FLUOROURACIL 2.5 GRAM/50 ML INTRAVENOUS SOLUTION [82180]
|
Facility
OP
|
$0.62
|
|
Service Code
|
CPT J9190
|
Hospital Charge Code |
NDG82180
|
Hospital Revenue Code
|
636
|
Min. Negotiated Rate |
$0.15 |
Max. Negotiated Rate |
$14.59 |
Rate for Payer: Aetna of CA HMO/PPO |
$6.34
|
Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$0.53
|
Rate for Payer: AlphaCare Medical Group Medi-Cal |
$0.34
|
Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$0.34
|
Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4.01
|
Rate for Payer: BCBS Transplant Transplant |
$0.37
|
Rate for Payer: Blue Shield of California Commercial |
$0.46
|
Rate for Payer: Blue Shield of California EPN |
$6.17
|
Rate for Payer: Cash Price |
$0.28
|
Rate for Payer: Cash Price |
$0.28
|
Rate for Payer: Cigna of CA HMO |
$0.43
|
Rate for Payer: Cigna of CA PPO |
$0.43
|
Rate for Payer: Dignity Health Commercial/Exchange |
$0.53
|
Rate for Payer: Dignity Health Media |
$0.53
|
Rate for Payer: Dignity Health Medi-Cal |
$0.53
|
Rate for Payer: EPIC Health Plan Commercial |
$0.25
|
Rate for Payer: EPIC Health Plan Transplant |
$0.25
|
Rate for Payer: Galaxy Health WC |
$0.53
|
Rate for Payer: Global Benefits Group Commercial |
$0.37
|
Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$0.47
|
Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.41
|
Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$14.59
|
Rate for Payer: LLUH Dept of Risk Management WC |
$0.15
|
Rate for Payer: Multiplan Commercial |
$0.50
|
Rate for Payer: Networks By Design Commercial |
$0.31
|
Rate for Payer: Prime Health Services Commercial |
$0.53
|
Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.37
|
Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.37
|
Rate for Payer: United Healthcare All Other Commercial |
$0.31
|
Rate for Payer: United Healthcare All Other HMO |
$0.31
|
Rate for Payer: United Healthcare HMO Rider |
$0.31
|
Rate for Payer: United Healthcare Select/Navigate/Core |
$0.31
|
Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.53
|
Rate for Payer: Vantage Medical Group Medi-Cal |
$0.53
|
Rate for Payer: Vantage Medical Group Senior |
$0.53
|
|
FLUOROURACIL 500 MG/10 ML INTRAVENOUS SOLUTION [82200]
|
Facility
OP
|
$0.36
|
|
Service Code
|
CPT J9190
|
Hospital Charge Code |
1755053
|
Hospital Revenue Code
|
636
|
Min. Negotiated Rate |
$0.09 |
Max. Negotiated Rate |
$14.59 |
Rate for Payer: Aetna of CA HMO/PPO |
$6.34
|
Rate for Payer: Aetna of CA HMO/PPO |
$6.34
|
Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$0.31
|
Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$1.30
|
Rate for Payer: AlphaCare Medical Group Medi-Cal |
$0.20
|
Rate for Payer: AlphaCare Medical Group Medi-Cal |
$0.84
|
Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$0.84
|
Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$0.20
|
Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4.01
|
Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4.01
|
Rate for Payer: BCBS Transplant Transplant |
$0.22
|
Rate for Payer: BCBS Transplant Transplant |
$0.92
|
Rate for Payer: Blue Shield of California Commercial |
$1.13
|
Rate for Payer: Blue Shield of California Commercial |
$0.27
|
Rate for Payer: Blue Shield of California EPN |
$6.17
|
Rate for Payer: Blue Shield of California EPN |
$6.17
|
Rate for Payer: Cash Price |
$0.16
|
Rate for Payer: Cash Price |
$0.69
|
Rate for Payer: Cash Price |
$0.16
|
Rate for Payer: Cash Price |
$0.69
|
Rate for Payer: Cigna of CA HMO |
$0.25
|
Rate for Payer: Cigna of CA HMO |
$1.07
|
Rate for Payer: Cigna of CA PPO |
$0.25
|
Rate for Payer: Cigna of CA PPO |
$1.07
|
Rate for Payer: Dignity Health Commercial/Exchange |
$1.30
|
Rate for Payer: Dignity Health Commercial/Exchange |
$0.31
|
Rate for Payer: Dignity Health Media |
$1.30
|
Rate for Payer: Dignity Health Media |
$0.31
|
Rate for Payer: Dignity Health Medi-Cal |
$1.30
|
Rate for Payer: Dignity Health Medi-Cal |
$0.31
|
Rate for Payer: EPIC Health Plan Commercial |
$0.61
|
Rate for Payer: EPIC Health Plan Commercial |
$0.14
|
Rate for Payer: EPIC Health Plan Transplant |
$0.61
|
Rate for Payer: EPIC Health Plan Transplant |
$0.14
|
Rate for Payer: Galaxy Health WC |
$1.30
|
Rate for Payer: Galaxy Health WC |
$0.31
|
Rate for Payer: Global Benefits Group Commercial |
$0.22
|
Rate for Payer: Global Benefits Group Commercial |
$0.92
|
Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$1.15
|
Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$0.27
|
Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.24
|
Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1.02
|
Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$14.59
|
Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$14.59
|
Rate for Payer: LLUH Dept of Risk Management WC |
$0.37
|
Rate for Payer: LLUH Dept of Risk Management WC |
$0.09
|
Rate for Payer: Multiplan Commercial |
$0.29
|
Rate for Payer: Multiplan Commercial |
$1.22
|
Rate for Payer: Networks By Design Commercial |
$0.77
|
Rate for Payer: Networks By Design Commercial |
$0.18
|
Rate for Payer: Prime Health Services Commercial |
$1.30
|
Rate for Payer: Prime Health Services Commercial |
$0.31
|
Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.22
|
Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.92
|
Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.22
|
Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.92
|
Rate for Payer: United Healthcare All Other Commercial |
$0.18
|
Rate for Payer: United Healthcare All Other Commercial |
$0.77
|
Rate for Payer: United Healthcare All Other HMO |
$0.77
|
Rate for Payer: United Healthcare All Other HMO |
$0.18
|
Rate for Payer: United Healthcare HMO Rider |
$0.77
|
Rate for Payer: United Healthcare HMO Rider |
$0.18
|
Rate for Payer: United Healthcare Select/Navigate/Core |
$0.77
|
Rate for Payer: United Healthcare Select/Navigate/Core |
$0.18
|
Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1.30
|
Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.31
|
Rate for Payer: Vantage Medical Group Medi-Cal |
$1.30
|
Rate for Payer: Vantage Medical Group Medi-Cal |
$0.31
|
Rate for Payer: Vantage Medical Group Senior |
$0.31
|
Rate for Payer: Vantage Medical Group Senior |
$1.30
|
|
FLUOROURACIL 500 MG/10 ML INTRAVENOUS SOLUTION [82200]
|
Facility
IP
|
$0.36
|
|
Service Code
|
CPT J9190
|
Hospital Charge Code |
1755053
|
Hospital Revenue Code
|
636
|
Min. Negotiated Rate |
$0.09 |
Max. Negotiated Rate |
$0.31 |
Rate for Payer: Blue Shield of California Commercial |
$0.26
|
Rate for Payer: Blue Shield of California Commercial |
$1.09
|
Rate for Payer: Blue Shield of California EPN |
$0.78
|
Rate for Payer: Blue Shield of California EPN |
$0.18
|
Rate for Payer: Cash Price |
$0.69
|
Rate for Payer: Cash Price |
$0.16
|
Rate for Payer: Cigna of CA HMO |
$1.07
|
Rate for Payer: Cigna of CA HMO |
$0.25
|
Rate for Payer: Cigna of CA PPO |
$0.25
|
Rate for Payer: Cigna of CA PPO |
$1.07
|
Rate for Payer: EPIC Health Plan Commercial |
$0.61
|
Rate for Payer: EPIC Health Plan Commercial |
$0.14
|
Rate for Payer: EPIC Health Plan Transplant |
$0.61
|
Rate for Payer: EPIC Health Plan Transplant |
$0.14
|
Rate for Payer: Galaxy Health WC |
$1.30
|
Rate for Payer: Galaxy Health WC |
$0.31
|
Rate for Payer: Global Benefits Group Commercial |
$0.22
|
Rate for Payer: Global Benefits Group Commercial |
$0.92
|
Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.24
|
Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1.02
|
Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.14
|
Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.58
|
Rate for Payer: LLUH Dept of Risk Management WC |
$0.09
|
Rate for Payer: LLUH Dept of Risk Management WC |
$0.37
|
Rate for Payer: Multiplan Commercial |
$1.22
|
Rate for Payer: Multiplan Commercial |
$0.29
|
Rate for Payer: Networks By Design Commercial |
$0.18
|
Rate for Payer: Networks By Design Commercial |
$0.77
|
Rate for Payer: Prime Health Services Commercial |
$0.31
|
Rate for Payer: Prime Health Services Commercial |
$1.30
|
|
FLUOROURACIL 5 GRAM/100 ML INTRAVENOUS SOLUTION [98249]
|
Facility
OP
|
$0.66
|
|
Service Code
|
CPT J9190
|
Hospital Charge Code |
NDG98249
|
Hospital Revenue Code
|
636
|
Min. Negotiated Rate |
$0.16 |
Max. Negotiated Rate |
$14.59 |
Rate for Payer: Aetna of CA HMO/PPO |
$6.34
|
Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$0.56
|
Rate for Payer: AlphaCare Medical Group Medi-Cal |
$0.36
|
Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$0.36
|
Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4.01
|
Rate for Payer: BCBS Transplant Transplant |
$0.40
|
Rate for Payer: Blue Shield of California Commercial |
$0.49
|
Rate for Payer: Blue Shield of California EPN |
$6.17
|
Rate for Payer: Cash Price |
$0.30
|
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 Transplant Other |
$0.50
|
Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.44
|
Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$14.59
|
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 |
$0.33
|
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
|
|
FLUOROURACIL 5 GRAM/100 ML INTRAVENOUS SOLUTION [98249]
|
Facility
IP
|
$0.66
|
|
Service Code
|
CPT J9190
|
Hospital Charge Code |
NDG98249
|
Hospital Revenue Code
|
636
|
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: 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: 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 |
$0.33
|
Rate for Payer: Prime Health Services Commercial |
$0.56
|
|
FLUOROURACIL 5 % TOPICAL CREAM [10065]
|
Facility
OP
|
$3.09
|
|
Service Code
|
NDC 51672-4118-6
|
Hospital Charge Code |
NDG10065
|
Hospital Revenue Code
|
259
|
Min. Negotiated Rate |
$0.74 |
Max. Negotiated Rate |
$2.63 |
Rate for Payer: Aetna of CA HMO/PPO |
$2.03
|
Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$2.63
|
Rate for Payer: AlphaCare Medical Group Medi-Cal |
$1.70
|
Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$1.70
|
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 |
$2.28
|
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 |
$2.63
|
Rate for Payer: Dignity Health Media |
$2.63
|
Rate for Payer: Dignity Health Medi-Cal |
$2.63
|
Rate for Payer: EPIC Health Plan Commercial |
$1.24
|
Rate for Payer: EPIC Health Plan Transplant |
$1.24
|
Rate for Payer: Galaxy Health WC |
$2.63
|
Rate for Payer: Global Benefits Group Commercial |
$1.85
|
Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$2.32
|
Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2.06
|
Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1.18
|
Rate for Payer: LLUH Dept of Risk Management WC |
$0.74
|
Rate for Payer: Multiplan Commercial |
$2.47
|
Rate for Payer: Networks By Design Commercial |
$2.01
|
Rate for Payer: Prime Health Services Commercial |
$2.63
|
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 |
$2.63
|
Rate for Payer: Vantage Medical Group Medi-Cal |
$2.63
|
Rate for Payer: Vantage Medical Group Senior |
$2.63
|
|
FLUOROURACIL 5 % TOPICAL CREAM [10065]
|
Facility
OP
|
$1.80
|
|
Service Code
|
NDC 0187-3204-47
|
Hospital Charge Code |
NDG10065
|
Hospital Revenue Code
|
259
|
Min. Negotiated Rate |
$0.43 |
Max. Negotiated Rate |
$1.53 |
Rate for Payer: Aetna of CA HMO/PPO |
$1.18
|
Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$1.53
|
Rate for Payer: AlphaCare Medical Group Medi-Cal |
$0.99
|
Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$0.99
|
Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1.07
|
Rate for Payer: BCBS Transplant Transplant |
$1.08
|
Rate for Payer: Blue Shield of California Commercial |
$1.33
|
Rate for Payer: Blue Shield of California EPN |
$1.05
|
Rate for Payer: Cash Price |
$0.81
|
Rate for Payer: Cigna of CA HMO |
$1.26
|
Rate for Payer: Cigna of CA PPO |
$1.26
|
Rate for Payer: Dignity Health Commercial/Exchange |
$1.53
|
Rate for Payer: Dignity Health Media |
$1.53
|
Rate for Payer: Dignity Health Medi-Cal |
$1.53
|
Rate for Payer: EPIC Health Plan Commercial |
$0.72
|
Rate for Payer: EPIC Health Plan Transplant |
$0.72
|
Rate for Payer: Galaxy Health WC |
$1.53
|
Rate for Payer: Global Benefits Group Commercial |
$1.08
|
Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$1.35
|
Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1.20
|
Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.69
|
Rate for Payer: LLUH Dept of Risk Management WC |
$0.43
|
Rate for Payer: Multiplan Commercial |
$1.44
|
Rate for Payer: Networks By Design Commercial |
$1.17
|
Rate for Payer: Prime Health Services Commercial |
$1.53
|
Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$1.08
|
Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1.08
|
Rate for Payer: TriValley Medical Group Commercial/Senior |
$1.08
|
Rate for Payer: United Healthcare All Other Commercial |
$0.90
|
Rate for Payer: United Healthcare All Other HMO |
$0.90
|
Rate for Payer: United Healthcare HMO Rider |
$0.90
|
Rate for Payer: United Healthcare Select/Navigate/Core |
$0.90
|
Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1.53
|
Rate for Payer: Vantage Medical Group Medi-Cal |
$1.53
|
Rate for Payer: Vantage Medical Group Senior |
$1.53
|
|
FLUOROURACIL 5 % TOPICAL CREAM [10065]
|
Facility
IP
|
$3.09
|
|
Service Code
|
NDC 51672-4118-6
|
Hospital Charge Code |
NDG10065
|
Hospital Revenue Code
|
259
|
Min. Negotiated Rate |
$0.74 |
Max. Negotiated Rate |
$2.63 |
Rate for Payer: Blue Shield of California Commercial |
$2.20
|
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 |
$1.24
|
Rate for Payer: Galaxy Health WC |
$2.63
|
Rate for Payer: Global Benefits Group Commercial |
$1.85
|
Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2.06
|
Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1.18
|
Rate for Payer: LLUH Dept of Risk Management WC |
$0.74
|
Rate for Payer: Multiplan Commercial |
$2.47
|
Rate for Payer: Networks By Design Commercial |
$2.01
|
Rate for Payer: Prime Health Services Commercial |
$2.63
|
|
FLUOROURACIL 5 % TOPICAL CREAM [10065]
|
Facility
IP
|
$1.80
|
|
Service Code
|
NDC 0187-3204-47
|
Hospital Charge Code |
NDG10065
|
Hospital Revenue Code
|
259
|
Min. Negotiated Rate |
$0.43 |
Max. Negotiated Rate |
$1.53 |
Rate for Payer: Blue Shield of California Commercial |
$1.28
|
Rate for Payer: Blue Shield of California EPN |
$0.92
|
Rate for Payer: Cash Price |
$0.81
|
Rate for Payer: Cigna of CA HMO |
$1.26
|
Rate for Payer: Cigna of CA PPO |
$1.26
|
Rate for Payer: EPIC Health Plan Commercial |
$0.72
|
Rate for Payer: Galaxy Health WC |
$1.53
|
Rate for Payer: Global Benefits Group Commercial |
$1.08
|
Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1.20
|
Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.69
|
Rate for Payer: LLUH Dept of Risk Management WC |
$0.43
|
Rate for Payer: Multiplan Commercial |
$1.44
|
Rate for Payer: Networks By Design Commercial |
$1.17
|
Rate for Payer: Prime Health Services Commercial |
$1.53
|
|
FLUOROURACIL 5 % TOPICAL CREAM [10065]
|
Facility
IP
|
$3.09
|
|
Service Code
|
NDC 51862-362-40
|
Hospital Charge Code |
NDG10065
|
Hospital Revenue Code
|
259
|
Min. Negotiated Rate |
$0.74 |
Max. Negotiated Rate |
$2.63 |
Rate for Payer: Blue Shield of California Commercial |
$2.20
|
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 |
$1.24
|
Rate for Payer: Galaxy Health WC |
$2.63
|
Rate for Payer: Global Benefits Group Commercial |
$1.85
|
Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2.06
|
Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1.18
|
Rate for Payer: LLUH Dept of Risk Management WC |
$0.74
|
Rate for Payer: Multiplan Commercial |
$2.47
|
Rate for Payer: Networks By Design Commercial |
$2.01
|
Rate for Payer: Prime Health Services Commercial |
$2.63
|
|
FLUOROURACIL 5 % TOPICAL CREAM [10065]
|
Facility
OP
|
$3.09
|
|
Service Code
|
NDC 51862-362-40
|
Hospital Charge Code |
NDG10065
|
Hospital Revenue Code
|
259
|
Min. Negotiated Rate |
$0.74 |
Max. Negotiated Rate |
$2.63 |
Rate for Payer: Aetna of CA HMO/PPO |
$2.03
|
Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$2.63
|
Rate for Payer: AlphaCare Medical Group Medi-Cal |
$1.70
|
Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$1.70
|
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 |
$2.28
|
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 |
$2.63
|
Rate for Payer: Dignity Health Media |
$2.63
|
Rate for Payer: Dignity Health Medi-Cal |
$2.63
|
Rate for Payer: EPIC Health Plan Commercial |
$1.24
|
Rate for Payer: EPIC Health Plan Transplant |
$1.24
|
Rate for Payer: Galaxy Health WC |
$2.63
|
Rate for Payer: Global Benefits Group Commercial |
$1.85
|
Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$2.32
|
Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2.06
|
Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1.18
|
Rate for Payer: LLUH Dept of Risk Management WC |
$0.74
|
Rate for Payer: Multiplan Commercial |
$2.47
|
Rate for Payer: Networks By Design Commercial |
$2.01
|
Rate for Payer: Prime Health Services Commercial |
$2.63
|
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 |
$2.63
|
Rate for Payer: Vantage Medical Group Medi-Cal |
$2.63
|
Rate for Payer: Vantage Medical Group Senior |
$2.63
|
|
FLUOXETINE 10 MG CAPSULE [10069]
|
Facility
OP
|
$0.07
|
|
Service Code
|
NDC 65862-192-01
|
Hospital Charge Code |
1711568
|
Hospital Revenue Code
|
259
|
Min. Negotiated Rate |
$0.02 |
Max. Negotiated Rate |
$0.06 |
Rate for Payer: Aetna of CA HMO/PPO |
$0.05
|
Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$0.06
|
Rate for Payer: AlphaCare Medical Group Medi-Cal |
$0.04
|
Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$0.04
|
Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.04
|
Rate for Payer: BCBS Transplant Transplant |
$0.04
|
Rate for Payer: Blue Shield of California Commercial |
$0.05
|
Rate for Payer: Blue Shield of California EPN |
$0.04
|
Rate for Payer: Cash Price |
$0.03
|
Rate for Payer: Cigna of CA HMO |
$0.05
|
Rate for Payer: Cigna of CA PPO |
$0.05
|
Rate for Payer: Dignity Health Commercial/Exchange |
$0.06
|
Rate for Payer: Dignity Health Media |
$0.06
|
Rate for Payer: Dignity Health Medi-Cal |
$0.06
|
Rate for Payer: EPIC Health Plan Commercial |
$0.03
|
Rate for Payer: EPIC Health Plan Transplant |
$0.03
|
Rate for Payer: Galaxy Health WC |
$0.06
|
Rate for Payer: Global Benefits Group Commercial |
$0.04
|
Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$0.05
|
Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.05
|
Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.03
|
Rate for Payer: LLUH Dept of Risk Management WC |
$0.02
|
Rate for Payer: Multiplan Commercial |
$0.06
|
Rate for Payer: Networks By Design Commercial |
$0.05
|
Rate for Payer: Prime Health Services Commercial |
$0.06
|
Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$0.04
|
Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.04
|
Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.04
|
Rate for Payer: United Healthcare All Other Commercial |
$0.04
|
Rate for Payer: United Healthcare All Other HMO |
$0.04
|
Rate for Payer: United Healthcare HMO Rider |
$0.04
|
Rate for Payer: United Healthcare Select/Navigate/Core |
$0.04
|
Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.06
|
Rate for Payer: Vantage Medical Group Medi-Cal |
$0.06
|
Rate for Payer: Vantage Medical Group Senior |
$0.06
|
|
FLUOXETINE 10 MG CAPSULE [10069]
|
Facility
IP
|
$0.07
|
|
Service Code
|
NDC 65862-192-01
|
Hospital Charge Code |
1711568
|
Hospital Revenue Code
|
259
|
Min. Negotiated Rate |
$0.02 |
Max. Negotiated Rate |
$0.06 |
Rate for Payer: Blue Shield of California Commercial |
$0.05
|
Rate for Payer: Blue Shield of California EPN |
$0.04
|
Rate for Payer: Cash Price |
$0.03
|
Rate for Payer: Cigna of CA HMO |
$0.05
|
Rate for Payer: Cigna of CA PPO |
$0.05
|
Rate for Payer: EPIC Health Plan Commercial |
$0.03
|
Rate for Payer: Galaxy Health WC |
$0.06
|
Rate for Payer: Global Benefits Group Commercial |
$0.04
|
Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.05
|
Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.03
|
Rate for Payer: LLUH Dept of Risk Management WC |
$0.02
|
Rate for Payer: Multiplan Commercial |
$0.06
|
Rate for Payer: Networks By Design Commercial |
$0.05
|
Rate for Payer: Prime Health Services Commercial |
$0.06
|
|
FLUOXETINE 10 MG CAPSULE [10069]
|
Facility
IP
|
$0.07
|
|
Service Code
|
NDC 68001-399-00
|
Hospital Charge Code |
1711568
|
Hospital Revenue Code
|
259
|
Min. Negotiated Rate |
$0.02 |
Max. Negotiated Rate |
$0.06 |
Rate for Payer: Blue Shield of California Commercial |
$0.05
|
Rate for Payer: Blue Shield of California EPN |
$0.04
|
Rate for Payer: Cash Price |
$0.03
|
Rate for Payer: Cigna of CA HMO |
$0.05
|
Rate for Payer: Cigna of CA PPO |
$0.05
|
Rate for Payer: EPIC Health Plan Commercial |
$0.03
|
Rate for Payer: Galaxy Health WC |
$0.06
|
Rate for Payer: Global Benefits Group Commercial |
$0.04
|
Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.05
|
Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.03
|
Rate for Payer: LLUH Dept of Risk Management WC |
$0.02
|
Rate for Payer: Multiplan Commercial |
$0.06
|
Rate for Payer: Networks By Design Commercial |
$0.05
|
Rate for Payer: Prime Health Services Commercial |
$0.06
|
|
FLUOXETINE 10 MG CAPSULE [10069]
|
Facility
IP
|
$0.07
|
|
Service Code
|
NDC 50111-647-01
|
Hospital Charge Code |
1711568
|
Hospital Revenue Code
|
259
|
Min. Negotiated Rate |
$0.02 |
Max. Negotiated Rate |
$0.06 |
Rate for Payer: Blue Shield of California Commercial |
$0.05
|
Rate for Payer: Blue Shield of California EPN |
$0.04
|
Rate for Payer: Cash Price |
$0.03
|
Rate for Payer: Cigna of CA HMO |
$0.05
|
Rate for Payer: Cigna of CA PPO |
$0.05
|
Rate for Payer: EPIC Health Plan Commercial |
$0.03
|
Rate for Payer: Galaxy Health WC |
$0.06
|
Rate for Payer: Global Benefits Group Commercial |
$0.04
|
Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.05
|
Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.03
|
Rate for Payer: LLUH Dept of Risk Management WC |
$0.02
|
Rate for Payer: Multiplan Commercial |
$0.06
|
Rate for Payer: Networks By Design Commercial |
$0.05
|
Rate for Payer: Prime Health Services Commercial |
$0.06
|
|
FLUOXETINE 10 MG CAPSULE [10069]
|
Facility
OP
|
$0.07
|
|
Service Code
|
NDC 68001-399-00
|
Hospital Charge Code |
1711568
|
Hospital Revenue Code
|
259
|
Min. Negotiated Rate |
$0.02 |
Max. Negotiated Rate |
$0.06 |
Rate for Payer: Aetna of CA HMO/PPO |
$0.05
|
Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$0.06
|
Rate for Payer: AlphaCare Medical Group Medi-Cal |
$0.04
|
Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$0.04
|
Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.04
|
Rate for Payer: BCBS Transplant Transplant |
$0.04
|
Rate for Payer: Blue Shield of California Commercial |
$0.05
|
Rate for Payer: Blue Shield of California EPN |
$0.04
|
Rate for Payer: Cash Price |
$0.03
|
Rate for Payer: Cigna of CA HMO |
$0.05
|
Rate for Payer: Cigna of CA PPO |
$0.05
|
Rate for Payer: Dignity Health Commercial/Exchange |
$0.06
|
Rate for Payer: Dignity Health Media |
$0.06
|
Rate for Payer: Dignity Health Medi-Cal |
$0.06
|
Rate for Payer: EPIC Health Plan Commercial |
$0.03
|
Rate for Payer: EPIC Health Plan Transplant |
$0.03
|
Rate for Payer: Galaxy Health WC |
$0.06
|
Rate for Payer: Global Benefits Group Commercial |
$0.04
|
Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$0.05
|
Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.05
|
Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.03
|
Rate for Payer: LLUH Dept of Risk Management WC |
$0.02
|
Rate for Payer: Multiplan Commercial |
$0.06
|
Rate for Payer: Networks By Design Commercial |
$0.05
|
Rate for Payer: Prime Health Services Commercial |
$0.06
|
Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$0.04
|
Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.04
|
Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.04
|
Rate for Payer: United Healthcare All Other Commercial |
$0.04
|
Rate for Payer: United Healthcare All Other HMO |
$0.04
|
Rate for Payer: United Healthcare HMO Rider |
$0.04
|
Rate for Payer: United Healthcare Select/Navigate/Core |
$0.04
|
Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.06
|
Rate for Payer: Vantage Medical Group Medi-Cal |
$0.06
|
Rate for Payer: Vantage Medical Group Senior |
$0.06
|
|
FLUOXETINE 10 MG CAPSULE [10069]
|
Facility
OP
|
$0.10
|
|
Service Code
|
NDC 0904-5784-61
|
Hospital Charge Code |
1711568
|
Hospital Revenue Code
|
259
|
Min. Negotiated Rate |
$0.02 |
Max. Negotiated Rate |
$0.09 |
Rate for Payer: Galaxy Health WC |
$0.09
|
Rate for Payer: Aetna of CA HMO/PPO |
$0.07
|
Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$0.09
|
Rate for Payer: AlphaCare Medical Group Medi-Cal |
$0.06
|
Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$0.06
|
Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.06
|
Rate for Payer: BCBS Transplant Transplant |
$0.06
|
Rate for Payer: Blue Shield of California Commercial |
$0.07
|
Rate for Payer: Blue Shield of California EPN |
$0.06
|
Rate for Payer: Cash Price |
$0.05
|
Rate for Payer: Cigna of CA HMO |
$0.07
|
Rate for Payer: Cigna of CA PPO |
$0.07
|
Rate for Payer: Dignity Health Commercial/Exchange |
$0.09
|
Rate for Payer: Dignity Health Media |
$0.09
|
Rate for Payer: Dignity Health Medi-Cal |
$0.09
|
Rate for Payer: EPIC Health Plan Commercial |
$0.04
|
Rate for Payer: EPIC Health Plan Transplant |
$0.04
|
Rate for Payer: Global Benefits Group Commercial |
$0.06
|
Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$0.08
|
Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.07
|
Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.04
|
Rate for Payer: LLUH Dept of Risk Management WC |
$0.02
|
Rate for Payer: Multiplan Commercial |
$0.08
|
Rate for Payer: Networks By Design Commercial |
$0.07
|
Rate for Payer: Prime Health Services Commercial |
$0.09
|
Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$0.06
|
Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.06
|
Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.06
|
Rate for Payer: United Healthcare All Other Commercial |
$0.05
|
Rate for Payer: United Healthcare All Other HMO |
$0.05
|
Rate for Payer: United Healthcare HMO Rider |
$0.05
|
Rate for Payer: United Healthcare Select/Navigate/Core |
$0.05
|
Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.09
|
Rate for Payer: Vantage Medical Group Medi-Cal |
$0.09
|
Rate for Payer: Vantage Medical Group Senior |
$0.09
|
|
FLUOXETINE 10 MG CAPSULE [10069]
|
Facility
IP
|
$0.10
|
|
Service Code
|
NDC 0904-5784-61
|
Hospital Charge Code |
1711568
|
Hospital Revenue Code
|
259
|
Min. Negotiated Rate |
$0.02 |
Max. Negotiated Rate |
$0.09 |
Rate for Payer: Blue Shield of California Commercial |
$0.07
|
Rate for Payer: Blue Shield of California EPN |
$0.05
|
Rate for Payer: Cash Price |
$0.05
|
Rate for Payer: Cigna of CA HMO |
$0.07
|
Rate for Payer: Cigna of CA PPO |
$0.07
|
Rate for Payer: EPIC Health Plan Commercial |
$0.04
|
Rate for Payer: Galaxy Health WC |
$0.09
|
Rate for Payer: Global Benefits Group Commercial |
$0.06
|
Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.07
|
Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.04
|
Rate for Payer: LLUH Dept of Risk Management WC |
$0.02
|
Rate for Payer: Multiplan Commercial |
$0.08
|
Rate for Payer: Networks By Design Commercial |
$0.07
|
Rate for Payer: Prime Health Services Commercial |
$0.09
|
|
FLUOXETINE 10 MG CAPSULE [10069]
|
Facility
OP
|
$0.07
|
|
Service Code
|
NDC 50111-647-01
|
Hospital Charge Code |
1711568
|
Hospital Revenue Code
|
259
|
Min. Negotiated Rate |
$0.02 |
Max. Negotiated Rate |
$0.06 |
Rate for Payer: Aetna of CA HMO/PPO |
$0.05
|
Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$0.06
|
Rate for Payer: AlphaCare Medical Group Medi-Cal |
$0.04
|
Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$0.04
|
Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.04
|
Rate for Payer: BCBS Transplant Transplant |
$0.04
|
Rate for Payer: Blue Shield of California Commercial |
$0.05
|
Rate for Payer: Blue Shield of California EPN |
$0.04
|
Rate for Payer: Cash Price |
$0.03
|
Rate for Payer: Cigna of CA HMO |
$0.05
|
Rate for Payer: Cigna of CA PPO |
$0.05
|
Rate for Payer: Dignity Health Commercial/Exchange |
$0.06
|
Rate for Payer: Dignity Health Media |
$0.06
|
Rate for Payer: Dignity Health Medi-Cal |
$0.06
|
Rate for Payer: EPIC Health Plan Commercial |
$0.03
|
Rate for Payer: EPIC Health Plan Transplant |
$0.03
|
Rate for Payer: Galaxy Health WC |
$0.06
|
Rate for Payer: Global Benefits Group Commercial |
$0.04
|
Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$0.05
|
Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.05
|
Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.03
|
Rate for Payer: LLUH Dept of Risk Management WC |
$0.02
|
Rate for Payer: Multiplan Commercial |
$0.06
|
Rate for Payer: Networks By Design Commercial |
$0.05
|
Rate for Payer: Prime Health Services Commercial |
$0.06
|
Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$0.04
|
Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.04
|
Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.04
|
Rate for Payer: United Healthcare All Other Commercial |
$0.04
|
Rate for Payer: United Healthcare All Other HMO |
$0.04
|
Rate for Payer: United Healthcare HMO Rider |
$0.04
|
Rate for Payer: United Healthcare Select/Navigate/Core |
$0.04
|
Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.06
|
Rate for Payer: Vantage Medical Group Medi-Cal |
$0.06
|
Rate for Payer: Vantage Medical Group Senior |
$0.06
|
|
FLUOXETINE 20 MG/5 ML (4 MG/ML) ORAL SOLUTION [38488]
|
Facility
OP
|
$1.37
|
|
Service Code
|
NDC 0121-4721-05
|
Hospital Charge Code |
1716061
|
Hospital Revenue Code
|
259
|
Min. Negotiated Rate |
$0.33 |
Max. Negotiated Rate |
$1.16 |
Rate for Payer: Aetna of CA HMO/PPO |
$0.90
|
Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$1.16
|
Rate for Payer: AlphaCare Medical Group Medi-Cal |
$0.75
|
Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$0.75
|
Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.82
|
Rate for Payer: BCBS Transplant Transplant |
$0.82
|
Rate for Payer: Blue Shield of California Commercial |
$1.01
|
Rate for Payer: Blue Shield of California EPN |
$0.80
|
Rate for Payer: Cash Price |
$0.62
|
Rate for Payer: Cigna of CA HMO |
$0.96
|
Rate for Payer: Cigna of CA PPO |
$0.96
|
Rate for Payer: Dignity Health Commercial/Exchange |
$1.16
|
Rate for Payer: Dignity Health Media |
$1.16
|
Rate for Payer: Dignity Health Medi-Cal |
$1.16
|
Rate for Payer: EPIC Health Plan Commercial |
$0.55
|
Rate for Payer: EPIC Health Plan Transplant |
$0.55
|
Rate for Payer: Galaxy Health WC |
$1.16
|
Rate for Payer: Global Benefits Group Commercial |
$0.82
|
Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$1.03
|
Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.91
|
Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.52
|
Rate for Payer: LLUH Dept of Risk Management WC |
$0.33
|
Rate for Payer: Multiplan Commercial |
$1.10
|
Rate for Payer: Networks By Design Commercial |
$0.89
|
Rate for Payer: Prime Health Services Commercial |
$1.16
|
Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$0.82
|
Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.82
|
Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.82
|
Rate for Payer: United Healthcare All Other Commercial |
$0.69
|
Rate for Payer: United Healthcare All Other HMO |
$0.69
|
Rate for Payer: United Healthcare HMO Rider |
$0.69
|
Rate for Payer: United Healthcare Select/Navigate/Core |
$0.69
|
Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1.16
|
Rate for Payer: Vantage Medical Group Medi-Cal |
$1.16
|
Rate for Payer: Vantage Medical Group Senior |
$1.16
|
|
FLUOXETINE 20 MG/5 ML (4 MG/ML) ORAL SOLUTION [38488]
|
Facility
OP
|
$0.69
|
|
Service Code
|
NDC 54838-523-40
|
Hospital Charge Code |
1715117
|
Hospital Revenue Code
|
259
|
Min. Negotiated Rate |
$0.17 |
Max. Negotiated Rate |
$0.59 |
Rate for Payer: Aetna of CA HMO/PPO |
$0.45
|
Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$0.59
|
Rate for Payer: AlphaCare Medical Group Medi-Cal |
$0.38
|
Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$0.38
|
Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.41
|
Rate for Payer: BCBS Transplant Transplant |
$0.41
|
Rate for Payer: Blue Shield of California Commercial |
$0.51
|
Rate for Payer: Blue Shield of California EPN |
$0.40
|
Rate for Payer: Cash Price |
$0.31
|
Rate for Payer: Cigna of CA HMO |
$0.48
|
Rate for Payer: Cigna of CA PPO |
$0.48
|
Rate for Payer: Dignity Health Commercial/Exchange |
$0.59
|
Rate for Payer: Dignity Health Media |
$0.59
|
Rate for Payer: Dignity Health Medi-Cal |
$0.59
|
Rate for Payer: EPIC Health Plan Commercial |
$0.28
|
Rate for Payer: EPIC Health Plan Transplant |
$0.28
|
Rate for Payer: Galaxy Health WC |
$0.59
|
Rate for Payer: Global Benefits Group Commercial |
$0.41
|
Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$0.52
|
Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.46
|
Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.26
|
Rate for Payer: LLUH Dept of Risk Management WC |
$0.17
|
Rate for Payer: Multiplan Commercial |
$0.55
|
Rate for Payer: Networks By Design Commercial |
$0.45
|
Rate for Payer: Prime Health Services Commercial |
$0.59
|
Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$0.41
|
Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.41
|
Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.41
|
Rate for Payer: United Healthcare All Other Commercial |
$0.35
|
Rate for Payer: United Healthcare All Other HMO |
$0.35
|
Rate for Payer: United Healthcare HMO Rider |
$0.35
|
Rate for Payer: United Healthcare Select/Navigate/Core |
$0.35
|
Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.59
|
Rate for Payer: Vantage Medical Group Medi-Cal |
$0.59
|
Rate for Payer: Vantage Medical Group Senior |
$0.59
|
|
FLUOXETINE 20 MG/5 ML (4 MG/ML) ORAL SOLUTION [38488]
|
Facility
IP
|
$0.69
|
|
Service Code
|
NDC 54838-523-40
|
Hospital Charge Code |
1715117
|
Hospital Revenue Code
|
259
|
Min. Negotiated Rate |
$0.17 |
Max. Negotiated Rate |
$0.59 |
Rate for Payer: Blue Shield of California Commercial |
$0.49
|
Rate for Payer: Blue Shield of California EPN |
$0.35
|
Rate for Payer: Cash Price |
$0.31
|
Rate for Payer: Cigna of CA HMO |
$0.48
|
Rate for Payer: Cigna of CA PPO |
$0.48
|
Rate for Payer: EPIC Health Plan Commercial |
$0.28
|
Rate for Payer: Galaxy Health WC |
$0.59
|
Rate for Payer: Global Benefits Group Commercial |
$0.41
|
Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.46
|
Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.26
|
Rate for Payer: LLUH Dept of Risk Management WC |
$0.17
|
Rate for Payer: Multiplan Commercial |
$0.55
|
Rate for Payer: Networks By Design Commercial |
$0.45
|
Rate for Payer: Prime Health Services Commercial |
$0.59
|
|
FLUOXETINE 20 MG/5 ML (4 MG/ML) ORAL SOLUTION [38488]
|
Facility
IP
|
$1.37
|
|
Service Code
|
NDC 0121-4721-05
|
Hospital Charge Code |
1716061
|
Hospital Revenue Code
|
259
|
Min. Negotiated Rate |
$0.33 |
Max. Negotiated Rate |
$1.16 |
Rate for Payer: Blue Shield of California Commercial |
$0.98
|
Rate for Payer: Blue Shield of California EPN |
$0.70
|
Rate for Payer: Cash Price |
$0.62
|
Rate for Payer: Cigna of CA HMO |
$0.96
|
Rate for Payer: Cigna of CA PPO |
$0.96
|
Rate for Payer: EPIC Health Plan Commercial |
$0.55
|
Rate for Payer: Galaxy Health WC |
$1.16
|
Rate for Payer: Global Benefits Group Commercial |
$0.82
|
Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.91
|
Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.52
|
Rate for Payer: LLUH Dept of Risk Management WC |
$0.33
|
Rate for Payer: Multiplan Commercial |
$1.10
|
Rate for Payer: Networks By Design Commercial |
$0.89
|
Rate for Payer: Prime Health Services Commercial |
$1.16
|
|
FLUOXETINE 20 MG CAPSULE [10070]
|
Facility
IP
|
$0.16
|
|
Service Code
|
NDC 68084-605-11
|
Hospital Charge Code |
1711185
|
Hospital Revenue Code
|
259
|
Min. Negotiated Rate |
$0.04 |
Max. Negotiated Rate |
$0.14 |
Rate for Payer: Blue Shield of California Commercial |
$0.11
|
Rate for Payer: Blue Shield of California EPN |
$0.08
|
Rate for Payer: Cash Price |
$0.07
|
Rate for Payer: Cigna of CA HMO |
$0.11
|
Rate for Payer: Cigna of CA PPO |
$0.11
|
Rate for Payer: EPIC Health Plan Commercial |
$0.06
|
Rate for Payer: Galaxy Health WC |
$0.14
|
Rate for Payer: Global Benefits Group Commercial |
$0.10
|
Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.11
|
Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.06
|
Rate for Payer: LLUH Dept of Risk Management WC |
$0.04
|
Rate for Payer: Multiplan Commercial |
$0.13
|
Rate for Payer: Networks By Design Commercial |
$0.10
|
Rate for Payer: Prime Health Services Commercial |
$0.14
|
|
FLUOXETINE 20 MG CAPSULE [10070]
|
Facility
OP
|
$0.08
|
|
Service Code
|
NDC 68001-400-00
|
Hospital Charge Code |
1711185
|
Hospital Revenue Code
|
259
|
Min. Negotiated Rate |
$0.02 |
Max. Negotiated Rate |
$0.07 |
Rate for Payer: Galaxy Health WC |
$0.07
|
Rate for Payer: Aetna of CA HMO/PPO |
$0.05
|
Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$0.07
|
Rate for Payer: AlphaCare Medical Group Medi-Cal |
$0.04
|
Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$0.04
|
Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.05
|
Rate for Payer: BCBS Transplant Transplant |
$0.05
|
Rate for Payer: Blue Shield of California Commercial |
$0.06
|
Rate for Payer: Blue Shield of California EPN |
$0.05
|
Rate for Payer: Cash Price |
$0.04
|
Rate for Payer: Cigna of CA HMO |
$0.06
|
Rate for Payer: Cigna of CA PPO |
$0.06
|
Rate for Payer: Dignity Health Commercial/Exchange |
$0.07
|
Rate for Payer: Dignity Health Media |
$0.07
|
Rate for Payer: Dignity Health Medi-Cal |
$0.07
|
Rate for Payer: EPIC Health Plan Commercial |
$0.03
|
Rate for Payer: EPIC Health Plan Transplant |
$0.03
|
Rate for Payer: Global Benefits Group Commercial |
$0.05
|
Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$0.06
|
Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.05
|
Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.03
|
Rate for Payer: LLUH Dept of Risk Management WC |
$0.02
|
Rate for Payer: Multiplan Commercial |
$0.06
|
Rate for Payer: Networks By Design Commercial |
$0.05
|
Rate for Payer: Prime Health Services Commercial |
$0.07
|
Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$0.05
|
Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.05
|
Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.05
|
Rate for Payer: United Healthcare All Other Commercial |
$0.04
|
Rate for Payer: United Healthcare All Other HMO |
$0.04
|
Rate for Payer: United Healthcare HMO Rider |
$0.04
|
Rate for Payer: United Healthcare Select/Navigate/Core |
$0.04
|
Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.07
|
Rate for Payer: Vantage Medical Group Medi-Cal |
$0.07
|
Rate for Payer: Vantage Medical Group Senior |
$0.07
|
|