Loma Linda University Behavioral Medicine Center (BMC)

All Charges

Charge

Type

Setting

Price

FLUOCINOLONE 0.01 % TOPICAL BODY OIL [10057]

Facility

$0.37

Service Code	NDC 68791-101-04
Hospital Charge Code	901700029
Hospital Revenue Code	259
Min. Negotiated Rate	$0.20
Max. Negotiated Rate	$0.30
Rate for Payer: Cash Price	$0.20
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$0.30
Rate for Payer: Health Smart Auto/Commercial	$0.22
Rate for Payer: LLUH Dept of Risk Management WC	$0.20
Rate for Payer: Multiplan Commercial	$0.28

FLUOCINOLONE 0.01 % TOPICAL CREAM [3183]

Facility

$2.23

Service Code	NDC 0713-0223-60
Hospital Charge Code	901700029
Hospital Revenue Code	259
Min. Negotiated Rate	$1.23
Max. Negotiated Rate	$1.78
Rate for Payer: Cash Price	$1.23
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$1.78
Rate for Payer: Health Smart Auto/Commercial	$1.34
Rate for Payer: LLUH Dept of Risk Management WC	$1.23
Rate for Payer: Multiplan Commercial	$1.67

FLUOCINOLONE 0.01 % TOPICAL CREAM [3183]

Facility

$3.00

Service Code	NDC 0713-0223-15
Hospital Charge Code	901700029
Hospital Revenue Code	259
Min. Negotiated Rate	$1.65
Max. Negotiated Rate	$2.40
Rate for Payer: Cash Price	$1.65
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$2.40
Rate for Payer: Health Smart Auto/Commercial	$1.80
Rate for Payer: LLUH Dept of Risk Management WC	$1.65
Rate for Payer: Multiplan Commercial	$2.25

FLUOCINOLONE 0.01 % TOPICAL CREAM [3183]

Facility

$3.00

Service Code	NDC 0713-0223-15
Hospital Charge Code	901700029
Hospital Revenue Code	259
Min. Negotiated Rate	$1.65
Max. Negotiated Rate	$2.40
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$1.80
Rate for Payer: Aetna of CA Government/Medicare	$1.80
Rate for Payer: Cash Price	$1.65
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$2.40
Rate for Payer: Health Smart Auto/Commercial	$1.80
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$1.80
Rate for Payer: LLUH Dept of Risk Management WC	$1.65
Rate for Payer: Multiplan Commercial	$2.25

FLUOCINOLONE 0.01 % TOPICAL CREAM [3183]

Facility

$2.97

Service Code	NDC 52565-031-15
Hospital Charge Code	901700029
Hospital Revenue Code	259
Min. Negotiated Rate	$1.63
Max. Negotiated Rate	$2.38
Rate for Payer: Cash Price	$1.63
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$2.38
Rate for Payer: Health Smart Auto/Commercial	$1.78
Rate for Payer: LLUH Dept of Risk Management WC	$1.63
Rate for Payer: Multiplan Commercial	$2.23

FLUOCINOLONE 0.01 % TOPICAL CREAM [3183]

Facility

$2.97

Service Code	NDC 52565-031-15
Hospital Charge Code	901700029
Hospital Revenue Code	259
Min. Negotiated Rate	$1.63
Max. Negotiated Rate	$2.38
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$1.78
Rate for Payer: Aetna of CA Government/Medicare	$1.78
Rate for Payer: Cash Price	$1.63
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$2.38
Rate for Payer: Health Smart Auto/Commercial	$1.78
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$1.78
Rate for Payer: LLUH Dept of Risk Management WC	$1.63
Rate for Payer: Multiplan Commercial	$2.23

FLUOCINOLONE 0.01 % TOPICAL CREAM [3183]

Facility

$2.23

Service Code	NDC 0713-0223-60
Hospital Charge Code	901700029
Hospital Revenue Code	259
Min. Negotiated Rate	$1.23
Max. Negotiated Rate	$1.78
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$1.34
Rate for Payer: Aetna of CA Government/Medicare	$1.34
Rate for Payer: Cash Price	$1.23
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$1.78
Rate for Payer: Health Smart Auto/Commercial	$1.34
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$1.34
Rate for Payer: LLUH Dept of Risk Management WC	$1.23
Rate for Payer: Multiplan Commercial	$1.67

FLUOCINOLONE 0.01 % TOPICAL SOLUTION [3186]

Facility

$1.60

Service Code	NDC 52565-012-59
Hospital Charge Code	901700029
Hospital Revenue Code	259
Min. Negotiated Rate	$0.88
Max. Negotiated Rate	$1.28
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$0.96
Rate for Payer: Aetna of CA Government/Medicare	$0.96
Rate for Payer: Cash Price	$0.88
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$1.28
Rate for Payer: Health Smart Auto/Commercial	$0.96
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$0.96
Rate for Payer: LLUH Dept of Risk Management WC	$0.88
Rate for Payer: Multiplan Commercial	$1.20

FLUOCINOLONE 0.01 % TOPICAL SOLUTION [3186]

Facility

$1.60

Service Code	NDC 52565-012-59
Hospital Charge Code	901700029
Hospital Revenue Code	259
Min. Negotiated Rate	$0.88
Max. Negotiated Rate	$1.28
Rate for Payer: Cash Price	$0.88
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$1.28
Rate for Payer: Health Smart Auto/Commercial	$0.96
Rate for Payer: LLUH Dept of Risk Management WC	$0.88
Rate for Payer: Multiplan Commercial	$1.20

FLUOCINOLONE 0.025 % TOPICAL OINTMENT [3185]

Facility

$2.25

Service Code	NDC 0168-0064-15
Hospital Charge Code	901700029
Hospital Revenue Code	259
Min. Negotiated Rate	$1.24
Max. Negotiated Rate	$1.80
Rate for Payer: Cash Price	$1.24
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$1.80
Rate for Payer: Health Smart Auto/Commercial	$1.35
Rate for Payer: LLUH Dept of Risk Management WC	$1.24
Rate for Payer: Multiplan Commercial	$1.69

FLUOCINOLONE 0.025 % TOPICAL OINTMENT [3185]

Facility

$2.26

Service Code	NDC 0713-0224-15
Hospital Charge Code	901700029
Hospital Revenue Code	259
Min. Negotiated Rate	$1.24
Max. Negotiated Rate	$1.81
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$1.36
Rate for Payer: Aetna of CA Government/Medicare	$1.36
Rate for Payer: Cash Price	$1.24
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$1.81
Rate for Payer: Health Smart Auto/Commercial	$1.36
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$1.36
Rate for Payer: LLUH Dept of Risk Management WC	$1.24
Rate for Payer: Multiplan Commercial	$1.70

FLUOCINOLONE 0.025 % TOPICAL OINTMENT [3185]

Facility

$1.69

Service Code	NDC 0713-0224-60
Hospital Charge Code	901700029
Hospital Revenue Code	259
Min. Negotiated Rate	$0.93
Max. Negotiated Rate	$1.35
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$1.01
Rate for Payer: Aetna of CA Government/Medicare	$1.01
Rate for Payer: Cash Price	$0.93
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$1.35
Rate for Payer: Health Smart Auto/Commercial	$1.01
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$1.01
Rate for Payer: LLUH Dept of Risk Management WC	$0.93
Rate for Payer: Multiplan Commercial	$1.27

FLUOCINOLONE 0.025 % TOPICAL OINTMENT [3185]

Facility

$2.25

Service Code	NDC 0168-0064-15
Hospital Charge Code	901700029
Hospital Revenue Code	259
Min. Negotiated Rate	$1.24
Max. Negotiated Rate	$1.80
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$1.35
Rate for Payer: Aetna of CA Government/Medicare	$1.35
Rate for Payer: Cash Price	$1.24
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$1.80
Rate for Payer: Health Smart Auto/Commercial	$1.35
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$1.35
Rate for Payer: LLUH Dept of Risk Management WC	$1.24
Rate for Payer: Multiplan Commercial	$1.69

FLUOCINOLONE 0.025 % TOPICAL OINTMENT [3185]

Facility

$1.69

Service Code	NDC 0713-0224-60
Hospital Charge Code	901700029
Hospital Revenue Code	259
Min. Negotiated Rate	$0.93
Max. Negotiated Rate	$1.35
Rate for Payer: Cash Price	$0.93
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$1.35
Rate for Payer: Health Smart Auto/Commercial	$1.01
Rate for Payer: LLUH Dept of Risk Management WC	$0.93
Rate for Payer: Multiplan Commercial	$1.27

FLUOCINOLONE 0.025 % TOPICAL OINTMENT [3185]

Facility

$2.26

Service Code	NDC 0713-0224-15
Hospital Charge Code	901700029
Hospital Revenue Code	259
Min. Negotiated Rate	$1.24
Max. Negotiated Rate	$1.81
Rate for Payer: Cash Price	$1.24
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$1.81
Rate for Payer: Health Smart Auto/Commercial	$1.36
Rate for Payer: LLUH Dept of Risk Management WC	$1.24
Rate for Payer: Multiplan Commercial	$1.70

FLUOCINONIDE 0.05 % TOPICAL CREAM [3187]

Facility

$2.92

Service Code	NDC 51862-494-15
Hospital Charge Code	901700029
Hospital Revenue Code	259
Min. Negotiated Rate	$1.61
Max. Negotiated Rate	$2.34
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$1.75
Rate for Payer: Aetna of CA Government/Medicare	$1.75
Rate for Payer: Cash Price	$1.60
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$2.34
Rate for Payer: Health Smart Auto/Commercial	$1.75
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$1.75
Rate for Payer: LLUH Dept of Risk Management WC	$1.61
Rate for Payer: Multiplan Commercial	$2.19

FLUOCINONIDE 0.05 % TOPICAL CREAM [3187]

Facility

$2.92

Service Code	NDC 51862-494-15
Hospital Charge Code	901700029
Hospital Revenue Code	259
Min. Negotiated Rate	$1.61
Max. Negotiated Rate	$2.34
Rate for Payer: Cash Price	$1.60
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$2.34
Rate for Payer: Health Smart Auto/Commercial	$1.75
Rate for Payer: LLUH Dept of Risk Management WC	$1.61
Rate for Payer: Multiplan Commercial	$2.19

FLUOCINONIDE 0.05 % TOPICAL CREAM [3187]

Facility

$2.92

Service Code	NDC 0093-0262-15
Hospital Charge Code	901700029
Hospital Revenue Code	259
Min. Negotiated Rate	$1.61
Max. Negotiated Rate	$2.34
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$1.75
Rate for Payer: Aetna of CA Government/Medicare	$1.75
Rate for Payer: Cash Price	$1.60
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$2.34
Rate for Payer: Health Smart Auto/Commercial	$1.75
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$1.75
Rate for Payer: LLUH Dept of Risk Management WC	$1.61
Rate for Payer: Multiplan Commercial	$2.19

FLUOCINONIDE 0.05 % TOPICAL CREAM [3187]

Facility

$1.20

Service Code	NDC 51672-1386-1
Hospital Charge Code	901700029
Hospital Revenue Code	259
Min. Negotiated Rate	$0.66
Max. Negotiated Rate	$0.96
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$0.72
Rate for Payer: Aetna of CA Government/Medicare	$0.72
Rate for Payer: Cash Price	$0.66
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$0.96
Rate for Payer: Health Smart Auto/Commercial	$0.72
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$0.72
Rate for Payer: LLUH Dept of Risk Management WC	$0.66
Rate for Payer: Multiplan Commercial	$0.90

FLUOCINONIDE 0.05 % TOPICAL CREAM [3187]

Facility

$1.20

Service Code	NDC 51672-1386-1
Hospital Charge Code	901700029
Hospital Revenue Code	259
Min. Negotiated Rate	$0.66
Max. Negotiated Rate	$0.96
Rate for Payer: Cash Price	$0.66
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$0.96
Rate for Payer: Health Smart Auto/Commercial	$0.72
Rate for Payer: LLUH Dept of Risk Management WC	$0.66
Rate for Payer: Multiplan Commercial	$0.90

FLUOCINONIDE 0.05 % TOPICAL CREAM [3187]

Facility

$2.92

Service Code	NDC 0093-0262-15
Hospital Charge Code	901700029
Hospital Revenue Code	259
Min. Negotiated Rate	$1.61
Max. Negotiated Rate	$2.34
Rate for Payer: Cash Price	$1.60
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$2.34
Rate for Payer: Health Smart Auto/Commercial	$1.75
Rate for Payer: LLUH Dept of Risk Management WC	$1.61
Rate for Payer: Multiplan Commercial	$2.19

FLUOCINONIDE 0.05 % TOPICAL CREAM. [4083187]

Facility

$3.08

Service Code	NDC 51672-1254-1
Hospital Charge Code	901700029
Hospital Revenue Code	259
Min. Negotiated Rate	$1.69
Max. Negotiated Rate	$2.46
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$1.85
Rate for Payer: Aetna of CA Government/Medicare	$1.85
Rate for Payer: Cash Price	$1.70
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$2.46
Rate for Payer: Health Smart Auto/Commercial	$1.85
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$1.85
Rate for Payer: LLUH Dept of Risk Management WC	$1.69
Rate for Payer: Multiplan Commercial	$2.31

FLUOCINONIDE 0.05 % TOPICAL CREAM. [4083187]

Facility

$2.92

Service Code	NDC 0093-0262-30
Hospital Charge Code	901700029
Hospital Revenue Code	259
Min. Negotiated Rate	$1.61
Max. Negotiated Rate	$2.34
Rate for Payer: Cash Price	$1.60
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$2.34
Rate for Payer: Health Smart Auto/Commercial	$1.75
Rate for Payer: LLUH Dept of Risk Management WC	$1.61
Rate for Payer: Multiplan Commercial	$2.19

FLUOCINONIDE 0.05 % TOPICAL CREAM. [4083187]

Facility

$2.92

Service Code	NDC 0093-0262-30
Hospital Charge Code	901700029
Hospital Revenue Code	259
Min. Negotiated Rate	$1.61
Max. Negotiated Rate	$2.34
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$1.75
Rate for Payer: Aetna of CA Government/Medicare	$1.75
Rate for Payer: Cash Price	$1.60
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$2.34
Rate for Payer: Health Smart Auto/Commercial	$1.75
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$1.75
Rate for Payer: LLUH Dept of Risk Management WC	$1.61
Rate for Payer: Multiplan Commercial	$2.19

FLUOCINONIDE 0.05 % TOPICAL CREAM. [4083187]

Facility

$3.08

Service Code	NDC 51672-1254-1
Hospital Charge Code	901700029
Hospital Revenue Code	259
Min. Negotiated Rate	$1.69
Max. Negotiated Rate	$2.46
Rate for Payer: Cash Price	$1.70
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$2.46
Rate for Payer: Health Smart Auto/Commercial	$1.85
Rate for Payer: LLUH Dept of Risk Management WC	$1.69
Rate for Payer: Multiplan Commercial	$2.31

Know your out-of-pocket cost for care.

All Charges