89.55
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	$53.73
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 Beech St/Commercial/PHCS	$89.55

STREPTOMYCIN 1 GRAM INTRAMUSCULAR SOLUTION [7508]

Facility

IP

$90.00

Service Code	CPT J3000
Hospital Charge Code	1720358
Hospital Revenue Code	636
Min. Negotiated Rate	$49.50
Max. Negotiated Rate	$72.00
Rate for Payer: Cash Price	$40.50
Rate for Payer: Cigna of CA HMO/PPO	$72.00
Rate for Payer: Health Smart Auto/Commercial	$54.00
Rate for Payer: LLUH Dept of Risk Management WC	$49.50
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$67.50

STREPTOMYCIN 1 GRAM INTRAMUSCULAR SOLUTION [7508]

Facility

OP

$90.00

Service Code	CPT J3000
Hospital Charge Code	1720358
Hospital Revenue Code	636
Min. Negotiated Rate	$49.50
Max. Negotiated Rate	$67.50
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$54.00
Rate for Payer: Aetna of CA Government/Medicare	$54.00
Rate for Payer: Cash Price	$40.50
Rate for Payer: Health Smart Auto/Commercial	$54.00
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$54.00
Rate for Payer: LLUH Dept of Risk Management WC	$49.50
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$67.50

SUCCIMER 100 MG CAPSULE [11438]

Facility

OP

$28.85

Service Code	NDC 55292-201-11
Hospital Charge Code	ERX11438
Hospital Revenue Code	250
Min. Negotiated Rate	$15.87
Max. Negotiated Rate	$21.64
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$17.31
Rate for Payer: Aetna of CA Government/Medicare	$17.31
Rate for Payer: Cash Price	$12.98
Rate for Payer: Health Smart Auto/Commercial	$17.31
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$17.31
Rate for Payer: LLUH Dept of Risk Management WC	$15.87
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$21.64

SUCCIMER 100 MG CAPSULE [11438]

Facility

IP

$28.85

Service Code	NDC 55292-201-11
Hospital Charge Code	ERX11438
Hospital Revenue Code	250
Min. Negotiated Rate	$15.87
Max. Negotiated Rate	$23.08
Rate for Payer: Cash Price	$12.98
Rate for Payer: Cigna of CA HMO/PPO	$23.08
Rate for Payer: Health Smart Auto/Commercial	$17.31
Rate for Payer: LLUH Dept of Risk Management WC	$15.87
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$21.64

SUCCINYLCHOLINE CHLORIDE 100 MG/5 ML (20 MG/ML) INTRAVENOUS SYRINGE [121307]

Facility

IP

$5.15

Service Code	CPT J0330
Hospital Charge Code	ERX121307
Hospital Revenue Code	636
Min. Negotiated Rate	$2.83
Max. Negotiated Rate	$4.12
Rate for Payer: Cash Price	$2.32
Rate for Payer: Cigna of CA HMO/PPO	$4.12
Rate for Payer: Health Smart Auto/Commercial	$3.09
Rate for Payer: LLUH Dept of Risk Management WC	$2.83
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$3.86

SUCCINYLCHOLINE CHLORIDE 100 MG/5 ML (20 MG/ML) INTRAVENOUS SYRINGE [121307]

Facility

OP

$5.15

Service Code	CPT J0330
Hospital Charge Code	ERX121307
Hospital Revenue Code	636
Min. Negotiated Rate	$2.83
Max. Negotiated Rate	$3.86
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$3.09
Rate for Payer: Aetna of CA Government/Medicare	$3.09
Rate for Payer: Cash Price	$2.32
Rate for Payer: Health Smart Auto/Commercial	$3.09
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$3.09
Rate for Payer: LLUH Dept of Risk Management WC	$2.83
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$3.86

SUCCINYLCHOLINE CHLORIDE 200 MG/10 ML INJECTION VIAL - CODE [4087536]

Facility

OP

$2.33

Service Code	CPT J0330
Hospital Charge Code	1720071
Hospital Revenue Code	636
Min. Negotiated Rate	$1.28
Max. Negotiated Rate	$1.75
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	$1.05
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	$1.28
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$1.75

SUCCINYLCHOLINE CHLORIDE 200 MG/10 ML INJECTION VIAL - CODE [4087536]

Facility

IP

$2.33

Service Code	CPT J0330
Hospital Charge Code	1720071
Hospital Revenue Code	636
Min. Negotiated Rate	$1.28
Max. Negotiated Rate	$1.86
Rate for Payer: Cash Price	$1.05
Rate for Payer: Cigna of CA HMO/PPO	$1.86
Rate for Payer: Health Smart Auto/Commercial	$1.40
Rate for Payer: LLUH Dept of Risk Management WC	$1.28
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$1.75

SUCCINYLCHOLINE CHLORIDE 20 MG/ML INJECTION SOLUTION [7536]

Facility

OP

$1.25

Service Code	CPT J0330
Hospital Charge Code	1720071
Hospital Revenue Code	636
Min. Negotiated Rate	$0.69
Max. Negotiated Rate	$0.94
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$0.75
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$0.43
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$1.38
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$0.61
Rate for Payer: Aetna of CA Government/Medicare	$0.61
Rate for Payer: Aetna of CA Government/Medicare	$0.75
Rate for Payer: Aetna of CA Government/Medicare	$1.38
Rate for Payer: Aetna of CA Government/Medicare	$0.43
Rate for Payer: Cash Price	$0.56
Rate for Payer: Cash Price	$0.32
Rate for Payer: Cash Price	$1.04
Rate for Payer: Cash Price	$0.46
Rate for Payer: Health Smart Auto/Commercial	$1.38
Rate for Payer: Health Smart Auto/Commercial	$0.61
Rate for Payer: Health Smart Auto/Commercial	$0.75
Rate for Payer: Health Smart Auto/Commercial	$0.43
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$0.43
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$1.38
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$0.61
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$0.75
Rate for Payer: LLUH Dept of Risk Management WC	$0.69
Rate for Payer: LLUH Dept of Risk Management WC	$0.56
Rate for Payer: LLUH Dept of Risk Management WC	$1.26
Rate for Payer: LLUH Dept of Risk Management WC	$0.40
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$1.72
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$0.94
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$0.77
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$0.54

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