Price Transparency

Know your out-of-pocket cost for care.

All Charges

Charge

Type

Setting

Price

URSODIOL 300 MG CAPSULE [11624]

Facility

OP

$1.26

Service Code	NDC 70710-1483-1
Hospital Charge Code	1711256
Hospital Revenue Code	259
Min. Negotiated Rate	$0.69
Max. Negotiated Rate	$0.95
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$0.76
Rate for Payer: Aetna of CA Government/Medicare	$0.76
Rate for Payer: Cash Price	$0.57
Rate for Payer: Health Smart Auto/Commercial	$0.76
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$0.76
Rate for Payer: LLUH Dept of Risk Management WC	$0.69
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$0.95

URSODIOL 300 MG CAPSULE [11624]

Facility

OP

$7.15

Service Code	NDC 60687-100-01
Hospital Charge Code	1711256
Hospital Revenue Code	259
Min. Negotiated Rate	$3.93
Max. Negotiated Rate	$5.36
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$4.29
Rate for Payer: Aetna of CA Government/Medicare	$4.29
Rate for Payer: Cash Price	$3.22
Rate for Payer: Health Smart Auto/Commercial	$4.29
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$4.29
Rate for Payer: LLUH Dept of Risk Management WC	$3.93
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$5.36

URSODIOL 300 MG CAPSULE [11624]

Facility

IP

$1.26

Service Code	NDC 70710-1483-1
Hospital Charge Code	1711256
Hospital Revenue Code	259
Min. Negotiated Rate	$0.69
Max. Negotiated Rate	$1.01
Rate for Payer: Cash Price	$0.57
Rate for Payer: Cigna of CA HMO/PPO	$1.01
Rate for Payer: Health Smart Auto/Commercial	$0.76
Rate for Payer: LLUH Dept of Risk Management WC	$0.69
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$0.95

URSODIOL 300 MG CAPSULE [11624]

Facility

IP

$7.50

Service Code	NDC 42806-503-01
Hospital Charge Code	1711256
Hospital Revenue Code	259
Min. Negotiated Rate	$4.12
Max. Negotiated Rate	$6.00
Rate for Payer: Cash Price	$3.38
Rate for Payer: Cigna of CA HMO/PPO	$6.00
Rate for Payer: Health Smart Auto/Commercial	$4.50
Rate for Payer: LLUH Dept of Risk Management WC	$4.12
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$5.62

URSODIOL 300 MG CAPSULE [11624]

Facility

OP

$3.06

Service Code	NDC 0378-1730-01
Hospital Charge Code	1711256
Hospital Revenue Code	259
Min. Negotiated Rate	$1.68
Max. Negotiated Rate	$2.30
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$1.84
Rate for Payer: Aetna of CA Government/Medicare	$1.84
Rate for Payer: Cash Price	$1.38
Rate for Payer: Health Smart Auto/Commercial	$1.84
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$1.84
Rate for Payer: LLUH Dept of Risk Management WC	$1.68
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$2.30

URSODIOL 300 MG CAPSULE [11624]

Facility

IP

$1.23

Service Code	NDC 0591-3159-01
Hospital Charge Code	1711256
Hospital Revenue Code	259
Min. Negotiated Rate	$0.68
Max. Negotiated Rate	$0.98
Rate for Payer: Cash Price	$0.55
Rate for Payer: Cigna of CA HMO/PPO	$0.98
Rate for Payer: Health Smart Auto/Commercial	$0.74
Rate for Payer: LLUH Dept of Risk Management WC	$0.68
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$0.92

URSODIOL 300 MG CAPSULE [11624]

Facility

IP

$7.15

Service Code	NDC 60687-100-01
Hospital Charge Code	1711256
Hospital Revenue Code	259
Min. Negotiated Rate	$3.93
Max. Negotiated Rate	$5.72
Rate for Payer: Cash Price	$3.22
Rate for Payer: Cigna of CA HMO/PPO	$5.72
Rate for Payer: Health Smart Auto/Commercial	$4.29
Rate for Payer: LLUH Dept of Risk Management WC	$3.93
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$5.36

URSODIOL 300 MG CAPSULE [11624]

Facility

OP

$7.50

Service Code	NDC 42806-503-01
Hospital Charge Code	1711256
Hospital Revenue Code	259
Min. Negotiated Rate	$4.12
Max. Negotiated Rate	$5.62
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$4.50
Rate for Payer: Aetna of CA Government/Medicare	$4.50
Rate for Payer: Cash Price	$3.38
Rate for Payer: Health Smart Auto/Commercial	$4.50
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$4.50
Rate for Payer: LLUH Dept of Risk Management WC	$4.12
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$5.62

URSODIOL 300 MG CAPSULE [11624]

Facility

OP

$7.15

Service Code	NDC 60687-100-11
Hospital Charge Code	1711256
Hospital Revenue Code	259
Min. Negotiated Rate	$3.93
Max. Negotiated Rate	$5.36
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$4.29
Rate for Payer: Aetna of CA Government/Medicare	$4.29
Rate for Payer: Cash Price	$3.22
Rate for Payer: Health Smart Auto/Commercial	$4.29
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$4.29
Rate for Payer: LLUH Dept of Risk Management WC	$3.93
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$5.36

URSODIOL 300 MG CAPSULE [11624]

Facility

IP

$1.50

Service Code	NDC 0527-1326-01
Hospital Charge Code	1711256
Hospital Revenue Code	259
Min. Negotiated Rate	$0.83
Max. Negotiated Rate	$1.20
Rate for Payer: Cash Price	$0.68
Rate for Payer: Cigna of CA HMO/PPO	$1.20
Rate for Payer: Health Smart Auto/Commercial	$0.90
Rate for Payer: LLUH Dept of Risk Management WC	$0.83
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$1.12

URSODIOL 300 MG CAPSULE [11624]

Facility

IP

$3.06

Service Code	NDC 0378-1730-01
Hospital Charge Code	1711256
Hospital Revenue Code	259
Min. Negotiated Rate	$1.68
Max. Negotiated Rate	$2.45
Rate for Payer: Cash Price	$1.38
Rate for Payer: Cigna of CA HMO/PPO	$2.45
Rate for Payer: Health Smart Auto/Commercial	$1.84
Rate for Payer: LLUH Dept of Risk Management WC	$1.68
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$2.30

URSODIOL 300 MG CAPSULE [11624]

Facility

IP

$9.20

Service Code	NDC 50268-796-11
Hospital Charge Code	1711256
Hospital Revenue Code	259
Min. Negotiated Rate	$5.06
Max. Negotiated Rate	$7.36
Rate for Payer: Cash Price	$4.14
Rate for Payer: Cigna of CA HMO/PPO	$7.36
Rate for Payer: Health Smart Auto/Commercial	$5.52
Rate for Payer: LLUH Dept of Risk Management WC	$5.06
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$6.90

URSODIOL ORAL SUSPENSION COMPOUND 60 MG/ML [4080354]

Facility

IP

$1.50

Service Code	NDC 9994-0803-54
Hospital Charge Code	1715942
Hospital Revenue Code	259
Min. Negotiated Rate	$0.83
Max. Negotiated Rate	$1.20
Rate for Payer: Cash Price	$0.68
Rate for Payer: Cigna of CA HMO/PPO	$1.20
Rate for Payer: Health Smart Auto/Commercial	$0.90
Rate for Payer: LLUH Dept of Risk Management WC	$0.83
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$1.12

URSODIOL ORAL SUSPENSION COMPOUND 60 MG/ML [4080354]

Facility

OP

$1.50

Service Code	NDC 9994-0803-54
Hospital Charge Code	1715942
Hospital Revenue Code	259
Min. Negotiated Rate	$0.83
Max. Negotiated Rate	$1.12
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$0.90
Rate for Payer: Aetna of CA Government/Medicare	$0.90
Rate for Payer: Cash Price	$0.68
Rate for Payer: Health Smart Auto/Commercial	$0.90
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$0.90
Rate for Payer: LLUH Dept of Risk Management WC	$0.83
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$1.12

USTEKINUMAB 130 MG/26 ML INTRAVENOUS SOLUTION [215734]

Facility

OP

$88.99

Service Code	CPT J3358
Hospital Charge Code	NDG215734
Hospital Revenue Code	636
Min. Negotiated Rate	$48.94
Max. Negotiated Rate	$66.74
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$53.39
Rate for Payer: Aetna of CA Government/Medicare	$53.39
Rate for Payer: Cash Price	$40.05
Rate for Payer: Health Smart Auto/Commercial	$53.39
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$53.39
Rate for Payer: LLUH Dept of Risk Management WC	$48.94
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$66.74

USTEKINUMAB 130 MG/26 ML INTRAVENOUS SOLUTION [215734]

Facility

IP

$88.99

Service Code	CPT J3358
Hospital Charge Code	NDG215734
Hospital Revenue Code	636
Min. Negotiated Rate	$48.94
Max. Negotiated Rate	$71.19
Rate for Payer: Cash Price	$40.05
Rate for Payer: Cigna of CA HMO/PPO	$71.19
Rate for Payer: Health Smart Auto/Commercial	$53.39
Rate for Payer: LLUH Dept of Risk Management WC	$48.94
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$66.74

USTEKINUMAB 90 MG/ML SUBCUTANEOUS SYRINGE [108054]

Facility

OP

$31,820.40

Service Code	CPT J3357
Hospital Charge Code	NDG108054
Hospital Revenue Code	636
Min. Negotiated Rate	$17,501.22
Max. Negotiated Rate	$23,865.30
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$19,092.24
Rate for Payer: Aetna of CA Government/Medicare	$19,092.24
Rate for Payer: Cash Price	$14,319.18
Rate for Payer: Health Smart Auto/Commercial	$19,092.24
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$19,092.24
Rate for Payer: LLUH Dept of Risk Management WC	$17,501.22
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$23,865.30

USTEKINUMAB 90 MG/ML SUBCUTANEOUS SYRINGE [108054]

Facility

IP

$31,820.40

Service Code	CPT J3357
Hospital Charge Code	NDG108054
Hospital Revenue Code	636
Min. Negotiated Rate	$17,501.22
Max. Negotiated Rate	$25,456.32
Rate for Payer: Cash Price	$14,319.18
Rate for Payer: Cigna of CA HMO/PPO	$25,456.32
Rate for Payer: Health Smart Auto/Commercial	$19,092.24
Rate for Payer: LLUH Dept of Risk Management WC	$17,501.22
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$23,865.30

VALACYCLOVIR 500 MG TABLET [13133]

Facility

IP

$3.84

Service Code	NDC 68084-215-11
Hospital Charge Code	1710891
Hospital Revenue Code	259
Min. Negotiated Rate	$2.11
Max. Negotiated Rate	$3.07
Rate for Payer: Cash Price	$1.73
Rate for Payer: Cigna of CA HMO/PPO	$3.07
Rate for Payer: Health Smart Auto/Commercial	$2.30
Rate for Payer: LLUH Dept of Risk Management WC	$2.11
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$2.88

VALACYCLOVIR 500 MG TABLET [13133]

Facility

IP

$0.98

Service Code	NDC 63304-904-30
Hospital Charge Code	1710891
Hospital Revenue Code	259
Min. Negotiated Rate	$0.54
Max. Negotiated Rate	$0.78
Rate for Payer: Cash Price	$0.44
Rate for Payer: Cigna of CA HMO/PPO	$0.78
Rate for Payer: Health Smart Auto/Commercial	$0.59
Rate for Payer: LLUH Dept of Risk Management WC	$0.54
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$0.74

VALACYCLOVIR 500 MG TABLET [13133]

Facility

IP

$0.48

Service Code	NDC 0378-4275-93
Hospital Charge Code	1710891
Hospital Revenue Code	259
Min. Negotiated Rate	$0.26
Max. Negotiated Rate	$0.38
Rate for Payer: Cash Price	$0.22
Rate for Payer: Cigna of CA HMO/PPO	$0.38
Rate for Payer: Health Smart Auto/Commercial	$0.29
Rate for Payer: LLUH Dept of Risk Management WC	$0.26
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$0.36

VALACYCLOVIR 500 MG TABLET [13133]

Facility

OP

$0.48

Service Code	NDC 0378-4275-93
Hospital Charge Code	1710891
Hospital Revenue Code	259
Min. Negotiated Rate	$0.26
Max. Negotiated Rate	$0.36
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$0.29
Rate for Payer: Aetna of CA Government/Medicare	$0.29
Rate for Payer: Cash Price	$0.22
Rate for Payer: Health Smart Auto/Commercial	$0.29
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$0.29
Rate for Payer: LLUH Dept of Risk Management WC	$0.26
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$0.36

VALACYCLOVIR 500 MG TABLET [13133]

Facility

IP

$0.98

Service Code	NDC 31722-704-30
Hospital Charge Code	1710891
Hospital Revenue Code	259
Min. Negotiated Rate	$0.54
Max. Negotiated Rate	$0.78
Rate for Payer: Cash Price	$0.44
Rate for Payer: Cigna of CA HMO/PPO	$0.78
Rate for Payer: Health Smart Auto/Commercial	$0.59
Rate for Payer: LLUH Dept of Risk Management WC	$0.54
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$0.74

VALACYCLOVIR 500 MG TABLET [13133]

Facility

IP

$0.98

Service Code	NDC 31722-704-90
Hospital Charge Code	1710891
Hospital Revenue Code	259
Min. Negotiated Rate	$0.54
Max. Negotiated Rate	$0.78
Rate for Payer: Cash Price	$0.44
Rate for Payer: Cigna of CA HMO/PPO	$0.78
Rate for Payer: Health Smart Auto/Commercial	$0.59
Rate for Payer: LLUH Dept of Risk Management WC	$0.54
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$0.74

VALACYCLOVIR 500 MG TABLET [13133]

Facility

OP

$0.47

Service Code	NDC 0378-4275-77
Hospital Charge Code	1710891
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

<<
<
733
734
735
736
737
738
739
740
741
742
>
>>