Loma Linda University Behavioral Medicine Center (BMC)

All Charges

Charge

Type

Setting

Price

FLUOCINONIDE 0.05 % TOPICAL OINTMENT [3189]

Facility

$0.78

Service Code	NDC 51672-1264-3
Hospital Charge Code	901700029
Hospital Revenue Code	259
Min. Negotiated Rate	$0.43
Max. Negotiated Rate	$0.62
Rate for Payer: Cash Price	$0.43
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$0.62
Rate for Payer: Health Smart Auto/Commercial	$0.47
Rate for Payer: LLUH Dept of Risk Management WC	$0.43
Rate for Payer: Multiplan Commercial	$0.59

FLUOCINONIDE 0.05 % TOPICAL OINTMENT [3189]

Facility

$0.78

Service Code	NDC 51672-1264-3
Hospital Charge Code	901700029
Hospital Revenue Code	259
Min. Negotiated Rate	$0.43
Max. Negotiated Rate	$0.62
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$0.47
Rate for Payer: Aetna of CA Government/Medicare	$0.47
Rate for Payer: Cash Price	$0.43
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$0.62
Rate for Payer: Health Smart Auto/Commercial	$0.47
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$0.47
Rate for Payer: LLUH Dept of Risk Management WC	$0.43
Rate for Payer: Multiplan Commercial	$0.59

FLUOCINONIDE 0.05 % TOPICAL OINTMENT [3189]

Facility

$4.53

Service Code	NDC 0093-0264-92
Hospital Charge Code	901700029
Hospital Revenue Code	259
Min. Negotiated Rate	$2.49
Max. Negotiated Rate	$3.62
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$2.72
Rate for Payer: Aetna of CA Government/Medicare	$2.72
Rate for Payer: Cash Price	$2.49
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$3.62
Rate for Payer: Health Smart Auto/Commercial	$2.72
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$2.72
Rate for Payer: LLUH Dept of Risk Management WC	$2.49
Rate for Payer: Multiplan Commercial	$3.40

FLUOCINONIDE 0.05 % TOPICAL OINTMENT [3189]

Facility

$1.48

Service Code	NDC 51672-1264-1
Hospital Charge Code	901700029
Hospital Revenue Code	259
Min. Negotiated Rate	$0.81
Max. Negotiated Rate	$1.18
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$0.89
Rate for Payer: Aetna of CA Government/Medicare	$0.89
Rate for Payer: Cash Price	$0.81
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$1.18
Rate for Payer: Health Smart Auto/Commercial	$0.89
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$0.89
Rate for Payer: LLUH Dept of Risk Management WC	$0.81
Rate for Payer: Multiplan Commercial	$1.11

FLUOCINONIDE 0.05 % TOPICAL OINTMENT [3189]

Facility

$1.48

Service Code	NDC 51672-1264-1
Hospital Charge Code	901700029
Hospital Revenue Code	259
Min. Negotiated Rate	$0.81
Max. Negotiated Rate	$1.18
Rate for Payer: Cash Price	$0.81
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$1.18
Rate for Payer: Health Smart Auto/Commercial	$0.89
Rate for Payer: LLUH Dept of Risk Management WC	$0.81
Rate for Payer: Multiplan Commercial	$1.11

FLUOCINONIDE 0.05 % TOPICAL OINTMENT [3189]

Facility

$4.53

Service Code	NDC 0093-0264-92
Hospital Charge Code	901700029
Hospital Revenue Code	259
Min. Negotiated Rate	$2.49
Max. Negotiated Rate	$3.62
Rate for Payer: Cash Price	$2.49
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$3.62
Rate for Payer: Health Smart Auto/Commercial	$2.72
Rate for Payer: LLUH Dept of Risk Management WC	$2.49
Rate for Payer: Multiplan Commercial	$3.40

FLUOCINONIDE 0.05 % TOPICAL SOLUTION [3190]

Facility

$1.16

Service Code	NDC 51672-1273-4
Hospital Charge Code	901700029
Hospital Revenue Code	259
Min. Negotiated Rate	$0.64
Max. Negotiated Rate	$0.93
Rate for Payer: Cash Price	$0.64
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$0.93
Rate for Payer: Health Smart Auto/Commercial	$0.70
Rate for Payer: LLUH Dept of Risk Management WC	$0.64
Rate for Payer: Multiplan Commercial	$0.87

FLUOCINONIDE 0.05 % TOPICAL SOLUTION [3190]

Facility

$1.20

Service Code	NDC 51672-1273-2
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 SOLUTION [3190]

Facility

$1.16

Service Code	NDC 51672-1273-4
Hospital Charge Code	901700029
Hospital Revenue Code	259
Min. Negotiated Rate	$0.64
Max. Negotiated Rate	$0.93
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$0.70
Rate for Payer: Aetna of CA Government/Medicare	$0.70
Rate for Payer: Cash Price	$0.64
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$0.93
Rate for Payer: Health Smart Auto/Commercial	$0.70
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$0.70
Rate for Payer: LLUH Dept of Risk Management WC	$0.64
Rate for Payer: Multiplan Commercial	$0.87

FLUOCINONIDE 0.05 % TOPICAL SOLUTION [3190]

Facility

$1.20

Service Code	NDC 51672-1273-2
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

FLUORESCEIN 1 MG EYE STRIPS [27663]

Facility

$0.25

Service Code	NDC 17238-900-99
Hospital Charge Code	901700029
Hospital Revenue Code	259
Min. Negotiated Rate	$0.14
Max. Negotiated Rate	$0.20
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$0.15
Rate for Payer: Aetna of CA Government/Medicare	$0.15
Rate for Payer: Cash Price	$0.14
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$0.20
Rate for Payer: Health Smart Auto/Commercial	$0.15
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$0.15
Rate for Payer: LLUH Dept of Risk Management WC	$0.14
Rate for Payer: Multiplan Commercial	$0.19

FLUORESCEIN 1 MG EYE STRIPS [27663]

Facility

$0.25

Service Code	NDC 17238-900-99
Hospital Charge Code	901700029
Hospital Revenue Code	259
Min. Negotiated Rate	$0.14
Max. Negotiated Rate	$0.20
Rate for Payer: Cash Price	$0.14
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$0.20
Rate for Payer: Health Smart Auto/Commercial	$0.15
Rate for Payer: LLUH Dept of Risk Management WC	$0.14
Rate for Payer: Multiplan Commercial	$0.19

FLUORESCEIN 1 MG EYE STRIPS [27663]

Facility

$0.25

Service Code	NDC 17238-900-11
Hospital Charge Code	901700029
Hospital Revenue Code	259
Min. Negotiated Rate	$0.14
Max. Negotiated Rate	$0.20
Rate for Payer: Cash Price	$0.14
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$0.20
Rate for Payer: Health Smart Auto/Commercial	$0.15
Rate for Payer: LLUH Dept of Risk Management WC	$0.14
Rate for Payer: Multiplan Commercial	$0.19

FLUORESCEIN 1 MG EYE STRIPS [27663]

Facility

$0.25

Service Code	NDC 17238-900-11
Hospital Charge Code	901700029
Hospital Revenue Code	259
Min. Negotiated Rate	$0.14
Max. Negotiated Rate	$0.20
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$0.15
Rate for Payer: Aetna of CA Government/Medicare	$0.15
Rate for Payer: Cash Price	$0.14
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$0.20
Rate for Payer: Health Smart Auto/Commercial	$0.15
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$0.15
Rate for Payer: LLUH Dept of Risk Management WC	$0.14
Rate for Payer: Multiplan Commercial	$0.19

FLUORESCEIN 500 MG/5 ML (10 %) INTRAVENOUS SOLUTION [10059]

Facility

$13.79

Service Code	NDC 0065-0092-65
Hospital Charge Code	901700004
Hospital Revenue Code	250
Min. Negotiated Rate	$7.58
Max. Negotiated Rate	$11.03
Rate for Payer: Cash Price	$7.58
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$11.03
Rate for Payer: Health Smart Auto/Commercial	$8.27
Rate for Payer: LLUH Dept of Risk Management WC	$7.58
Rate for Payer: Multiplan Commercial	$10.34

FLUORESCEIN 500 MG/5 ML (10 %) INTRAVENOUS SOLUTION [10059]

Facility

$13.79

Service Code	NDC 0065-0092-65
Hospital Charge Code	901700004
Hospital Revenue Code	250
Min. Negotiated Rate	$7.58
Max. Negotiated Rate	$11.03
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$8.27
Rate for Payer: Aetna of CA Government/Medicare	$8.27
Rate for Payer: Cash Price	$7.58
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$11.03
Rate for Payer: Health Smart Auto/Commercial	$8.27
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$8.27
Rate for Payer: LLUH Dept of Risk Management WC	$7.58
Rate for Payer: Multiplan Commercial	$10.34

FLUOROMETHOLONE 0.1 % EYE DROPS,SUSPENSION [3208]

Facility

$18.59

Service Code	NDC 60758-880-05
Hospital Charge Code	901700029
Hospital Revenue Code	259
Min. Negotiated Rate	$10.22
Max. Negotiated Rate	$14.87
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$11.15
Rate for Payer: Aetna of CA Government/Medicare	$11.15
Rate for Payer: Cash Price	$10.22
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$14.87
Rate for Payer: Health Smart Auto/Commercial	$11.15
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$11.15
Rate for Payer: LLUH Dept of Risk Management WC	$10.22
Rate for Payer: Multiplan Commercial	$13.94

FLUOROMETHOLONE 0.1 % EYE DROPS,SUSPENSION [3208]

Facility

$18.58

Service Code	NDC 60219-1586-6
Hospital Charge Code	901700029
Hospital Revenue Code	259
Min. Negotiated Rate	$10.22
Max. Negotiated Rate	$14.86
Rate for Payer: Cash Price	$10.22
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$14.86
Rate for Payer: Health Smart Auto/Commercial	$11.15
Rate for Payer: LLUH Dept of Risk Management WC	$10.22
Rate for Payer: Multiplan Commercial	$13.94

FLUOROMETHOLONE 0.1 % EYE DROPS,SUSPENSION [3208]

Facility

$18.58

Service Code	NDC 60219-1586-6
Hospital Charge Code	901700029
Hospital Revenue Code	259
Min. Negotiated Rate	$10.22
Max. Negotiated Rate	$14.86
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$11.15
Rate for Payer: Aetna of CA Government/Medicare	$11.15
Rate for Payer: Cash Price	$10.22
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$14.86
Rate for Payer: Health Smart Auto/Commercial	$11.15
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$11.15
Rate for Payer: LLUH Dept of Risk Management WC	$10.22
Rate for Payer: Multiplan Commercial	$13.94

FLUOROMETHOLONE 0.1 % EYE DROPS,SUSPENSION [3208]

Facility

$18.59

Service Code	NDC 60758-880-05
Hospital Charge Code	901700029
Hospital Revenue Code	259
Min. Negotiated Rate	$10.22
Max. Negotiated Rate	$14.87
Rate for Payer: Cash Price	$10.22
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$14.87
Rate for Payer: Health Smart Auto/Commercial	$11.15
Rate for Payer: LLUH Dept of Risk Management WC	$10.22
Rate for Payer: Multiplan Commercial	$13.94

FLUOROURACIL 1 GRAM/20 ML INTRAVENOUS SOLUTION [82204]

Facility

$0.79

Service Code	HCPCS J9190
Hospital Charge Code	901700025
Hospital Revenue Code	636
Min. Negotiated Rate	$0.43
Max. Negotiated Rate	$0.63
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$0.47
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$0.25
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$0.43
Rate for Payer: Aetna of CA Government/Medicare	$0.25
Rate for Payer: Aetna of CA Government/Medicare	$0.43
Rate for Payer: Aetna of CA Government/Medicare	$0.47
Rate for Payer: Cash Price	$0.40
Rate for Payer: Cash Price	$0.23
Rate for Payer: Cash Price	$0.44
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$0.63
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$0.33
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$0.58
Rate for Payer: Health Smart Auto/Commercial	$0.47
Rate for Payer: Health Smart Auto/Commercial	$0.43
Rate for Payer: Health Smart Auto/Commercial	$0.25
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$0.47
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$0.43
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$0.25
Rate for Payer: LLUH Dept of Risk Management WC	$0.23
Rate for Payer: LLUH Dept of Risk Management WC	$0.40
Rate for Payer: LLUH Dept of Risk Management WC	$0.43
Rate for Payer: Multiplan Commercial	$0.54
Rate for Payer: Multiplan Commercial	$0.31
Rate for Payer: Multiplan Commercial	$0.59

FLUOROURACIL 1 GRAM/20 ML INTRAVENOUS SOLUTION [82204]

Facility

$0.41

Service Code	HCPCS J9190
Hospital Charge Code	901700025
Hospital Revenue Code	636
Min. Negotiated Rate	$0.23
Max. Negotiated Rate	$0.33
Rate for Payer: Cash Price	$0.23
Rate for Payer: Cash Price	$0.44
Rate for Payer: Cash Price	$0.40
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$0.63
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$0.33
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$0.58
Rate for Payer: Health Smart Auto/Commercial	$0.47
Rate for Payer: Health Smart Auto/Commercial	$0.43
Rate for Payer: Health Smart Auto/Commercial	$0.25
Rate for Payer: LLUH Dept of Risk Management WC	$0.43
Rate for Payer: LLUH Dept of Risk Management WC	$0.23
Rate for Payer: LLUH Dept of Risk Management WC	$0.40
Rate for Payer: Multiplan Commercial	$0.59
Rate for Payer: Multiplan Commercial	$0.54
Rate for Payer: Multiplan Commercial	$0.31

FLUOROURACIL 2.5 GRAM/50 ML INTRAVENOUS SOLUTION [82180]

Facility

$0.62

Service Code	HCPCS J9190
Hospital Charge Code	901700025
Hospital Revenue Code	636
Min. Negotiated Rate	$0.34
Max. Negotiated Rate	$0.50
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$0.37
Rate for Payer: Aetna of CA Government/Medicare	$0.37
Rate for Payer: Cash Price	$0.34
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$0.50
Rate for Payer: Health Smart Auto/Commercial	$0.37
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$0.37
Rate for Payer: LLUH Dept of Risk Management WC	$0.34
Rate for Payer: Multiplan Commercial	$0.47

FLUOROURACIL 2.5 GRAM/50 ML INTRAVENOUS SOLUTION [82180]

Facility

$0.62

Service Code	HCPCS J9190
Hospital Charge Code	901700025
Hospital Revenue Code	636
Min. Negotiated Rate	$0.34
Max. Negotiated Rate	$0.50
Rate for Payer: Cash Price	$0.34
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$0.50
Rate for Payer: Health Smart Auto/Commercial	$0.37
Rate for Payer: LLUH Dept of Risk Management WC	$0.34
Rate for Payer: Multiplan Commercial	$0.47

FLUOROURACIL 500 MG/10 ML INTRAVENOUS SOLUTION [82200]

Facility

$1.65

Service Code	HCPCS J9190
Hospital Charge Code	901700025
Hospital Revenue Code	636
Min. Negotiated Rate	$0.91
Max. Negotiated Rate	$1.32
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$0.99
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$0.25
Rate for Payer: Aetna of CA Government/Medicare	$0.25
Rate for Payer: Aetna of CA Government/Medicare	$0.99
Rate for Payer: Cash Price	$0.23
Rate for Payer: Cash Price	$0.91
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$1.32
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$0.33
Rate for Payer: Health Smart Auto/Commercial	$0.99
Rate for Payer: Health Smart Auto/Commercial	$0.25
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$0.25
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$0.99
Rate for Payer: LLUH Dept of Risk Management WC	$0.23
Rate for Payer: LLUH Dept of Risk Management WC	$0.91
Rate for Payer: Multiplan Commercial	$1.24
Rate for Payer: Multiplan Commercial	$0.31

Know your out-of-pocket cost for care.

All Charges