|
FLUCONAZOLE 50 MG TABLET [10046]
|
Facility
|
IP
|
$0.40
|
|
|
Service Code
|
NDC 6255999030
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.08 |
| Max. Negotiated Rate |
$0.34 |
| Rate for Payer: Adventist Health Commercial |
$0.08
|
| Rate for Payer: Blue Shield of California Commercial |
$0.20
|
| Rate for Payer: Blue Shield of California Commercial |
$0.31
|
| Rate for Payer: Cash Price |
$0.18
|
| Rate for Payer: Cigna of CA HMO |
$0.28
|
| Rate for Payer: Cigna of CA PPO |
$0.28
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$0.28
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.16
|
| Rate for Payer: EPIC Health Plan Senior |
$0.16
|
| Rate for Payer: Galaxy Health WC |
$0.34
|
| Rate for Payer: Global Benefits Group Commercial |
$0.24
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$0.25
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$0.24
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.10
|
| Rate for Payer: Multiplan Commercial |
$0.32
|
| Rate for Payer: Networks By Design Commercial |
$0.26
|
| Rate for Payer: Prime Health Services Commercial |
$0.34
|
|
|
FLUCONAZOLE 50 MG TABLET [10046]
|
Facility
|
OP
|
$0.40
|
|
|
Service Code
|
NDC 6255999030
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.08 |
| Max. Negotiated Rate |
$0.34 |
| Rate for Payer: Adventist Health Commercial |
$0.08
|
| Rate for Payer: Aetna of CA HMO/PPO |
$0.26
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.34
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.22
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.30
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.26
|
| Rate for Payer: Cash Price |
$0.18
|
| Rate for Payer: Cigna of CA HMO |
$0.28
|
| Rate for Payer: Cigna of CA PPO |
$0.28
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.34
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.34
|
| Rate for Payer: Dignity Health Medicare Advantage |
$0.34
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$0.28
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.16
|
| Rate for Payer: EPIC Health Plan Senior |
$0.16
|
| Rate for Payer: Galaxy Health WC |
$0.34
|
| Rate for Payer: Global Benefits Group Commercial |
$0.24
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$0.25
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.15
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$0.24
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.10
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$0.28
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$0.28
|
| Rate for Payer: Multiplan Commercial |
$0.32
|
| Rate for Payer: Networks By Design Commercial |
$0.26
|
| Rate for Payer: Prime Health Services Commercial |
$0.34
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.24
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.24
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.20
|
| Rate for Payer: United Healthcare All Other HMO |
$0.20
|
| Rate for Payer: United Healthcare HMO Rider |
$0.20
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.20
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.34
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.34
|
| Rate for Payer: Vantage Medical Group Senior |
$0.34
|
|
|
FLUCYTOSINE 250 MG CAPSULE [10051]
|
Facility
|
IP
|
$12.00
|
|
|
Service Code
|
NDC 5965133101
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$2.40 |
| Max. Negotiated Rate |
$10.20 |
| Rate for Payer: Adventist Health Commercial |
$2.40
|
| Rate for Payer: Blue Shield of California Commercial |
$6.08
|
| Rate for Payer: Blue Shield of California Commercial |
$9.23
|
| Rate for Payer: Cash Price |
$5.40
|
| Rate for Payer: Cigna of CA HMO |
$8.40
|
| Rate for Payer: Cigna of CA PPO |
$8.40
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$8.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$4.80
|
| Rate for Payer: EPIC Health Plan Senior |
$4.80
|
| Rate for Payer: Galaxy Health WC |
$10.20
|
| Rate for Payer: Global Benefits Group Commercial |
$7.20
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$7.62
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$7.08
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.88
|
| Rate for Payer: Multiplan Commercial |
$9.60
|
| Rate for Payer: Networks By Design Commercial |
$7.80
|
| Rate for Payer: Prime Health Services Commercial |
$10.20
|
|
|
FLUCYTOSINE 250 MG CAPSULE [10051]
|
Facility
|
OP
|
$36.00
|
|
|
Service Code
|
NDC 4279400908
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$7.20 |
| Max. Negotiated Rate |
$30.60 |
| Rate for Payer: Adventist Health Commercial |
$7.20
|
| Rate for Payer: Aetna of CA HMO/PPO |
$23.61
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$30.60
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$19.80
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$27.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$23.10
|
| Rate for Payer: Cash Price |
$16.20
|
| Rate for Payer: Cigna of CA HMO |
$25.20
|
| Rate for Payer: Cigna of CA PPO |
$25.20
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$30.60
|
| Rate for Payer: Dignity Health Medi-Cal |
$30.60
|
| Rate for Payer: Dignity Health Medicare Advantage |
$30.60
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$25.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$14.40
|
| Rate for Payer: EPIC Health Plan Senior |
$14.40
|
| Rate for Payer: Galaxy Health WC |
$30.60
|
| Rate for Payer: Global Benefits Group Commercial |
$21.60
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$22.86
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$13.07
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$21.24
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$8.64
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$25.20
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$25.20
|
| Rate for Payer: Multiplan Commercial |
$28.80
|
| Rate for Payer: Networks By Design Commercial |
$23.40
|
| Rate for Payer: Prime Health Services Commercial |
$30.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$21.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$21.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$18.00
|
| Rate for Payer: United Healthcare All Other HMO |
$18.00
|
| Rate for Payer: United Healthcare HMO Rider |
$18.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$18.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$30.60
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$30.60
|
| Rate for Payer: Vantage Medical Group Senior |
$30.60
|
|
|
FLUCYTOSINE 250 MG CAPSULE [10051]
|
Facility
|
IP
|
$36.00
|
|
|
Service Code
|
NDC 4279400908
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$7.20 |
| Max. Negotiated Rate |
$30.60 |
| Rate for Payer: Adventist Health Commercial |
$7.20
|
| Rate for Payer: Blue Shield of California Commercial |
$18.25
|
| Rate for Payer: Blue Shield of California Commercial |
$27.68
|
| Rate for Payer: Cash Price |
$16.20
|
| Rate for Payer: Cigna of CA HMO |
$25.20
|
| Rate for Payer: Cigna of CA PPO |
$25.20
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$25.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$14.40
|
| Rate for Payer: EPIC Health Plan Senior |
$14.40
|
| Rate for Payer: Galaxy Health WC |
$30.60
|
| Rate for Payer: Global Benefits Group Commercial |
$21.60
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$22.86
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$21.24
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$8.64
|
| Rate for Payer: Multiplan Commercial |
$28.80
|
| Rate for Payer: Networks By Design Commercial |
$23.40
|
| Rate for Payer: Prime Health Services Commercial |
$30.60
|
|
|
FLUCYTOSINE 250 MG CAPSULE [10051]
|
Facility
|
OP
|
$12.00
|
|
|
Service Code
|
NDC 5965133101
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$2.40 |
| Max. Negotiated Rate |
$10.20 |
| Rate for Payer: Adventist Health Commercial |
$2.40
|
| Rate for Payer: Aetna of CA HMO/PPO |
$7.87
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$10.20
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$6.60
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$9.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$7.70
|
| Rate for Payer: Cash Price |
$5.40
|
| Rate for Payer: Cigna of CA HMO |
$8.40
|
| Rate for Payer: Cigna of CA PPO |
$8.40
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$10.20
|
| Rate for Payer: Dignity Health Medi-Cal |
$10.20
|
| Rate for Payer: Dignity Health Medicare Advantage |
$10.20
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$8.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$4.80
|
| Rate for Payer: EPIC Health Plan Senior |
$4.80
|
| Rate for Payer: Galaxy Health WC |
$10.20
|
| Rate for Payer: Global Benefits Group Commercial |
$7.20
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$7.62
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$4.36
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$7.08
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.88
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$8.40
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$8.40
|
| Rate for Payer: Multiplan Commercial |
$9.60
|
| Rate for Payer: Networks By Design Commercial |
$7.80
|
| Rate for Payer: Prime Health Services Commercial |
$10.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$7.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$7.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$6.00
|
| Rate for Payer: United Healthcare All Other HMO |
$6.00
|
| Rate for Payer: United Healthcare HMO Rider |
$6.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$6.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$10.20
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$10.20
|
| Rate for Payer: Vantage Medical Group Senior |
$10.20
|
|
|
FLUCYTOSINE 500 MG CAPSULE [10052]
|
Facility
|
IP
|
$24.00
|
|
|
Service Code
|
NDC 4338677001
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$4.80 |
| Max. Negotiated Rate |
$20.40 |
| Rate for Payer: Adventist Health Commercial |
$4.80
|
| Rate for Payer: Blue Shield of California Commercial |
$12.17
|
| Rate for Payer: Blue Shield of California Commercial |
$18.46
|
| Rate for Payer: Cash Price |
$10.80
|
| Rate for Payer: Cigna of CA HMO |
$16.80
|
| Rate for Payer: Cigna of CA PPO |
$16.80
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$16.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$9.60
|
| Rate for Payer: EPIC Health Plan Senior |
$9.60
|
| Rate for Payer: Galaxy Health WC |
$20.40
|
| Rate for Payer: Global Benefits Group Commercial |
$14.40
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$15.24
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$14.16
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5.76
|
| Rate for Payer: Multiplan Commercial |
$19.20
|
| Rate for Payer: Networks By Design Commercial |
$15.60
|
| Rate for Payer: Prime Health Services Commercial |
$20.40
|
|
|
FLUCYTOSINE 500 MG CAPSULE [10052]
|
Facility
|
IP
|
$68.00
|
|
|
Service Code
|
NDC 4279401008
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$13.60 |
| Max. Negotiated Rate |
$57.80 |
| Rate for Payer: Adventist Health Commercial |
$13.60
|
| Rate for Payer: Blue Shield of California Commercial |
$34.48
|
| Rate for Payer: Blue Shield of California Commercial |
$52.29
|
| Rate for Payer: Cash Price |
$30.60
|
| Rate for Payer: Cigna of CA HMO |
$47.60
|
| Rate for Payer: Cigna of CA PPO |
$47.60
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$47.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$27.20
|
| Rate for Payer: EPIC Health Plan Senior |
$27.20
|
| Rate for Payer: Galaxy Health WC |
$57.80
|
| Rate for Payer: Global Benefits Group Commercial |
$40.80
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$43.18
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$40.12
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$16.32
|
| Rate for Payer: Multiplan Commercial |
$54.40
|
| Rate for Payer: Networks By Design Commercial |
$44.20
|
| Rate for Payer: Prime Health Services Commercial |
$57.80
|
|
|
FLUCYTOSINE 500 MG CAPSULE [10052]
|
Facility
|
OP
|
$68.00
|
|
|
Service Code
|
NDC 4279401008
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$13.60 |
| Max. Negotiated Rate |
$57.80 |
| Rate for Payer: Adventist Health Commercial |
$13.60
|
| Rate for Payer: Aetna of CA HMO/PPO |
$44.60
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$57.80
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$37.40
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$51.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$43.64
|
| Rate for Payer: Cash Price |
$30.60
|
| Rate for Payer: Cigna of CA HMO |
$47.60
|
| Rate for Payer: Cigna of CA PPO |
$47.60
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$57.80
|
| Rate for Payer: Dignity Health Medi-Cal |
$57.80
|
| Rate for Payer: Dignity Health Medicare Advantage |
$57.80
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$47.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$27.20
|
| Rate for Payer: EPIC Health Plan Senior |
$27.20
|
| Rate for Payer: Galaxy Health WC |
$57.80
|
| Rate for Payer: Global Benefits Group Commercial |
$40.80
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$43.18
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$24.68
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$40.12
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$16.32
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$47.60
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$47.60
|
| Rate for Payer: Multiplan Commercial |
$54.40
|
| Rate for Payer: Networks By Design Commercial |
$44.20
|
| Rate for Payer: Prime Health Services Commercial |
$57.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$40.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$40.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$34.00
|
| Rate for Payer: United Healthcare All Other HMO |
$34.00
|
| Rate for Payer: United Healthcare HMO Rider |
$34.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$34.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$57.80
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$57.80
|
| Rate for Payer: Vantage Medical Group Senior |
$57.80
|
|
|
FLUCYTOSINE 500 MG CAPSULE [10052]
|
Facility
|
IP
|
$24.00
|
|
|
Service Code
|
NDC 5965133201
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$4.80 |
| Max. Negotiated Rate |
$20.40 |
| Rate for Payer: Adventist Health Commercial |
$4.80
|
| Rate for Payer: Blue Shield of California Commercial |
$12.17
|
| Rate for Payer: Blue Shield of California Commercial |
$18.46
|
| Rate for Payer: Cash Price |
$10.80
|
| Rate for Payer: Cigna of CA HMO |
$16.80
|
| Rate for Payer: Cigna of CA PPO |
$16.80
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$16.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$9.60
|
| Rate for Payer: EPIC Health Plan Senior |
$9.60
|
| Rate for Payer: Galaxy Health WC |
$20.40
|
| Rate for Payer: Global Benefits Group Commercial |
$14.40
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$15.24
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$14.16
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5.76
|
| Rate for Payer: Multiplan Commercial |
$19.20
|
| Rate for Payer: Networks By Design Commercial |
$15.60
|
| Rate for Payer: Prime Health Services Commercial |
$20.40
|
|
|
FLUCYTOSINE 500 MG CAPSULE [10052]
|
Facility
|
OP
|
$24.00
|
|
|
Service Code
|
NDC 5965133201
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$4.80 |
| Max. Negotiated Rate |
$20.40 |
| Rate for Payer: Adventist Health Commercial |
$4.80
|
| Rate for Payer: Aetna of CA HMO/PPO |
$15.74
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$20.40
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$13.20
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$18.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$15.40
|
| Rate for Payer: Cash Price |
$10.80
|
| Rate for Payer: Cigna of CA HMO |
$16.80
|
| Rate for Payer: Cigna of CA PPO |
$16.80
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$20.40
|
| Rate for Payer: Dignity Health Medi-Cal |
$20.40
|
| Rate for Payer: Dignity Health Medicare Advantage |
$20.40
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$16.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$9.60
|
| Rate for Payer: EPIC Health Plan Senior |
$9.60
|
| Rate for Payer: Galaxy Health WC |
$20.40
|
| Rate for Payer: Global Benefits Group Commercial |
$14.40
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$15.24
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$8.71
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$14.16
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5.76
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$16.80
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$16.80
|
| Rate for Payer: Multiplan Commercial |
$19.20
|
| Rate for Payer: Networks By Design Commercial |
$15.60
|
| Rate for Payer: Prime Health Services Commercial |
$20.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$14.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$14.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$12.00
|
| Rate for Payer: United Healthcare All Other HMO |
$12.00
|
| Rate for Payer: United Healthcare HMO Rider |
$12.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$12.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$20.40
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$20.40
|
| Rate for Payer: Vantage Medical Group Senior |
$20.40
|
|
|
FLUCYTOSINE 500 MG CAPSULE [10052]
|
Facility
|
OP
|
$24.00
|
|
|
Service Code
|
NDC 4338677001
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$4.80 |
| Max. Negotiated Rate |
$20.40 |
| Rate for Payer: Adventist Health Commercial |
$4.80
|
| Rate for Payer: Aetna of CA HMO/PPO |
$15.74
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$20.40
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$13.20
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$18.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$15.40
|
| Rate for Payer: Cash Price |
$10.80
|
| Rate for Payer: Cigna of CA HMO |
$16.80
|
| Rate for Payer: Cigna of CA PPO |
$16.80
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$20.40
|
| Rate for Payer: Dignity Health Medi-Cal |
$20.40
|
| Rate for Payer: Dignity Health Medicare Advantage |
$20.40
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$16.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$9.60
|
| Rate for Payer: EPIC Health Plan Senior |
$9.60
|
| Rate for Payer: Galaxy Health WC |
$20.40
|
| Rate for Payer: Global Benefits Group Commercial |
$14.40
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$15.24
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$8.71
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$14.16
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5.76
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$16.80
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$16.80
|
| Rate for Payer: Multiplan Commercial |
$19.20
|
| Rate for Payer: Networks By Design Commercial |
$15.60
|
| Rate for Payer: Prime Health Services Commercial |
$20.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$14.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$14.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$12.00
|
| Rate for Payer: United Healthcare All Other HMO |
$12.00
|
| Rate for Payer: United Healthcare HMO Rider |
$12.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$12.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$20.40
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$20.40
|
| Rate for Payer: Vantage Medical Group Senior |
$20.40
|
|
|
FLUCYTOSINE ORAL SUSPENSION COMPOUND 50 MG/ML [4080274]
|
Facility
|
OP
|
$9.38
|
|
|
Service Code
|
NDC 9994080274
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$1.88 |
| Max. Negotiated Rate |
$7.97 |
| Rate for Payer: Adventist Health Commercial |
$1.88
|
| Rate for Payer: Aetna of CA HMO/PPO |
$6.15
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$7.97
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$5.16
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$7.04
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$6.02
|
| Rate for Payer: Cash Price |
$4.22
|
| Rate for Payer: Cigna of CA HMO |
$6.57
|
| Rate for Payer: Cigna of CA PPO |
$6.57
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$7.97
|
| Rate for Payer: Dignity Health Medi-Cal |
$7.97
|
| Rate for Payer: Dignity Health Medicare Advantage |
$7.97
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$6.57
|
| Rate for Payer: EPIC Health Plan Commercial |
$3.75
|
| Rate for Payer: EPIC Health Plan Senior |
$3.75
|
| Rate for Payer: Galaxy Health WC |
$7.97
|
| Rate for Payer: Global Benefits Group Commercial |
$5.63
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$5.96
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$3.40
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$5.53
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$6.57
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$6.57
|
| Rate for Payer: Multiplan Commercial |
$7.50
|
| Rate for Payer: Networks By Design Commercial |
$6.10
|
| Rate for Payer: Prime Health Services Commercial |
$7.97
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$5.63
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$5.63
|
| Rate for Payer: United Healthcare All Other Commercial |
$4.69
|
| Rate for Payer: United Healthcare All Other HMO |
$4.69
|
| Rate for Payer: United Healthcare HMO Rider |
$4.69
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$4.69
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$7.97
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$7.97
|
| Rate for Payer: Vantage Medical Group Senior |
$7.97
|
|
|
FLUCYTOSINE ORAL SUSPENSION COMPOUND 50 MG/ML [4080274]
|
Facility
|
IP
|
$9.38
|
|
|
Service Code
|
NDC 9994080274
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$1.88 |
| Max. Negotiated Rate |
$7.97 |
| Rate for Payer: Adventist Health Commercial |
$1.88
|
| Rate for Payer: Blue Shield of California Commercial |
$4.76
|
| Rate for Payer: Blue Shield of California Commercial |
$7.21
|
| Rate for Payer: Cash Price |
$4.22
|
| Rate for Payer: Cigna of CA HMO |
$6.57
|
| Rate for Payer: Cigna of CA PPO |
$6.57
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$6.57
|
| Rate for Payer: EPIC Health Plan Commercial |
$3.75
|
| Rate for Payer: EPIC Health Plan Senior |
$3.75
|
| Rate for Payer: Galaxy Health WC |
$7.97
|
| Rate for Payer: Global Benefits Group Commercial |
$5.63
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$5.96
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$5.53
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.25
|
| Rate for Payer: Multiplan Commercial |
$7.50
|
| Rate for Payer: Networks By Design Commercial |
$6.10
|
| Rate for Payer: Prime Health Services Commercial |
$7.97
|
|
|
FLUDARABINE 50 MG/2 ML INTRAVENOUS SOLUTION [41294]
|
Facility
|
IP
|
$163.13
|
|
|
Service Code
|
HCPCS J9185
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$32.63 |
| Max. Negotiated Rate |
$138.66 |
| Rate for Payer: Adventist Health Commercial |
$32.63
|
| Rate for Payer: Adventist Health Commercial |
$26.10
|
| Rate for Payer: Blue Shield of California Commercial |
$66.16
|
| Rate for Payer: Blue Shield of California Commercial |
$125.45
|
| Rate for Payer: Blue Shield of California Commercial |
$82.71
|
| Rate for Payer: Blue Shield of California Commercial |
$100.35
|
| Rate for Payer: Cash Price |
$58.72
|
| Rate for Payer: Cash Price |
$73.41
|
| Rate for Payer: Cigna of CA HMO |
$114.19
|
| Rate for Payer: Cigna of CA HMO |
$91.35
|
| Rate for Payer: Cigna of CA PPO |
$91.35
|
| Rate for Payer: Cigna of CA PPO |
$114.19
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$91.35
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$114.19
|
| Rate for Payer: EPIC Health Plan Commercial |
$52.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$65.25
|
| Rate for Payer: EPIC Health Plan Senior |
$52.20
|
| Rate for Payer: EPIC Health Plan Senior |
$65.25
|
| Rate for Payer: Galaxy Health WC |
$110.92
|
| Rate for Payer: Galaxy Health WC |
$138.66
|
| Rate for Payer: Global Benefits Group Commercial |
$97.88
|
| Rate for Payer: Global Benefits Group Commercial |
$78.30
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$82.87
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$103.59
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$77.00
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$96.25
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$31.32
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$39.15
|
| Rate for Payer: Multiplan Commercial |
$104.40
|
| Rate for Payer: Multiplan Commercial |
$130.50
|
| Rate for Payer: Networks By Design Commercial |
$81.56
|
| Rate for Payer: Networks By Design Commercial |
$65.25
|
| Rate for Payer: Prime Health Services Commercial |
$138.66
|
| Rate for Payer: Prime Health Services Commercial |
$110.92
|
| Rate for Payer: United Healthcare All Other Commercial |
$48.98
|
| Rate for Payer: United Healthcare All Other Commercial |
$61.22
|
| Rate for Payer: United Healthcare All Other HMO |
$59.59
|
| Rate for Payer: United Healthcare All Other HMO |
$47.67
|
| Rate for Payer: United Healthcare HMO Rider |
$46.64
|
| Rate for Payer: United Healthcare HMO Rider |
$58.30
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$42.74
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$53.43
|
|
|
FLUDARABINE 50 MG/2 ML INTRAVENOUS SOLUTION [41294]
|
Facility
|
OP
|
$130.50
|
|
|
Service Code
|
HCPCS J9185
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$26.10 |
| Max. Negotiated Rate |
$732.25 |
| Rate for Payer: Adventist Health Commercial |
$26.10
|
| Rate for Payer: Adventist Health Commercial |
$32.63
|
| Rate for Payer: Aetna of CA HMO/PPO |
$117.23
|
| Rate for Payer: Aetna of CA HMO/PPO |
$117.23
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$138.66
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$110.92
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$89.72
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$71.78
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$122.35
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$97.88
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$732.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$732.25
|
| Rate for Payer: Blue Shield of California Commercial |
$122.70
|
| Rate for Payer: Blue Shield of California Commercial |
$122.70
|
| Rate for Payer: Cash Price |
$58.72
|
| Rate for Payer: Cash Price |
$73.41
|
| Rate for Payer: Cash Price |
$58.72
|
| Rate for Payer: Cash Price |
$73.41
|
| Rate for Payer: Cigna of CA HMO |
$114.19
|
| Rate for Payer: Cigna of CA HMO |
$91.35
|
| Rate for Payer: Cigna of CA PPO |
$114.19
|
| Rate for Payer: Cigna of CA PPO |
$91.35
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$138.66
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$110.92
|
| Rate for Payer: Dignity Health Medi-Cal |
$110.92
|
| Rate for Payer: Dignity Health Medi-Cal |
$138.66
|
| Rate for Payer: Dignity Health Medicare Advantage |
$138.66
|
| Rate for Payer: Dignity Health Medicare Advantage |
$110.92
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$91.35
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$114.19
|
| Rate for Payer: EPIC Health Plan Commercial |
$52.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$65.25
|
| Rate for Payer: EPIC Health Plan Senior |
$65.25
|
| Rate for Payer: EPIC Health Plan Senior |
$52.20
|
| Rate for Payer: Galaxy Health WC |
$138.66
|
| Rate for Payer: Galaxy Health WC |
$110.92
|
| Rate for Payer: Global Benefits Group Commercial |
$97.88
|
| Rate for Payer: Global Benefits Group Commercial |
$78.30
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$206.30
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$206.30
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$82.87
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$103.59
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$154.68
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$154.68
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$96.25
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$77.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$39.15
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$31.32
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$91.35
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$114.19
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$91.35
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$114.19
|
| Rate for Payer: Multiplan Commercial |
$130.50
|
| Rate for Payer: Multiplan Commercial |
$104.40
|
| Rate for Payer: Networks By Design Commercial |
$81.56
|
| Rate for Payer: Networks By Design Commercial |
$65.25
|
| Rate for Payer: Prime Health Services Commercial |
$110.92
|
| Rate for Payer: Prime Health Services Commercial |
$138.66
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$78.30
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$97.88
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$78.30
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$97.88
|
| Rate for Payer: United Healthcare All Other Commercial |
$48.98
|
| Rate for Payer: United Healthcare All Other Commercial |
$61.22
|
| Rate for Payer: United Healthcare All Other HMO |
$47.67
|
| Rate for Payer: United Healthcare All Other HMO |
$59.59
|
| Rate for Payer: United Healthcare HMO Rider |
$58.30
|
| Rate for Payer: United Healthcare HMO Rider |
$46.64
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$42.74
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$53.43
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$138.66
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$110.92
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$110.92
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$138.66
|
| Rate for Payer: Vantage Medical Group Senior |
$110.92
|
| Rate for Payer: Vantage Medical Group Senior |
$138.66
|
|
|
FLUDARABINE 50 MG INTRAVENOUS SOLUTION [10053]
|
Facility
|
IP
|
$113.40
|
|
|
Service Code
|
HCPCS J9185
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$22.68 |
| Max. Negotiated Rate |
$96.39 |
| Rate for Payer: Galaxy Health WC |
$96.39
|
| Rate for Payer: Adventist Health Commercial |
$22.68
|
| Rate for Payer: Blue Shield of California Commercial |
$57.49
|
| Rate for Payer: Blue Shield of California Commercial |
$87.20
|
| Rate for Payer: Cash Price |
$51.03
|
| Rate for Payer: Cigna of CA HMO |
$79.38
|
| Rate for Payer: Cigna of CA PPO |
$79.38
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$79.38
|
| Rate for Payer: EPIC Health Plan Commercial |
$45.36
|
| Rate for Payer: EPIC Health Plan Senior |
$45.36
|
| Rate for Payer: Global Benefits Group Commercial |
$68.04
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$72.01
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$66.91
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$27.22
|
| Rate for Payer: Multiplan Commercial |
$90.72
|
| Rate for Payer: Networks By Design Commercial |
$56.70
|
| Rate for Payer: Prime Health Services Commercial |
$96.39
|
| Rate for Payer: United Healthcare All Other Commercial |
$42.56
|
| Rate for Payer: United Healthcare All Other HMO |
$41.43
|
| Rate for Payer: United Healthcare HMO Rider |
$40.53
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$37.14
|
|
|
FLUDARABINE 50 MG INTRAVENOUS SOLUTION [10053]
|
Facility
|
OP
|
$113.40
|
|
|
Service Code
|
HCPCS J9185
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$22.68 |
| Max. Negotiated Rate |
$732.25 |
| Rate for Payer: Adventist Health Commercial |
$22.68
|
| Rate for Payer: Aetna of CA HMO/PPO |
$117.23
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$96.39
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$62.37
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$85.05
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$732.25
|
| Rate for Payer: Blue Shield of California Commercial |
$122.70
|
| Rate for Payer: Cash Price |
$51.03
|
| Rate for Payer: Cash Price |
$51.03
|
| Rate for Payer: Cigna of CA HMO |
$79.38
|
| Rate for Payer: Cigna of CA PPO |
$79.38
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$96.39
|
| Rate for Payer: Dignity Health Medi-Cal |
$96.39
|
| Rate for Payer: Dignity Health Medicare Advantage |
$96.39
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$79.38
|
| Rate for Payer: EPIC Health Plan Commercial |
$45.36
|
| Rate for Payer: EPIC Health Plan Senior |
$45.36
|
| Rate for Payer: Galaxy Health WC |
$96.39
|
| Rate for Payer: Global Benefits Group Commercial |
$68.04
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$206.30
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$72.01
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$154.68
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$66.91
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$27.22
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$79.38
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$79.38
|
| Rate for Payer: Multiplan Commercial |
$90.72
|
| Rate for Payer: Networks By Design Commercial |
$56.70
|
| Rate for Payer: Prime Health Services Commercial |
$96.39
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$68.04
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$68.04
|
| Rate for Payer: United Healthcare All Other Commercial |
$42.56
|
| Rate for Payer: United Healthcare All Other HMO |
$41.43
|
| Rate for Payer: United Healthcare HMO Rider |
$40.53
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$37.14
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$96.39
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$96.39
|
| Rate for Payer: Vantage Medical Group Senior |
$96.39
|
|
|
FLUDEOXYGLUCOSE F-18 20 MCI TO 200 MCI/ML INTRAVENOUS SOLUTION [222882]
|
Facility
|
OP
|
$60.00
|
|
|
Service Code
|
HCPCS A9552
|
| Hospital Charge Code |
901700057
|
|
Hospital Revenue Code
|
343
|
| Min. Negotiated Rate |
$12.00 |
| Max. Negotiated Rate |
$1,064.52 |
| Rate for Payer: Adventist Health Commercial |
$12.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$51.00
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$33.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$45.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,064.52
|
| Rate for Payer: Blue Shield of California Commercial |
$38.28
|
| Rate for Payer: Blue Shield of California Commercial |
$25.26
|
| Rate for Payer: Cash Price |
$27.00
|
| Rate for Payer: Cash Price |
$27.00
|
| Rate for Payer: Cigna of CA HMO |
$38.40
|
| Rate for Payer: Cigna of CA PPO |
$44.40
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$51.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$51.00
|
| Rate for Payer: Dignity Health Medicare Advantage |
$51.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$42.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$24.00
|
| Rate for Payer: EPIC Health Plan Senior |
$24.00
|
| Rate for Payer: Galaxy Health WC |
$51.00
|
| Rate for Payer: Global Benefits Group Commercial |
$36.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$604.80
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$38.10
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$684.00
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$35.40
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$14.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$42.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$42.00
|
| Rate for Payer: Multiplan Commercial |
$48.00
|
| Rate for Payer: Networks By Design Commercial |
$39.00
|
| Rate for Payer: Prime Health Services Commercial |
$51.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$36.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$36.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$22.52
|
| Rate for Payer: United Healthcare All Other HMO |
$21.92
|
| Rate for Payer: United Healthcare HMO Rider |
$21.44
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$19.65
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$51.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$51.00
|
| Rate for Payer: Vantage Medical Group Senior |
$51.00
|
|
|
FLUDEOXYGLUCOSE F-18 20 MCI TO 200 MCI/ML INTRAVENOUS SOLUTION [222882]
|
Facility
|
IP
|
$60.00
|
|
|
Service Code
|
HCPCS A9552
|
| Hospital Charge Code |
901700057
|
|
Hospital Revenue Code
|
343
|
| Min. Negotiated Rate |
$12.00 |
| Max. Negotiated Rate |
$51.00 |
| Rate for Payer: Adventist Health Commercial |
$12.00
|
| Rate for Payer: Blue Shield of California Commercial |
$46.14
|
| Rate for Payer: Blue Shield of California Commercial |
$30.42
|
| Rate for Payer: Cash Price |
$27.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$42.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$24.00
|
| Rate for Payer: EPIC Health Plan Senior |
$24.00
|
| Rate for Payer: Galaxy Health WC |
$51.00
|
| Rate for Payer: Global Benefits Group Commercial |
$36.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$38.10
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$35.40
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$14.40
|
| Rate for Payer: Multiplan Commercial |
$48.00
|
| Rate for Payer: Networks By Design Commercial |
$39.00
|
| Rate for Payer: Prime Health Services Commercial |
$51.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$22.52
|
| Rate for Payer: United Healthcare All Other HMO |
$21.92
|
| Rate for Payer: United Healthcare HMO Rider |
$21.44
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$19.65
|
|
|
FLUDROCORTISONE 0.1 MG TABLET [10054]
|
Facility
|
IP
|
$0.66
|
|
|
Service Code
|
NDC 0555099702
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.13 |
| Max. Negotiated Rate |
$0.56 |
| Rate for Payer: Adventist Health Commercial |
$0.13
|
| Rate for Payer: Blue Shield of California Commercial |
$0.33
|
| Rate for Payer: Blue Shield of California Commercial |
$0.51
|
| Rate for Payer: Cash Price |
$0.30
|
| Rate for Payer: Cigna of CA HMO |
$0.46
|
| Rate for Payer: Cigna of CA PPO |
$0.46
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$0.46
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.26
|
| Rate for Payer: EPIC Health Plan Senior |
$0.26
|
| Rate for Payer: Galaxy Health WC |
$0.56
|
| Rate for Payer: Global Benefits Group Commercial |
$0.40
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$0.42
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$0.39
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.16
|
| Rate for Payer: Multiplan Commercial |
$0.53
|
| Rate for Payer: Networks By Design Commercial |
$0.43
|
| Rate for Payer: Prime Health Services Commercial |
$0.56
|
|
|
FLUDROCORTISONE 0.1 MG TABLET [10054]
|
Facility
|
IP
|
$0.71
|
|
|
Service Code
|
NDC 0115703301
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.14 |
| Max. Negotiated Rate |
$0.60 |
| Rate for Payer: Adventist Health Commercial |
$0.14
|
| Rate for Payer: Blue Shield of California Commercial |
$0.36
|
| Rate for Payer: Blue Shield of California Commercial |
$0.55
|
| Rate for Payer: Cash Price |
$0.32
|
| Rate for Payer: Cigna of CA HMO |
$0.50
|
| Rate for Payer: Cigna of CA PPO |
$0.50
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$0.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.28
|
| Rate for Payer: EPIC Health Plan Senior |
$0.28
|
| Rate for Payer: Galaxy Health WC |
$0.60
|
| Rate for Payer: Global Benefits Group Commercial |
$0.43
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$0.45
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$0.42
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.17
|
| Rate for Payer: Multiplan Commercial |
$0.57
|
| Rate for Payer: Networks By Design Commercial |
$0.46
|
| Rate for Payer: Prime Health Services Commercial |
$0.60
|
|
|
FLUDROCORTISONE 0.1 MG TABLET [10054]
|
Facility
|
IP
|
$0.57
|
|
|
Service Code
|
NDC 5026833015
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.11 |
| Max. Negotiated Rate |
$0.48 |
| Rate for Payer: Adventist Health Commercial |
$0.11
|
| Rate for Payer: Blue Shield of California Commercial |
$0.29
|
| Rate for Payer: Blue Shield of California Commercial |
$0.44
|
| Rate for Payer: Cash Price |
$0.26
|
| Rate for Payer: Cigna of CA HMO |
$0.40
|
| Rate for Payer: Cigna of CA PPO |
$0.40
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$0.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.23
|
| Rate for Payer: EPIC Health Plan Senior |
$0.23
|
| Rate for Payer: Galaxy Health WC |
$0.48
|
| Rate for Payer: Global Benefits Group Commercial |
$0.34
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$0.36
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$0.34
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.14
|
| Rate for Payer: Multiplan Commercial |
$0.46
|
| Rate for Payer: Networks By Design Commercial |
$0.37
|
| Rate for Payer: Prime Health Services Commercial |
$0.48
|
|
|
FLUDROCORTISONE 0.1 MG TABLET [10054]
|
Facility
|
IP
|
$0.67
|
|
|
Service Code
|
NDC 7095425220
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.13 |
| Max. Negotiated Rate |
$0.57 |
| Rate for Payer: Adventist Health Commercial |
$0.13
|
| Rate for Payer: Blue Shield of California Commercial |
$0.34
|
| Rate for Payer: Blue Shield of California Commercial |
$0.52
|
| Rate for Payer: Cash Price |
$0.30
|
| Rate for Payer: Cigna of CA HMO |
$0.47
|
| Rate for Payer: Cigna of CA PPO |
$0.47
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$0.47
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.27
|
| Rate for Payer: EPIC Health Plan Senior |
$0.27
|
| Rate for Payer: Galaxy Health WC |
$0.57
|
| Rate for Payer: Global Benefits Group Commercial |
$0.40
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$0.43
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$0.40
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.16
|
| Rate for Payer: Multiplan Commercial |
$0.54
|
| Rate for Payer: Networks By Design Commercial |
$0.44
|
| Rate for Payer: Prime Health Services Commercial |
$0.57
|
|
|
FLUDROCORTISONE 0.1 MG TABLET [10054]
|
Facility
|
OP
|
$0.57
|
|
|
Service Code
|
NDC 5026833015
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.11 |
| Max. Negotiated Rate |
$0.48 |
| Rate for Payer: Adventist Health Commercial |
$0.11
|
| Rate for Payer: Aetna of CA HMO/PPO |
$0.37
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.48
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.31
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.43
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.37
|
| Rate for Payer: Cash Price |
$0.26
|
| Rate for Payer: Cigna of CA HMO |
$0.40
|
| Rate for Payer: Cigna of CA PPO |
$0.40
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.48
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.48
|
| Rate for Payer: Dignity Health Medicare Advantage |
$0.48
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$0.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.23
|
| Rate for Payer: EPIC Health Plan Senior |
$0.23
|
| Rate for Payer: Galaxy Health WC |
$0.48
|
| Rate for Payer: Global Benefits Group Commercial |
$0.34
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$0.36
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.21
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$0.34
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.14
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$0.40
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$0.40
|
| Rate for Payer: Multiplan Commercial |
$0.46
|
| Rate for Payer: Networks By Design Commercial |
$0.37
|
| Rate for Payer: Prime Health Services Commercial |
$0.48
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.34
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.34
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.29
|
| Rate for Payer: United Healthcare All Other HMO |
$0.29
|
| Rate for Payer: United Healthcare HMO Rider |
$0.29
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.29
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.48
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.48
|
| Rate for Payer: Vantage Medical Group Senior |
$0.48
|
|
