Price Transparency

Know your out-of-pocket cost for care.

All Charges

Charge

Type

Setting

Price

FLUPHENAZINE 2.5 MG/5 ML ORAL ELIXIR [10072]

Facility

OP

$0.64

Service Code	NDC 0121-0654-02
Hospital Charge Code	901700029
Hospital Revenue Code	259
Min. Negotiated Rate	$0.35
Max. Negotiated Rate	$0.51
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$0.38
Rate for Payer: Aetna of CA Government/Medicare	$0.38
Rate for Payer: Cash Price	$0.35
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$0.51
Rate for Payer: Health Smart Auto/Commercial	$0.38
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$0.38
Rate for Payer: LLUH Dept of Risk Management WC	$0.35
Rate for Payer: Multiplan Commercial	$0.48

FLUPHENAZINE 2.5 MG/5 ML ORAL ELIXIR [10072]

Facility

IP

$0.64

Service Code	NDC 0121-0654-02
Hospital Charge Code	901700029
Hospital Revenue Code	259
Min. Negotiated Rate	$0.35
Max. Negotiated Rate	$0.51
Rate for Payer: Cash Price	$0.35
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$0.51
Rate for Payer: Health Smart Auto/Commercial	$0.38
Rate for Payer: LLUH Dept of Risk Management WC	$0.35
Rate for Payer: Multiplan Commercial	$0.48

FLUPHENAZINE 2.5 MG TABLET [3220]

Facility

OP

$1.28

Service Code	NDC 51672-4234-1
Hospital Charge Code	901700029
Hospital Revenue Code	259
Min. Negotiated Rate	$0.70
Max. Negotiated Rate	$1.02
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$0.77
Rate for Payer: Aetna of CA Government/Medicare	$0.77
Rate for Payer: Cash Price	$0.71
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$1.02
Rate for Payer: Health Smart Auto/Commercial	$0.77
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$0.77
Rate for Payer: LLUH Dept of Risk Management WC	$0.70
Rate for Payer: Multiplan Commercial	$0.96

FLUPHENAZINE 2.5 MG TABLET [3220]

Facility

IP

$2.78

Service Code	NDC 0527-1789-01
Hospital Charge Code	901700029
Hospital Revenue Code	259
Min. Negotiated Rate	$1.53
Max. Negotiated Rate	$2.22
Rate for Payer: Cash Price	$1.53
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$2.22
Rate for Payer: Health Smart Auto/Commercial	$1.67
Rate for Payer: LLUH Dept of Risk Management WC	$1.53
Rate for Payer: Multiplan Commercial	$2.08

FLUPHENAZINE 2.5 MG TABLET [3220]

Facility

IP

$8.89

Service Code	NDC 0904-7158-61
Hospital Charge Code	901700029
Hospital Revenue Code	259
Min. Negotiated Rate	$4.89
Max. Negotiated Rate	$7.11
Rate for Payer: Cash Price	$4.89
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$7.11
Rate for Payer: Health Smart Auto/Commercial	$5.33
Rate for Payer: LLUH Dept of Risk Management WC	$4.89
Rate for Payer: Multiplan Commercial	$6.67

FLUPHENAZINE 2.5 MG TABLET [3220]

Facility

IP

$1.28

Service Code	NDC 69238-1679-1
Hospital Charge Code	901700029
Hospital Revenue Code	259
Min. Negotiated Rate	$0.70
Max. Negotiated Rate	$1.02
Rate for Payer: Cash Price	$0.71
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$1.02
Rate for Payer: Health Smart Auto/Commercial	$0.77
Rate for Payer: LLUH Dept of Risk Management WC	$0.70
Rate for Payer: Multiplan Commercial	$0.96

FLUPHENAZINE 2.5 MG TABLET [3220]

Facility

OP

$1.28

Service Code	NDC 69238-1679-1
Hospital Charge Code	901700029
Hospital Revenue Code	259
Min. Negotiated Rate	$0.70
Max. Negotiated Rate	$1.02
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$0.77
Rate for Payer: Aetna of CA Government/Medicare	$0.77
Rate for Payer: Cash Price	$0.71
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$1.02
Rate for Payer: Health Smart Auto/Commercial	$0.77
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$0.77
Rate for Payer: LLUH Dept of Risk Management WC	$0.70
Rate for Payer: Multiplan Commercial	$0.96

FLUPHENAZINE 2.5 MG TABLET [3220]

Facility

IP

$4.34

Service Code	NDC 50268-367-11
Hospital Charge Code	901700029
Hospital Revenue Code	259
Min. Negotiated Rate	$2.39
Max. Negotiated Rate	$3.47
Rate for Payer: Cash Price	$2.39
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$3.47
Rate for Payer: Health Smart Auto/Commercial	$2.60
Rate for Payer: LLUH Dept of Risk Management WC	$2.39
Rate for Payer: Multiplan Commercial	$3.25

FLUPHENAZINE 2.5 MG TABLET [3220]

Facility

OP

$4.34

Service Code	NDC 50268-367-15
Hospital Charge Code	901700029
Hospital Revenue Code	259
Min. Negotiated Rate	$2.39
Max. Negotiated Rate	$3.47
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$2.60
Rate for Payer: Aetna of CA Government/Medicare	$2.60
Rate for Payer: Cash Price	$2.39
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$3.47
Rate for Payer: Health Smart Auto/Commercial	$2.60
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$2.60
Rate for Payer: LLUH Dept of Risk Management WC	$2.39
Rate for Payer: Multiplan Commercial	$3.25

FLUPHENAZINE 2.5 MG TABLET [3220]

Facility

IP

$4.34

Service Code	NDC 50268-367-15
Hospital Charge Code	901700029
Hospital Revenue Code	259
Min. Negotiated Rate	$2.39
Max. Negotiated Rate	$3.47
Rate for Payer: Cash Price	$2.39
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$3.47
Rate for Payer: Health Smart Auto/Commercial	$2.60
Rate for Payer: LLUH Dept of Risk Management WC	$2.39
Rate for Payer: Multiplan Commercial	$3.25

FLUPHENAZINE 2.5 MG TABLET [3220]

Facility

OP

$2.78

Service Code	NDC 0527-1789-01
Hospital Charge Code	901700029
Hospital Revenue Code	259
Min. Negotiated Rate	$1.53
Max. Negotiated Rate	$2.22
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$1.67
Rate for Payer: Aetna of CA Government/Medicare	$1.67
Rate for Payer: Cash Price	$1.53
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$2.22
Rate for Payer: Health Smart Auto/Commercial	$1.67
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$1.67
Rate for Payer: LLUH Dept of Risk Management WC	$1.53
Rate for Payer: Multiplan Commercial	$2.08

FLUPHENAZINE 2.5 MG TABLET [3220]

Facility

OP

$8.89

Service Code	NDC 0904-7158-61
Hospital Charge Code	901700029
Hospital Revenue Code	259
Min. Negotiated Rate	$4.89
Max. Negotiated Rate	$7.11
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$5.33
Rate for Payer: Aetna of CA Government/Medicare	$5.33
Rate for Payer: Cash Price	$4.89
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$7.11
Rate for Payer: Health Smart Auto/Commercial	$5.33
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$5.33
Rate for Payer: LLUH Dept of Risk Management WC	$4.89
Rate for Payer: Multiplan Commercial	$6.67

FLUPHENAZINE 2.5 MG TABLET [3220]

Facility

IP

$1.28

Service Code	NDC 51672-4234-1
Hospital Charge Code	901700029
Hospital Revenue Code	259
Min. Negotiated Rate	$0.70
Max. Negotiated Rate	$1.02
Rate for Payer: Cash Price	$0.71
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$1.02
Rate for Payer: Health Smart Auto/Commercial	$0.77
Rate for Payer: LLUH Dept of Risk Management WC	$0.70
Rate for Payer: Multiplan Commercial	$0.96

FLUPHENAZINE 2.5 MG TABLET [3220]

Facility

OP

$4.34

Service Code	NDC 50268-367-11
Hospital Charge Code	901700029
Hospital Revenue Code	259
Min. Negotiated Rate	$2.39
Max. Negotiated Rate	$3.47
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$2.60
Rate for Payer: Aetna of CA Government/Medicare	$2.60
Rate for Payer: Cash Price	$2.39
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$3.47
Rate for Payer: Health Smart Auto/Commercial	$2.60
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$2.60
Rate for Payer: LLUH Dept of Risk Management WC	$2.39
Rate for Payer: Multiplan Commercial	$3.25

FLUPHENAZINE DECANOATE 25 MG/ML INJECTION SOLUTION [3215]

Facility

IP

$29.04

Service Code	HCPCS J2680
Hospital Charge Code	901700025
Hospital Revenue Code	636
Min. Negotiated Rate	$15.97
Max. Negotiated Rate	$23.23
Rate for Payer: Cash Price	$15.97
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$23.23
Rate for Payer: Health Smart Auto/Commercial	$17.42
Rate for Payer: LLUH Dept of Risk Management WC	$15.97
Rate for Payer: Multiplan Commercial	$21.78

FLUPHENAZINE DECANOATE 25 MG/ML INJECTION SOLUTION [3215]

Facility

OP

$29.04

Service Code	HCPCS J2680
Hospital Charge Code	901700025
Hospital Revenue Code	636
Min. Negotiated Rate	$15.97
Max. Negotiated Rate	$23.23
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$17.42
Rate for Payer: Aetna of CA Government/Medicare	$17.42
Rate for Payer: Cash Price	$15.97
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$23.23
Rate for Payer: Health Smart Auto/Commercial	$17.42
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$17.42
Rate for Payer: LLUH Dept of Risk Management WC	$15.97
Rate for Payer: Multiplan Commercial	$21.78

FLUTICASONE 250 MCG-SALMETEROL 50 MCG/DOSE BLISTR POWDR FOR INHALATION [26538]

Facility

OP

$3.92

Service Code	NDC 0173-0696-00
Hospital Charge Code	901700029
Hospital Revenue Code	259
Min. Negotiated Rate	$2.16
Max. Negotiated Rate	$3.14
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$2.35
Rate for Payer: Aetna of CA Government/Medicare	$2.35
Rate for Payer: Cash Price	$2.15
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$3.14
Rate for Payer: Health Smart Auto/Commercial	$2.35
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$2.35
Rate for Payer: LLUH Dept of Risk Management WC	$2.16
Rate for Payer: Multiplan Commercial	$2.94

FLUTICASONE 250 MCG-SALMETEROL 50 MCG/DOSE BLISTR POWDR FOR INHALATION [26538]

Facility

IP

$3.92

Service Code	NDC 0173-0696-00
Hospital Charge Code	901700029
Hospital Revenue Code	259
Min. Negotiated Rate	$2.16
Max. Negotiated Rate	$3.14
Rate for Payer: Cash Price	$2.15
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$3.14
Rate for Payer: Health Smart Auto/Commercial	$2.35
Rate for Payer: LLUH Dept of Risk Management WC	$2.16
Rate for Payer: Multiplan Commercial	$2.94

FLUTICASONE 500 MCG-SALMETEROL 50 MCG/DOSE BLISTR POWDR FOR INHALATION [104566]

Facility

IP

$5.30

Service Code	NDC 0173-0697-00
Hospital Charge Code	901700029
Hospital Revenue Code	259
Min. Negotiated Rate	$2.92
Max. Negotiated Rate	$4.24
Rate for Payer: Cash Price	$2.92
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$4.24
Rate for Payer: Health Smart Auto/Commercial	$3.18
Rate for Payer: LLUH Dept of Risk Management WC	$2.92
Rate for Payer: Multiplan Commercial	$3.98

FLUTICASONE 500 MCG-SALMETEROL 50 MCG/DOSE BLISTR POWDR FOR INHALATION [104566]

Facility

OP

$5.30

Service Code	NDC 0173-0697-00
Hospital Charge Code	901700029
Hospital Revenue Code	259
Min. Negotiated Rate	$2.92
Max. Negotiated Rate	$4.24
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$3.18
Rate for Payer: Aetna of CA Government/Medicare	$3.18
Rate for Payer: Cash Price	$2.92
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$4.24
Rate for Payer: Health Smart Auto/Commercial	$3.18
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$3.18
Rate for Payer: LLUH Dept of Risk Management WC	$2.92
Rate for Payer: Multiplan Commercial	$3.98

FLUTICASONE PROPIONATE 50 MCG/ACTUATION NASAL SPRAY,SUSPENSION [70536]

Facility

OP

$1.35

Service Code	NDC 60505-0829-1
Hospital Charge Code	901700029
Hospital Revenue Code	259
Min. Negotiated Rate	$0.74
Max. Negotiated Rate	$1.08
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$0.81
Rate for Payer: Aetna of CA Government/Medicare	$0.81
Rate for Payer: Cash Price	$0.74
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$1.08
Rate for Payer: Health Smart Auto/Commercial	$0.81
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$0.81
Rate for Payer: LLUH Dept of Risk Management WC	$0.74
Rate for Payer: Multiplan Commercial	$1.01

FLUTICASONE PROPIONATE 50 MCG/ACTUATION NASAL SPRAY,SUSPENSION [70536]

Facility

IP

$1.35

Service Code	NDC 60505-0829-1
Hospital Charge Code	901700029
Hospital Revenue Code	259
Min. Negotiated Rate	$0.74
Max. Negotiated Rate	$1.08
Rate for Payer: Cash Price	$0.74
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$1.08
Rate for Payer: Health Smart Auto/Commercial	$0.81
Rate for Payer: LLUH Dept of Risk Management WC	$0.74
Rate for Payer: Multiplan Commercial	$1.01

FLU VACCINE TS 2025-26(6MOS UP)(PF) 45 MCG(15MCG X3)/0.5 ML IM SYRINGE [246638]

Facility

IP

$47.37

Service Code	HCPCS 90656
Hospital Charge Code	901700025
Hospital Revenue Code	636
Min. Negotiated Rate	$26.05
Max. Negotiated Rate	$37.90
Rate for Payer: Cash Price	$26.06
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$37.90
Rate for Payer: Health Smart Auto/Commercial	$28.42
Rate for Payer: LLUH Dept of Risk Management WC	$26.05
Rate for Payer: Multiplan Commercial	$35.53

FLU VACCINE TS 2025-26(6MOS UP)(PF) 45 MCG(15MCG X3)/0.5 ML IM SYRINGE [246638]

Facility

OP

$47.37

Service Code	HCPCS 90656
Hospital Charge Code	901700025
Hospital Revenue Code	636
Min. Negotiated Rate	$26.05
Max. Negotiated Rate	$37.90
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$28.42
Rate for Payer: Aetna of CA Government/Medicare	$28.42
Rate for Payer: Cash Price	$26.06
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$37.90
Rate for Payer: Health Smart Auto/Commercial	$28.42
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$28.42
Rate for Payer: LLUH Dept of Risk Management WC	$26.05
Rate for Payer: Multiplan Commercial	$35.53

FLU VACCINE TV2025(9 YR UP)RCMB(PF)135 MCG(45 MCGX3)/0.5 ML IM SYRINGE [246640]

Facility

IP

$188.21

Service Code	HCPCS 90673
Hospital Charge Code	901700025
Hospital Revenue Code	636
Min. Negotiated Rate	$103.52
Max. Negotiated Rate	$150.57
Rate for Payer: Cash Price	$103.51
Rate for Payer: Cash Price	$103.52
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$150.57
Rate for Payer: Health Smart Auto/Commercial	$112.93
Rate for Payer: LLUH Dept of Risk Management WC	$103.52
Rate for Payer: Multiplan Commercial	$141.16

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