|
FLUOCINOLONE 0.025 % TOPICAL OINTMENT [3185]
|
Facility
IP
|
$2.26
|
|
|
Service Code
|
NDC 0713-0224-15
|
| Hospital Charge Code |
1743235
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.54 |
| Max. Negotiated Rate |
$1.92 |
| Rate for Payer: Blue Shield of California Commercial |
$1.61
|
| Rate for Payer: Blue Shield of California EPN |
$1.16
|
| Rate for Payer: Cash Price |
$1.02
|
| Rate for Payer: Cigna of CA HMO |
$1.58
|
| Rate for Payer: Cigna of CA PPO |
$1.58
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.90
|
| Rate for Payer: Galaxy Health WC |
$1.92
|
| Rate for Payer: Global Benefits Group Commercial |
$1.36
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1.51
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.86
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.54
|
| Rate for Payer: Multiplan Commercial |
$1.81
|
| Rate for Payer: Networks By Design Commercial |
$1.47
|
| Rate for Payer: Prime Health Services Commercial |
$1.92
|
|
|
FLUOCINOLONE 0.025 % TOPICAL OINTMENT [3185]
|
Facility
OP
|
$1.69
|
|
|
Service Code
|
NDC 0713-0224-60
|
| Hospital Charge Code |
1743208
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.41 |
| Max. Negotiated Rate |
$1.44 |
| Rate for Payer: Aetna of CA HMO/PPO |
$1.11
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$1.44
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$0.93
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$0.93
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1.01
|
| Rate for Payer: BCBS Transplant Transplant |
$1.01
|
| Rate for Payer: Blue Shield of California Commercial |
$1.25
|
| Rate for Payer: Blue Shield of California EPN |
$0.99
|
| Rate for Payer: Cash Price |
$0.76
|
| Rate for Payer: Cigna of CA HMO |
$1.18
|
| Rate for Payer: Cigna of CA PPO |
$1.18
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1.44
|
| Rate for Payer: Dignity Health Media |
$1.44
|
| Rate for Payer: Dignity Health Medi-Cal |
$1.44
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.68
|
| Rate for Payer: EPIC Health Plan Transplant |
$0.68
|
| Rate for Payer: Galaxy Health WC |
$1.44
|
| Rate for Payer: Global Benefits Group Commercial |
$1.01
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$1.27
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1.13
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.64
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.41
|
| Rate for Payer: Multiplan Commercial |
$1.35
|
| Rate for Payer: Networks By Design Commercial |
$1.10
|
| Rate for Payer: Prime Health Services Commercial |
$1.44
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$1.01
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1.01
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1.01
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.85
|
| Rate for Payer: United Healthcare All Other HMO |
$0.85
|
| Rate for Payer: United Healthcare HMO Rider |
$0.85
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.85
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1.44
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1.44
|
| Rate for Payer: Vantage Medical Group Senior |
$1.44
|
|
|
FLUOCINOLONE 0.025 % TOPICAL OINTMENT [3185]
|
Facility
IP
|
$2.25
|
|
|
Service Code
|
NDC 0168-0064-15
|
| Hospital Charge Code |
1743235
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.54 |
| Max. Negotiated Rate |
$1.91 |
| Rate for Payer: Blue Shield of California Commercial |
$1.60
|
| Rate for Payer: Blue Shield of California EPN |
$1.15
|
| Rate for Payer: Cash Price |
$1.01
|
| Rate for Payer: Cigna of CA HMO |
$1.58
|
| Rate for Payer: Cigna of CA PPO |
$1.58
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.90
|
| Rate for Payer: Galaxy Health WC |
$1.91
|
| Rate for Payer: Global Benefits Group Commercial |
$1.35
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1.50
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.86
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.54
|
| Rate for Payer: Multiplan Commercial |
$1.80
|
| Rate for Payer: Networks By Design Commercial |
$1.46
|
| Rate for Payer: Prime Health Services Commercial |
$1.91
|
|
|
FLUOCINOLONE 0.025 % TOPICAL OINTMENT [3185]
|
Facility
OP
|
$2.26
|
|
|
Service Code
|
NDC 0713-0224-15
|
| Hospital Charge Code |
1743235
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.54 |
| Max. Negotiated Rate |
$1.92 |
| Rate for Payer: BCBS Transplant Transplant |
$1.36
|
| Rate for Payer: Aetna of CA HMO/PPO |
$1.48
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$1.92
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$1.24
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$1.24
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1.35
|
| Rate for Payer: Blue Shield of California Commercial |
$1.67
|
| Rate for Payer: Blue Shield of California EPN |
$1.32
|
| Rate for Payer: Cash Price |
$1.02
|
| Rate for Payer: Cigna of CA HMO |
$1.58
|
| Rate for Payer: Cigna of CA PPO |
$1.58
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1.92
|
| Rate for Payer: Dignity Health Media |
$1.92
|
| Rate for Payer: Dignity Health Medi-Cal |
$1.92
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.90
|
| Rate for Payer: EPIC Health Plan Transplant |
$0.90
|
| Rate for Payer: Galaxy Health WC |
$1.92
|
| Rate for Payer: Global Benefits Group Commercial |
$1.36
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$1.70
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1.51
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.86
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.54
|
| Rate for Payer: Multiplan Commercial |
$1.81
|
| Rate for Payer: Networks By Design Commercial |
$1.47
|
| Rate for Payer: Prime Health Services Commercial |
$1.92
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$1.36
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1.36
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1.36
|
| Rate for Payer: United Healthcare All Other Commercial |
$1.13
|
| Rate for Payer: United Healthcare All Other HMO |
$1.13
|
| Rate for Payer: United Healthcare HMO Rider |
$1.13
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1.13
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1.92
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1.92
|
| Rate for Payer: Vantage Medical Group Senior |
$1.92
|
|
|
FLUOCINOLONE 0.025 % TOPICAL OINTMENT [3185]
|
Facility
IP
|
$1.69
|
|
|
Service Code
|
NDC 0713-0224-60
|
| Hospital Charge Code |
1743208
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.41 |
| Max. Negotiated Rate |
$1.44 |
| Rate for Payer: Blue Shield of California Commercial |
$1.20
|
| Rate for Payer: Blue Shield of California EPN |
$0.87
|
| Rate for Payer: Cash Price |
$0.76
|
| Rate for Payer: Cigna of CA HMO |
$1.18
|
| Rate for Payer: Cigna of CA PPO |
$1.18
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.68
|
| Rate for Payer: Galaxy Health WC |
$1.44
|
| Rate for Payer: Global Benefits Group Commercial |
$1.01
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1.13
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.64
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.41
|
| Rate for Payer: Multiplan Commercial |
$1.35
|
| Rate for Payer: Networks By Design Commercial |
$1.10
|
| Rate for Payer: Prime Health Services Commercial |
$1.44
|
|
|
FLUOCINOLONE 0.18 MG INTRAVITREAL IMPLANT [223628]
|
Facility
OP
|
$10,795.20
|
|
|
Service Code
|
CPT J7314
|
| Hospital Charge Code |
ERX223628
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$529.00 |
| Max. Negotiated Rate |
$9,175.92 |
| Rate for Payer: Aetna of CA HMO/PPO |
$3,327.13
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$661.25
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$581.90
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$581.90
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,020.63
|
| Rate for Payer: BCBS Transplant Transplant |
$6,477.12
|
| Rate for Payer: Blue Shield of California Commercial |
$7,956.06
|
| Rate for Payer: Blue Shield of California EPN |
$6,304.40
|
| Rate for Payer: Cash Price |
$4,857.84
|
| Rate for Payer: Cash Price |
$4,857.84
|
| Rate for Payer: Cigna of CA HMO |
$7,556.64
|
| Rate for Payer: Cigna of CA PPO |
$7,556.64
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$793.50
|
| Rate for Payer: Dignity Health Media |
$529.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$581.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$714.15
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$529.00
|
| Rate for Payer: EPIC Health Plan Transplant |
$529.00
|
| Rate for Payer: Galaxy Health WC |
$9,175.92
|
| Rate for Payer: Global Benefits Group Commercial |
$6,477.12
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$8,096.40
|
| Rate for Payer: Heritage Provider Network Commercial |
$867.56
|
| Rate for Payer: Heritage Provider Network Transplant |
$867.56
|
| Rate for Payer: IEHP Medi-Cal |
$856.98
|
| Rate for Payer: IEHP Medi-Cal Transplant |
$856.98
|
| Rate for Payer: IEHP Medicare Advantage |
$529.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$7,200.40
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,005.10
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$529.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,590.85
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$666.54
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$708.86
|
| Rate for Payer: Multiplan Commercial |
$8,636.16
|
| Rate for Payer: Networks By Design Commercial |
$5,397.60
|
| Rate for Payer: Prime Health Services Commercial |
$9,175.92
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$6,477.12
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$6,477.12
|
| Rate for Payer: United Healthcare All Other Commercial |
$5,397.60
|
| Rate for Payer: United Healthcare All Other HMO |
$5,397.60
|
| Rate for Payer: United Healthcare HMO Rider |
$5,397.60
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$5,397.60
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$793.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$581.90
|
| Rate for Payer: Vantage Medical Group Senior |
$529.00
|
|
|
FLUOCINOLONE 0.18 MG INTRAVITREAL IMPLANT [223628]
|
Facility
IP
|
$10,795.20
|
|
|
Service Code
|
CPT J7314
|
| Hospital Charge Code |
ERX223628
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$2,590.85 |
| Max. Negotiated Rate |
$9,175.92 |
| Rate for Payer: Blue Shield of California Commercial |
$7,686.18
|
| Rate for Payer: Blue Shield of California EPN |
$5,527.14
|
| Rate for Payer: Cash Price |
$4,857.84
|
| Rate for Payer: Cigna of CA HMO |
$7,556.64
|
| Rate for Payer: Cigna of CA PPO |
$7,556.64
|
| Rate for Payer: EPIC Health Plan Commercial |
$4,318.08
|
| Rate for Payer: EPIC Health Plan Transplant |
$4,318.08
|
| Rate for Payer: Galaxy Health WC |
$9,175.92
|
| Rate for Payer: Global Benefits Group Commercial |
$6,477.12
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$7,200.40
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4,112.97
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,590.85
|
| Rate for Payer: Multiplan Commercial |
$8,636.16
|
| Rate for Payer: Networks By Design Commercial |
$5,397.60
|
| Rate for Payer: Prime Health Services Commercial |
$9,175.92
|
|
|
FLUOCINOLONE 0.19 MG INTRAVITREAL IMPLANT [208310]
|
Facility
IP
|
$10,560.00
|
|
|
Service Code
|
CPT J7313
|
| Hospital Charge Code |
ERX208310
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$2,534.40 |
| Max. Negotiated Rate |
$8,976.00 |
| Rate for Payer: Blue Shield of California Commercial |
$7,518.72
|
| Rate for Payer: Blue Shield of California EPN |
$5,406.72
|
| Rate for Payer: Cash Price |
$4,752.00
|
| Rate for Payer: Cigna of CA HMO |
$7,392.00
|
| Rate for Payer: Cigna of CA PPO |
$7,392.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$4,224.00
|
| Rate for Payer: EPIC Health Plan Transplant |
$4,224.00
|
| Rate for Payer: Galaxy Health WC |
$8,976.00
|
| Rate for Payer: Global Benefits Group Commercial |
$6,336.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$7,043.52
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4,023.36
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,534.40
|
| Rate for Payer: Multiplan Commercial |
$8,448.00
|
| Rate for Payer: Networks By Design Commercial |
$5,280.00
|
| Rate for Payer: Prime Health Services Commercial |
$8,976.00
|
|
|
FLUOCINOLONE 0.19 MG INTRAVITREAL IMPLANT [208310]
|
Facility
OP
|
$10,560.00
|
|
|
Service Code
|
CPT J7313
|
| Hospital Charge Code |
ERX208310
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$490.95 |
| Max. Negotiated Rate |
$8,976.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$3,087.82
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$613.68
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$540.04
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$540.04
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$987.23
|
| Rate for Payer: BCBS Transplant Transplant |
$6,336.00
|
| Rate for Payer: Blue Shield of California Commercial |
$7,782.72
|
| Rate for Payer: Blue Shield of California EPN |
$555.79
|
| Rate for Payer: Cash Price |
$4,752.00
|
| Rate for Payer: Cash Price |
$4,752.00
|
| Rate for Payer: Cigna of CA HMO |
$7,392.00
|
| Rate for Payer: Cigna of CA PPO |
$7,392.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$736.42
|
| Rate for Payer: Dignity Health Media |
$490.95
|
| Rate for Payer: Dignity Health Medi-Cal |
$540.04
|
| Rate for Payer: EPIC Health Plan Commercial |
$662.78
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$490.95
|
| Rate for Payer: EPIC Health Plan Transplant |
$490.95
|
| Rate for Payer: Galaxy Health WC |
$8,976.00
|
| Rate for Payer: Global Benefits Group Commercial |
$6,336.00
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$7,920.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$805.15
|
| Rate for Payer: Heritage Provider Network Transplant |
$805.15
|
| Rate for Payer: IEHP Medi-Cal |
$795.33
|
| Rate for Payer: IEHP Medi-Cal Transplant |
$795.33
|
| Rate for Payer: IEHP Medicare Advantage |
$490.95
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$7,043.52
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$932.80
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$490.95
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,534.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$618.59
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$657.87
|
| Rate for Payer: Multiplan Commercial |
$8,448.00
|
| Rate for Payer: Networks By Design Commercial |
$5,280.00
|
| Rate for Payer: Prime Health Services Commercial |
$8,976.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$6,336.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$6,336.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$5,280.00
|
| Rate for Payer: United Healthcare All Other HMO |
$5,280.00
|
| Rate for Payer: United Healthcare HMO Rider |
$5,280.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$5,280.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$736.42
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$540.04
|
| Rate for Payer: Vantage Medical Group Senior |
$490.95
|
|
|
FLUOCINONIDE 0.05 % TOPICAL CREAM [3187]
|
Facility
IP
|
$2.92
|
|
|
Service Code
|
NDC 51862-494-15
|
| Hospital Charge Code |
1743410
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.70 |
| Max. Negotiated Rate |
$2.48 |
| Rate for Payer: Blue Shield of California Commercial |
$2.08
|
| Rate for Payer: Blue Shield of California EPN |
$1.50
|
| 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: EPIC Health Plan Commercial |
$1.17
|
| Rate for Payer: Galaxy Health WC |
$2.48
|
| Rate for Payer: Global Benefits Group Commercial |
$1.75
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1.95
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1.11
|
| 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 [3187]
|
Facility
OP
|
$2.92
|
|
|
Service Code
|
NDC 51862-494-15
|
| Hospital Charge Code |
1743410
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.70 |
| Max. Negotiated Rate |
$2.48 |
| Rate for Payer: Aetna of CA HMO/PPO |
$1.92
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$2.48
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$1.61
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$1.61
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1.74
|
| Rate for Payer: BCBS Transplant Transplant |
$1.75
|
| Rate for Payer: Blue Shield of California Commercial |
$2.15
|
| Rate for Payer: Blue Shield of California EPN |
$1.71
|
| 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: Dignity Health Commercial/Exchange |
$2.48
|
| Rate for Payer: Dignity Health Media |
$2.48
|
| Rate for Payer: Dignity Health Medi-Cal |
$2.48
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.17
|
| Rate for Payer: EPIC Health Plan Transplant |
$1.17
|
| Rate for Payer: Galaxy Health WC |
$2.48
|
| Rate for Payer: Global Benefits Group Commercial |
$1.75
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$2.19
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1.95
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1.11
|
| 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
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$1.75
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1.75
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1.75
|
| Rate for Payer: United Healthcare All Other Commercial |
$1.46
|
| Rate for Payer: United Healthcare All Other HMO |
$1.46
|
| Rate for Payer: United Healthcare HMO Rider |
$1.46
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1.46
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2.48
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2.48
|
| Rate for Payer: Vantage Medical Group Senior |
$2.48
|
|
|
FLUOCINONIDE 0.05 % TOPICAL CREAM [3187]
|
Facility
IP
|
$2.92
|
|
|
Service Code
|
NDC 0093-0262-15
|
| Hospital Charge Code |
1743410
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.70 |
| Max. Negotiated Rate |
$2.48 |
| Rate for Payer: Blue Shield of California Commercial |
$2.08
|
| Rate for Payer: Blue Shield of California EPN |
$1.50
|
| 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: EPIC Health Plan Commercial |
$1.17
|
| Rate for Payer: Galaxy Health WC |
$2.48
|
| Rate for Payer: Global Benefits Group Commercial |
$1.75
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1.95
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1.11
|
| 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 [3187]
|
Facility
OP
|
$2.92
|
|
|
Service Code
|
NDC 0093-0262-15
|
| Hospital Charge Code |
1743410
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.70 |
| Max. Negotiated Rate |
$2.48 |
| Rate for Payer: Galaxy Health WC |
$2.48
|
| Rate for Payer: Aetna of CA HMO/PPO |
$1.92
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$2.48
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$1.61
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$1.61
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1.74
|
| Rate for Payer: BCBS Transplant Transplant |
$1.75
|
| Rate for Payer: Blue Shield of California Commercial |
$2.15
|
| Rate for Payer: Blue Shield of California EPN |
$1.71
|
| 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: Dignity Health Commercial/Exchange |
$2.48
|
| Rate for Payer: Dignity Health Media |
$2.48
|
| Rate for Payer: Dignity Health Medi-Cal |
$2.48
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.17
|
| Rate for Payer: EPIC Health Plan Transplant |
$1.17
|
| Rate for Payer: Global Benefits Group Commercial |
$1.75
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$2.19
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1.95
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1.11
|
| 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
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$1.75
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1.75
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1.75
|
| Rate for Payer: United Healthcare All Other Commercial |
$1.46
|
| Rate for Payer: United Healthcare All Other HMO |
$1.46
|
| Rate for Payer: United Healthcare HMO Rider |
$1.46
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1.46
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2.48
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2.48
|
| Rate for Payer: Vantage Medical Group Senior |
$2.48
|
|
|
FLUOCINONIDE 0.05 % TOPICAL CREAM [3187]
|
Facility
IP
|
$1.20
|
|
|
Service Code
|
NDC 51672-1386-1
|
| Hospital Charge Code |
1743410
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.29 |
| Max. Negotiated Rate |
$1.02 |
| Rate for Payer: Blue Shield of California Commercial |
$0.85
|
| Rate for Payer: Blue Shield of California EPN |
$0.61
|
| 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: EPIC Health Plan Commercial |
$0.48
|
| Rate for Payer: Galaxy Health WC |
$1.02
|
| Rate for Payer: Global Benefits Group Commercial |
$0.72
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.80
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.46
|
| 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 CREAM [3187]
|
Facility
OP
|
$1.20
|
|
|
Service Code
|
NDC 51672-1386-1
|
| Hospital Charge Code |
1743410
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.29 |
| Max. Negotiated Rate |
$1.02 |
| Rate for Payer: Aetna of CA HMO/PPO |
$0.79
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$1.02
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$0.66
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$0.66
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.71
|
| Rate for Payer: BCBS Transplant Transplant |
$0.72
|
| Rate for Payer: Blue Shield of California Commercial |
$0.88
|
| Rate for Payer: Blue Shield of California EPN |
$0.70
|
| 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 Media |
$1.02
|
| Rate for Payer: Dignity Health Medi-Cal |
$1.02
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.48
|
| Rate for Payer: EPIC Health Plan Transplant |
$0.48
|
| Rate for Payer: Galaxy Health WC |
$1.02
|
| Rate for Payer: Global Benefits Group Commercial |
$0.72
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$0.90
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.80
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.46
|
| 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
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$0.72
|
| 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
|
|
|
FLUOCINONIDE 0.05 % TOPICAL CREAM. [4083187]
|
Facility
IP
|
$2.92
|
|
|
Service Code
|
NDC 0093-0262-30
|
| Hospital Charge Code |
1743039
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.70 |
| Max. Negotiated Rate |
$2.48 |
| Rate for Payer: Blue Shield of California Commercial |
$2.08
|
| Rate for Payer: Blue Shield of California EPN |
$1.50
|
| 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: EPIC Health Plan Commercial |
$1.17
|
| Rate for Payer: Galaxy Health WC |
$2.48
|
| Rate for Payer: Global Benefits Group Commercial |
$1.75
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1.95
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1.11
|
| 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
OP
|
$3.08
|
|
|
Service Code
|
NDC 51672-1254-1
|
| Hospital Charge Code |
1743410
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.74 |
| Max. Negotiated Rate |
$2.62 |
| Rate for Payer: Aetna of CA HMO/PPO |
$2.02
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$2.62
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$1.69
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$1.69
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1.84
|
| Rate for Payer: BCBS Transplant Transplant |
$1.85
|
| Rate for Payer: Blue Shield of California Commercial |
$2.27
|
| Rate for Payer: Blue Shield of California EPN |
$1.80
|
| 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 Media |
$2.62
|
| Rate for Payer: Dignity Health Medi-Cal |
$2.62
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.23
|
| Rate for Payer: EPIC Health Plan Transplant |
$1.23
|
| Rate for Payer: Galaxy Health WC |
$2.62
|
| Rate for Payer: Global Benefits Group Commercial |
$1.85
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$2.31
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2.05
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1.17
|
| 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
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$1.85
|
| 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 CREAM. [4083187]
|
Facility
IP
|
$3.08
|
|
|
Service Code
|
NDC 51672-1254-1
|
| Hospital Charge Code |
1743410
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.74 |
| Max. Negotiated Rate |
$2.62 |
| Rate for Payer: Blue Shield of California Commercial |
$2.19
|
| Rate for Payer: Blue Shield of California EPN |
$1.58
|
| 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: EPIC Health Plan Commercial |
$1.23
|
| Rate for Payer: Galaxy Health WC |
$2.62
|
| Rate for Payer: Global Benefits Group Commercial |
$1.85
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2.05
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1.17
|
| 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
|
$2.92
|
|
|
Service Code
|
NDC 0093-0262-30
|
| Hospital Charge Code |
1743039
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.70 |
| Max. Negotiated Rate |
$2.48 |
| Rate for Payer: Aetna of CA HMO/PPO |
$1.92
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$2.48
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$1.61
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$1.61
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1.74
|
| Rate for Payer: BCBS Transplant Transplant |
$1.75
|
| Rate for Payer: Blue Shield of California Commercial |
$2.15
|
| Rate for Payer: Blue Shield of California EPN |
$1.71
|
| 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: Dignity Health Commercial/Exchange |
$2.48
|
| Rate for Payer: Dignity Health Media |
$2.48
|
| Rate for Payer: Dignity Health Medi-Cal |
$2.48
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.17
|
| Rate for Payer: EPIC Health Plan Transplant |
$1.17
|
| Rate for Payer: Galaxy Health WC |
$2.48
|
| Rate for Payer: Global Benefits Group Commercial |
$1.75
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$2.19
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1.95
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1.11
|
| 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
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$1.75
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1.75
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1.75
|
| Rate for Payer: United Healthcare All Other Commercial |
$1.46
|
| Rate for Payer: United Healthcare All Other HMO |
$1.46
|
| Rate for Payer: United Healthcare HMO Rider |
$1.46
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1.46
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2.48
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2.48
|
| Rate for Payer: Vantage Medical Group Senior |
$2.48
|
|
|
FLUOCINONIDE 0.05 % TOPICAL OINTMENT [3189]
|
Facility
OP
|
$1.48
|
|
|
Service Code
|
NDC 52565-040-15
|
| Hospital Charge Code |
1743019
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.36 |
| Max. Negotiated Rate |
$1.26 |
| Rate for Payer: Aetna of CA HMO/PPO |
$0.97
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$1.26
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$0.81
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$0.81
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.88
|
| Rate for Payer: BCBS Transplant Transplant |
$0.89
|
| Rate for Payer: Blue Shield of California Commercial |
$1.09
|
| Rate for Payer: Blue Shield of California EPN |
$0.86
|
| 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 Media |
$1.26
|
| Rate for Payer: Dignity Health Medi-Cal |
$1.26
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.59
|
| Rate for Payer: EPIC Health Plan Transplant |
$0.59
|
| Rate for Payer: Galaxy Health WC |
$1.26
|
| Rate for Payer: Global Benefits Group Commercial |
$0.89
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$1.11
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.99
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.56
|
| 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
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$0.89
|
| 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 0093-0264-92
|
| Hospital Charge Code |
1743029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$1.09 |
| Max. Negotiated Rate |
$3.85 |
| Rate for Payer: Blue Shield of California Commercial |
$3.23
|
| Rate for Payer: Blue Shield of California EPN |
$2.32
|
| 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: EPIC Health Plan Commercial |
$1.81
|
| Rate for Payer: Galaxy Health WC |
$3.85
|
| Rate for Payer: Global Benefits Group Commercial |
$2.72
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3.02
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1.73
|
| 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
|
$1.48
|
|
|
Service Code
|
NDC 52565-040-15
|
| Hospital Charge Code |
1743019
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.36 |
| Max. Negotiated Rate |
$1.26 |
| Rate for Payer: Blue Shield of California Commercial |
$1.05
|
| Rate for Payer: Blue Shield of California EPN |
$0.76
|
| 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: EPIC Health Plan Commercial |
$0.59
|
| Rate for Payer: Galaxy Health WC |
$1.26
|
| Rate for Payer: Global Benefits Group Commercial |
$0.89
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.99
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.56
|
| 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 51672-1264-3
|
| Hospital Charge Code |
1743029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.19 |
| Max. Negotiated Rate |
$0.66 |
| Rate for Payer: Aetna of CA HMO/PPO |
$0.51
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$0.66
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$0.43
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$0.43
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.46
|
| Rate for Payer: BCBS Transplant Transplant |
$0.47
|
| Rate for Payer: Blue Shield of California Commercial |
$0.57
|
| Rate for Payer: Blue Shield of California EPN |
$0.46
|
| 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 Media |
$0.66
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.66
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.31
|
| Rate for Payer: EPIC Health Plan Transplant |
$0.31
|
| Rate for Payer: Galaxy Health WC |
$0.66
|
| Rate for Payer: Global Benefits Group Commercial |
$0.47
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$0.59
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.52
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.30
|
| 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
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$0.47
|
| 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
IP
|
$1.48
|
|
|
Service Code
|
NDC 51672-1264-1
|
| Hospital Charge Code |
1743019
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.36 |
| Max. Negotiated Rate |
$1.26 |
| Rate for Payer: Blue Shield of California Commercial |
$1.05
|
| Rate for Payer: Blue Shield of California EPN |
$0.76
|
| 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: EPIC Health Plan Commercial |
$0.59
|
| Rate for Payer: Galaxy Health WC |
$1.26
|
| Rate for Payer: Global Benefits Group Commercial |
$0.89
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.99
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.56
|
| 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
IP
|
$0.78
|
|
|
Service Code
|
NDC 51672-1264-3
|
| Hospital Charge Code |
1743029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.19 |
| Max. Negotiated Rate |
$0.66 |
| Rate for Payer: Blue Shield of California Commercial |
$0.56
|
| Rate for Payer: Blue Shield of California EPN |
$0.40
|
| 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: EPIC Health Plan Commercial |
$0.31
|
| Rate for Payer: Galaxy Health WC |
$0.66
|
| Rate for Payer: Global Benefits Group Commercial |
$0.47
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.52
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.30
|
| 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
|
|
