Loma Linda University Behavioral Medicine Center (BMC)

All Charges

Charge

Type

Setting

Price

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	$0.79
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

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	$0.50
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$0.40
Rate for Payer: Aetna of CA Government/Medicare	$0.40
Rate for Payer: Cash Price	$0.30
Rate for Payer: Health Smart Auto/Commercial	$0.40
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$0.40
Rate for Payer: LLUH Dept of Risk Management WC	$0.36
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$0.50

FLUDROCORTISONE ORAL SUSPENSION COMPOUND 0.05 MG/ML [4080275]

Facility

$0.40

Service Code	NDC 9994-0802-75
Hospital Charge Code	1715215
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

FLUDROCORTISONE ORAL SUSPENSION COMPOUND 0.05 MG/ML [4080275]

Facility

$0.40

Service Code	NDC 9994-0802-75
Hospital Charge Code	1715215
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

FLUMAZENIL 0.1 MG/ML INTRAVENOUS SOLUTION [10055]

Facility

$1.78

Service Code	NDC 63323-424-05
Hospital Charge Code	1721033
Hospital Revenue Code	250
Min. Negotiated Rate	$0.98
Max. Negotiated Rate	$1.42
Rate for Payer: Cash Price	$0.80
Rate for Payer: Cigna of CA HMO/PPO	$1.42
Rate for Payer: Health Smart Auto/Commercial	$1.07
Rate for Payer: LLUH Dept of Risk Management WC	$0.98
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$1.34

FLUMAZENIL 0.1 MG/ML INTRAVENOUS SOLUTION [10055]

Facility

$1.70

Service Code	NDC 36000-148-01
Hospital Charge Code	1721033
Hospital Revenue Code	250
Min. Negotiated Rate	$0.94
Max. Negotiated Rate	$1.28
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$1.02
Rate for Payer: Aetna of CA Government/Medicare	$1.02
Rate for Payer: Cash Price	$0.77
Rate for Payer: Health Smart Auto/Commercial	$1.02
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$1.02
Rate for Payer: LLUH Dept of Risk Management WC	$0.94
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$1.28

FLUMAZENIL 0.1 MG/ML INTRAVENOUS SOLUTION [10055]

Facility

$1.56

Service Code	NDC 0143-9784-10
Hospital Charge Code	1721033
Hospital Revenue Code	250
Min. Negotiated Rate	$0.86
Max. Negotiated Rate	$1.17
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$0.94
Rate for Payer: Aetna of CA Government/Medicare	$0.94
Rate for Payer: Cash Price	$0.70
Rate for Payer: Health Smart Auto/Commercial	$0.94
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$0.94
Rate for Payer: LLUH Dept of Risk Management WC	$0.86
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$1.17

FLUMAZENIL 0.1 MG/ML INTRAVENOUS SOLUTION [10055]

Facility

$1.70

Service Code	NDC 36000-148-10
Hospital Charge Code	1721033
Hospital Revenue Code	250
Min. Negotiated Rate	$0.94
Max. Negotiated Rate	$1.36
Rate for Payer: Cash Price	$0.77
Rate for Payer: Cigna of CA HMO/PPO	$1.36
Rate for Payer: Health Smart Auto/Commercial	$1.02
Rate for Payer: LLUH Dept of Risk Management WC	$0.94
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$1.28

FLUMAZENIL 0.1 MG/ML INTRAVENOUS SOLUTION [10055]

Facility

$1.70

Service Code	NDC 36000-148-10
Hospital Charge Code	1721033
Hospital Revenue Code	250
Min. Negotiated Rate	$0.94
Max. Negotiated Rate	$1.28
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$1.02
Rate for Payer: Aetna of CA Government/Medicare	$1.02
Rate for Payer: Cash Price	$0.77
Rate for Payer: Health Smart Auto/Commercial	$1.02
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$1.02
Rate for Payer: LLUH Dept of Risk Management WC	$0.94
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$1.28

FLUMAZENIL 0.1 MG/ML INTRAVENOUS SOLUTION [10055]

Facility

$1.56

Service Code	NDC 0143-9784-10
Hospital Charge Code	1721033
Hospital Revenue Code	250
Min. Negotiated Rate	$0.86
Max. Negotiated Rate	$1.25
Rate for Payer: Cash Price	$0.70
Rate for Payer: Cigna of CA HMO/PPO	$1.25
Rate for Payer: Health Smart Auto/Commercial	$0.94
Rate for Payer: LLUH Dept of Risk Management WC	$0.86
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$1.17

FLUMAZENIL 0.1 MG/ML INTRAVENOUS SOLUTION [10055]

Facility

$1.78

Service Code	NDC 63323-424-05
Hospital Charge Code	1721033
Hospital Revenue Code	250
Min. Negotiated Rate	$0.98
Max. Negotiated Rate	$1.34
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$1.07
Rate for Payer: Aetna of CA Government/Medicare	$1.07
Rate for Payer: Cash Price	$0.80
Rate for Payer: Health Smart Auto/Commercial	$1.07
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$1.07
Rate for Payer: LLUH Dept of Risk Management WC	$0.98
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$1.34

FLUMAZENIL 0.1 MG/ML INTRAVENOUS SOLUTION [10055]

Facility

$1.70

Service Code	NDC 36000-148-01
Hospital Charge Code	1721033
Hospital Revenue Code	250
Min. Negotiated Rate	$0.94
Max. Negotiated Rate	$1.36
Rate for Payer: Cash Price	$0.77
Rate for Payer: Cigna of CA HMO/PPO	$1.36
Rate for Payer: Health Smart Auto/Commercial	$1.02
Rate for Payer: LLUH Dept of Risk Management WC	$0.94
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$1.28

FLUMAZENIL 0.5 MG/5 ML VIAL - CODE [4080567]

Facility

$1.78

Service Code	NDC 63323-424-05
Hospital Charge Code	1721033
Hospital Revenue Code	250
Min. Negotiated Rate	$0.98
Max. Negotiated Rate	$1.42
Rate for Payer: Cash Price	$0.80
Rate for Payer: Cigna of CA HMO/PPO	$1.42
Rate for Payer: Health Smart Auto/Commercial	$1.07
Rate for Payer: LLUH Dept of Risk Management WC	$0.98
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$1.34

FLUMAZENIL 0.5 MG/5 ML VIAL - CODE [4080567]

Facility

$1.78

Service Code	NDC 63323-424-05
Hospital Charge Code	1721033
Hospital Revenue Code	250
Min. Negotiated Rate	$0.98
Max. Negotiated Rate	$1.34
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$1.07
Rate for Payer: Aetna of CA Government/Medicare	$1.07
Rate for Payer: Cash Price	$0.80
Rate for Payer: Health Smart Auto/Commercial	$1.07
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$1.07
Rate for Payer: LLUH Dept of Risk Management WC	$0.98
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$1.34

FLUOCINOLONE 0.01 % SCALP OIL AND SHOWER CAP [117479]

Facility

$0.35

Service Code	NDC 68791-102-04
Hospital Charge Code	1743712
Hospital Revenue Code	250
Min. Negotiated Rate	$0.19
Max. Negotiated Rate	$0.28
Rate for Payer: Cash Price	$0.16
Rate for Payer: Cigna of CA HMO/PPO	$0.28
Rate for Payer: Health Smart Auto/Commercial	$0.21
Rate for Payer: LLUH Dept of Risk Management WC	$0.19
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$0.26

FLUOCINOLONE 0.01 % SCALP OIL AND SHOWER CAP [117479]

Facility

$0.35

Service Code	NDC 68791-102-04
Hospital Charge Code	1743712
Hospital Revenue Code	250
Min. Negotiated Rate	$0.19
Max. Negotiated Rate	$0.26
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$0.21
Rate for Payer: Aetna of CA Government/Medicare	$0.21
Rate for Payer: Cash Price	$0.16
Rate for Payer: Health Smart Auto/Commercial	$0.21
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$0.21
Rate for Payer: LLUH Dept of Risk Management WC	$0.19
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$0.26

FLUOCINOLONE 0.01 % TOPICAL BODY OIL [10057]

Facility

$0.37

Service Code	NDC 45802-887-26
Hospital Charge Code	NDG10057
Hospital Revenue Code	259
Min. Negotiated Rate	$0.20
Max. Negotiated Rate	$0.30
Rate for Payer: Cash Price	$0.17
Rate for Payer: Cigna of CA 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 Beech St/Commercial/PHCS	$0.28

FLUOCINOLONE 0.01 % TOPICAL BODY OIL [10057]

Facility

$0.37

Service Code	NDC 68791-101-04
Hospital Charge Code	NDG10057
Hospital Revenue Code	259
Min. Negotiated Rate	$0.20
Max. Negotiated Rate	$0.28
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$0.22
Rate for Payer: Aetna of CA Government/Medicare	$0.22
Rate for Payer: Cash Price	$0.17
Rate for Payer: Health Smart Auto/Commercial	$0.22
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$0.22
Rate for Payer: LLUH Dept of Risk Management WC	$0.20
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$0.28

FLUOCINOLONE 0.01 % TOPICAL BODY OIL [10057]

Facility

$0.37

Service Code	NDC 68791-101-04
Hospital Charge Code	NDG10057
Hospital Revenue Code	259
Min. Negotiated Rate	$0.20
Max. Negotiated Rate	$0.30
Rate for Payer: Cash Price	$0.17
Rate for Payer: Cigna of CA 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 Beech St/Commercial/PHCS	$0.28

FLUOCINOLONE 0.01 % TOPICAL BODY OIL [10057]

Facility

$0.37

Service Code	NDC 45802-887-26
Hospital Charge Code	NDG10057
Hospital Revenue Code	259
Min. Negotiated Rate	$0.20
Max. Negotiated Rate	$0.28
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$0.22
Rate for Payer: Aetna of CA Government/Medicare	$0.22
Rate for Payer: Cash Price	$0.17
Rate for Payer: Health Smart Auto/Commercial	$0.22
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$0.22
Rate for Payer: LLUH Dept of Risk Management WC	$0.20
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$0.28

FLUOCINOLONE 0.01 % TOPICAL CREAM [3183]

Facility

$2.23

Service Code	NDC 0713-0223-60
Hospital Charge Code	1743169
Hospital Revenue Code	259
Min. Negotiated Rate	$1.23
Max. Negotiated Rate	$1.78
Rate for Payer: Cash Price	$1.00
Rate for Payer: Cigna of CA 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 Beech St/Commercial/PHCS	$1.67

FLUOCINOLONE 0.01 % TOPICAL CREAM [3183]

Facility

$2.97

Service Code	NDC 52565-031-15
Hospital Charge Code	1743274
Hospital Revenue Code	259
Min. Negotiated Rate	$1.63
Max. Negotiated Rate	$2.23
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	$1.34
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 Beech St/Commercial/PHCS	$2.23

FLUOCINOLONE 0.01 % TOPICAL CREAM [3183]

Facility

$2.23

Service Code	NDC 0713-0223-60
Hospital Charge Code	1743169
Hospital Revenue Code	259
Min. Negotiated Rate	$1.23
Max. Negotiated Rate	$1.67
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	$1.00
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 Beech St/Commercial/PHCS	$1.67

FLUOCINOLONE 0.01 % TOPICAL CREAM [3183]

Facility

$3.00

Service Code	NDC 0713-0223-15
Hospital Charge Code	1743274
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

Know your out-of-pocket cost for care.

All Charges