Loma Linda University Behavioral Medicine Center (BMC)

All Charges

Charge

Type

Setting

Price

FLUCONAZOLE 50 MG TABLET [10046]

Facility

$0.40

Service Code	NDC 57237-003-30
Hospital Charge Code	1711487
Hospital Revenue Code	259
Min. Negotiated Rate	$0.22
Max. Negotiated Rate	$0.32
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

$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

FLUCYTOSINE 250 MG CAPSULE [10051]

Facility

$36.00

Service Code	NDC 42794-009-08
Hospital Charge Code	1710458
Hospital Revenue Code	259
Min. Negotiated Rate	$19.80
Max. Negotiated Rate	$28.80
Rate for Payer: Cash Price	$16.20
Rate for Payer: Cigna of CA HMO/PPO	$28.80
Rate for Payer: Health Smart Auto/Commercial	$21.60
Rate for Payer: LLUH Dept of Risk Management WC	$19.80
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$27.00

FLUCYTOSINE 250 MG CAPSULE [10051]

Facility

$30.12

Service Code	NDC 59651-331-01
Hospital Charge Code	1710458
Hospital Revenue Code	259
Min. Negotiated Rate	$16.57
Max. Negotiated Rate	$24.10
Rate for Payer: Cash Price	$13.55
Rate for Payer: Cigna of CA HMO/PPO	$24.10
Rate for Payer: Health Smart Auto/Commercial	$18.07
Rate for Payer: LLUH Dept of Risk Management WC	$16.57
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$22.59

FLUCYTOSINE 250 MG CAPSULE [10051]

Facility

$30.12

Service Code	NDC 59651-331-01
Hospital Charge Code	1710458
Hospital Revenue Code	259
Min. Negotiated Rate	$16.57
Max. Negotiated Rate	$22.59
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$18.07
Rate for Payer: Aetna of CA Government/Medicare	$18.07
Rate for Payer: Cash Price	$13.55
Rate for Payer: Health Smart Auto/Commercial	$18.07
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$18.07
Rate for Payer: LLUH Dept of Risk Management WC	$16.57
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$22.59

FLUCYTOSINE 250 MG CAPSULE [10051]

Facility

$36.00

Service Code	NDC 42794-009-08
Hospital Charge Code	1710458
Hospital Revenue Code	259
Min. Negotiated Rate	$19.80
Max. Negotiated Rate	$27.00
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$21.60
Rate for Payer: Aetna of CA Government/Medicare	$21.60
Rate for Payer: Cash Price	$16.20
Rate for Payer: Health Smart Auto/Commercial	$21.60
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$21.60
Rate for Payer: LLUH Dept of Risk Management WC	$19.80
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$27.00

FLUCYTOSINE 500 MG CAPSULE [10052]

Facility

$68.00

Service Code	NDC 42794-010-08
Hospital Charge Code	1710466
Hospital Revenue Code	259
Min. Negotiated Rate	$37.40
Max. Negotiated Rate	$51.00
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$40.80
Rate for Payer: Aetna of CA Government/Medicare	$40.80
Rate for Payer: Cash Price	$30.60
Rate for Payer: Health Smart Auto/Commercial	$40.80
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$40.80
Rate for Payer: LLUH Dept of Risk Management WC	$37.40
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$51.00

FLUCYTOSINE 500 MG CAPSULE [10052]

Facility

$68.00

Service Code	NDC 42794-010-08
Hospital Charge Code	1710466
Hospital Revenue Code	259
Min. Negotiated Rate	$37.40
Max. Negotiated Rate	$54.40
Rate for Payer: Cash Price	$30.60
Rate for Payer: Cigna of CA HMO/PPO	$54.40
Rate for Payer: Health Smart Auto/Commercial	$40.80
Rate for Payer: LLUH Dept of Risk Management WC	$37.40
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$51.00

FLUCYTOSINE 500 MG CAPSULE [10052]

Facility

$158.81

Service Code	NDC 42494-340-03
Hospital Charge Code	1710466
Hospital Revenue Code	259
Min. Negotiated Rate	$87.35
Max. Negotiated Rate	$127.05
Rate for Payer: Cash Price	$71.46
Rate for Payer: Cigna of CA HMO/PPO	$127.05
Rate for Payer: Health Smart Auto/Commercial	$95.29
Rate for Payer: LLUH Dept of Risk Management WC	$87.35
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$119.11

FLUCYTOSINE 500 MG CAPSULE [10052]

Facility

$158.81

Service Code	NDC 42494-340-03
Hospital Charge Code	1710466
Hospital Revenue Code	259
Min. Negotiated Rate	$87.35
Max. Negotiated Rate	$119.11
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$95.29
Rate for Payer: Aetna of CA Government/Medicare	$95.29
Rate for Payer: Cash Price	$71.46
Rate for Payer: Health Smart Auto/Commercial	$95.29
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$95.29
Rate for Payer: LLUH Dept of Risk Management WC	$87.35
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$119.11

FLUCYTOSINE 500 MG CAPSULE [10052]

Facility

$24.00

Service Code	NDC 43386-770-01
Hospital Charge Code	1710466
Hospital Revenue Code	259
Min. Negotiated Rate	$13.20
Max. Negotiated Rate	$19.20
Rate for Payer: Cash Price	$10.80
Rate for Payer: Cigna of CA HMO/PPO	$19.20
Rate for Payer: Health Smart Auto/Commercial	$14.40
Rate for Payer: LLUH Dept of Risk Management WC	$13.20
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$18.00

FLUCYTOSINE 500 MG CAPSULE [10052]

Facility

$24.00

Service Code	NDC 43386-770-01
Hospital Charge Code	1710466
Hospital Revenue Code	259
Min. Negotiated Rate	$13.20
Max. Negotiated Rate	$18.00
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$14.40
Rate for Payer: Aetna of CA Government/Medicare	$14.40
Rate for Payer: Cash Price	$10.80
Rate for Payer: Health Smart Auto/Commercial	$14.40
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$14.40
Rate for Payer: LLUH Dept of Risk Management WC	$13.20
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$18.00

FLUCYTOSINE ORAL SUSPENSION COMPOUND 50 MG/ML [4080274]

Facility

$9.38

Service Code	NDC 9994-0802-74
Hospital Charge Code	1715313
Hospital Revenue Code	259
Min. Negotiated Rate	$5.16
Max. Negotiated Rate	$7.04
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$5.63
Rate for Payer: Aetna of CA Government/Medicare	$5.63
Rate for Payer: Cash Price	$4.22
Rate for Payer: Health Smart Auto/Commercial	$5.63
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$5.63
Rate for Payer: LLUH Dept of Risk Management WC	$5.16
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$7.04

FLUCYTOSINE ORAL SUSPENSION COMPOUND 50 MG/ML [4080274]

Facility

$9.38

Service Code	NDC 9994-0802-74
Hospital Charge Code	1715313
Hospital Revenue Code	259
Min. Negotiated Rate	$5.16
Max. Negotiated Rate	$7.50
Rate for Payer: Cash Price	$4.22
Rate for Payer: Cigna of CA HMO/PPO	$7.50
Rate for Payer: Health Smart Auto/Commercial	$5.63
Rate for Payer: LLUH Dept of Risk Management WC	$5.16
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$7.04

FLUDARABINE 50 MG/2 ML INTRAVENOUS SOLUTION [41294]

Facility

$228.00

Service Code	CPT J9185
Hospital Charge Code	1755589
Hospital Revenue Code	636
Min. Negotiated Rate	$125.40
Max. Negotiated Rate	$171.00
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$136.80
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$78.30
Rate for Payer: Aetna of CA Government/Medicare	$78.30
Rate for Payer: Aetna of CA Government/Medicare	$136.80
Rate for Payer: Cash Price	$102.60
Rate for Payer: Cash Price	$58.73
Rate for Payer: Health Smart Auto/Commercial	$78.30
Rate for Payer: Health Smart Auto/Commercial	$136.80
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$136.80
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$78.30
Rate for Payer: LLUH Dept of Risk Management WC	$125.40
Rate for Payer: LLUH Dept of Risk Management WC	$71.78
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$171.00
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$97.88

FLUDARABINE 50 MG/2 ML INTRAVENOUS SOLUTION [41294]

Facility

$130.50

Service Code	CPT J9185
Hospital Charge Code	1755589
Hospital Revenue Code	636
Min. Negotiated Rate	$71.78
Max. Negotiated Rate	$104.40
Rate for Payer: Cash Price	$58.73
Rate for Payer: Cash Price	$102.60
Rate for Payer: Cigna of CA HMO/PPO	$104.40
Rate for Payer: Cigna of CA HMO/PPO	$182.40
Rate for Payer: Health Smart Auto/Commercial	$78.30
Rate for Payer: Health Smart Auto/Commercial	$136.80
Rate for Payer: LLUH Dept of Risk Management WC	$125.40
Rate for Payer: LLUH Dept of Risk Management WC	$71.78
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$97.88
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$171.00

FLUDEOXYGLUCOSE F-18 20 MCI TO 200 MCI/ML INTRAVENOUS SOLUTION [222882]

Facility

$60.00

Service Code	CPT A9552
Hospital Charge Code	ERX222882
Hospital Revenue Code	343
Min. Negotiated Rate	$33.00
Max. Negotiated Rate	$45.00
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$36.00
Rate for Payer: Aetna of CA Government/Medicare	$36.00
Rate for Payer: Cash Price	$27.00
Rate for Payer: Health Smart Auto/Commercial	$36.00
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$36.00
Rate for Payer: LLUH Dept of Risk Management WC	$33.00
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$45.00

FLUDEOXYGLUCOSE F-18 20 MCI TO 200 MCI/ML INTRAVENOUS SOLUTION [222882]

Facility

$60.00

Service Code	CPT A9552
Hospital Charge Code	ERX222882
Hospital Revenue Code	343
Min. Negotiated Rate	$33.00
Max. Negotiated Rate	$48.00
Rate for Payer: Cash Price	$27.00
Rate for Payer: Cigna of CA HMO/PPO	$48.00
Rate for Payer: Health Smart Auto/Commercial	$36.00
Rate for Payer: LLUH Dept of Risk Management WC	$33.00
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$45.00

FLUDROCORTISONE 0.1 MG TABLET [10054]

Facility

$0.99

Service Code	NDC 50268-330-15
Hospital Charge Code	1710256
Hospital Revenue Code	259
Min. Negotiated Rate	$0.54
Max. Negotiated Rate	$0.74
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$0.59
Rate for Payer: Aetna of CA Government/Medicare	$0.59
Rate for Payer: Cash Price	$0.45
Rate for Payer: Health Smart Auto/Commercial	$0.59
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$0.59
Rate for Payer: LLUH Dept of Risk Management WC	$0.54
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$0.74

FLUDROCORTISONE 0.1 MG TABLET [10054]

Facility

$0.71

Service Code	NDC 0115-7033-02
Hospital Charge Code	1710256
Hospital Revenue Code	259
Min. Negotiated Rate	$0.39
Max. Negotiated Rate	$0.53
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$0.43
Rate for Payer: Aetna of CA Government/Medicare	$0.43
Rate for Payer: Cash Price	$0.32
Rate for Payer: Health Smart Auto/Commercial	$0.43
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$0.43
Rate for Payer: LLUH Dept of Risk Management WC	$0.39
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$0.53

FLUDROCORTISONE 0.1 MG TABLET [10054]

Facility

$0.71

Service Code	NDC 0115-7033-01
Hospital Charge Code	1710256
Hospital Revenue Code	259
Min. Negotiated Rate	$0.39
Max. Negotiated Rate	$0.53
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$0.43
Rate for Payer: Aetna of CA Government/Medicare	$0.43
Rate for Payer: Cash Price	$0.32
Rate for Payer: Health Smart Auto/Commercial	$0.43
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$0.43
Rate for Payer: LLUH Dept of Risk Management WC	$0.39
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$0.53

FLUDROCORTISONE 0.1 MG TABLET [10054]

Facility

$0.66

Service Code	NDC 0555-0997-02
Hospital Charge Code	1710256
Hospital Revenue Code	259
Min. Negotiated Rate	$0.36
Max. Negotiated Rate	$0.53
Rate for Payer: Cash Price	$0.30
Rate for Payer: Cigna of CA HMO/PPO	$0.53
Rate for Payer: Health Smart Auto/Commercial	$0.40
Rate for Payer: LLUH Dept of Risk Management WC	$0.36
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$0.50

FLUDROCORTISONE 0.1 MG TABLET [10054]

Facility

$0.71

Service Code	NDC 0115-7033-02
Hospital Charge Code	1710256
Hospital Revenue Code	259
Min. Negotiated Rate	$0.39
Max. Negotiated Rate	$0.57
Rate for Payer: Cash Price	$0.32
Rate for Payer: Cigna of CA HMO/PPO	$0.57
Rate for Payer: Health Smart Auto/Commercial	$0.43
Rate for Payer: LLUH Dept of Risk Management WC	$0.39
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$0.53

FLUDROCORTISONE 0.1 MG TABLET [10054]

Facility

$0.99

Service Code	NDC 50268-330-11
Hospital Charge Code	1710256
Hospital Revenue Code	259
Min. Negotiated Rate	$0.54
Max. Negotiated Rate	$0.74
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$0.59
Rate for Payer: Aetna of CA Government/Medicare	$0.59
Rate for Payer: Cash Price	$0.45
Rate for Payer: Health Smart Auto/Commercial	$0.59
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$0.59
Rate for Payer: LLUH Dept of Risk Management WC	$0.54
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$0.74

FLUDROCORTISONE 0.1 MG TABLET [10054]

Facility

$0.99

Service Code	NDC 50268-330-15
Hospital Charge Code	1710256
Hospital Revenue Code	259
Min. Negotiated Rate	$0.54
Max. Negotiated Rate	$0.79
Rate for Payer: Cash Price	$0.45
Rate for Payer: Cigna of CA HMO/PPO	$0.79
Rate for Payer: Health Smart Auto/Commercial	$0.59
Rate for Payer: LLUH Dept of Risk Management WC	$0.54
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$0.74

Know your out-of-pocket cost for care.

All Charges