Price Transparency

Know your out-of-pocket cost for care.

All Charges

Charge

Type

Setting

Price

FLUOCINOLONE 0.01 % TOPICAL CREAM [3183]

Facility

OP

$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

IP

$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

FLUOCINOLONE 0.01 % TOPICAL SOLUTION [3186]

Facility

IP

$1.60

Service Code	NDC 52565-012-59
Hospital Charge Code	1743114
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

FLUOCINOLONE 0.01 % TOPICAL SOLUTION [3186]

Facility

OP

$1.60

Service Code	NDC 52565-012-59
Hospital Charge Code	1743114
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

FLUOCINOLONE 0.025 % TOPICAL OINTMENT [3185]

Facility

IP

$2.26

Service Code	NDC 0713-0224-15
Hospital Charge Code	1743235
Hospital Revenue Code	259
Min. Negotiated Rate	$1.24
Max. Negotiated Rate	$1.81
Rate for Payer: Cash Price	$1.02
Rate for Payer: Cigna of CA HMO/PPO	$1.81
Rate for Payer: Health Smart Auto/Commercial	$1.36
Rate for Payer: LLUH Dept of Risk Management WC	$1.24
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$1.70

FLUOCINOLONE 0.025 % TOPICAL OINTMENT [3185]

Facility

OP

$2.26

Service Code	NDC 0713-0224-15
Hospital Charge Code	1743235
Hospital Revenue Code	259
Min. Negotiated Rate	$1.24
Max. Negotiated Rate	$1.70
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$1.36
Rate for Payer: Aetna of CA Government/Medicare	$1.36
Rate for Payer: Cash Price	$1.02
Rate for Payer: Health Smart Auto/Commercial	$1.36
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$1.36
Rate for Payer: LLUH Dept of Risk Management WC	$1.24
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$1.70

FLUOCINOLONE 0.025 % TOPICAL OINTMENT [3185]

Facility

IP

$2.25

Service Code	NDC 0168-0064-15
Hospital Charge Code	1743235
Hospital Revenue Code	259
Min. Negotiated Rate	$1.24
Max. Negotiated Rate	$1.80
Rate for Payer: Cash Price	$1.01
Rate for Payer: Cigna of CA HMO/PPO	$1.80
Rate for Payer: Health Smart Auto/Commercial	$1.35
Rate for Payer: LLUH Dept of Risk Management WC	$1.24
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$1.69

FLUOCINOLONE 0.025 % TOPICAL OINTMENT [3185]

Facility

OP

$2.25

Service Code	NDC 0168-0064-15
Hospital Charge Code	1743235
Hospital Revenue Code	259
Min. Negotiated Rate	$1.24
Max. Negotiated Rate	$1.69
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$1.35
Rate for Payer: Aetna of CA Government/Medicare	$1.35
Rate for Payer: Cash Price	$1.01
Rate for Payer: Health Smart Auto/Commercial	$1.35
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$1.35
Rate for Payer: LLUH Dept of Risk Management WC	$1.24
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$1.69

FLUOCINOLONE 0.025 % TOPICAL OINTMENT [3185]

Facility

IP

$1.69

Service Code	NDC 0713-0224-60
Hospital Charge Code	1743208
Hospital Revenue Code	259
Min. Negotiated Rate	$0.93
Max. Negotiated Rate	$1.35
Rate for Payer: Cash Price	$0.76
Rate for Payer: Cigna of CA HMO/PPO	$1.35
Rate for Payer: Health Smart Auto/Commercial	$1.01
Rate for Payer: LLUH Dept of Risk Management WC	$0.93
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$1.27

FLUOCINOLONE 0.025 % TOPICAL OINTMENT [3185]

Facility

OP

$1.69

Service Code	NDC 0713-0224-60
Hospital Charge Code	1743208
Hospital Revenue Code	259
Min. Negotiated Rate	$0.93
Max. Negotiated Rate	$1.27
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$1.01
Rate for Payer: Aetna of CA Government/Medicare	$1.01
Rate for Payer: Cash Price	$0.76
Rate for Payer: Health Smart Auto/Commercial	$1.01
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$1.01
Rate for Payer: LLUH Dept of Risk Management WC	$0.93
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$1.27

FLUOCINOLONE 0.18 MG INTRAVITREAL IMPLANT [223628]

Facility

OP

$10,795.20

Service Code	CPT J7314
Hospital Charge Code	ERX223628
Hospital Revenue Code	636
Min. Negotiated Rate	$5,937.36
Max. Negotiated Rate	$8,096.40
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$6,477.12
Rate for Payer: Aetna of CA Government/Medicare	$6,477.12
Rate for Payer: Cash Price	$4,857.84
Rate for Payer: Health Smart Auto/Commercial	$6,477.12
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$6,477.12
Rate for Payer: LLUH Dept of Risk Management WC	$5,937.36
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$8,096.40

FLUOCINOLONE 0.18 MG INTRAVITREAL IMPLANT [223628]

Facility

IP

$10,795.20

Service Code	CPT J7314
Hospital Charge Code	ERX223628
Hospital Revenue Code	636
Min. Negotiated Rate	$5,937.36
Max. Negotiated Rate	$8,636.16
Rate for Payer: Health Smart Auto/Commercial	$6,477.12
Rate for Payer: Cash Price	$4,857.84
Rate for Payer: Cigna of CA HMO/PPO	$8,636.16
Rate for Payer: LLUH Dept of Risk Management WC	$5,937.36
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$8,096.40

FLUOCINOLONE 0.19 MG INTRAVITREAL IMPLANT [208310]

Facility

IP

$10,560.00

Service Code	CPT J7313
Hospital Charge Code	ERX208310
Hospital Revenue Code	636
Min. Negotiated Rate	$5,808.00
Max. Negotiated Rate	$8,448.00
Rate for Payer: Cash Price	$4,752.00
Rate for Payer: Cigna of CA HMO/PPO	$8,448.00
Rate for Payer: Health Smart Auto/Commercial	$6,336.00
Rate for Payer: LLUH Dept of Risk Management WC	$5,808.00
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$7,920.00

FLUOCINOLONE 0.19 MG INTRAVITREAL IMPLANT [208310]

Facility

OP

$10,560.00

Service Code	CPT J7313
Hospital Charge Code	ERX208310
Hospital Revenue Code	636
Min. Negotiated Rate	$5,808.00
Max. Negotiated Rate	$7,920.00
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$6,336.00
Rate for Payer: Aetna of CA Government/Medicare	$6,336.00
Rate for Payer: Cash Price	$4,752.00
Rate for Payer: Health Smart Auto/Commercial	$6,336.00
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$6,336.00
Rate for Payer: LLUH Dept of Risk Management WC	$5,808.00
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$7,920.00

FLUOCINONIDE 0.05 % TOPICAL CREAM [3187]

Facility

IP

$2.92

Service Code	NDC 51862-494-15
Hospital Charge Code	1743410
Hospital Revenue Code	259
Min. Negotiated Rate	$1.61
Max. Negotiated Rate	$2.34
Rate for Payer: Cash Price	$1.31
Rate for Payer: Cigna of CA HMO/PPO	$2.34
Rate for Payer: Health Smart Auto/Commercial	$1.75
Rate for Payer: LLUH Dept of Risk Management WC	$1.61
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$2.19

FLUOCINONIDE 0.05 % TOPICAL CREAM [3187]

Facility

OP

$2.92

Service Code	NDC 0093-0262-15
Hospital Charge Code	1743410
Hospital Revenue Code	259
Min. Negotiated Rate	$1.61
Max. Negotiated Rate	$2.19
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$1.75
Rate for Payer: Aetna of CA Government/Medicare	$1.75
Rate for Payer: Cash Price	$1.31
Rate for Payer: Health Smart Auto/Commercial	$1.75
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$1.75
Rate for Payer: LLUH Dept of Risk Management WC	$1.61
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$2.19

FLUOCINONIDE 0.05 % TOPICAL CREAM [3187]

Facility

IP

$1.20

Service Code	NDC 51672-1386-1
Hospital Charge Code	1743410
Hospital Revenue Code	259
Min. Negotiated Rate	$0.66
Max. Negotiated Rate	$0.96
Rate for Payer: Cash Price	$0.54
Rate for Payer: Cigna of CA 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 Beech St/Commercial/PHCS	$0.90

FLUOCINONIDE 0.05 % TOPICAL CREAM [3187]

Facility

IP

$2.92

Service Code	NDC 0093-0262-15
Hospital Charge Code	1743410
Hospital Revenue Code	259
Min. Negotiated Rate	$1.61
Max. Negotiated Rate	$2.34
Rate for Payer: Cash Price	$1.31
Rate for Payer: Cigna of CA HMO/PPO	$2.34
Rate for Payer: Health Smart Auto/Commercial	$1.75
Rate for Payer: LLUH Dept of Risk Management WC	$1.61
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$2.19

FLUOCINONIDE 0.05 % TOPICAL CREAM [3187]

Facility

OP

$1.20

Service Code	NDC 51672-1386-1
Hospital Charge Code	1743410
Hospital Revenue Code	259
Min. Negotiated Rate	$0.66
Max. Negotiated Rate	$0.90
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	$0.54
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 Beech St/Commercial/PHCS	$0.90

FLUOCINONIDE 0.05 % TOPICAL CREAM [3187]

Facility

OP

$2.92

Service Code	NDC 51862-494-15
Hospital Charge Code	1743410
Hospital Revenue Code	259
Min. Negotiated Rate	$1.61
Max. Negotiated Rate	$2.19
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$1.75
Rate for Payer: Aetna of CA Government/Medicare	$1.75
Rate for Payer: Cash Price	$1.31
Rate for Payer: Health Smart Auto/Commercial	$1.75
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$1.75
Rate for Payer: LLUH Dept of Risk Management WC	$1.61
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$2.19

FLUOCINONIDE 0.05 % TOPICAL CREAM. [4083187]

Facility

IP

$2.92

Service Code	NDC 0093-0262-30
Hospital Charge Code	1743039
Hospital Revenue Code	259
Min. Negotiated Rate	$1.61
Max. Negotiated Rate	$2.34
Rate for Payer: Cash Price	$1.31
Rate for Payer: Cigna of CA HMO/PPO	$2.34
Rate for Payer: Health Smart Auto/Commercial	$1.75
Rate for Payer: LLUH Dept of Risk Management WC	$1.61
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$2.19

FLUOCINONIDE 0.05 % TOPICAL CREAM. [4083187]

Facility

OP

$3.08

Service Code	NDC 51672-1254-1
Hospital Charge Code	1743410
Hospital Revenue Code	259
Min. Negotiated Rate	$1.69
Max. Negotiated Rate	$2.31
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$1.85
Rate for Payer: Aetna of CA Government/Medicare	$1.85
Rate for Payer: Cash Price	$1.39
Rate for Payer: Health Smart Auto/Commercial	$1.85
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$1.85
Rate for Payer: LLUH Dept of Risk Management WC	$1.69
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$2.31

FLUOCINONIDE 0.05 % TOPICAL CREAM. [4083187]

Facility

OP

$2.92

Service Code	NDC 0093-0262-30
Hospital Charge Code	1743039
Hospital Revenue Code	259
Min. Negotiated Rate	$1.61
Max. Negotiated Rate	$2.19
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$1.75
Rate for Payer: Aetna of CA Government/Medicare	$1.75
Rate for Payer: Cash Price	$1.31
Rate for Payer: Health Smart Auto/Commercial	$1.75
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$1.75
Rate for Payer: LLUH Dept of Risk Management WC	$1.61
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$2.19

FLUOCINONIDE 0.05 % TOPICAL CREAM. [4083187]

Facility

IP

$3.08

Service Code	NDC 51672-1254-1
Hospital Charge Code	1743410
Hospital Revenue Code	259
Min. Negotiated Rate	$1.69
Max. Negotiated Rate	$2.46
Rate for Payer: Cash Price	$1.39
Rate for Payer: Cigna of CA HMO/PPO	$2.46
Rate for Payer: Health Smart Auto/Commercial	$1.85
Rate for Payer: LLUH Dept of Risk Management WC	$1.69
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$2.31

FLUOCINONIDE 0.05 % TOPICAL OINTMENT [3189]

Facility

OP

$0.78

Service Code	NDC 51672-1264-3
Hospital Charge Code	1743029
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	$0.35
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

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