Price Transparency

Know your out-of-pocket cost for care.

All Charges

Charge

Type

Setting

Price

FLUOCINONIDE 0.05 % TOPICAL OINTMENT [3189]

Facility

IP

$1.48

Service Code	NDC 52565-040-15
Hospital Charge Code	1743019
Hospital Revenue Code	259
Min. Negotiated Rate	$0.81
Max. Negotiated Rate	$1.18
Rate for Payer: Cash Price	$0.67
Rate for Payer: Cigna of CA HMO/PPO	$1.18
Rate for Payer: Health Smart Auto/Commercial	$0.89
Rate for Payer: LLUH Dept of Risk Management WC	$0.81
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$1.11

FLUOCINONIDE 0.05 % TOPICAL OINTMENT [3189]

Facility

OP

$1.48

Service Code	NDC 52565-040-15
Hospital Charge Code	1743019
Hospital Revenue Code	259
Min. Negotiated Rate	$0.81
Max. Negotiated Rate	$1.11
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$0.89
Rate for Payer: Aetna of CA Government/Medicare	$0.89
Rate for Payer: Cash Price	$0.67
Rate for Payer: Health Smart Auto/Commercial	$0.89
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$0.89
Rate for Payer: LLUH Dept of Risk Management WC	$0.81
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$1.11

FLUOCINONIDE 0.05 % TOPICAL OINTMENT [3189]

Facility

IP

$0.78

Service Code	NDC 51672-1264-3
Hospital Charge Code	1743029
Hospital Revenue Code	259
Min. Negotiated Rate	$0.43
Max. Negotiated Rate	$0.62
Rate for Payer: Cash Price	$0.35
Rate for Payer: Cigna of CA HMO/PPO	$0.62
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

FLUOCINONIDE 0.05 % TOPICAL OINTMENT [3189]

Facility

IP

$1.48

Service Code	NDC 51672-1264-1
Hospital Charge Code	1743019
Hospital Revenue Code	259
Min. Negotiated Rate	$0.81
Max. Negotiated Rate	$1.18
Rate for Payer: Cash Price	$0.67
Rate for Payer: Cigna of CA HMO/PPO	$1.18
Rate for Payer: Health Smart Auto/Commercial	$0.89
Rate for Payer: LLUH Dept of Risk Management WC	$0.81
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$1.11

FLUOCINONIDE 0.05 % TOPICAL OINTMENT [3189]

Facility

IP

$4.53

Service Code	NDC 0093-0264-92
Hospital Charge Code	1743029
Hospital Revenue Code	259
Min. Negotiated Rate	$2.49
Max. Negotiated Rate	$3.62
Rate for Payer: Cash Price	$2.04
Rate for Payer: Cigna of CA HMO/PPO	$3.62
Rate for Payer: Health Smart Auto/Commercial	$2.72
Rate for Payer: LLUH Dept of Risk Management WC	$2.49
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$3.40

FLUOCINONIDE 0.05 % TOPICAL OINTMENT [3189]

Facility

OP

$1.48

Service Code	NDC 51672-1264-1
Hospital Charge Code	1743019
Hospital Revenue Code	259
Min. Negotiated Rate	$0.81
Max. Negotiated Rate	$1.11
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$0.89
Rate for Payer: Aetna of CA Government/Medicare	$0.89
Rate for Payer: Cash Price	$0.67
Rate for Payer: Health Smart Auto/Commercial	$0.89
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$0.89
Rate for Payer: LLUH Dept of Risk Management WC	$0.81
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$1.11

FLUOCINONIDE 0.05 % TOPICAL OINTMENT [3189]

Facility

OP

$4.53

Service Code	NDC 0093-0264-92
Hospital Charge Code	1743029
Hospital Revenue Code	259
Min. Negotiated Rate	$2.49
Max. Negotiated Rate	$3.40
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$2.72
Rate for Payer: Aetna of CA Government/Medicare	$2.72
Rate for Payer: Cash Price	$2.04
Rate for Payer: Health Smart Auto/Commercial	$2.72
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$2.72
Rate for Payer: LLUH Dept of Risk Management WC	$2.49
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$3.40

FLUOCINONIDE 0.05 % TOPICAL SOLUTION [3190]

Facility

OP

$1.16

Service Code	NDC 51672-1273-4
Hospital Charge Code	1743430
Hospital Revenue Code	259
Min. Negotiated Rate	$0.64
Max. Negotiated Rate	$0.87
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$0.70
Rate for Payer: Aetna of CA Government/Medicare	$0.70
Rate for Payer: Cash Price	$0.52
Rate for Payer: Health Smart Auto/Commercial	$0.70
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$0.70
Rate for Payer: LLUH Dept of Risk Management WC	$0.64
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$0.87

FLUOCINONIDE 0.05 % TOPICAL SOLUTION [3190]

Facility

IP

$1.16

Service Code	NDC 51672-1273-4
Hospital Charge Code	1743430
Hospital Revenue Code	259
Min. Negotiated Rate	$0.64
Max. Negotiated Rate	$0.93
Rate for Payer: Cash Price	$0.52
Rate for Payer: Cigna of CA HMO/PPO	$0.93
Rate for Payer: Health Smart Auto/Commercial	$0.70
Rate for Payer: LLUH Dept of Risk Management WC	$0.64
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$0.87

FLUOCINONIDE 0.05 % TOPICAL SOLUTION [3190]

Facility

IP

$1.20

Service Code	NDC 51672-1273-2
Hospital Charge Code	NDG3190
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 SOLUTION [3190]

Facility

OP

$0.80

Service Code	NDC 64980-452-06
Hospital Charge Code	1743430
Hospital Revenue Code	259
Min. Negotiated Rate	$0.44
Max. Negotiated Rate	$0.60
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$0.48
Rate for Payer: Aetna of CA Government/Medicare	$0.48
Rate for Payer: Cash Price	$0.36
Rate for Payer: Health Smart Auto/Commercial	$0.48
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$0.48
Rate for Payer: LLUH Dept of Risk Management WC	$0.44
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$0.60

FLUOCINONIDE 0.05 % TOPICAL SOLUTION [3190]

Facility

OP

$1.20

Service Code	NDC 51672-1273-2
Hospital Charge Code	NDG3190
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 SOLUTION [3190]

Facility

IP

$0.80

Service Code	NDC 64980-452-06
Hospital Charge Code	1743430
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

FLUORESCEIN 0.6 MG EYE STRIPS [27662]

Facility

IP

$0.14

Service Code	NDC 17478-403-03
Hospital Charge Code	ERX27662
Hospital Revenue Code	259
Min. Negotiated Rate	$0.08
Max. Negotiated Rate	$0.11
Rate for Payer: Cash Price	$0.06
Rate for Payer: Cigna of CA HMO/PPO	$0.11
Rate for Payer: Health Smart Auto/Commercial	$0.08
Rate for Payer: LLUH Dept of Risk Management WC	$0.08
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$0.11

FLUORESCEIN 0.6 MG EYE STRIPS [27662]

Facility

OP

$0.14

Service Code	NDC 17478-403-03
Hospital Charge Code	ERX27662
Hospital Revenue Code	259
Min. Negotiated Rate	$0.08
Max. Negotiated Rate	$0.11
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$0.08
Rate for Payer: Aetna of CA Government/Medicare	$0.08
Rate for Payer: Cash Price	$0.06
Rate for Payer: Health Smart Auto/Commercial	$0.08
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$0.08
Rate for Payer: LLUH Dept of Risk Management WC	$0.08
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$0.11

FLUORESCEIN 1 MG EYE STRIPS [27663]

Facility

IP

$0.22

Service Code	NDC 17238-900-11
Hospital Charge Code	1740396
Hospital Revenue Code	259
Min. Negotiated Rate	$0.12
Max. Negotiated Rate	$0.18
Rate for Payer: Cash Price	$0.10
Rate for Payer: Cigna of CA HMO/PPO	$0.18
Rate for Payer: Health Smart Auto/Commercial	$0.13
Rate for Payer: LLUH Dept of Risk Management WC	$0.12
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$0.17

FLUORESCEIN 1 MG EYE STRIPS [27663]

Facility

OP

$0.22

Service Code	NDC 17238-900-11
Hospital Charge Code	1740396
Hospital Revenue Code	259
Min. Negotiated Rate	$0.12
Max. Negotiated Rate	$0.17
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$0.13
Rate for Payer: Aetna of CA Government/Medicare	$0.13
Rate for Payer: Cash Price	$0.10
Rate for Payer: Health Smart Auto/Commercial	$0.13
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$0.13
Rate for Payer: LLUH Dept of Risk Management WC	$0.12
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$0.17

FLUORESCEIN 1 MG EYE STRIPS [27663]

Facility

OP

$0.22

Service Code	NDC 17238-900-99
Hospital Charge Code	1740396
Hospital Revenue Code	259
Min. Negotiated Rate	$0.12
Max. Negotiated Rate	$0.17
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$0.13
Rate for Payer: Aetna of CA Government/Medicare	$0.13
Rate for Payer: Cash Price	$0.10
Rate for Payer: Health Smart Auto/Commercial	$0.13
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$0.13
Rate for Payer: LLUH Dept of Risk Management WC	$0.12
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$0.17

FLUORESCEIN 1 MG EYE STRIPS [27663]

Facility

IP

$0.22

Service Code	NDC 17238-900-99
Hospital Charge Code	1740396
Hospital Revenue Code	259
Min. Negotiated Rate	$0.12
Max. Negotiated Rate	$0.18
Rate for Payer: Cash Price	$0.10
Rate for Payer: Cigna of CA HMO/PPO	$0.18
Rate for Payer: Health Smart Auto/Commercial	$0.13
Rate for Payer: LLUH Dept of Risk Management WC	$0.12
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$0.17

FLUORESCEIN 500 MG/5 ML (10 %) INTRAVENOUS SOLUTION [10059]

Facility

OP

$12.38

Service Code	NDC 0065-0092-65
Hospital Charge Code	1720246
Hospital Revenue Code	250
Min. Negotiated Rate	$6.81
Max. Negotiated Rate	$9.28
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$7.43
Rate for Payer: Aetna of CA Government/Medicare	$7.43
Rate for Payer: Cash Price	$5.57
Rate for Payer: Health Smart Auto/Commercial	$7.43
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$7.43
Rate for Payer: LLUH Dept of Risk Management WC	$6.81
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$9.28

FLUORESCEIN 500 MG/5 ML (10 %) INTRAVENOUS SOLUTION [10059]

Facility

IP

$17.28

Service Code	NDC 17478-253-10
Hospital Charge Code	1720246
Hospital Revenue Code	250
Min. Negotiated Rate	$9.50
Max. Negotiated Rate	$13.82
Rate for Payer: Cash Price	$7.78
Rate for Payer: Cigna of CA HMO/PPO	$13.82
Rate for Payer: Health Smart Auto/Commercial	$10.37
Rate for Payer: LLUH Dept of Risk Management WC	$9.50
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$12.96

FLUORESCEIN 500 MG/5 ML (10 %) INTRAVENOUS SOLUTION [10059]

Facility

OP

$17.28

Service Code	NDC 17478-253-10
Hospital Charge Code	1720246
Hospital Revenue Code	250
Min. Negotiated Rate	$9.50
Max. Negotiated Rate	$12.96
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$10.37
Rate for Payer: Aetna of CA Government/Medicare	$10.37
Rate for Payer: Cash Price	$7.78
Rate for Payer: Health Smart Auto/Commercial	$10.37
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$10.37
Rate for Payer: LLUH Dept of Risk Management WC	$9.50
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$12.96

FLUORESCEIN 500 MG/5 ML (10 %) INTRAVENOUS SOLUTION [10059]

Facility

IP

$12.38

Service Code	NDC 0065-0092-65
Hospital Charge Code	1720246
Hospital Revenue Code	250
Min. Negotiated Rate	$6.81
Max. Negotiated Rate	$9.90
Rate for Payer: Cash Price	$5.57
Rate for Payer: Cigna of CA HMO/PPO	$9.90
Rate for Payer: Health Smart Auto/Commercial	$7.43
Rate for Payer: LLUH Dept of Risk Management WC	$6.81
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$9.28

FLUOROESTRADIOL F-18 148 MBQ/ML TO 3,700 MBQ/ML INTRAVENOUS SOLUTION [229585]

Facility

IP

$4,599.00

Service Code	CPT A9591
Hospital Charge Code	ERX229585
Hospital Revenue Code	636
Min. Negotiated Rate	$2,529.45
Max. Negotiated Rate	$3,679.20
Rate for Payer: Cash Price	$2,069.55
Rate for Payer: Cigna of CA HMO/PPO	$3,679.20
Rate for Payer: Health Smart Auto/Commercial	$2,759.40
Rate for Payer: LLUH Dept of Risk Management WC	$2,529.45
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$3,449.25

FLUOROESTRADIOL F-18 148 MBQ/ML TO 3,700 MBQ/ML INTRAVENOUS SOLUTION [229585]

Facility

OP

$4,599.00

Service Code	CPT A9591
Hospital Charge Code	ERX229585
Hospital Revenue Code	636
Min. Negotiated Rate	$2,529.45
Max. Negotiated Rate	$3,449.25
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$2,759.40
Rate for Payer: Aetna of CA Government/Medicare	$2,759.40
Rate for Payer: Cash Price	$2,069.55
Rate for Payer: Health Smart Auto/Commercial	$2,759.40
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$2,759.40
Rate for Payer: LLUH Dept of Risk Management WC	$2,529.45
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$3,449.25

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