Price Transparency

Know your out-of-pocket cost for care.

All Charges

Charge

Type

Setting

Price

CEFDINIR 250 MG/5 ML ORAL SUSPENSION [39522]

Facility

OP

$0.18

Service Code	NDC 67877-548-88
Hospital Charge Code	NDG39522
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	$0.08
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 Beech St/Commercial/PHCS	$0.14

CEFDINIR 300 MG CAPSULE [22289]

Facility

OP

$1.00

Service Code	NDC 65862-177-60
Hospital Charge Code	ERX22289
Hospital Revenue Code	259
Min. Negotiated Rate	$0.55
Max. Negotiated Rate	$0.75
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$0.60
Rate for Payer: Aetna of CA Government/Medicare	$0.60
Rate for Payer: Cash Price	$0.45
Rate for Payer: Health Smart Auto/Commercial	$0.60
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$0.60
Rate for Payer: LLUH Dept of Risk Management WC	$0.55
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$0.75

CEFDINIR 300 MG CAPSULE [22289]

Facility

OP

$1.45

Service Code	NDC 68001-362-06
Hospital Charge Code	ERX22289
Hospital Revenue Code	259
Min. Negotiated Rate	$0.80
Max. Negotiated Rate	$1.09
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$0.87
Rate for Payer: Aetna of CA Government/Medicare	$0.87
Rate for Payer: Cash Price	$0.65
Rate for Payer: Health Smart Auto/Commercial	$0.87
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$0.87
Rate for Payer: LLUH Dept of Risk Management WC	$0.80
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$1.09

CEFDINIR 300 MG CAPSULE [22289]

Facility

IP

$1.00

Service Code	NDC 65862-177-60
Hospital Charge Code	ERX22289
Hospital Revenue Code	259
Min. Negotiated Rate	$0.55
Max. Negotiated Rate	$0.80
Rate for Payer: Cash Price	$0.45
Rate for Payer: Cigna of CA HMO/PPO	$0.80
Rate for Payer: Health Smart Auto/Commercial	$0.60
Rate for Payer: LLUH Dept of Risk Management WC	$0.55
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$0.75

CEFDINIR 300 MG CAPSULE [22289]

Facility

IP

$1.00

Service Code	NDC 57237-099-60
Hospital Charge Code	ERX22289
Hospital Revenue Code	259
Min. Negotiated Rate	$0.55
Max. Negotiated Rate	$0.80
Rate for Payer: Cash Price	$0.45
Rate for Payer: Cigna of CA HMO/PPO	$0.80
Rate for Payer: Health Smart Auto/Commercial	$0.60
Rate for Payer: LLUH Dept of Risk Management WC	$0.55
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$0.75

CEFDINIR 300 MG CAPSULE [22289]

Facility

IP

$1.45

Service Code	NDC 68001-362-06
Hospital Charge Code	ERX22289
Hospital Revenue Code	259
Min. Negotiated Rate	$0.80
Max. Negotiated Rate	$1.16
Rate for Payer: Cash Price	$0.65
Rate for Payer: Cigna of CA HMO/PPO	$1.16
Rate for Payer: Health Smart Auto/Commercial	$0.87
Rate for Payer: LLUH Dept of Risk Management WC	$0.80
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$1.09

CEFDINIR 300 MG CAPSULE [22289]

Facility

OP

$1.00

Service Code	NDC 57237-099-60
Hospital Charge Code	ERX22289
Hospital Revenue Code	259
Min. Negotiated Rate	$0.55
Max. Negotiated Rate	$0.75
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$0.60
Rate for Payer: Aetna of CA Government/Medicare	$0.60
Rate for Payer: Cash Price	$0.45
Rate for Payer: Health Smart Auto/Commercial	$0.60
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$0.60
Rate for Payer: LLUH Dept of Risk Management WC	$0.55
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$0.75

CEFEPIME 100 GRAM INTRAVENOUS SOLUTION [223402]

Facility

IP

$540.00

Service Code	CPT J0692
Hospital Charge Code	ERX223402
Hospital Revenue Code	636
Min. Negotiated Rate	$297.00
Max. Negotiated Rate	$432.00
Rate for Payer: Cash Price	$243.00
Rate for Payer: Cigna of CA HMO/PPO	$432.00
Rate for Payer: Health Smart Auto/Commercial	$324.00
Rate for Payer: LLUH Dept of Risk Management WC	$297.00
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$405.00

CEFEPIME 100 GRAM INTRAVENOUS SOLUTION [223402]

Facility

OP

$540.00

Service Code	CPT J0692
Hospital Charge Code	ERX223402
Hospital Revenue Code	636
Min. Negotiated Rate	$297.00
Max. Negotiated Rate	$405.00
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$324.00
Rate for Payer: Aetna of CA Government/Medicare	$324.00
Rate for Payer: Cash Price	$243.00
Rate for Payer: Health Smart Auto/Commercial	$324.00
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$324.00
Rate for Payer: LLUH Dept of Risk Management WC	$297.00
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$405.00

CEFEPIME 1 GRAM SOLUTION FOR INJECTION [16369]

Facility

OP

$6.06

Service Code	CPT J0692
Hospital Charge Code	1750496
Hospital Revenue Code	636
Min. Negotiated Rate	$3.33
Max. Negotiated Rate	$4.54
Rate for Payer: Health Smart Auto/Commercial	$3.64
Rate for Payer: Health Smart Auto/Commercial	$4.32
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$3.64
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$4.32
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$3.63
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$4.57
Rate for Payer: Aetna of CA Government/Medicare	$3.63
Rate for Payer: Aetna of CA Government/Medicare	$3.64
Rate for Payer: Aetna of CA Government/Medicare	$4.57
Rate for Payer: Aetna of CA Government/Medicare	$4.32
Rate for Payer: Cash Price	$3.43
Rate for Payer: Cash Price	$2.73
Rate for Payer: Cash Price	$3.24
Rate for Payer: Cash Price	$2.72
Rate for Payer: Health Smart Auto/Commercial	$4.57
Rate for Payer: Health Smart Auto/Commercial	$3.63
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$4.32
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$3.64
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$3.63
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$4.57
Rate for Payer: LLUH Dept of Risk Management WC	$4.19
Rate for Payer: LLUH Dept of Risk Management WC	$3.96
Rate for Payer: LLUH Dept of Risk Management WC	$3.33
Rate for Payer: LLUH Dept of Risk Management WC	$3.33
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$5.40
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$5.72
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$4.54
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$4.54

CEFEPIME 1 GRAM SOLUTION FOR INJECTION [16369]

Facility

IP

$6.06

Service Code	CPT J0692
Hospital Charge Code	1750496
Hospital Revenue Code	636
Min. Negotiated Rate	$3.33
Max. Negotiated Rate	$4.85
Rate for Payer: Cash Price	$2.73
Rate for Payer: Cash Price	$3.24
Rate for Payer: Cash Price	$3.43
Rate for Payer: Cash Price	$2.72
Rate for Payer: Cigna of CA HMO/PPO	$6.10
Rate for Payer: Cigna of CA HMO/PPO	$5.76
Rate for Payer: Cigna of CA HMO/PPO	$4.84
Rate for Payer: Cigna of CA HMO/PPO	$4.85
Rate for Payer: Health Smart Auto/Commercial	$4.57
Rate for Payer: Health Smart Auto/Commercial	$4.32
Rate for Payer: Health Smart Auto/Commercial	$3.64
Rate for Payer: Health Smart Auto/Commercial	$3.63
Rate for Payer: LLUH Dept of Risk Management WC	$3.33
Rate for Payer: LLUH Dept of Risk Management WC	$3.33
Rate for Payer: LLUH Dept of Risk Management WC	$3.96
Rate for Payer: LLUH Dept of Risk Management WC	$4.19
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$5.40
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$4.54
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$4.54
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$5.72

CEFEPIME 2 GRAM SOLUTION FOR INJECTION (100 MG/ML IVPB) [16371]

Facility

IP

$11.76

Service Code	CPT J0692
Hospital Charge Code	1720938
Hospital Revenue Code	636
Min. Negotiated Rate	$6.47
Max. Negotiated Rate	$9.41
Rate for Payer: Cash Price	$5.29
Rate for Payer: Cash Price	$5.85
Rate for Payer: Cash Price	$5.43
Rate for Payer: Cash Price	$5.40
Rate for Payer: Cigna of CA HMO/PPO	$9.65
Rate for Payer: Cigna of CA HMO/PPO	$9.41
Rate for Payer: Cigna of CA HMO/PPO	$10.41
Rate for Payer: Cigna of CA HMO/PPO	$9.60
Rate for Payer: Health Smart Auto/Commercial	$7.06
Rate for Payer: Health Smart Auto/Commercial	$7.20
Rate for Payer: Health Smart Auto/Commercial	$7.81
Rate for Payer: Health Smart Auto/Commercial	$7.24
Rate for Payer: LLUH Dept of Risk Management WC	$6.60
Rate for Payer: LLUH Dept of Risk Management WC	$6.47
Rate for Payer: LLUH Dept of Risk Management WC	$7.16
Rate for Payer: LLUH Dept of Risk Management WC	$6.63
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$9.00
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$8.82
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$9.76
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$9.04

CEFEPIME 2 GRAM SOLUTION FOR INJECTION (100 MG/ML IVPB) [16371]

Facility

OP

$12.00

Service Code	CPT J0692
Hospital Charge Code	1720938
Hospital Revenue Code	636
Min. Negotiated Rate	$6.60
Max. Negotiated Rate	$9.00
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$7.20
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$7.24
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$7.81
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$7.06
Rate for Payer: Aetna of CA Government/Medicare	$7.06
Rate for Payer: Aetna of CA Government/Medicare	$7.81
Rate for Payer: Aetna of CA Government/Medicare	$7.24
Rate for Payer: Aetna of CA Government/Medicare	$7.20
Rate for Payer: Cash Price	$5.43
Rate for Payer: Cash Price	$5.85
Rate for Payer: Cash Price	$5.40
Rate for Payer: Cash Price	$5.29
Rate for Payer: Health Smart Auto/Commercial	$7.81
Rate for Payer: Health Smart Auto/Commercial	$7.20
Rate for Payer: Health Smart Auto/Commercial	$7.06
Rate for Payer: Health Smart Auto/Commercial	$7.24
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$7.24
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$7.81
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$7.06
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$7.20
Rate for Payer: LLUH Dept of Risk Management WC	$7.16
Rate for Payer: LLUH Dept of Risk Management WC	$6.60
Rate for Payer: LLUH Dept of Risk Management WC	$6.47
Rate for Payer: LLUH Dept of Risk Management WC	$6.63
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$8.82
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$9.04
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$9.76
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$9.00

CEFEPIME (MAXIPIME) 1G/10ML FROZEN SYRINGE [4081917]

Facility

IP

$0.59

Service Code	CPT J0692
Hospital Charge Code	NDC4081912
Hospital Revenue Code	636
Min. Negotiated Rate	$0.32
Max. Negotiated Rate	$0.47
Rate for Payer: Cash Price	$0.27
Rate for Payer: Cigna of CA HMO/PPO	$0.47
Rate for Payer: Health Smart Auto/Commercial	$0.35
Rate for Payer: LLUH Dept of Risk Management WC	$0.32
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$0.44

CEFEPIME (MAXIPIME) 1G/10ML FROZEN SYRINGE [4081917]

Facility

OP

$0.59

Service Code	CPT J0692
Hospital Charge Code	NDC4081912
Hospital Revenue Code	636
Min. Negotiated Rate	$0.32
Max. Negotiated Rate	$0.44
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$0.35
Rate for Payer: Aetna of CA Government/Medicare	$0.35
Rate for Payer: Cash Price	$0.27
Rate for Payer: Health Smart Auto/Commercial	$0.35
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$0.35
Rate for Payer: LLUH Dept of Risk Management WC	$0.32
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$0.44

CEFEPIME (MAXIPIME) 1G/10ML FROZEN SYRINGE [4081917]

Facility

OP

$0.54

Service Code	CPT J0692
Hospital Charge Code	NDG4081917
Hospital Revenue Code	636
Min. Negotiated Rate	$0.30
Max. Negotiated Rate	$0.41
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$0.32
Rate for Payer: Aetna of CA Government/Medicare	$0.32
Rate for Payer: Cash Price	$0.24
Rate for Payer: Health Smart Auto/Commercial	$0.32
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$0.32
Rate for Payer: LLUH Dept of Risk Management WC	$0.30
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$0.41

CEFEPIME (MAXIPIME) 1G/10ML FROZEN SYRINGE [4081917]

Facility

IP

$0.54

Service Code	CPT J0692
Hospital Charge Code	NDG4081917
Hospital Revenue Code	636
Min. Negotiated Rate	$0.30
Max. Negotiated Rate	$0.43
Rate for Payer: Cash Price	$0.24
Rate for Payer: Cigna of CA HMO/PPO	$0.43
Rate for Payer: Health Smart Auto/Commercial	$0.32
Rate for Payer: LLUH Dept of Risk Management WC	$0.30
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$0.41

CEFEPIME (MAXIPIME) 2G/20ML FROZEN SYRINGE [4081790]

Facility

OP

$0.54

Service Code	CPT J0692
Hospital Charge Code	NDG4081790
Hospital Revenue Code	636
Min. Negotiated Rate	$0.30
Max. Negotiated Rate	$0.41
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$0.32
Rate for Payer: Aetna of CA Government/Medicare	$0.32
Rate for Payer: Cash Price	$0.24
Rate for Payer: Health Smart Auto/Commercial	$0.32
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$0.32
Rate for Payer: LLUH Dept of Risk Management WC	$0.30
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$0.41

CEFEPIME (MAXIPIME) 2G/20ML FROZEN SYRINGE [4081790]

Facility

IP

$0.54

Service Code	CPT J0692
Hospital Charge Code	NDG4081790
Hospital Revenue Code	636
Min. Negotiated Rate	$0.30
Max. Negotiated Rate	$0.43
Rate for Payer: Cash Price	$0.24
Rate for Payer: Cigna of CA HMO/PPO	$0.43
Rate for Payer: Health Smart Auto/Commercial	$0.32
Rate for Payer: LLUH Dept of Risk Management WC	$0.30
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$0.41

CEFEPIME (MAXIPIME) 2G/20ML FROZEN SYRINGE [4081790]

Facility

IP

$0.59

Service Code	CPT J0692
Hospital Charge Code	NDC4081790
Hospital Revenue Code	636
Min. Negotiated Rate	$0.32
Max. Negotiated Rate	$0.47
Rate for Payer: Cash Price	$0.27
Rate for Payer: Cigna of CA HMO/PPO	$0.47
Rate for Payer: Health Smart Auto/Commercial	$0.35
Rate for Payer: LLUH Dept of Risk Management WC	$0.32
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$0.44

CEFEPIME (MAXIPIME) 2G/20ML FROZEN SYRINGE [4081790]

Facility

OP

$0.59

Service Code	CPT J0692
Hospital Charge Code	NDC4081790
Hospital Revenue Code	636
Min. Negotiated Rate	$0.32
Max. Negotiated Rate	$0.44
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$0.35
Rate for Payer: Aetna of CA Government/Medicare	$0.35
Rate for Payer: Cash Price	$0.27
Rate for Payer: Health Smart Auto/Commercial	$0.35
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$0.35
Rate for Payer: LLUH Dept of Risk Management WC	$0.32
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$0.44

CEFIDEROCOL 1 GRAM INTRAVENOUS SOLUTION [227170]

Facility

IP

$251.04

Service Code	CPT J0699
Hospital Charge Code	ERX227170
Hospital Revenue Code	636
Min. Negotiated Rate	$138.07
Max. Negotiated Rate	$200.83
Rate for Payer: Cash Price	$112.97
Rate for Payer: Cigna of CA HMO/PPO	$200.83
Rate for Payer: Health Smart Auto/Commercial	$150.62
Rate for Payer: LLUH Dept of Risk Management WC	$138.07
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$188.28

CEFIDEROCOL 1 GRAM INTRAVENOUS SOLUTION [227170]

Facility

OP

$251.04

Service Code	CPT J0699
Hospital Charge Code	ERX227170
Hospital Revenue Code	636
Min. Negotiated Rate	$138.07
Max. Negotiated Rate	$188.28
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$150.62
Rate for Payer: Aetna of CA Government/Medicare	$150.62
Rate for Payer: Cash Price	$112.97
Rate for Payer: Health Smart Auto/Commercial	$150.62
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$150.62
Rate for Payer: LLUH Dept of Risk Management WC	$138.07
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$188.28

CEFIXIME 200 MG/5 ML ORAL SUSPENSION [81816]

Facility

OP

$8.02

Service Code	NDC 65862-752-75
Hospital Charge Code	NDG81816
Hospital Revenue Code	259
Min. Negotiated Rate	$4.41
Max. Negotiated Rate	$6.02
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$4.81
Rate for Payer: Aetna of CA Government/Medicare	$4.81
Rate for Payer: Cash Price	$3.61
Rate for Payer: Health Smart Auto/Commercial	$4.81
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$4.81
Rate for Payer: LLUH Dept of Risk Management WC	$4.41
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$6.02

CEFIXIME 200 MG/5 ML ORAL SUSPENSION [81816]

Facility

IP

$8.02

Service Code	NDC 65862-752-75
Hospital Charge Code	NDG81816
Hospital Revenue Code	259
Min. Negotiated Rate	$4.41
Max. Negotiated Rate	$6.42
Rate for Payer: Cash Price	$3.61
Rate for Payer: Cigna of CA HMO/PPO	$6.42
Rate for Payer: Health Smart Auto/Commercial	$4.81
Rate for Payer: LLUH Dept of Risk Management WC	$4.41
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$6.02

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