Loma Linda University Behavioral Medicine Center (BMC)

All Charges

Charge

Type

Setting

Price

HYDROCORTISONE 2.5 % TOPICAL OINTMENT [3732]

Facility

$0.14

Service Code	NDC 0168-0146-30
Hospital Charge Code	1743576
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 2.5 % TOPICAL OINTMENT [3732]

Facility

$0.16

Service Code	NDC 45802-014-02
Hospital Charge Code	NDG3732
Hospital Revenue Code	259
Min. Negotiated Rate	$0.09
Max. Negotiated Rate	$0.12
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$0.10
Rate for Payer: Aetna of CA Government/Medicare	$0.10
Rate for Payer: Cash Price	$0.07
Rate for Payer: Health Smart Auto/Commercial	$0.10
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$0.10
Rate for Payer: LLUH Dept of Risk Management WC	$0.09
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$0.12

HYDROCORTISONE 5 MG TABLET [10209]

Facility

$0.21

Service Code	NDC 59762-0073-1
Hospital Charge Code	1710846
Hospital Revenue Code	259
Min. Negotiated Rate	$0.12
Max. Negotiated Rate	$0.16
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	$0.09
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	$0.16

HYDROCORTISONE 5 MG TABLET [10209]

Facility

$0.34

Service Code	NDC 0115-1696-06
Hospital Charge Code	1710846
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 5 MG TABLET [10209]

Facility

$0.21

Service Code	NDC 59762-0073-1
Hospital Charge Code	1710846
Hospital Revenue Code	259
Min. Negotiated Rate	$0.12
Max. Negotiated Rate	$0.17
Rate for Payer: Cash Price	$0.09
Rate for Payer: Cigna of CA HMO/PPO	$0.17
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	$0.16

HYDROCORTISONE 5 MG TABLET [10209]

Facility

$0.34

Service Code	NDC 0115-1696-06
Hospital Charge Code	1710846
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 ACETATE 0.5 % TOPICAL CREAM [3736]

Facility

$0.07

Service Code	NDC 8770155397
Hospital Charge Code	NDG3736
Hospital Revenue Code	259
Min. Negotiated Rate	$0.04
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	$0.04
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$0.05

HYDROCORTISONE ACETATE 0.5 % TOPICAL CREAM [3736]

Facility

$0.07

Service Code	NDC 24385-190-03
Hospital Charge Code	NDG3736
Hospital Revenue Code	259
Min. Negotiated Rate	$0.04
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	$0.04
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$0.05

HYDROCORTISONE ACETATE 0.5 % TOPICAL CREAM [3736]

Facility

$0.07

Service Code	NDC 24385-190-03
Hospital Charge Code	NDG3736
Hospital Revenue Code	259
Min. Negotiated Rate	$0.04
Max. Negotiated Rate	$0.06
Rate for Payer: Cash Price	$0.03
Rate for Payer: Cigna of CA HMO/PPO	$0.06
Rate for Payer: Health Smart Auto/Commercial	$0.04
Rate for Payer: LLUH Dept of Risk Management WC	$0.04
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$0.05

HYDROCORTISONE ACETATE 0.5 % TOPICAL CREAM [3736]

Facility

$0.07

Service Code	NDC 8770155397
Hospital Charge Code	NDG3736
Hospital Revenue Code	259
Min. Negotiated Rate	$0.04
Max. Negotiated Rate	$0.06
Rate for Payer: Cash Price	$0.03
Rate for Payer: Cigna of CA HMO/PPO	$0.06
Rate for Payer: Health Smart Auto/Commercial	$0.04
Rate for Payer: LLUH Dept of Risk Management WC	$0.04
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$0.05

HYDROCORTISONE ACETATE 25 MG RECTAL SUPPOSITORY [3738]

Facility

$14.17

Service Code	NDC 42494-341-12
Hospital Charge Code	1748041
Hospital Revenue Code	259
Min. Negotiated Rate	$7.79
Max. Negotiated Rate	$11.34
Rate for Payer: Cash Price	$6.38
Rate for Payer: Cigna of CA HMO/PPO	$11.34
Rate for Payer: Health Smart Auto/Commercial	$8.50
Rate for Payer: LLUH Dept of Risk Management WC	$7.79
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$10.63

HYDROCORTISONE ACETATE 25 MG RECTAL SUPPOSITORY [3738]

Facility

$14.17

Service Code	NDC 42494-341-12
Hospital Charge Code	1748041
Hospital Revenue Code	259
Min. Negotiated Rate	$7.79
Max. Negotiated Rate	$10.63
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$8.50
Rate for Payer: Aetna of CA Government/Medicare	$8.50
Rate for Payer: Cash Price	$6.38
Rate for Payer: Health Smart Auto/Commercial	$8.50
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$8.50
Rate for Payer: LLUH Dept of Risk Management WC	$7.79
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$10.63

HYDROCORTISONE-ACETIC ACID 1 %-2 % EAR DROPS [24385]

Facility

$16.26

Service Code	NDC 51672-3007-1
Hospital Charge Code	1740196
Hospital Revenue Code	259
Min. Negotiated Rate	$8.94
Max. Negotiated Rate	$12.20
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$9.76
Rate for Payer: Aetna of CA Government/Medicare	$9.76
Rate for Payer: Cash Price	$7.32
Rate for Payer: Health Smart Auto/Commercial	$9.76
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$9.76
Rate for Payer: LLUH Dept of Risk Management WC	$8.94
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$12.20

HYDROCORTISONE-ACETIC ACID 1 %-2 % EAR DROPS [24385]

Facility

$16.26

Service Code	NDC 51672-3007-1
Hospital Charge Code	1740196
Hospital Revenue Code	259
Min. Negotiated Rate	$8.94
Max. Negotiated Rate	$13.01
Rate for Payer: Cash Price	$7.32
Rate for Payer: Cigna of CA HMO/PPO	$13.01
Rate for Payer: Health Smart Auto/Commercial	$9.76
Rate for Payer: LLUH Dept of Risk Management WC	$8.94
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$12.20

HYDROCORTISONE-ACETIC ACID 1 %-2 % EAR DROPS [24385]

Facility

$19.33

Service Code	NDC 50383-901-10
Hospital Charge Code	1740196
Hospital Revenue Code	259
Min. Negotiated Rate	$10.63
Max. Negotiated Rate	$15.46
Rate for Payer: Cash Price	$8.70
Rate for Payer: Cigna of CA HMO/PPO	$15.46
Rate for Payer: Health Smart Auto/Commercial	$11.60
Rate for Payer: LLUH Dept of Risk Management WC	$10.63
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$14.50

HYDROCORTISONE-ACETIC ACID 1 %-2 % EAR DROPS [24385]

Facility

$19.33

Service Code	NDC 50383-901-10
Hospital Charge Code	1740196
Hospital Revenue Code	259
Min. Negotiated Rate	$10.63
Max. Negotiated Rate	$14.50
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$11.60
Rate for Payer: Aetna of CA Government/Medicare	$11.60
Rate for Payer: Cash Price	$8.70
Rate for Payer: Health Smart Auto/Commercial	$11.60
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$11.60
Rate for Payer: LLUH Dept of Risk Management WC	$10.63
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$14.50

HYDROCORTISONE-ALOE VERA 0.5 % TOPICAL CREAM [110413]

Facility

$0.07

Service Code	NDC 0179-8016-30
Hospital Charge Code	NDG110413
Hospital Revenue Code	259
Min. Negotiated Rate	$0.04
Max. Negotiated Rate	$0.06
Rate for Payer: Cash Price	$0.03
Rate for Payer: Cigna of CA HMO/PPO	$0.06
Rate for Payer: Health Smart Auto/Commercial	$0.04
Rate for Payer: LLUH Dept of Risk Management WC	$0.04
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$0.05

HYDROCORTISONE-ALOE VERA 0.5 % TOPICAL CREAM [110413]

Facility

$0.07

Service Code	NDC 0179-8016-30
Hospital Charge Code	NDG110413
Hospital Revenue Code	259
Min. Negotiated Rate	$0.04
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	$0.04
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$0.05

HYDROCORTISONE ORAL SUSPENSION COMPOUND 2 MG/ML [4080281]

Facility

$0.62

Service Code	NDC 9994-0802-81
Hospital Charge Code	1715652
Hospital Revenue Code	259
Min. Negotiated Rate	$0.34
Max. Negotiated Rate	$0.47
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$0.37
Rate for Payer: Aetna of CA Government/Medicare	$0.37
Rate for Payer: Cash Price	$0.28
Rate for Payer: Health Smart Auto/Commercial	$0.37
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$0.37
Rate for Payer: LLUH Dept of Risk Management WC	$0.34
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$0.47

HYDROCORTISONE ORAL SUSPENSION COMPOUND 2 MG/ML [4080281]

Facility

$0.62

Service Code	NDC 9994-0802-81
Hospital Charge Code	1715652
Hospital Revenue Code	259
Min. Negotiated Rate	$0.34
Max. Negotiated Rate	$0.50
Rate for Payer: Cash Price	$0.28
Rate for Payer: Cigna of CA HMO/PPO	$0.50
Rate for Payer: Health Smart Auto/Commercial	$0.37
Rate for Payer: LLUH Dept of Risk Management WC	$0.34
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$0.47

HYDROCORTISONE SODIUM SUCCINATE 100 MG SOLUTION FOR INJECTION [111163]

Facility

$17.26

Service Code	CPT J1720
Hospital Charge Code	ERX111163
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 Government/Medicare	$10.36
Rate for Payer: Cash Price	$7.77
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: LLUH Dept of Risk Management WC	$9.49
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$12.94

HYDROCORTISONE SODIUM SUCCINATE 100 MG SOLUTION FOR INJECTION [111163]

Facility

$17.26

Service Code	CPT J1720
Hospital Charge Code	ERX111163
Hospital Revenue Code	636
Min. Negotiated Rate	$9.49
Max. Negotiated Rate	$13.81
Rate for Payer: Cash Price	$7.77
Rate for Payer: Cigna of CA HMO/PPO	$13.81
Rate for Payer: Health Smart Auto/Commercial	$10.36
Rate for Payer: LLUH Dept of Risk Management WC	$9.49
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$12.94

HYDROCORTISONE SOD SUCCINATE (PF) 250 MG/2 ML SOLUTION FOR INJECTION [121170]

Facility

$43.14

Service Code	CPT J1720
Hospital Charge Code	1720335
Hospital Revenue Code	636
Min. Negotiated Rate	$23.73
Max. Negotiated Rate	$32.36
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$25.88
Rate for Payer: Aetna of CA Government/Medicare	$25.88
Rate for Payer: Cash Price	$19.41
Rate for Payer: Health Smart Auto/Commercial	$25.88
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$25.88
Rate for Payer: LLUH Dept of Risk Management WC	$23.73
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$32.36

HYDROCORTISONE SOD SUCCINATE (PF) 250 MG/2 ML SOLUTION FOR INJECTION [121170]

Facility

$43.14

Service Code	CPT J1720
Hospital Charge Code	1720335
Hospital Revenue Code	636
Min. Negotiated Rate	$23.73
Max. Negotiated Rate	$34.51
Rate for Payer: Cash Price	$19.41
Rate for Payer: Cigna of CA HMO/PPO	$34.51
Rate for Payer: Health Smart Auto/Commercial	$25.88
Rate for Payer: LLUH Dept of Risk Management WC	$23.73
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$32.36

HYDROCORTISONE SOD SUCCINATE (PF) 500 MG/4 ML SOLUTION FOR INJECTION [121169]

Facility

$86.32

Service Code	CPT J1720
Hospital Charge Code	ERX121169
Hospital Revenue Code	636
Min. Negotiated Rate	$47.48
Max. Negotiated Rate	$69.06
Rate for Payer: Cash Price	$38.84
Rate for Payer: Cigna of CA HMO/PPO	$69.06
Rate for Payer: Health Smart Auto/Commercial	$51.79
Rate for Payer: LLUH Dept of Risk Management WC	$47.48
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$64.74

Know your out-of-pocket cost for care.

All Charges