|
FLUOCINONIDE 0.05 % TOPICAL CREAM. [4083187]
|
Facility
|
IP
|
$2.92
|
|
|
Service Code
|
NDC 0093026230
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.58 |
| Max. Negotiated Rate |
$2.48 |
| Rate for Payer: Adventist Health Commercial |
$0.58
|
| Rate for Payer: Blue Shield of California Commercial |
$1.48
|
| Rate for Payer: Blue Shield of California Commercial |
$2.25
|
| Rate for Payer: Cash Price |
$1.31
|
| Rate for Payer: Cigna of CA HMO |
$2.04
|
| Rate for Payer: Cigna of CA PPO |
$2.04
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$2.04
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.17
|
| Rate for Payer: EPIC Health Plan Senior |
$1.17
|
| Rate for Payer: Galaxy Health WC |
$2.48
|
| Rate for Payer: Global Benefits Group Commercial |
$1.75
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1.85
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1.72
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.70
|
| Rate for Payer: Multiplan Commercial |
$2.34
|
| Rate for Payer: Networks By Design Commercial |
$1.90
|
| Rate for Payer: Prime Health Services Commercial |
$2.48
|
|
|
FLUOCINONIDE 0.05 % TOPICAL CREAM. [4083187]
|
Facility
|
IP
|
$3.08
|
|
|
Service Code
|
NDC 5167212541
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.62 |
| Max. Negotiated Rate |
$2.62 |
| Rate for Payer: Adventist Health Commercial |
$0.62
|
| Rate for Payer: Blue Shield of California Commercial |
$1.56
|
| Rate for Payer: Blue Shield of California Commercial |
$2.37
|
| Rate for Payer: Cash Price |
$1.39
|
| Rate for Payer: Cigna of CA HMO |
$2.16
|
| Rate for Payer: Cigna of CA PPO |
$2.16
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$2.16
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.23
|
| Rate for Payer: EPIC Health Plan Senior |
$1.23
|
| Rate for Payer: Galaxy Health WC |
$2.62
|
| Rate for Payer: Global Benefits Group Commercial |
$1.85
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1.96
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1.82
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.74
|
| Rate for Payer: Multiplan Commercial |
$2.46
|
| Rate for Payer: Networks By Design Commercial |
$2.00
|
| Rate for Payer: Prime Health Services Commercial |
$2.62
|
|
|
FLUOCINONIDE 0.05 % TOPICAL CREAM. [4083187]
|
Facility
|
OP
|
$3.08
|
|
|
Service Code
|
NDC 5167212541
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.62 |
| Max. Negotiated Rate |
$2.62 |
| Rate for Payer: Adventist Health Commercial |
$0.62
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2.02
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2.62
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1.69
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2.31
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1.98
|
| Rate for Payer: Cash Price |
$1.39
|
| Rate for Payer: Cigna of CA HMO |
$2.16
|
| Rate for Payer: Cigna of CA PPO |
$2.16
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2.62
|
| Rate for Payer: Dignity Health Medi-Cal |
$2.62
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2.62
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$2.16
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.23
|
| Rate for Payer: EPIC Health Plan Senior |
$1.23
|
| Rate for Payer: Galaxy Health WC |
$2.62
|
| Rate for Payer: Global Benefits Group Commercial |
$1.85
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1.96
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1.12
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1.82
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.74
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2.16
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2.16
|
| Rate for Payer: Multiplan Commercial |
$2.46
|
| Rate for Payer: Networks By Design Commercial |
$2.00
|
| Rate for Payer: Prime Health Services Commercial |
$2.62
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1.85
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1.85
|
| Rate for Payer: United Healthcare All Other Commercial |
$1.54
|
| Rate for Payer: United Healthcare All Other HMO |
$1.54
|
| Rate for Payer: United Healthcare HMO Rider |
$1.54
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1.54
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2.62
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2.62
|
| Rate for Payer: Vantage Medical Group Senior |
$2.62
|
|
|
FLUOCINONIDE 0.05 % TOPICAL OINTMENT [3189]
|
Facility
|
IP
|
$1.48
|
|
|
Service Code
|
NDC 5167212641
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.30 |
| Max. Negotiated Rate |
$1.26 |
| Rate for Payer: Adventist Health Commercial |
$0.30
|
| Rate for Payer: Blue Shield of California Commercial |
$0.75
|
| Rate for Payer: Blue Shield of California Commercial |
$1.14
|
| Rate for Payer: Cash Price |
$0.67
|
| Rate for Payer: Cigna of CA HMO |
$1.04
|
| Rate for Payer: Cigna of CA PPO |
$1.04
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1.04
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.59
|
| Rate for Payer: EPIC Health Plan Senior |
$0.59
|
| Rate for Payer: Galaxy Health WC |
$1.26
|
| Rate for Payer: Global Benefits Group Commercial |
$0.89
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$0.94
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$0.87
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.36
|
| Rate for Payer: Multiplan Commercial |
$1.18
|
| Rate for Payer: Networks By Design Commercial |
$0.96
|
| Rate for Payer: Prime Health Services Commercial |
$1.26
|
|
|
FLUOCINONIDE 0.05 % TOPICAL OINTMENT [3189]
|
Facility
|
OP
|
$0.78
|
|
|
Service Code
|
NDC 5167212643
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.16 |
| Max. Negotiated Rate |
$0.66 |
| Rate for Payer: Adventist Health Commercial |
$0.16
|
| Rate for Payer: Aetna of CA HMO/PPO |
$0.51
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.66
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.43
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.59
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.50
|
| Rate for Payer: Cash Price |
$0.35
|
| Rate for Payer: Cigna of CA HMO |
$0.55
|
| Rate for Payer: Cigna of CA PPO |
$0.55
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.66
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.66
|
| Rate for Payer: Dignity Health Medicare Advantage |
$0.66
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$0.55
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.31
|
| Rate for Payer: EPIC Health Plan Senior |
$0.31
|
| Rate for Payer: Galaxy Health WC |
$0.66
|
| Rate for Payer: Global Benefits Group Commercial |
$0.47
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$0.50
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.28
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$0.46
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.19
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$0.55
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$0.55
|
| Rate for Payer: Multiplan Commercial |
$0.62
|
| Rate for Payer: Networks By Design Commercial |
$0.51
|
| Rate for Payer: Prime Health Services Commercial |
$0.66
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.47
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.47
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.39
|
| Rate for Payer: United Healthcare All Other HMO |
$0.39
|
| Rate for Payer: United Healthcare HMO Rider |
$0.39
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.39
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.66
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.66
|
| Rate for Payer: Vantage Medical Group Senior |
$0.66
|
|
|
FLUOCINONIDE 0.05 % TOPICAL OINTMENT [3189]
|
Facility
|
OP
|
$4.53
|
|
|
Service Code
|
NDC 0093026492
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.91 |
| Max. Negotiated Rate |
$3.85 |
| Rate for Payer: Adventist Health Commercial |
$0.91
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2.97
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3.85
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2.49
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$3.40
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2.91
|
| Rate for Payer: Cash Price |
$2.04
|
| Rate for Payer: Cigna of CA HMO |
$3.17
|
| Rate for Payer: Cigna of CA PPO |
$3.17
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3.85
|
| Rate for Payer: Dignity Health Medi-Cal |
$3.85
|
| Rate for Payer: Dignity Health Medicare Advantage |
$3.85
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$3.17
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.81
|
| Rate for Payer: EPIC Health Plan Senior |
$1.81
|
| Rate for Payer: Galaxy Health WC |
$3.85
|
| Rate for Payer: Global Benefits Group Commercial |
$2.72
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$2.88
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1.64
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2.67
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.09
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$3.17
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$3.17
|
| Rate for Payer: Multiplan Commercial |
$3.62
|
| Rate for Payer: Networks By Design Commercial |
$2.94
|
| Rate for Payer: Prime Health Services Commercial |
$3.85
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2.72
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2.72
|
| Rate for Payer: United Healthcare All Other Commercial |
$2.27
|
| Rate for Payer: United Healthcare All Other HMO |
$2.27
|
| Rate for Payer: United Healthcare HMO Rider |
$2.27
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2.27
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3.85
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$3.85
|
| Rate for Payer: Vantage Medical Group Senior |
$3.85
|
|
|
FLUOCINONIDE 0.05 % TOPICAL OINTMENT [3189]
|
Facility
|
OP
|
$1.48
|
|
|
Service Code
|
NDC 5167212641
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.30 |
| Max. Negotiated Rate |
$1.26 |
| Rate for Payer: Adventist Health Commercial |
$0.30
|
| Rate for Payer: Aetna of CA HMO/PPO |
$0.97
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1.26
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.81
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1.11
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.95
|
| Rate for Payer: Cash Price |
$0.67
|
| Rate for Payer: Cigna of CA HMO |
$1.04
|
| Rate for Payer: Cigna of CA PPO |
$1.04
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1.26
|
| Rate for Payer: Dignity Health Medi-Cal |
$1.26
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1.26
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1.04
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.59
|
| Rate for Payer: EPIC Health Plan Senior |
$0.59
|
| Rate for Payer: Galaxy Health WC |
$1.26
|
| Rate for Payer: Global Benefits Group Commercial |
$0.89
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$0.94
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.54
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$0.87
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.36
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1.04
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1.04
|
| Rate for Payer: Multiplan Commercial |
$1.18
|
| Rate for Payer: Networks By Design Commercial |
$0.96
|
| Rate for Payer: Prime Health Services Commercial |
$1.26
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.89
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.89
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.74
|
| Rate for Payer: United Healthcare All Other HMO |
$0.74
|
| Rate for Payer: United Healthcare HMO Rider |
$0.74
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.74
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1.26
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1.26
|
| Rate for Payer: Vantage Medical Group Senior |
$1.26
|
|
|
FLUOCINONIDE 0.05 % TOPICAL OINTMENT [3189]
|
Facility
|
IP
|
$4.53
|
|
|
Service Code
|
NDC 0093026492
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.91 |
| Max. Negotiated Rate |
$3.85 |
| Rate for Payer: Adventist Health Commercial |
$0.91
|
| Rate for Payer: Blue Shield of California Commercial |
$2.30
|
| Rate for Payer: Blue Shield of California Commercial |
$3.48
|
| Rate for Payer: Cash Price |
$2.04
|
| Rate for Payer: Cigna of CA HMO |
$3.17
|
| Rate for Payer: Cigna of CA PPO |
$3.17
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$3.17
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.81
|
| Rate for Payer: EPIC Health Plan Senior |
$1.81
|
| Rate for Payer: Galaxy Health WC |
$3.85
|
| Rate for Payer: Global Benefits Group Commercial |
$2.72
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$2.88
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2.67
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.09
|
| Rate for Payer: Multiplan Commercial |
$3.62
|
| Rate for Payer: Networks By Design Commercial |
$2.94
|
| Rate for Payer: Prime Health Services Commercial |
$3.85
|
|
|
FLUOCINONIDE 0.05 % TOPICAL OINTMENT [3189]
|
Facility
|
IP
|
$0.78
|
|
|
Service Code
|
NDC 5167212643
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.16 |
| Max. Negotiated Rate |
$0.66 |
| Rate for Payer: Adventist Health Commercial |
$0.16
|
| Rate for Payer: Blue Shield of California Commercial |
$0.40
|
| Rate for Payer: Blue Shield of California Commercial |
$0.60
|
| Rate for Payer: Cash Price |
$0.35
|
| Rate for Payer: Cigna of CA HMO |
$0.55
|
| Rate for Payer: Cigna of CA PPO |
$0.55
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$0.55
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.31
|
| Rate for Payer: EPIC Health Plan Senior |
$0.31
|
| Rate for Payer: Galaxy Health WC |
$0.66
|
| Rate for Payer: Global Benefits Group Commercial |
$0.47
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$0.50
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$0.46
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.19
|
| Rate for Payer: Multiplan Commercial |
$0.62
|
| Rate for Payer: Networks By Design Commercial |
$0.51
|
| Rate for Payer: Prime Health Services Commercial |
$0.66
|
|
|
FLUOCINONIDE 0.05 % TOPICAL SOLUTION [3190]
|
Facility
|
OP
|
$1.16
|
|
|
Service Code
|
NDC 5167212734
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.23 |
| Max. Negotiated Rate |
$0.99 |
| Rate for Payer: Adventist Health Commercial |
$0.23
|
| Rate for Payer: Aetna of CA HMO/PPO |
$0.76
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.99
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.64
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.87
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.74
|
| Rate for Payer: Cash Price |
$0.52
|
| Rate for Payer: Cigna of CA HMO |
$0.81
|
| Rate for Payer: Cigna of CA PPO |
$0.81
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.99
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.99
|
| Rate for Payer: Dignity Health Medicare Advantage |
$0.99
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$0.81
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.46
|
| Rate for Payer: EPIC Health Plan Senior |
$0.46
|
| Rate for Payer: Galaxy Health WC |
$0.99
|
| Rate for Payer: Global Benefits Group Commercial |
$0.70
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$0.74
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.42
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$0.68
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.28
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$0.81
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$0.81
|
| Rate for Payer: Multiplan Commercial |
$0.93
|
| Rate for Payer: Networks By Design Commercial |
$0.75
|
| Rate for Payer: Prime Health Services Commercial |
$0.99
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.70
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.70
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.58
|
| Rate for Payer: United Healthcare All Other HMO |
$0.58
|
| Rate for Payer: United Healthcare HMO Rider |
$0.58
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.58
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.99
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.99
|
| Rate for Payer: Vantage Medical Group Senior |
$0.99
|
|
|
FLUOCINONIDE 0.05 % TOPICAL SOLUTION [3190]
|
Facility
|
IP
|
$1.20
|
|
|
Service Code
|
NDC 5167212732
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.24 |
| Max. Negotiated Rate |
$1.02 |
| Rate for Payer: Adventist Health Commercial |
$0.24
|
| Rate for Payer: Blue Shield of California Commercial |
$0.61
|
| Rate for Payer: Blue Shield of California Commercial |
$0.92
|
| Rate for Payer: Cash Price |
$0.54
|
| Rate for Payer: Cigna of CA HMO |
$0.84
|
| Rate for Payer: Cigna of CA PPO |
$0.84
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$0.84
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.48
|
| Rate for Payer: EPIC Health Plan Senior |
$0.48
|
| Rate for Payer: Galaxy Health WC |
$1.02
|
| Rate for Payer: Global Benefits Group Commercial |
$0.72
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$0.76
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$0.71
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.29
|
| Rate for Payer: Multiplan Commercial |
$0.96
|
| Rate for Payer: Networks By Design Commercial |
$0.78
|
| Rate for Payer: Prime Health Services Commercial |
$1.02
|
|
|
FLUOCINONIDE 0.05 % TOPICAL SOLUTION [3190]
|
Facility
|
IP
|
$1.16
|
|
|
Service Code
|
NDC 5167212734
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.23 |
| Max. Negotiated Rate |
$0.99 |
| Rate for Payer: Adventist Health Commercial |
$0.23
|
| Rate for Payer: Blue Shield of California Commercial |
$0.59
|
| Rate for Payer: Blue Shield of California Commercial |
$0.89
|
| Rate for Payer: Cash Price |
$0.52
|
| Rate for Payer: Cigna of CA HMO |
$0.81
|
| Rate for Payer: Cigna of CA PPO |
$0.81
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$0.81
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.46
|
| Rate for Payer: EPIC Health Plan Senior |
$0.46
|
| Rate for Payer: Galaxy Health WC |
$0.99
|
| Rate for Payer: Global Benefits Group Commercial |
$0.70
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$0.74
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$0.68
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.28
|
| Rate for Payer: Multiplan Commercial |
$0.93
|
| Rate for Payer: Networks By Design Commercial |
$0.75
|
| Rate for Payer: Prime Health Services Commercial |
$0.99
|
|
|
FLUOCINONIDE 0.05 % TOPICAL SOLUTION [3190]
|
Facility
|
OP
|
$1.20
|
|
|
Service Code
|
NDC 5167212732
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.24 |
| Max. Negotiated Rate |
$1.02 |
| Rate for Payer: Adventist Health Commercial |
$0.24
|
| Rate for Payer: Aetna of CA HMO/PPO |
$0.79
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1.02
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.66
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.90
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.77
|
| Rate for Payer: Cash Price |
$0.54
|
| Rate for Payer: Cigna of CA HMO |
$0.84
|
| Rate for Payer: Cigna of CA PPO |
$0.84
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1.02
|
| Rate for Payer: Dignity Health Medi-Cal |
$1.02
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1.02
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$0.84
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.48
|
| Rate for Payer: EPIC Health Plan Senior |
$0.48
|
| Rate for Payer: Galaxy Health WC |
$1.02
|
| Rate for Payer: Global Benefits Group Commercial |
$0.72
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$0.76
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.44
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$0.71
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.29
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$0.84
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$0.84
|
| Rate for Payer: Multiplan Commercial |
$0.96
|
| Rate for Payer: Networks By Design Commercial |
$0.78
|
| Rate for Payer: Prime Health Services Commercial |
$1.02
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.72
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.72
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.60
|
| Rate for Payer: United Healthcare All Other HMO |
$0.60
|
| Rate for Payer: United Healthcare HMO Rider |
$0.60
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.60
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1.02
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1.02
|
| Rate for Payer: Vantage Medical Group Senior |
$1.02
|
|
|
FLUORESCEIN 1 MG EYE STRIPS [27663]
|
Facility
|
IP
|
$0.25
|
|
|
Service Code
|
NDC 1723890099
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.05 |
| Max. Negotiated Rate |
$0.21 |
| Rate for Payer: Adventist Health Commercial |
$0.05
|
| Rate for Payer: Blue Shield of California Commercial |
$0.13
|
| Rate for Payer: Blue Shield of California Commercial |
$0.19
|
| Rate for Payer: Cash Price |
$0.11
|
| Rate for Payer: Cigna of CA HMO |
$0.18
|
| Rate for Payer: Cigna of CA PPO |
$0.18
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$0.18
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.10
|
| Rate for Payer: EPIC Health Plan Senior |
$0.10
|
| Rate for Payer: Galaxy Health WC |
$0.21
|
| Rate for Payer: Global Benefits Group Commercial |
$0.15
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$0.16
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$0.15
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.06
|
| Rate for Payer: Multiplan Commercial |
$0.20
|
| Rate for Payer: Networks By Design Commercial |
$0.16
|
| Rate for Payer: Prime Health Services Commercial |
$0.21
|
|
|
FLUORESCEIN 1 MG EYE STRIPS [27663]
|
Facility
|
IP
|
$0.25
|
|
|
Service Code
|
NDC 1723890011
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.05 |
| Max. Negotiated Rate |
$0.21 |
| Rate for Payer: Adventist Health Commercial |
$0.05
|
| Rate for Payer: Blue Shield of California Commercial |
$0.13
|
| Rate for Payer: Blue Shield of California Commercial |
$0.19
|
| Rate for Payer: Cash Price |
$0.11
|
| Rate for Payer: Cigna of CA HMO |
$0.18
|
| Rate for Payer: Cigna of CA PPO |
$0.18
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$0.18
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.10
|
| Rate for Payer: EPIC Health Plan Senior |
$0.10
|
| Rate for Payer: Galaxy Health WC |
$0.21
|
| Rate for Payer: Global Benefits Group Commercial |
$0.15
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$0.16
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$0.15
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.06
|
| Rate for Payer: Multiplan Commercial |
$0.20
|
| Rate for Payer: Networks By Design Commercial |
$0.16
|
| Rate for Payer: Prime Health Services Commercial |
$0.21
|
|
|
FLUORESCEIN 1 MG EYE STRIPS [27663]
|
Facility
|
OP
|
$0.25
|
|
|
Service Code
|
NDC 1723890099
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.05 |
| Max. Negotiated Rate |
$0.21 |
| Rate for Payer: Adventist Health Commercial |
$0.05
|
| Rate for Payer: Aetna of CA HMO/PPO |
$0.16
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.21
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.14
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.19
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.16
|
| Rate for Payer: Cash Price |
$0.11
|
| Rate for Payer: Cigna of CA HMO |
$0.18
|
| Rate for Payer: Cigna of CA PPO |
$0.18
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.21
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.21
|
| Rate for Payer: Dignity Health Medicare Advantage |
$0.21
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$0.18
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.10
|
| Rate for Payer: EPIC Health Plan Senior |
$0.10
|
| Rate for Payer: Galaxy Health WC |
$0.21
|
| Rate for Payer: Global Benefits Group Commercial |
$0.15
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$0.16
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.09
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$0.15
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.06
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$0.18
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$0.18
|
| Rate for Payer: Multiplan Commercial |
$0.20
|
| Rate for Payer: Networks By Design Commercial |
$0.16
|
| Rate for Payer: Prime Health Services Commercial |
$0.21
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.15
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.15
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.13
|
| Rate for Payer: United Healthcare All Other HMO |
$0.13
|
| Rate for Payer: United Healthcare HMO Rider |
$0.13
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.13
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.21
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.21
|
| Rate for Payer: Vantage Medical Group Senior |
$0.21
|
|
|
FLUORESCEIN 1 MG EYE STRIPS [27663]
|
Facility
|
OP
|
$0.25
|
|
|
Service Code
|
NDC 1723890011
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.05 |
| Max. Negotiated Rate |
$0.21 |
| Rate for Payer: Adventist Health Commercial |
$0.05
|
| Rate for Payer: Aetna of CA HMO/PPO |
$0.16
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.21
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.14
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.19
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.16
|
| Rate for Payer: Cash Price |
$0.11
|
| Rate for Payer: Cigna of CA HMO |
$0.18
|
| Rate for Payer: Cigna of CA PPO |
$0.18
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.21
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.21
|
| Rate for Payer: Dignity Health Medicare Advantage |
$0.21
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$0.18
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.10
|
| Rate for Payer: EPIC Health Plan Senior |
$0.10
|
| Rate for Payer: Galaxy Health WC |
$0.21
|
| Rate for Payer: Global Benefits Group Commercial |
$0.15
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$0.16
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.09
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$0.15
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.06
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$0.18
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$0.18
|
| Rate for Payer: Multiplan Commercial |
$0.20
|
| Rate for Payer: Networks By Design Commercial |
$0.16
|
| Rate for Payer: Prime Health Services Commercial |
$0.21
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.15
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.15
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.13
|
| Rate for Payer: United Healthcare All Other HMO |
$0.13
|
| Rate for Payer: United Healthcare HMO Rider |
$0.13
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.13
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.21
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.21
|
| Rate for Payer: Vantage Medical Group Senior |
$0.21
|
|
|
FLUORESCEIN 500 MG/5 ML (10 %) INTRAVENOUS SOLUTION [10059]
|
Facility
|
OP
|
$12.00
|
|
|
Service Code
|
HCPCS A9612
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.97 |
| Max. Negotiated Rate |
$10.20 |
| Rate for Payer: Adventist Health Commercial |
$2.40
|
| Rate for Payer: Adventist Health Commercial |
$3.46
|
| Rate for Payer: Aetna of CA HMO/PPO |
$11.33
|
| 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 Commercial/Exchange |
$14.69
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$6.60
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$9.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$9.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$12.96
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.97
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.97
|
| Rate for Payer: Cash Price |
$7.78
|
| Rate for Payer: Cash Price |
$5.40
|
| Rate for Payer: Cash Price |
$5.40
|
| Rate for Payer: Cash Price |
$7.78
|
| Rate for Payer: Cigna of CA HMO |
$12.10
|
| Rate for Payer: Cigna of CA HMO |
$8.40
|
| Rate for Payer: Cigna of CA PPO |
$12.10
|
| Rate for Payer: Cigna of CA PPO |
$8.40
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$10.20
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$14.69
|
| Rate for Payer: Dignity Health Medi-Cal |
$10.20
|
| Rate for Payer: Dignity Health Medi-Cal |
$14.69
|
| Rate for Payer: Dignity Health Medicare Advantage |
$14.69
|
| Rate for Payer: Dignity Health Medicare Advantage |
$10.20
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$12.10
|
| 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 Commercial |
$6.91
|
| Rate for Payer: EPIC Health Plan Senior |
$4.80
|
| Rate for Payer: EPIC Health Plan Senior |
$6.91
|
| Rate for Payer: Galaxy Health WC |
$14.69
|
| Rate for Payer: Galaxy Health WC |
$10.20
|
| Rate for Payer: Global Benefits Group Commercial |
$10.37
|
| 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 Commercial/Self Funded |
$10.97
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$7.08
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$10.20
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.15
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.88
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$12.10
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$8.40
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$8.40
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$12.10
|
| Rate for Payer: Multiplan Commercial |
$13.82
|
| Rate for Payer: Multiplan Commercial |
$9.60
|
| Rate for Payer: Networks By Design Commercial |
$6.00
|
| Rate for Payer: Networks By Design Commercial |
$8.64
|
| Rate for Payer: Prime Health Services Commercial |
$14.69
|
| Rate for Payer: Prime Health Services Commercial |
$10.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$10.37
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$7.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$7.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$10.37
|
| Rate for Payer: United Healthcare All Other Commercial |
$4.50
|
| Rate for Payer: United Healthcare All Other Commercial |
$6.49
|
| Rate for Payer: United Healthcare All Other HMO |
$6.31
|
| Rate for Payer: United Healthcare All Other HMO |
$4.38
|
| Rate for Payer: United Healthcare HMO Rider |
$6.18
|
| Rate for Payer: United Healthcare HMO Rider |
$4.29
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3.93
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$5.66
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$10.20
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$14.69
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$10.20
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$14.69
|
| Rate for Payer: Vantage Medical Group Senior |
$14.69
|
| Rate for Payer: Vantage Medical Group Senior |
$10.20
|
|
|
FLUORESCEIN 500 MG/5 ML (10 %) INTRAVENOUS SOLUTION [10059]
|
Facility
|
IP
|
$17.28
|
|
|
Service Code
|
HCPCS A9612
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$3.46 |
| Max. Negotiated Rate |
$14.69 |
| Rate for Payer: Adventist Health Commercial |
$3.46
|
| Rate for Payer: Adventist Health Commercial |
$2.40
|
| Rate for Payer: Blue Shield of California Commercial |
$9.23
|
| Rate for Payer: Blue Shield of California Commercial |
$13.29
|
| Rate for Payer: Blue Shield of California Commercial |
$8.76
|
| Rate for Payer: Blue Shield of California Commercial |
$6.08
|
| Rate for Payer: Cash Price |
$5.40
|
| Rate for Payer: Cash Price |
$7.78
|
| Rate for Payer: Cigna of CA HMO |
$12.10
|
| Rate for Payer: Cigna of CA HMO |
$8.40
|
| Rate for Payer: Cigna of CA PPO |
$8.40
|
| Rate for Payer: Cigna of CA PPO |
$12.10
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$8.40
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$12.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$4.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$6.91
|
| Rate for Payer: EPIC Health Plan Senior |
$4.80
|
| Rate for Payer: EPIC Health Plan Senior |
$6.91
|
| Rate for Payer: Galaxy Health WC |
$10.20
|
| Rate for Payer: Galaxy Health WC |
$14.69
|
| Rate for Payer: Global Benefits Group Commercial |
$10.37
|
| 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 Commercial/Self Funded |
$10.97
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$7.08
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$10.20
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.88
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.15
|
| Rate for Payer: Multiplan Commercial |
$9.60
|
| Rate for Payer: Multiplan Commercial |
$13.82
|
| Rate for Payer: Networks By Design Commercial |
$8.64
|
| Rate for Payer: Networks By Design Commercial |
$6.00
|
| Rate for Payer: Prime Health Services Commercial |
$14.69
|
| Rate for Payer: Prime Health Services Commercial |
$10.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$4.50
|
| Rate for Payer: United Healthcare All Other Commercial |
$6.49
|
| Rate for Payer: United Healthcare All Other HMO |
$6.31
|
| Rate for Payer: United Healthcare All Other HMO |
$4.38
|
| Rate for Payer: United Healthcare HMO Rider |
$4.29
|
| Rate for Payer: United Healthcare HMO Rider |
$6.18
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3.93
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$5.66
|
|
|
FLUOROESTRADIOL F-18 148 MBQ/ML TO 3,700 MBQ/ML INTRAVENOUS SOLUTION [229585]
|
Facility
|
IP
|
$5,703.60
|
|
|
Service Code
|
HCPCS A9591
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1,140.72 |
| Max. Negotiated Rate |
$4,848.06 |
| Rate for Payer: Adventist Health Commercial |
$1,140.72
|
| Rate for Payer: Blue Shield of California Commercial |
$2,891.73
|
| Rate for Payer: Blue Shield of California Commercial |
$4,386.07
|
| Rate for Payer: Cash Price |
$2,566.62
|
| Rate for Payer: Cigna of CA HMO |
$3,992.52
|
| Rate for Payer: Cigna of CA PPO |
$3,992.52
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$3,992.52
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,281.44
|
| Rate for Payer: EPIC Health Plan Senior |
$2,281.44
|
| Rate for Payer: Galaxy Health WC |
$4,848.06
|
| Rate for Payer: Global Benefits Group Commercial |
$3,422.16
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$3,621.79
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$3,365.12
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,368.86
|
| Rate for Payer: Multiplan Commercial |
$4,562.88
|
| Rate for Payer: Networks By Design Commercial |
$2,851.80
|
| Rate for Payer: Prime Health Services Commercial |
$4,848.06
|
| Rate for Payer: United Healthcare All Other Commercial |
$2,140.56
|
| Rate for Payer: United Healthcare All Other HMO |
$2,083.53
|
| Rate for Payer: United Healthcare HMO Rider |
$2,038.47
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,867.93
|
|
|
FLUOROESTRADIOL F-18 148 MBQ/ML TO 3,700 MBQ/ML INTRAVENOUS SOLUTION [229585]
|
Facility
|
OP
|
$5,703.60
|
|
|
Service Code
|
HCPCS A9591
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$93.25 |
| Max. Negotiated Rate |
$4,848.06 |
| Rate for Payer: Adventist Health Commercial |
$1,140.72
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$575.52
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$506.46
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$506.46
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$93.25
|
| Rate for Payer: Cash Price |
$2,566.62
|
| Rate for Payer: Cash Price |
$2,566.62
|
| Rate for Payer: Cigna of CA HMO |
$3,992.52
|
| Rate for Payer: Cigna of CA PPO |
$3,992.52
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$575.52
|
| Rate for Payer: Dignity Health Medi-Cal |
$506.46
|
| Rate for Payer: Dignity Health Medicare Advantage |
$506.46
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$3,992.52
|
| Rate for Payer: EPIC Health Plan Commercial |
$759.69
|
| Rate for Payer: EPIC Health Plan Senior |
$506.46
|
| Rate for Payer: Galaxy Health WC |
$4,848.06
|
| Rate for Payer: Global Benefits Group Commercial |
$3,422.16
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$755.09
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$460.42
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$3,621.79
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$644.59
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,368.86
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$580.13
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$616.96
|
| Rate for Payer: Multiplan Commercial |
$4,562.88
|
| Rate for Payer: Networks By Design Commercial |
$2,851.80
|
| Rate for Payer: Prime Health Services Commercial |
$4,848.06
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3,422.16
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$3,422.16
|
| Rate for Payer: United Healthcare All Other Commercial |
$2,140.56
|
| Rate for Payer: United Healthcare All Other HMO |
$2,083.53
|
| Rate for Payer: United Healthcare HMO Rider |
$2,038.47
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,867.93
|
| Rate for Payer: Upland Medical Group Pediatric |
$460.42
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$575.52
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$506.46
|
| Rate for Payer: Vantage Medical Group Senior |
$506.46
|
|
|
FLUOROMETHOLONE 0.1 % EYE DROPS,SUSPENSION [3208]
|
Facility
|
IP
|
$18.58
|
|
|
Service Code
|
NDC 6021915866
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$3.72 |
| Max. Negotiated Rate |
$15.79 |
| Rate for Payer: Adventist Health Commercial |
$3.72
|
| Rate for Payer: Blue Shield of California Commercial |
$14.29
|
| Rate for Payer: Blue Shield of California Commercial |
$9.42
|
| Rate for Payer: Cash Price |
$8.36
|
| Rate for Payer: Cigna of CA HMO |
$13.01
|
| Rate for Payer: Cigna of CA PPO |
$13.01
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$13.01
|
| Rate for Payer: EPIC Health Plan Commercial |
$7.43
|
| Rate for Payer: EPIC Health Plan Senior |
$7.43
|
| Rate for Payer: Galaxy Health WC |
$15.79
|
| Rate for Payer: Global Benefits Group Commercial |
$11.15
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$11.80
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$10.96
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.46
|
| Rate for Payer: Multiplan Commercial |
$14.86
|
| Rate for Payer: Networks By Design Commercial |
$12.08
|
| Rate for Payer: Prime Health Services Commercial |
$15.79
|
|
|
FLUOROMETHOLONE 0.1 % EYE DROPS,SUSPENSION [3208]
|
Facility
|
IP
|
$18.59
|
|
|
Service Code
|
NDC 6075888005
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$3.72 |
| Max. Negotiated Rate |
$15.80 |
| Rate for Payer: Adventist Health Commercial |
$3.72
|
| Rate for Payer: Blue Shield of California Commercial |
$14.30
|
| Rate for Payer: Blue Shield of California Commercial |
$9.43
|
| Rate for Payer: Cash Price |
$8.37
|
| Rate for Payer: Cigna of CA HMO |
$13.01
|
| Rate for Payer: Cigna of CA PPO |
$13.01
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$13.01
|
| Rate for Payer: EPIC Health Plan Commercial |
$7.44
|
| Rate for Payer: EPIC Health Plan Senior |
$7.44
|
| Rate for Payer: Galaxy Health WC |
$15.80
|
| Rate for Payer: Global Benefits Group Commercial |
$11.15
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$11.80
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$10.97
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.46
|
| Rate for Payer: Multiplan Commercial |
$14.87
|
| Rate for Payer: Networks By Design Commercial |
$12.08
|
| Rate for Payer: Prime Health Services Commercial |
$15.80
|
|
|
FLUOROMETHOLONE 0.1 % EYE DROPS,SUSPENSION [3208]
|
Facility
|
OP
|
$18.58
|
|
|
Service Code
|
NDC 6021915866
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$3.72 |
| Max. Negotiated Rate |
$15.79 |
| Rate for Payer: Adventist Health Commercial |
$3.72
|
| Rate for Payer: Aetna of CA HMO/PPO |
$12.19
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$15.79
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$10.22
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$13.94
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$11.92
|
| Rate for Payer: Cash Price |
$8.36
|
| Rate for Payer: Cigna of CA HMO |
$13.01
|
| Rate for Payer: Cigna of CA PPO |
$13.01
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$15.79
|
| Rate for Payer: Dignity Health Medi-Cal |
$15.79
|
| Rate for Payer: Dignity Health Medicare Advantage |
$15.79
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$13.01
|
| Rate for Payer: EPIC Health Plan Commercial |
$7.43
|
| Rate for Payer: EPIC Health Plan Senior |
$7.43
|
| Rate for Payer: Galaxy Health WC |
$15.79
|
| Rate for Payer: Global Benefits Group Commercial |
$11.15
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$11.80
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$6.74
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$10.96
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.46
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$13.01
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$13.01
|
| Rate for Payer: Multiplan Commercial |
$14.86
|
| Rate for Payer: Networks By Design Commercial |
$12.08
|
| Rate for Payer: Prime Health Services Commercial |
$15.79
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$11.15
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$11.15
|
| Rate for Payer: United Healthcare All Other Commercial |
$9.29
|
| Rate for Payer: United Healthcare All Other HMO |
$9.29
|
| Rate for Payer: United Healthcare HMO Rider |
$9.29
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$9.29
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$15.79
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$15.79
|
| Rate for Payer: Vantage Medical Group Senior |
$15.79
|
|
|
FLUOROMETHOLONE 0.1 % EYE DROPS,SUSPENSION [3208]
|
Facility
|
OP
|
$18.59
|
|
|
Service Code
|
NDC 6075888005
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$3.72 |
| Max. Negotiated Rate |
$15.80 |
| Rate for Payer: Adventist Health Commercial |
$3.72
|
| Rate for Payer: Aetna of CA HMO/PPO |
$12.19
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$15.80
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$10.22
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$13.94
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$11.93
|
| Rate for Payer: Cash Price |
$8.37
|
| Rate for Payer: Cigna of CA HMO |
$13.01
|
| Rate for Payer: Cigna of CA PPO |
$13.01
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$15.80
|
| Rate for Payer: Dignity Health Medi-Cal |
$15.80
|
| Rate for Payer: Dignity Health Medicare Advantage |
$15.80
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$13.01
|
| Rate for Payer: EPIC Health Plan Commercial |
$7.44
|
| Rate for Payer: EPIC Health Plan Senior |
$7.44
|
| Rate for Payer: Galaxy Health WC |
$15.80
|
| Rate for Payer: Global Benefits Group Commercial |
$11.15
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$11.80
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$6.75
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$10.97
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.46
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$13.01
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$13.01
|
| Rate for Payer: Multiplan Commercial |
$14.87
|
| Rate for Payer: Networks By Design Commercial |
$12.08
|
| Rate for Payer: Prime Health Services Commercial |
$15.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$11.15
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$11.15
|
| Rate for Payer: United Healthcare All Other Commercial |
$9.29
|
| Rate for Payer: United Healthcare All Other HMO |
$9.29
|
| Rate for Payer: United Healthcare HMO Rider |
$9.29
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$9.29
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$15.80
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$15.80
|
| Rate for Payer: Vantage Medical Group Senior |
$15.80
|
|
