Price Transparency

Know your out-of-pocket cost for care.

All Charges

Charge

Type

Setting

Price

FLUCONAZOLE 200 MG TABLET [10045]

Facility

IP

$1.60

Service Code	NDC 67405-604-03
Hospital Charge Code	1711489
Hospital Revenue Code	259
Min. Negotiated Rate	$0.88
Max. Negotiated Rate	$1.28
Rate for Payer: Cash Price	$0.72
Rate for Payer: Cigna of CA 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 Beech St/Commercial/PHCS	$1.20

FLUCONAZOLE 200 MG TABLET [10045]

Facility

IP

$75.11

Service Code	NDC 0049-3430-41
Hospital Charge Code	1711489
Hospital Revenue Code	259
Min. Negotiated Rate	$41.31
Max. Negotiated Rate	$60.09
Rate for Payer: Cash Price	$33.80
Rate for Payer: Cigna of CA HMO/PPO	$60.09
Rate for Payer: Health Smart Auto/Commercial	$45.07
Rate for Payer: LLUH Dept of Risk Management WC	$41.31
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$56.33

FLUCONAZOLE 200 MG TABLET [10045]

Facility

IP

$3.23

Service Code	NDC 68084-735-01
Hospital Charge Code	1711489
Hospital Revenue Code	259
Min. Negotiated Rate	$1.78
Max. Negotiated Rate	$2.58
Rate for Payer: Cash Price	$1.45
Rate for Payer: Cigna of CA HMO/PPO	$2.58
Rate for Payer: Health Smart Auto/Commercial	$1.94
Rate for Payer: LLUH Dept of Risk Management WC	$1.78
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$2.42

FLUCONAZOLE 200 MG TABLET [10045]

Facility

OP

$3.23

Service Code	NDC 68084-735-01
Hospital Charge Code	1711489
Hospital Revenue Code	259
Min. Negotiated Rate	$1.78
Max. Negotiated Rate	$2.42
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$1.94
Rate for Payer: Aetna of CA Government/Medicare	$1.94
Rate for Payer: Cash Price	$1.45
Rate for Payer: Health Smart Auto/Commercial	$1.94
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$1.94
Rate for Payer: LLUH Dept of Risk Management WC	$1.78
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$2.42

FLUCONAZOLE 200 MG TABLET [10045]

Facility

IP

$2.30

Service Code	NDC 68001-254-04
Hospital Charge Code	1711489
Hospital Revenue Code	259
Min. Negotiated Rate	$1.26
Max. Negotiated Rate	$1.84
Rate for Payer: Cash Price	$1.04
Rate for Payer: Cigna of CA HMO/PPO	$1.84
Rate for Payer: Health Smart Auto/Commercial	$1.38
Rate for Payer: LLUH Dept of Risk Management WC	$1.26
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$1.72

FLUCONAZOLE 200 MG TABLET [10045]

Facility

OP

$0.79

Service Code	NDC 62559-993-30
Hospital Charge Code	1711489
Hospital Revenue Code	259
Min. Negotiated Rate	$0.43
Max. Negotiated Rate	$0.59
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	$0.36
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 Beech St/Commercial/PHCS	$0.59

FLUCONAZOLE 200 MG TABLET [10045]

Facility

IP

$3.00

Service Code	NDC 50268-339-11
Hospital Charge Code	1711489
Hospital Revenue Code	259
Min. Negotiated Rate	$1.65
Max. Negotiated Rate	$2.40
Rate for Payer: Cash Price	$1.35
Rate for Payer: Cigna of CA 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 Beech St/Commercial/PHCS	$2.25

FLUCONAZOLE 200 MG TABLET [10045]

Facility

OP

$1.60

Service Code	NDC 68462-104-30
Hospital Charge Code	1711489
Hospital Revenue Code	259
Min. Negotiated Rate	$0.88
Max. Negotiated Rate	$1.20
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	$0.72
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 Beech St/Commercial/PHCS	$1.20

FLUCONAZOLE 200 MG TABLET [10045]

Facility

OP

$2.30

Service Code	NDC 68001-254-04
Hospital Charge Code	1711489
Hospital Revenue Code	259
Min. Negotiated Rate	$1.26
Max. Negotiated Rate	$1.72
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$1.38
Rate for Payer: Aetna of CA Government/Medicare	$1.38
Rate for Payer: Cash Price	$1.04
Rate for Payer: Health Smart Auto/Commercial	$1.38
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$1.38
Rate for Payer: LLUH Dept of Risk Management WC	$1.26
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$1.72

FLUCONAZOLE 200 MG TABLET [10045]

Facility

IP

$3.46

Service Code	NDC 55111-146-30
Hospital Charge Code	1711489
Hospital Revenue Code	259
Min. Negotiated Rate	$1.90
Max. Negotiated Rate	$2.77
Rate for Payer: Cash Price	$1.56
Rate for Payer: Cigna of CA HMO/PPO	$2.77
Rate for Payer: Health Smart Auto/Commercial	$2.08
Rate for Payer: LLUH Dept of Risk Management WC	$1.90
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$2.60

FLUCONAZOLE 200 MG TABLET [10045]

Facility

IP

$0.79

Service Code	NDC 62559-993-30
Hospital Charge Code	1711489
Hospital Revenue Code	259
Min. Negotiated Rate	$0.43
Max. Negotiated Rate	$0.63
Rate for Payer: Cash Price	$0.36
Rate for Payer: Cigna of CA HMO/PPO	$0.63
Rate for Payer: Health Smart Auto/Commercial	$0.47
Rate for Payer: LLUH Dept of Risk Management WC	$0.43
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$0.59

FLUCONAZOLE 400 MG/200 ML IN SOD. CHLORIDE (ISO) HIGH DOSE IVPB [4081121]

Facility

IP

$0.08

Service Code	CPT J1450
Hospital Charge Code	1753160
Hospital Revenue Code	636
Min. Negotiated Rate	$0.04
Max. Negotiated Rate	$0.06
Rate for Payer: Cash Price	$0.04
Rate for Payer: Cigna of CA HMO/PPO	$0.06
Rate for Payer: Health Smart Auto/Commercial	$0.05
Rate for Payer: LLUH Dept of Risk Management WC	$0.04
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$0.06

FLUCONAZOLE 400 MG/200 ML IN SOD. CHLORIDE (ISO) HIGH DOSE IVPB [4081121]

Facility

OP

$0.08

Service Code	CPT J1450
Hospital Charge Code	1753160
Hospital Revenue Code	636
Min. Negotiated Rate	$0.04
Max. Negotiated Rate	$0.06
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$0.05
Rate for Payer: Aetna of CA Government/Medicare	$0.05
Rate for Payer: Cash Price	$0.04
Rate for Payer: Health Smart Auto/Commercial	$0.05
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$0.05
Rate for Payer: LLUH Dept of Risk Management WC	$0.04
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$0.06

FLUCONAZOLE 400 MG/200 ML IN SOD. CHLORIDE(ISO) INTRAVENOUS PIGGYBACK [10050]

Facility

OP

$0.04

Service Code	CPT J1450
Hospital Charge Code	1753160
Hospital Revenue Code	636
Min. Negotiated Rate	$0.02
Max. Negotiated Rate	$0.03
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$0.02
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$0.05
Rate for Payer: Aetna of CA Government/Medicare	$0.02
Rate for Payer: Aetna of CA Government/Medicare	$0.05
Rate for Payer: Cash Price	$0.02
Rate for Payer: Cash Price	$0.04
Rate for Payer: Health Smart Auto/Commercial	$0.02
Rate for Payer: Health Smart Auto/Commercial	$0.05
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$0.02
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$0.05
Rate for Payer: LLUH Dept of Risk Management WC	$0.02
Rate for Payer: LLUH Dept of Risk Management WC	$0.04
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$0.06
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$0.03

FLUCONAZOLE 400 MG/200 ML IN SOD. CHLORIDE(ISO) INTRAVENOUS PIGGYBACK [10050]

Facility

IP

$0.08

Service Code	CPT J1450
Hospital Charge Code	1753160
Hospital Revenue Code	636
Min. Negotiated Rate	$0.04
Max. Negotiated Rate	$0.06
Rate for Payer: Cash Price	$0.04
Rate for Payer: Cash Price	$0.02
Rate for Payer: Cigna of CA HMO/PPO	$0.03
Rate for Payer: Cigna of CA HMO/PPO	$0.06
Rate for Payer: Health Smart Auto/Commercial	$0.05
Rate for Payer: Health Smart Auto/Commercial	$0.02
Rate for Payer: LLUH Dept of Risk Management WC	$0.02
Rate for Payer: LLUH Dept of Risk Management WC	$0.04
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$0.03
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$0.06

FLUCONAZOLE 40 MG/ML ORAL SUSPENSION [14233]

Facility

OP

$0.96

Service Code	NDC 0049-3450-19
Hospital Charge Code	1715300
Hospital Revenue Code	259
Min. Negotiated Rate	$0.53
Max. Negotiated Rate	$0.72
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$0.58
Rate for Payer: Aetna of CA Government/Medicare	$0.58
Rate for Payer: Cash Price	$0.43
Rate for Payer: Health Smart Auto/Commercial	$0.58
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$0.58
Rate for Payer: LLUH Dept of Risk Management WC	$0.53
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$0.72

FLUCONAZOLE 40 MG/ML ORAL SUSPENSION [14233]

Facility

OP

$1.37

Service Code	NDC 57237-150-35
Hospital Charge Code	1715300
Hospital Revenue Code	259
Min. Negotiated Rate	$0.75
Max. Negotiated Rate	$1.03
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$0.82
Rate for Payer: Aetna of CA Government/Medicare	$0.82
Rate for Payer: Cash Price	$0.62
Rate for Payer: Health Smart Auto/Commercial	$0.82
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$0.82
Rate for Payer: LLUH Dept of Risk Management WC	$0.75
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$1.03

FLUCONAZOLE 40 MG/ML ORAL SUSPENSION [14233]

Facility

OP

$2.02

Service Code	NDC 59762-5030-1
Hospital Charge Code	1715300
Hospital Revenue Code	259
Min. Negotiated Rate	$1.11
Max. Negotiated Rate	$1.52
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$1.21
Rate for Payer: Aetna of CA Government/Medicare	$1.21
Rate for Payer: Cash Price	$0.91
Rate for Payer: Health Smart Auto/Commercial	$1.21
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$1.21
Rate for Payer: LLUH Dept of Risk Management WC	$1.11
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$1.52

FLUCONAZOLE 40 MG/ML ORAL SUSPENSION [14233]

Facility

IP

$1.37

Service Code	NDC 57237-150-35
Hospital Charge Code	1715300
Hospital Revenue Code	259
Min. Negotiated Rate	$0.75
Max. Negotiated Rate	$1.10
Rate for Payer: Cash Price	$0.62
Rate for Payer: Cigna of CA HMO/PPO	$1.10
Rate for Payer: Health Smart Auto/Commercial	$0.82
Rate for Payer: LLUH Dept of Risk Management WC	$0.75
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$1.03

FLUCONAZOLE 40 MG/ML ORAL SUSPENSION [14233]

Facility

IP

$0.96

Service Code	NDC 0049-3450-19
Hospital Charge Code	1715300
Hospital Revenue Code	259
Min. Negotiated Rate	$0.53
Max. Negotiated Rate	$0.77
Rate for Payer: Cash Price	$0.43
Rate for Payer: Cigna of CA HMO/PPO	$0.77
Rate for Payer: Health Smart Auto/Commercial	$0.58
Rate for Payer: LLUH Dept of Risk Management WC	$0.53
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$0.72

FLUCONAZOLE 40 MG/ML ORAL SUSPENSION [14233]

Facility

IP

$2.02

Service Code	NDC 59762-5030-1
Hospital Charge Code	1715300
Hospital Revenue Code	259
Min. Negotiated Rate	$1.11
Max. Negotiated Rate	$1.62
Rate for Payer: Cash Price	$0.91
Rate for Payer: Cigna of CA HMO/PPO	$1.62
Rate for Payer: Health Smart Auto/Commercial	$1.21
Rate for Payer: LLUH Dept of Risk Management WC	$1.11
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$1.52

FLUCONAZOLE 50 MG TABLET [10046]

Facility

OP

$0.40

Service Code	NDC 57237-003-30
Hospital Charge Code	1711487
Hospital Revenue Code	259
Min. Negotiated Rate	$0.22
Max. Negotiated Rate	$0.30
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$0.24
Rate for Payer: Aetna of CA Government/Medicare	$0.24
Rate for Payer: Cash Price	$0.18
Rate for Payer: Health Smart Auto/Commercial	$0.24
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$0.24
Rate for Payer: LLUH Dept of Risk Management WC	$0.22
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$0.30

FLUCONAZOLE 50 MG TABLET [10046]

Facility

IP

$0.40

Service Code	NDC 62559-990-30
Hospital Charge Code	1711487
Hospital Revenue Code	259
Min. Negotiated Rate	$0.22
Max. Negotiated Rate	$0.32
Rate for Payer: Cash Price	$0.18
Rate for Payer: Cigna of CA HMO/PPO	$0.32
Rate for Payer: Health Smart Auto/Commercial	$0.24
Rate for Payer: LLUH Dept of Risk Management WC	$0.22
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$0.30

FLUCONAZOLE 50 MG TABLET [10046]

Facility

IP

$0.80

Service Code	NDC 68462-101-30
Hospital Charge Code	1711487
Hospital Revenue Code	259
Min. Negotiated Rate	$0.44
Max. Negotiated Rate	$0.64
Rate for Payer: Cash Price	$0.36
Rate for Payer: Cigna of CA HMO/PPO	$0.64
Rate for Payer: Health Smart Auto/Commercial	$0.48
Rate for Payer: LLUH Dept of Risk Management WC	$0.44
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$0.60

FLUCONAZOLE 50 MG TABLET [10046]

Facility

OP

$0.40

Service Code	NDC 62559-990-30
Hospital Charge Code	1711487
Hospital Revenue Code	259
Min. Negotiated Rate	$0.22
Max. Negotiated Rate	$0.30
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$0.24
Rate for Payer: Aetna of CA Government/Medicare	$0.24
Rate for Payer: Cash Price	$0.18
Rate for Payer: Health Smart Auto/Commercial	$0.24
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$0.24
Rate for Payer: LLUH Dept of Risk Management WC	$0.22
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$0.30

<<
<
212
213
214
215
216
217
218
219
220
221
>
>>