|
FLUCONAZOLE 50 MG TABLET [10046]
|
Facility
|
IP
|
$0.40
|
|
|
Service Code
|
NDC 62559-990-30
|
| Hospital Charge Code |
1711487
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.10 |
| Max. Negotiated Rate |
$0.34 |
| Rate for Payer: Blue Shield of California Commercial |
$0.28
|
| Rate for Payer: Blue Shield of California EPN |
$0.20
|
| 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: EPIC Health Plan Commercial |
$0.16
|
| Rate for Payer: Galaxy Health WC |
$0.34
|
| Rate for Payer: Global Benefits Group Commercial |
$0.24
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.27
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.15
|
| 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
|
IP
|
$0.40
|
|
|
Service Code
|
NDC 57237-003-30
|
| Hospital Charge Code |
1711487
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.10 |
| Max. Negotiated Rate |
$0.34 |
| Rate for Payer: Blue Shield of California Commercial |
$0.28
|
| Rate for Payer: Blue Shield of California EPN |
$0.20
|
| 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: EPIC Health Plan Commercial |
$0.16
|
| Rate for Payer: Galaxy Health WC |
$0.34
|
| Rate for Payer: Global Benefits Group Commercial |
$0.24
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.27
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.15
|
| 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 57237-003-30
|
| Hospital Charge Code |
1711487
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.10 |
| Max. Negotiated Rate |
$0.34 |
| 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 |
$0.22
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.24
|
| Rate for Payer: Blue Distinction Transplant |
$0.24
|
| Rate for Payer: Blue Shield of California Commercial |
$0.29
|
| Rate for Payer: Blue Shield of California EPN |
$0.23
|
| 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 Media |
$0.34
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.34
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.16
|
| Rate for Payer: EPIC Health Plan Transplant |
$0.16
|
| Rate for Payer: Galaxy Health WC |
$0.34
|
| Rate for Payer: Global Benefits Group Commercial |
$0.24
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$0.30
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.27
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.15
|
| 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
|
| 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
|
$30.12
|
|
|
Service Code
|
NDC 59651-331-01
|
| Hospital Charge Code |
1710458
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$7.23 |
| Max. Negotiated Rate |
$25.60 |
| Rate for Payer: Blue Shield of California Commercial |
$21.45
|
| Rate for Payer: Blue Shield of California EPN |
$15.42
|
| Rate for Payer: Cash Price |
$13.55
|
| Rate for Payer: Cigna of CA HMO |
$21.08
|
| Rate for Payer: Cigna of CA PPO |
$21.08
|
| Rate for Payer: EPIC Health Plan Commercial |
$12.05
|
| Rate for Payer: Galaxy Health WC |
$25.60
|
| Rate for Payer: Global Benefits Group Commercial |
$18.07
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$20.09
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$11.48
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$7.23
|
| Rate for Payer: Multiplan Commercial |
$24.10
|
| Rate for Payer: Networks By Design Commercial |
$19.58
|
| Rate for Payer: Prime Health Services Commercial |
$25.60
|
|
|
FLUCYTOSINE 250 MG CAPSULE [10051]
|
Facility
|
OP
|
$36.00
|
|
|
Service Code
|
NDC 42794-009-08
|
| Hospital Charge Code |
1710458
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$8.64 |
| Max. Negotiated Rate |
$30.60 |
| 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 |
$19.80
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$21.45
|
| Rate for Payer: Blue Distinction Transplant |
$21.60
|
| Rate for Payer: Blue Shield of California Commercial |
$26.53
|
| Rate for Payer: Blue Shield of California EPN |
$21.02
|
| 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 Media |
$30.60
|
| Rate for Payer: Dignity Health Medi-Cal |
$30.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$14.40
|
| Rate for Payer: EPIC Health Plan Transplant |
$14.40
|
| Rate for Payer: Galaxy Health WC |
$30.60
|
| Rate for Payer: Global Benefits Group Commercial |
$21.60
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$27.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$24.01
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$13.72
|
| 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
|
| 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 42794-009-08
|
| Hospital Charge Code |
1710458
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$8.64 |
| Max. Negotiated Rate |
$30.60 |
| Rate for Payer: Blue Shield of California Commercial |
$25.63
|
| Rate for Payer: Blue Shield of California EPN |
$18.43
|
| 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: EPIC Health Plan Commercial |
$14.40
|
| Rate for Payer: Galaxy Health WC |
$30.60
|
| Rate for Payer: Global Benefits Group Commercial |
$21.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$24.01
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$13.72
|
| 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
|
$30.12
|
|
|
Service Code
|
NDC 59651-331-01
|
| Hospital Charge Code |
1710458
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$7.23 |
| Max. Negotiated Rate |
$25.60 |
| Rate for Payer: Aetna of CA HMO/PPO |
$19.76
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$25.60
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$16.57
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$16.57
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$17.95
|
| Rate for Payer: Blue Distinction Transplant |
$18.07
|
| Rate for Payer: Blue Shield of California Commercial |
$22.20
|
| Rate for Payer: Blue Shield of California EPN |
$17.59
|
| Rate for Payer: Cash Price |
$13.55
|
| Rate for Payer: Cigna of CA HMO |
$21.08
|
| Rate for Payer: Cigna of CA PPO |
$21.08
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$25.60
|
| Rate for Payer: Dignity Health Media |
$25.60
|
| Rate for Payer: Dignity Health Medi-Cal |
$25.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$12.05
|
| Rate for Payer: EPIC Health Plan Transplant |
$12.05
|
| Rate for Payer: Galaxy Health WC |
$25.60
|
| Rate for Payer: Global Benefits Group Commercial |
$18.07
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$22.59
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$20.09
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$11.48
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$7.23
|
| Rate for Payer: Multiplan Commercial |
$24.10
|
| Rate for Payer: Networks By Design Commercial |
$19.58
|
| Rate for Payer: Prime Health Services Commercial |
$25.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$18.07
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$18.07
|
| Rate for Payer: United Healthcare All Other Commercial |
$15.06
|
| Rate for Payer: United Healthcare All Other HMO |
$15.06
|
| Rate for Payer: United Healthcare HMO Rider |
$15.06
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$15.06
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$25.60
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$25.60
|
| Rate for Payer: Vantage Medical Group Senior |
$25.60
|
|
|
FLUCYTOSINE 500 MG CAPSULE [10052]
|
Facility
|
OP
|
$158.81
|
|
|
Service Code
|
NDC 42494-340-03
|
| Hospital Charge Code |
1710466
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$38.11 |
| Max. Negotiated Rate |
$134.99 |
| Rate for Payer: Aetna of CA HMO/PPO |
$104.16
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$134.99
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$87.35
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$87.35
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$94.62
|
| Rate for Payer: Blue Distinction Transplant |
$95.29
|
| Rate for Payer: Blue Shield of California Commercial |
$117.04
|
| Rate for Payer: Blue Shield of California EPN |
$92.75
|
| Rate for Payer: Cash Price |
$71.46
|
| Rate for Payer: Cigna of CA HMO |
$111.17
|
| Rate for Payer: Cigna of CA PPO |
$111.17
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$134.99
|
| Rate for Payer: Dignity Health Media |
$134.99
|
| Rate for Payer: Dignity Health Medi-Cal |
$134.99
|
| Rate for Payer: EPIC Health Plan Commercial |
$63.52
|
| Rate for Payer: EPIC Health Plan Transplant |
$63.52
|
| Rate for Payer: Galaxy Health WC |
$134.99
|
| Rate for Payer: Global Benefits Group Commercial |
$95.29
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$119.11
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$105.93
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$60.51
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$38.11
|
| Rate for Payer: Multiplan Commercial |
$127.05
|
| Rate for Payer: Networks By Design Commercial |
$103.23
|
| Rate for Payer: Prime Health Services Commercial |
$134.99
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$95.29
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$95.29
|
| Rate for Payer: United Healthcare All Other Commercial |
$79.40
|
| Rate for Payer: United Healthcare All Other HMO |
$79.40
|
| Rate for Payer: United Healthcare HMO Rider |
$79.40
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$79.40
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$134.99
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$134.99
|
| Rate for Payer: Vantage Medical Group Senior |
$134.99
|
|
|
FLUCYTOSINE 500 MG CAPSULE [10052]
|
Facility
|
IP
|
$158.81
|
|
|
Service Code
|
NDC 42494-340-03
|
| Hospital Charge Code |
1710466
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$38.11 |
| Max. Negotiated Rate |
$134.99 |
| Rate for Payer: Blue Shield of California Commercial |
$113.07
|
| Rate for Payer: Blue Shield of California EPN |
$81.31
|
| Rate for Payer: Cash Price |
$71.46
|
| Rate for Payer: Cigna of CA HMO |
$111.17
|
| Rate for Payer: Cigna of CA PPO |
$111.17
|
| Rate for Payer: EPIC Health Plan Commercial |
$63.52
|
| Rate for Payer: Galaxy Health WC |
$134.99
|
| Rate for Payer: Global Benefits Group Commercial |
$95.29
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$105.93
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$60.51
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$38.11
|
| Rate for Payer: Multiplan Commercial |
$127.05
|
| Rate for Payer: Networks By Design Commercial |
$103.23
|
| Rate for Payer: Prime Health Services Commercial |
$134.99
|
|
|
FLUCYTOSINE 500 MG CAPSULE [10052]
|
Facility
|
OP
|
$68.00
|
|
|
Service Code
|
NDC 42794-010-08
|
| Hospital Charge Code |
1710466
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$16.32 |
| Max. Negotiated Rate |
$57.80 |
| 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 |
$37.40
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$40.51
|
| Rate for Payer: Blue Distinction Transplant |
$40.80
|
| Rate for Payer: Blue Shield of California Commercial |
$50.12
|
| Rate for Payer: Blue Shield of California EPN |
$39.71
|
| 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 Media |
$57.80
|
| Rate for Payer: Dignity Health Medi-Cal |
$57.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$27.20
|
| Rate for Payer: EPIC Health Plan Transplant |
$27.20
|
| Rate for Payer: Galaxy Health WC |
$57.80
|
| Rate for Payer: Global Benefits Group Commercial |
$40.80
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$51.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$45.36
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$25.91
|
| 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
|
| 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 43386-770-01
|
| Hospital Charge Code |
1710466
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$5.76 |
| Max. Negotiated Rate |
$20.40 |
| Rate for Payer: Blue Shield of California Commercial |
$17.09
|
| Rate for Payer: Blue Shield of California EPN |
$12.29
|
| 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: EPIC Health Plan Commercial |
$9.60
|
| Rate for Payer: Galaxy Health WC |
$20.40
|
| Rate for Payer: Global Benefits Group Commercial |
$14.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$16.01
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$9.14
|
| 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 43386-770-01
|
| Hospital Charge Code |
1710466
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$5.76 |
| Max. Negotiated Rate |
$20.40 |
| 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 |
$13.20
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$14.30
|
| Rate for Payer: Blue Distinction Transplant |
$14.40
|
| Rate for Payer: Blue Shield of California Commercial |
$17.69
|
| Rate for Payer: Blue Shield of California EPN |
$14.02
|
| 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 Media |
$20.40
|
| Rate for Payer: Dignity Health Medi-Cal |
$20.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$9.60
|
| Rate for Payer: EPIC Health Plan Transplant |
$9.60
|
| Rate for Payer: Galaxy Health WC |
$20.40
|
| Rate for Payer: Global Benefits Group Commercial |
$14.40
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$18.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$16.01
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$9.14
|
| 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
|
| 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
|
IP
|
$68.00
|
|
|
Service Code
|
NDC 42794-010-08
|
| Hospital Charge Code |
1710466
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$16.32 |
| Max. Negotiated Rate |
$57.80 |
| Rate for Payer: Blue Shield of California Commercial |
$48.42
|
| Rate for Payer: Blue Shield of California EPN |
$34.82
|
| 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: EPIC Health Plan Commercial |
$27.20
|
| Rate for Payer: Galaxy Health WC |
$57.80
|
| Rate for Payer: Global Benefits Group Commercial |
$40.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$45.36
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$25.91
|
| 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 ORAL SUSPENSION COMPOUND 50 MG/ML [4080274]
|
Facility
|
IP
|
$9.38
|
|
|
Service Code
|
NDC 9994-0802-74
|
| Hospital Charge Code |
1715313
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$2.25 |
| Max. Negotiated Rate |
$7.97 |
| Rate for Payer: Blue Shield of California Commercial |
$6.68
|
| Rate for Payer: Blue Shield of California EPN |
$4.80
|
| 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: EPIC Health Plan Commercial |
$3.75
|
| Rate for Payer: Galaxy Health WC |
$7.97
|
| Rate for Payer: Global Benefits Group Commercial |
$5.63
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$6.26
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3.57
|
| 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
|
|
|
FLUCYTOSINE ORAL SUSPENSION COMPOUND 50 MG/ML [4080274]
|
Facility
|
OP
|
$9.38
|
|
|
Service Code
|
NDC 9994-0802-74
|
| Hospital Charge Code |
1715313
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$2.25 |
| Max. Negotiated Rate |
$7.97 |
| 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 |
$5.16
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5.59
|
| Rate for Payer: Blue Distinction Transplant |
$5.63
|
| Rate for Payer: Blue Shield of California Commercial |
$6.91
|
| Rate for Payer: Blue Shield of California EPN |
$5.48
|
| 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 Media |
$7.97
|
| Rate for Payer: Dignity Health Medi-Cal |
$7.97
|
| Rate for Payer: EPIC Health Plan Commercial |
$3.75
|
| Rate for Payer: EPIC Health Plan Transplant |
$3.75
|
| Rate for Payer: Galaxy Health WC |
$7.97
|
| Rate for Payer: Global Benefits Group Commercial |
$5.63
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$7.04
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$6.26
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3.57
|
| 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
|
| 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
|
|
|
FLUDARABINE 50 MG/2 ML INTRAVENOUS SOLUTION [41294]
|
Facility
|
IP
|
$130.50
|
|
|
Service Code
|
CPT J9185
|
| Hospital Charge Code |
1755589
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$31.32 |
| Max. Negotiated Rate |
$110.92 |
| Rate for Payer: Blue Shield of California Commercial |
$92.92
|
| Rate for Payer: Blue Shield of California Commercial |
$162.34
|
| Rate for Payer: Blue Shield of California EPN |
$66.82
|
| Rate for Payer: Blue Shield of California EPN |
$116.74
|
| Rate for Payer: Cash Price |
$58.73
|
| Rate for Payer: Cash Price |
$102.60
|
| Rate for Payer: Cigna of CA HMO |
$91.35
|
| Rate for Payer: Cigna of CA HMO |
$159.60
|
| Rate for Payer: Cigna of CA PPO |
$159.60
|
| Rate for Payer: Cigna of CA PPO |
$91.35
|
| Rate for Payer: EPIC Health Plan Commercial |
$91.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$52.20
|
| Rate for Payer: EPIC Health Plan Transplant |
$52.20
|
| Rate for Payer: EPIC Health Plan Transplant |
$91.20
|
| Rate for Payer: Galaxy Health WC |
$110.92
|
| Rate for Payer: Galaxy Health WC |
$193.80
|
| Rate for Payer: Global Benefits Group Commercial |
$136.80
|
| Rate for Payer: Global Benefits Group Commercial |
$78.30
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$152.08
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$87.04
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$49.72
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$86.87
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$31.32
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$54.72
|
| Rate for Payer: Multiplan Commercial |
$104.40
|
| Rate for Payer: Multiplan Commercial |
$182.40
|
| Rate for Payer: Networks By Design Commercial |
$65.25
|
| Rate for Payer: Networks By Design Commercial |
$114.00
|
| Rate for Payer: Prime Health Services Commercial |
$110.92
|
| Rate for Payer: Prime Health Services Commercial |
$193.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$49.28
|
| Rate for Payer: United Healthcare All Other Commercial |
$86.09
|
| Rate for Payer: United Healthcare All Other HMO |
$48.13
|
| Rate for Payer: United Healthcare All Other HMO |
$84.09
|
| Rate for Payer: United Healthcare HMO Rider |
$47.08
|
| Rate for Payer: United Healthcare HMO Rider |
$82.26
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$43.06
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$75.24
|
|
|
FLUDARABINE 50 MG/2 ML INTRAVENOUS SOLUTION [41294]
|
Facility
|
OP
|
$130.50
|
|
|
Service Code
|
CPT J9185
|
| Hospital Charge Code |
1755589
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$31.32 |
| Max. Negotiated Rate |
$610.91 |
| Rate for Payer: Aetna of CA HMO/PPO |
$342.63
|
| Rate for Payer: Aetna of CA HMO/PPO |
$342.63
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$217.46
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$217.46
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$191.37
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$191.37
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$191.37
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$191.37
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$610.91
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$610.91
|
| Rate for Payer: Blue Distinction Transplant |
$136.80
|
| Rate for Payer: Blue Distinction Transplant |
$78.30
|
| Rate for Payer: Blue Shield of California Commercial |
$168.04
|
| Rate for Payer: Blue Shield of California Commercial |
$96.18
|
| Rate for Payer: Blue Shield of California EPN |
$122.70
|
| Rate for Payer: Blue Shield of California EPN |
$122.70
|
| Rate for Payer: Cash Price |
$102.60
|
| Rate for Payer: Cash Price |
$58.73
|
| Rate for Payer: Cash Price |
$102.60
|
| Rate for Payer: Cash Price |
$58.73
|
| Rate for Payer: Cigna of CA HMO |
$159.60
|
| 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 |
$159.60
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$260.95
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$260.95
|
| Rate for Payer: Dignity Health Media |
$173.97
|
| Rate for Payer: Dignity Health Media |
$173.97
|
| Rate for Payer: Dignity Health Medi-Cal |
$191.37
|
| Rate for Payer: Dignity Health Medi-Cal |
$191.37
|
| Rate for Payer: EPIC Health Plan Commercial |
$234.86
|
| Rate for Payer: EPIC Health Plan Commercial |
$234.86
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$173.97
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$173.97
|
| Rate for Payer: EPIC Health Plan Transplant |
$173.97
|
| Rate for Payer: EPIC Health Plan Transplant |
$173.97
|
| Rate for Payer: Galaxy Health WC |
$110.92
|
| Rate for Payer: Galaxy Health WC |
$193.80
|
| Rate for Payer: Global Benefits Group Commercial |
$78.30
|
| Rate for Payer: Global Benefits Group Commercial |
$136.80
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$97.88
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$171.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$285.31
|
| Rate for Payer: Heritage Provider Network Commercial |
$285.31
|
| Rate for Payer: Heritage Provider Network Transplant |
$285.31
|
| Rate for Payer: Heritage Provider Network Transplant |
$285.31
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$281.83
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$281.83
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal Transplant |
$281.83
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal Transplant |
$281.83
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$173.97
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$173.97
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$87.04
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$152.08
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$339.02
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$339.02
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$173.97
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$173.97
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$31.32
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$54.72
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$219.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$219.20
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$233.12
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$233.12
|
| Rate for Payer: Multiplan Commercial |
$104.40
|
| Rate for Payer: Multiplan Commercial |
$182.40
|
| Rate for Payer: Networks By Design Commercial |
$114.00
|
| 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 |
$193.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$136.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$78.30
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$136.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$78.30
|
| Rate for Payer: United Healthcare All Other Commercial |
$114.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$65.25
|
| Rate for Payer: United Healthcare All Other HMO |
$65.25
|
| Rate for Payer: United Healthcare All Other HMO |
$114.00
|
| Rate for Payer: United Healthcare HMO Rider |
$65.25
|
| Rate for Payer: United Healthcare HMO Rider |
$114.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$65.25
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$114.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$260.95
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$260.95
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$191.37
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$191.37
|
| Rate for Payer: Vantage Medical Group Senior |
$173.97
|
| Rate for Payer: Vantage Medical Group Senior |
$173.97
|
|
|
FLUDEOXYGLUCOSE F-18 20 MCI TO 200 MCI/ML INTRAVENOUS SOLUTION [222882]
|
Facility
|
OP
|
$60.00
|
|
|
Service Code
|
CPT A9552
|
| Hospital Charge Code |
ERX222882
|
|
Hospital Revenue Code
|
343
|
| Min. Negotiated Rate |
$14.40 |
| Max. Negotiated Rate |
$888.12 |
| 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 |
$33.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$888.12
|
| Rate for Payer: Blue Distinction Transplant |
$36.00
|
| Rate for Payer: Blue Shield of California Commercial |
$35.46
|
| Rate for Payer: Blue Shield of California EPN |
$28.14
|
| 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 Media |
$51.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$51.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$24.00
|
| Rate for Payer: EPIC Health Plan Transplant |
$24.00
|
| Rate for Payer: Galaxy Health WC |
$51.00
|
| Rate for Payer: Global Benefits Group Commercial |
$36.00
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$45.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$40.02
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$684.00
|
| 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: 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 |
$30.00
|
| Rate for Payer: United Healthcare All Other HMO |
$30.00
|
| Rate for Payer: United Healthcare HMO Rider |
$30.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$30.00
|
| 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
|
CPT A9552
|
| Hospital Charge Code |
ERX222882
|
|
Hospital Revenue Code
|
343
|
| Min. Negotiated Rate |
$14.40 |
| Max. Negotiated Rate |
$51.00 |
| Rate for Payer: Blue Shield of California Commercial |
$42.72
|
| Rate for Payer: Blue Shield of California EPN |
$30.72
|
| Rate for Payer: Cash Price |
$27.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$24.00
|
| Rate for Payer: Galaxy Health WC |
$51.00
|
| Rate for Payer: Global Benefits Group Commercial |
$36.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$40.02
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$22.86
|
| 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 |
$22.66
|
| Rate for Payer: United Healthcare All Other HMO |
$22.13
|
| Rate for Payer: United Healthcare HMO Rider |
$21.65
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$19.80
|
|
|
FLUDROCORTISONE 0.1 MG TABLET [10054]
|
Facility
|
OP
|
$0.99
|
|
|
Service Code
|
NDC 50268-330-11
|
| Hospital Charge Code |
1710256
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.24 |
| Max. Negotiated Rate |
$0.84 |
| Rate for Payer: Aetna of CA HMO/PPO |
$0.65
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.84
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.54
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.54
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.59
|
| Rate for Payer: Blue Distinction Transplant |
$0.59
|
| Rate for Payer: Blue Shield of California Commercial |
$0.73
|
| Rate for Payer: Blue Shield of California EPN |
$0.58
|
| Rate for Payer: Cash Price |
$0.45
|
| Rate for Payer: Cigna of CA HMO |
$0.69
|
| Rate for Payer: Cigna of CA PPO |
$0.69
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.84
|
| Rate for Payer: Dignity Health Media |
$0.84
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.84
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.40
|
| Rate for Payer: EPIC Health Plan Transplant |
$0.40
|
| Rate for Payer: Galaxy Health WC |
$0.84
|
| Rate for Payer: Global Benefits Group Commercial |
$0.59
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$0.74
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.66
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.38
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.24
|
| Rate for Payer: Multiplan Commercial |
$0.79
|
| Rate for Payer: Networks By Design Commercial |
$0.64
|
| Rate for Payer: Prime Health Services Commercial |
$0.84
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.59
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.59
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.50
|
| Rate for Payer: United Healthcare All Other HMO |
$0.50
|
| Rate for Payer: United Healthcare HMO Rider |
$0.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.84
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.84
|
| Rate for Payer: Vantage Medical Group Senior |
$0.84
|
|
|
FLUDROCORTISONE 0.1 MG TABLET [10054]
|
Facility
|
IP
|
$0.99
|
|
|
Service Code
|
NDC 50268-330-11
|
| Hospital Charge Code |
1710256
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.24 |
| Max. Negotiated Rate |
$0.84 |
| Rate for Payer: Blue Shield of California Commercial |
$0.70
|
| Rate for Payer: Blue Shield of California EPN |
$0.51
|
| Rate for Payer: Cash Price |
$0.45
|
| Rate for Payer: Cigna of CA HMO |
$0.69
|
| Rate for Payer: Cigna of CA PPO |
$0.69
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.40
|
| Rate for Payer: Galaxy Health WC |
$0.84
|
| Rate for Payer: Global Benefits Group Commercial |
$0.59
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.66
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.38
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.24
|
| Rate for Payer: Multiplan Commercial |
$0.79
|
| Rate for Payer: Networks By Design Commercial |
$0.64
|
| Rate for Payer: Prime Health Services Commercial |
$0.84
|
|
|
FLUDROCORTISONE 0.1 MG TABLET [10054]
|
Facility
|
IP
|
$0.71
|
|
|
Service Code
|
NDC 0115-7033-02
|
| Hospital Charge Code |
1710256
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.17 |
| Max. Negotiated Rate |
$0.60 |
| Rate for Payer: Blue Shield of California Commercial |
$0.51
|
| Rate for Payer: Blue Shield of California EPN |
$0.36
|
| 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: EPIC Health Plan Commercial |
$0.28
|
| Rate for Payer: Galaxy Health WC |
$0.60
|
| Rate for Payer: Global Benefits Group Commercial |
$0.43
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.47
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.27
|
| 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
|
$0.66
|
|
|
Service Code
|
NDC 0555-0997-02
|
| Hospital Charge Code |
1710256
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.16 |
| Max. Negotiated Rate |
$0.56 |
| Rate for Payer: Blue Shield of California Commercial |
$0.47
|
| Rate for Payer: Blue Shield of California EPN |
$0.34
|
| 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: EPIC Health Plan Commercial |
$0.26
|
| Rate for Payer: Galaxy Health WC |
$0.56
|
| Rate for Payer: Global Benefits Group Commercial |
$0.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.44
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.25
|
| 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
|
OP
|
$0.99
|
|
|
Service Code
|
NDC 50268-330-15
|
| Hospital Charge Code |
1710256
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.24 |
| Max. Negotiated Rate |
$0.84 |
| Rate for Payer: Aetna of CA HMO/PPO |
$0.65
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.84
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.54
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.54
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.59
|
| Rate for Payer: Blue Distinction Transplant |
$0.59
|
| Rate for Payer: Blue Shield of California Commercial |
$0.73
|
| Rate for Payer: Blue Shield of California EPN |
$0.58
|
| Rate for Payer: Cash Price |
$0.45
|
| Rate for Payer: Cigna of CA HMO |
$0.69
|
| Rate for Payer: Cigna of CA PPO |
$0.69
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.84
|
| Rate for Payer: Dignity Health Media |
$0.84
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.84
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.40
|
| Rate for Payer: EPIC Health Plan Transplant |
$0.40
|
| Rate for Payer: Galaxy Health WC |
$0.84
|
| Rate for Payer: Global Benefits Group Commercial |
$0.59
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$0.74
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.66
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.38
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.24
|
| Rate for Payer: Multiplan Commercial |
$0.79
|
| Rate for Payer: Networks By Design Commercial |
$0.64
|
| Rate for Payer: Prime Health Services Commercial |
$0.84
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.59
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.59
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.50
|
| Rate for Payer: United Healthcare All Other HMO |
$0.50
|
| Rate for Payer: United Healthcare HMO Rider |
$0.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.84
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.84
|
| Rate for Payer: Vantage Medical Group Senior |
$0.84
|
|
|
FLUDROCORTISONE 0.1 MG TABLET [10054]
|
Facility
|
OP
|
$0.66
|
|
|
Service Code
|
NDC 0555-0997-02
|
| Hospital Charge Code |
1710256
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.16 |
| Max. Negotiated Rate |
$0.56 |
| Rate for Payer: Aetna of CA HMO/PPO |
$0.43
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.56
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.36
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.36
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.39
|
| Rate for Payer: Blue Distinction Transplant |
$0.40
|
| Rate for Payer: Blue Shield of California Commercial |
$0.49
|
| Rate for Payer: Blue Shield of California EPN |
$0.39
|
| 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: Dignity Health Commercial/Exchange |
$0.56
|
| Rate for Payer: Dignity Health Media |
$0.56
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.56
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.26
|
| Rate for Payer: EPIC Health Plan Transplant |
$0.26
|
| Rate for Payer: Galaxy Health WC |
$0.56
|
| Rate for Payer: Global Benefits Group Commercial |
$0.40
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$0.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.44
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.25
|
| 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
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.33
|
| Rate for Payer: United Healthcare All Other HMO |
$0.33
|
| Rate for Payer: United Healthcare HMO Rider |
$0.33
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.33
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.56
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.56
|
| Rate for Payer: Vantage Medical Group Senior |
$0.56
|
|
