Loma Linda University Behavioral Medicine Center (BMC)

All Charges

Charge

Type

Setting

Price

HYDROCORTISONE 0.5 % TOPICAL CREAM [3725]

Facility

$0.14

Service Code	NDC 51672-2010-2
Hospital Charge Code	1743346
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

HYDROCORTISONE 0.5 % TOPICAL CREAM [3725]

Facility

$0.14

Service Code	NDC 51672-2010-2
Hospital Charge Code	1743346
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

HYDROCORTISONE 100 MG/60 ML ENEMA [10210]

Facility

$0.43

Service Code	NDC 62559-138-11
Hospital Charge Code	1748028
Hospital Revenue Code	259
Min. Negotiated Rate	$0.24
Max. Negotiated Rate	$0.34
Rate for Payer: Cash Price	$0.19
Rate for Payer: Cigna of CA HMO/PPO	$0.34
Rate for Payer: Health Smart Auto/Commercial	$0.26
Rate for Payer: LLUH Dept of Risk Management WC	$0.24
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$0.32

HYDROCORTISONE 100 MG/60 ML ENEMA [10210]

Facility

$0.43

Service Code	NDC 62559-138-11
Hospital Charge Code	1748028
Hospital Revenue Code	259
Min. Negotiated Rate	$0.24
Max. Negotiated Rate	$0.32
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$0.26
Rate for Payer: Aetna of CA Government/Medicare	$0.26
Rate for Payer: Cash Price	$0.19
Rate for Payer: Health Smart Auto/Commercial	$0.26
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$0.26
Rate for Payer: LLUH Dept of Risk Management WC	$0.24
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$0.32

HYDROCORTISONE 100 MG/60 ML ENEMA [10210]

Facility

$0.43

Service Code	NDC 62559-138-07
Hospital Charge Code	1748028
Hospital Revenue Code	259
Min. Negotiated Rate	$0.24
Max. Negotiated Rate	$0.32
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$0.26
Rate for Payer: Aetna of CA Government/Medicare	$0.26
Rate for Payer: Cash Price	$0.19
Rate for Payer: Health Smart Auto/Commercial	$0.26
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$0.26
Rate for Payer: LLUH Dept of Risk Management WC	$0.24
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$0.32

HYDROCORTISONE 100 MG/60 ML ENEMA [10210]

Facility

$0.43

Service Code	NDC 62559-138-07
Hospital Charge Code	1748028
Hospital Revenue Code	259
Min. Negotiated Rate	$0.24
Max. Negotiated Rate	$0.34
Rate for Payer: Cash Price	$0.19
Rate for Payer: Cigna of CA HMO/PPO	$0.34
Rate for Payer: Health Smart Auto/Commercial	$0.26
Rate for Payer: LLUH Dept of Risk Management WC	$0.24
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$0.32

HYDROCORTISONE 100 MG SOLUTION FOR INJECTION. [408111163]

Facility

$17.26

Service Code	CPT J1720
Hospital Charge Code	1720332
Hospital Revenue Code	636
Min. Negotiated Rate	$9.49
Max. Negotiated Rate	$12.94
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$10.36
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$13.99
Rate for Payer: Aetna of CA Government/Medicare	$10.36
Rate for Payer: Aetna of CA Government/Medicare	$13.99
Rate for Payer: Cash Price	$7.77
Rate for Payer: Cash Price	$10.49
Rate for Payer: Health Smart Auto/Commercial	$13.99
Rate for Payer: Health Smart Auto/Commercial	$10.36
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$10.36
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$13.99
Rate for Payer: LLUH Dept of Risk Management WC	$9.49
Rate for Payer: LLUH Dept of Risk Management WC	$12.83
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$12.94
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$17.49

HYDROCORTISONE 100 MG SOLUTION FOR INJECTION. [408111163]

Facility

$23.32

Service Code	CPT J1720
Hospital Charge Code	1720332
Hospital Revenue Code	636
Min. Negotiated Rate	$12.83
Max. Negotiated Rate	$18.66
Rate for Payer: Cash Price	$10.49
Rate for Payer: Cash Price	$7.77
Rate for Payer: Cigna of CA HMO/PPO	$18.66
Rate for Payer: Cigna of CA HMO/PPO	$13.81
Rate for Payer: Health Smart Auto/Commercial	$10.36
Rate for Payer: Health Smart Auto/Commercial	$13.99
Rate for Payer: LLUH Dept of Risk Management WC	$12.83
Rate for Payer: LLUH Dept of Risk Management WC	$9.49
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$12.94
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$17.49

HYDROCORTISONE 10 MG TABLET [3733]

Facility

$0.57

Service Code	NDC 0115-1697-01
Hospital Charge Code	1710792
Hospital Revenue Code	259
Min. Negotiated Rate	$0.31
Max. Negotiated Rate	$0.43
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$0.34
Rate for Payer: Aetna of CA Government/Medicare	$0.34
Rate for Payer: Cash Price	$0.26
Rate for Payer: Health Smart Auto/Commercial	$0.34
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$0.34
Rate for Payer: LLUH Dept of Risk Management WC	$0.31
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$0.43

HYDROCORTISONE 10 MG TABLET [3733]

Facility

$0.34

Service Code	NDC 59762-0074-1
Hospital Charge Code	1710792
Hospital Revenue Code	259
Min. Negotiated Rate	$0.19
Max. Negotiated Rate	$0.27
Rate for Payer: Cash Price	$0.15
Rate for Payer: Cigna of CA HMO/PPO	$0.27
Rate for Payer: Health Smart Auto/Commercial	$0.20
Rate for Payer: LLUH Dept of Risk Management WC	$0.19
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$0.26

HYDROCORTISONE 10 MG TABLET [3733]

Facility

$0.34

Service Code	NDC 59762-0074-1
Hospital Charge Code	1710792
Hospital Revenue Code	259
Min. Negotiated Rate	$0.19
Max. Negotiated Rate	$0.26
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$0.20
Rate for Payer: Aetna of CA Government/Medicare	$0.20
Rate for Payer: Cash Price	$0.15
Rate for Payer: Health Smart Auto/Commercial	$0.20
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$0.20
Rate for Payer: LLUH Dept of Risk Management WC	$0.19
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$0.26

HYDROCORTISONE 10 MG TABLET [3733]

Facility

$0.57

Service Code	NDC 0115-1697-01
Hospital Charge Code	1710792
Hospital Revenue Code	259
Min. Negotiated Rate	$0.31
Max. Negotiated Rate	$0.46
Rate for Payer: Cash Price	$0.26
Rate for Payer: Cigna of CA HMO/PPO	$0.46
Rate for Payer: Health Smart Auto/Commercial	$0.34
Rate for Payer: LLUH Dept of Risk Management WC	$0.31
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$0.43

HYDROCORTISONE 1 % LOTION [3728]

Facility

$0.06

Service Code	NDC 6373633942
Hospital Charge Code	1743220
Hospital Revenue Code	259
Min. Negotiated Rate	$0.03
Max. Negotiated Rate	$0.05
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$0.04
Rate for Payer: Aetna of CA Government/Medicare	$0.04
Rate for Payer: Cash Price	$0.03
Rate for Payer: Health Smart Auto/Commercial	$0.04
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$0.04
Rate for Payer: LLUH Dept of Risk Management WC	$0.03
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$0.05

HYDROCORTISONE 1 % LOTION [3728]

Facility

$0.06

Service Code	NDC 6373633942
Hospital Charge Code	1743220
Hospital Revenue Code	259
Min. Negotiated Rate	$0.03
Max. Negotiated Rate	$0.05
Rate for Payer: Cash Price	$0.03
Rate for Payer: Cigna of CA HMO/PPO	$0.05
Rate for Payer: Health Smart Auto/Commercial	$0.04
Rate for Payer: LLUH Dept of Risk Management WC	$0.03
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$0.05

HYDROCORTISONE 1 %-PRAMOXINE 1 % RECTAL FOAM [28849]

Facility

$21.16

Service Code	NDC 0037-6822-10
Hospital Charge Code	1748005
Hospital Revenue Code	259
Min. Negotiated Rate	$11.64
Max. Negotiated Rate	$15.87
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$12.70
Rate for Payer: Aetna of CA Government/Medicare	$12.70
Rate for Payer: Cash Price	$9.52
Rate for Payer: Health Smart Auto/Commercial	$12.70
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$12.70
Rate for Payer: LLUH Dept of Risk Management WC	$11.64
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$15.87

HYDROCORTISONE 1 %-PRAMOXINE 1 % RECTAL FOAM [28849]

Facility

$21.16

Service Code	NDC 0037-6822-10
Hospital Charge Code	1748005
Hospital Revenue Code	259
Min. Negotiated Rate	$11.64
Max. Negotiated Rate	$16.93
Rate for Payer: Cash Price	$9.52
Rate for Payer: Cigna of CA HMO/PPO	$16.93
Rate for Payer: Health Smart Auto/Commercial	$12.70
Rate for Payer: LLUH Dept of Risk Management WC	$11.64
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$15.87

HYDROCORTISONE 1 % TOPICAL CREAM [3726]

Facility

$0.09

Service Code	NDC 45802-438-03
Hospital Charge Code	1743342
Hospital Revenue Code	259
Min. Negotiated Rate	$0.05
Max. Negotiated Rate	$0.07
Rate for Payer: Cash Price	$0.04
Rate for Payer: Cigna of CA HMO/PPO	$0.07
Rate for Payer: Health Smart Auto/Commercial	$0.05
Rate for Payer: LLUH Dept of Risk Management WC	$0.05
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$0.07

HYDROCORTISONE 1 % TOPICAL CREAM [3726]

Facility

$0.09

Service Code	NDC 45802-438-03
Hospital Charge Code	1743342
Hospital Revenue Code	259
Min. Negotiated Rate	$0.05
Max. Negotiated Rate	$0.07
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	$0.05
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$0.07

HYDROCORTISONE 1 % TOPICAL CREAM [3726]

Facility

$0.25

Service Code	NDC 0168-0015-31
Hospital Charge Code	1743342
Hospital Revenue Code	259
Min. Negotiated Rate	$0.14
Max. Negotiated Rate	$0.19
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$0.15
Rate for Payer: Aetna of CA Government/Medicare	$0.15
Rate for Payer: Cash Price	$0.11
Rate for Payer: Health Smart Auto/Commercial	$0.15
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$0.15
Rate for Payer: LLUH Dept of Risk Management WC	$0.14
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$0.19

HYDROCORTISONE 1 % TOPICAL CREAM [3726]

Facility

$0.25

Service Code	NDC 0168-0015-31
Hospital Charge Code	1743342
Hospital Revenue Code	259
Min. Negotiated Rate	$0.14
Max. Negotiated Rate	$0.20
Rate for Payer: Cash Price	$0.11
Rate for Payer: Cigna of CA HMO/PPO	$0.20
Rate for Payer: Health Smart Auto/Commercial	$0.15
Rate for Payer: LLUH Dept of Risk Management WC	$0.14
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$0.19

HYDROCORTISONE 1 % TOPICAL CREAM WRAP [4081930]

Facility

$0.09

Service Code	NDC 45802-438-03
Hospital Charge Code	1743342
Hospital Revenue Code	259
Min. Negotiated Rate	$0.05
Max. Negotiated Rate	$0.07
Rate for Payer: Cash Price	$0.04
Rate for Payer: Cigna of CA HMO/PPO	$0.07
Rate for Payer: Health Smart Auto/Commercial	$0.05
Rate for Payer: LLUH Dept of Risk Management WC	$0.05
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$0.07

HYDROCORTISONE 1 % TOPICAL CREAM WRAP [4081930]

Facility

$0.25

Service Code	NDC 0168-0015-31
Hospital Charge Code	1743342
Hospital Revenue Code	259
Min. Negotiated Rate	$0.14
Max. Negotiated Rate	$0.19
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$0.15
Rate for Payer: Aetna of CA Government/Medicare	$0.15
Rate for Payer: Cash Price	$0.11
Rate for Payer: Health Smart Auto/Commercial	$0.15
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$0.15
Rate for Payer: LLUH Dept of Risk Management WC	$0.14
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$0.19

HYDROCORTISONE 1 % TOPICAL CREAM WRAP [4081930]

Facility

$0.09

Service Code	NDC 45802-438-03
Hospital Charge Code	1743342
Hospital Revenue Code	259
Min. Negotiated Rate	$0.05
Max. Negotiated Rate	$0.07
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	$0.05
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$0.07

HYDROCORTISONE 1 % TOPICAL CREAM WRAP [4081930]

Facility

$0.11

Service Code	NDC 24385-021-03
Hospital Charge Code	NDG3726B
Hospital Revenue Code	259
Min. Negotiated Rate	$0.06
Max. Negotiated Rate	$0.09
Rate for Payer: Cash Price	$0.05
Rate for Payer: Cigna of CA HMO/PPO	$0.09
Rate for Payer: Health Smart Auto/Commercial	$0.07
Rate for Payer: LLUH Dept of Risk Management WC	$0.06
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$0.08

HYDROCORTISONE 1 % TOPICAL CREAM WRAP [4081930]

Facility

$0.25

Service Code	NDC 0168-0015-31
Hospital Charge Code	1743342
Hospital Revenue Code	259
Min. Negotiated Rate	$0.14
Max. Negotiated Rate	$0.20
Rate for Payer: Cash Price	$0.11
Rate for Payer: Cigna of CA HMO/PPO	$0.20
Rate for Payer: Health Smart Auto/Commercial	$0.15
Rate for Payer: LLUH Dept of Risk Management WC	$0.14
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$0.19

Know your out-of-pocket cost for care.

All Charges