|
FLECAINIDE ORAL SUSPENSION COMPOUND 20 MG/ML [4080273]
|
Facility
|
IP
|
$0.55
|
|
|
Service Code
|
NDC 9994080273
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.11 |
| Max. Negotiated Rate |
$0.50 |
| Rate for Payer: Adventist Health Commercial |
$0.11
|
| Rate for Payer: Blue Shield of California Commercial |
$0.44
|
| Rate for Payer: Blue Shield of California EPN |
$0.28
|
| Rate for Payer: Cash Price |
$0.25
|
| Rate for Payer: Central Health Plan Commercial |
$0.44
|
| Rate for Payer: Cigna of CA HMO |
$0.39
|
| Rate for Payer: Cigna of CA PPO |
$0.39
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$0.39
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.22
|
| Rate for Payer: EPIC Health Plan Senior |
$0.22
|
| Rate for Payer: Galaxy Health WC |
$0.47
|
| Rate for Payer: Global Benefits Group Commercial |
$0.33
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.50
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$0.35
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$0.32
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.11
|
| Rate for Payer: Multiplan Commercial |
$0.41
|
| Rate for Payer: Networks By Design Commercial |
$0.36
|
| Rate for Payer: Prime Health Services Commercial |
$0.47
|
|
|
FLEXOR ORIGIN SLIDE (EG, FOR CEREBRAL PALSY, VOLKMANN CONTRACTURE), FOREARM AND/OR WRIST;
|
Facility
|
OP
|
$27,467.00
|
|
|
Service Code
|
CPT 25315
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$870.25 |
| Max. Negotiated Rate |
$27,467.00 |
| Rate for Payer: Adventist Health Medi-Cal |
$9,332.70
|
| Rate for Payer: Aetna of CA HMO/PPO |
$27,467.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$13,999.05
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$10,265.97
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$9,332.70
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$5,806.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$8,074.00
|
| Rate for Payer: Anthem Blue Cross of CA Workers' Comp |
$14,462.30
|
| Rate for Payer: Blue Shield of California Commercial |
$5,036.70
|
| Rate for Payer: Blue Shield of California EPN |
$3,165.61
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$13,999.05
|
| Rate for Payer: Dignity Health Medi-Cal |
$10,265.97
|
| Rate for Payer: Dignity Health Medicare Advantage |
$9,332.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$15,398.95
|
| Rate for Payer: EPIC Health Plan Senior |
$10,265.97
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$15,305.63
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$870.25
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$9,332.70
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$961.32
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$13,065.78
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$12,505.82
|
| Rate for Payer: Multiplan WC |
$14,462.30
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$9,332.70
|
| Rate for Payer: Preferred Health Network WC |
$14,757.45
|
| Rate for Payer: Prime Health Services Medicare |
$9,892.66
|
| Rate for Payer: Prime Health Services WC |
$14,314.73
|
| Rate for Payer: Riverside University Health System MISP |
$10,265.97
|
| Rate for Payer: United Healthcare All Other HMO |
$20,902.00
|
| Rate for Payer: United Healthcare HMO Rider |
$13,066.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$11,971.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$9,332.70
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$13,999.05
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$10,265.97
|
| Rate for Payer: Vantage Medical Group Senior |
$9,332.70
|
|
|
FLORBETABEN F-18 8.1 MCI (300 MBQ) INTRAVENOUS SOLUTION [231724]
|
Facility
|
IP
|
$4,202.40
|
|
|
Service Code
|
HCPCS A9609
|
| Hospital Charge Code |
901700057
|
|
Hospital Revenue Code
|
343
|
| Min. Negotiated Rate |
$840.48 |
| Max. Negotiated Rate |
$3,782.16 |
| Rate for Payer: Adventist Health Commercial |
$840.48
|
| Rate for Payer: Blue Shield of California Commercial |
$3,370.32
|
| Rate for Payer: Blue Shield of California EPN |
$2,118.01
|
| Rate for Payer: Cash Price |
$1,891.08
|
| Rate for Payer: Central Health Plan Commercial |
$3,361.92
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$2,941.68
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,680.96
|
| Rate for Payer: EPIC Health Plan Senior |
$1,680.96
|
| Rate for Payer: Galaxy Health WC |
$3,572.04
|
| Rate for Payer: Global Benefits Group Commercial |
$2,521.44
|
| Rate for Payer: Health Management Network EPO/PPO |
$3,782.16
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$2,668.52
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2,479.42
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$840.48
|
| Rate for Payer: Multiplan Commercial |
$3,151.80
|
| Rate for Payer: Networks By Design Commercial |
$2,731.56
|
| Rate for Payer: Prime Health Services Commercial |
$3,572.04
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,577.16
|
| Rate for Payer: United Healthcare All Other HMO |
$1,535.14
|
| Rate for Payer: United Healthcare HMO Rider |
$1,501.94
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,376.29
|
|
|
FLORBETABEN F-18 8.1 MCI (300 MBQ) INTRAVENOUS SOLUTION [231724]
|
Facility
|
OP
|
$4,202.40
|
|
|
Service Code
|
HCPCS A9609
|
| Hospital Charge Code |
901700057
|
|
Hospital Revenue Code
|
343
|
| Min. Negotiated Rate |
$840.48 |
| Max. Negotiated Rate |
$3,782.16 |
| Rate for Payer: Adventist Health Commercial |
$840.48
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,552.12
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3,572.04
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,311.32
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$3,151.80
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$2,034.80
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,444.54
|
| Rate for Payer: Blue Shield of California Commercial |
$2,647.51
|
| Rate for Payer: Blue Shield of California EPN |
$1,668.35
|
| Rate for Payer: Cash Price |
$1,891.08
|
| Rate for Payer: Central Health Plan Commercial |
$3,361.92
|
| Rate for Payer: Cigna of CA HMO |
$2,689.54
|
| Rate for Payer: Cigna of CA PPO |
$3,109.78
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,572.04
|
| Rate for Payer: Dignity Health Medi-Cal |
$3,572.04
|
| Rate for Payer: Dignity Health Medicare Advantage |
$3,572.04
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$2,941.68
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,680.96
|
| Rate for Payer: EPIC Health Plan Senior |
$1,680.96
|
| Rate for Payer: Galaxy Health WC |
$3,572.04
|
| Rate for Payer: Global Benefits Group Commercial |
$2,521.44
|
| Rate for Payer: Health Management Network EPO/PPO |
$3,782.16
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$2,668.52
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2,479.42
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$840.48
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$2,941.68
|
| Rate for Payer: Multiplan Commercial |
$3,151.80
|
| Rate for Payer: Networks By Design Commercial |
$2,731.56
|
| Rate for Payer: Prime Health Services Commercial |
$3,572.04
|
| Rate for Payer: Riverside University Health System MISP |
$1,680.96
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,521.44
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2,521.44
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,577.16
|
| Rate for Payer: United Healthcare All Other HMO |
$1,535.14
|
| Rate for Payer: United Healthcare HMO Rider |
$1,501.94
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,376.29
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,572.04
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$3,572.04
|
| Rate for Payer: Vantage Medical Group Senior |
$3,572.04
|
|
|
FLORBETAPIR F-18 10 MCI (370 MBQ) INTRAVENOUS SOLUTION [196481]
|
Facility
|
OP
|
$342.12
|
|
|
Service Code
|
HCPCS A9586
|
| Hospital Charge Code |
901700057
|
|
Hospital Revenue Code
|
343
|
| Min. Negotiated Rate |
$68.42 |
| Max. Negotiated Rate |
$3,951.59 |
| Rate for Payer: Adventist Health Commercial |
$68.42
|
| Rate for Payer: Adventist Health Medi-Cal |
$1,825.64
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2,282.05
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,008.20
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,008.20
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$3,166.56
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,951.59
|
| Rate for Payer: Blue Shield of California Commercial |
$215.54
|
| Rate for Payer: Blue Shield of California EPN |
$135.82
|
| Rate for Payer: Cash Price |
$153.95
|
| Rate for Payer: Cash Price |
$153.95
|
| Rate for Payer: Central Health Plan Commercial |
$273.70
|
| Rate for Payer: Cigna of CA HMO |
$218.96
|
| Rate for Payer: Cigna of CA PPO |
$253.17
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2,282.05
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,008.20
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2,008.20
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$239.48
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,012.31
|
| Rate for Payer: EPIC Health Plan Senior |
$2,008.20
|
| Rate for Payer: Galaxy Health WC |
$290.80
|
| Rate for Payer: Global Benefits Group Commercial |
$205.27
|
| Rate for Payer: Health Management Network EPO/PPO |
$307.91
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$2,994.05
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$1,825.64
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$217.25
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$124.19
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2,555.90
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$68.42
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$2,446.36
|
| Rate for Payer: Multiplan Commercial |
$256.59
|
| Rate for Payer: Networks By Design Commercial |
$222.38
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$1,825.64
|
| Rate for Payer: Prime Health Services Commercial |
$290.80
|
| Rate for Payer: Prime Health Services Medicare |
$1,935.18
|
| Rate for Payer: Riverside University Health System MISP |
$2,008.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$205.27
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$205.27
|
| Rate for Payer: United Healthcare All Other Commercial |
$128.40
|
| Rate for Payer: United Healthcare All Other HMO |
$124.98
|
| Rate for Payer: United Healthcare HMO Rider |
$122.27
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$112.04
|
| Rate for Payer: Upland Medical Group Pediatric |
$1,825.64
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2,282.05
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,008.20
|
| Rate for Payer: Vantage Medical Group Senior |
$2,008.20
|
|
|
FLORBETAPIR F-18 10 MCI (370 MBQ) INTRAVENOUS SOLUTION [196481]
|
Facility
|
IP
|
$342.12
|
|
|
Service Code
|
HCPCS A9586
|
| Hospital Charge Code |
901700057
|
|
Hospital Revenue Code
|
343
|
| Min. Negotiated Rate |
$68.42 |
| Max. Negotiated Rate |
$307.91 |
| Rate for Payer: Adventist Health Commercial |
$68.42
|
| Rate for Payer: Blue Shield of California Commercial |
$274.38
|
| Rate for Payer: Blue Shield of California EPN |
$172.43
|
| Rate for Payer: Cash Price |
$153.95
|
| Rate for Payer: Central Health Plan Commercial |
$273.70
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$239.48
|
| Rate for Payer: EPIC Health Plan Commercial |
$136.85
|
| Rate for Payer: EPIC Health Plan Senior |
$136.85
|
| Rate for Payer: Galaxy Health WC |
$290.80
|
| Rate for Payer: Global Benefits Group Commercial |
$205.27
|
| Rate for Payer: Health Management Network EPO/PPO |
$307.91
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$217.25
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$201.85
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$68.42
|
| Rate for Payer: Multiplan Commercial |
$256.59
|
| Rate for Payer: Networks By Design Commercial |
$222.38
|
| Rate for Payer: Prime Health Services Commercial |
$290.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$128.40
|
| Rate for Payer: United Healthcare All Other HMO |
$124.98
|
| Rate for Payer: United Healthcare HMO Rider |
$122.27
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$112.04
|
|
|
FLUCICLOVINE F18 10 MCI (370 MBQ) INTRAVENOUS SOLUTION [219653]
|
Facility
|
IP
|
$6,589.20
|
|
|
Service Code
|
HCPCS A9588
|
| Hospital Charge Code |
901700057
|
|
Hospital Revenue Code
|
343
|
| Min. Negotiated Rate |
$1,317.84 |
| Max. Negotiated Rate |
$5,930.28 |
| Rate for Payer: Adventist Health Commercial |
$1,317.84
|
| Rate for Payer: Blue Shield of California Commercial |
$5,284.54
|
| Rate for Payer: Blue Shield of California EPN |
$3,320.96
|
| Rate for Payer: Cash Price |
$2,965.14
|
| Rate for Payer: Central Health Plan Commercial |
$5,271.36
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$4,612.44
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,635.68
|
| Rate for Payer: EPIC Health Plan Senior |
$2,635.68
|
| Rate for Payer: Galaxy Health WC |
$5,600.82
|
| Rate for Payer: Global Benefits Group Commercial |
$3,953.52
|
| Rate for Payer: Health Management Network EPO/PPO |
$5,930.28
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$4,184.14
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$3,887.63
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,317.84
|
| Rate for Payer: Multiplan Commercial |
$4,941.90
|
| Rate for Payer: Networks By Design Commercial |
$4,282.98
|
| Rate for Payer: Prime Health Services Commercial |
$5,600.82
|
| Rate for Payer: United Healthcare All Other Commercial |
$2,472.93
|
| Rate for Payer: United Healthcare All Other HMO |
$2,407.03
|
| Rate for Payer: United Healthcare HMO Rider |
$2,354.98
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,157.96
|
|
|
FLUCICLOVINE F18 10 MCI (370 MBQ) INTRAVENOUS SOLUTION [219653]
|
Facility
|
OP
|
$6,589.20
|
|
|
Service Code
|
HCPCS A9588
|
| Hospital Charge Code |
901700057
|
|
Hospital Revenue Code
|
343
|
| Min. Negotiated Rate |
$322.27 |
| Max. Negotiated Rate |
$5,930.28 |
| Rate for Payer: Adventist Health Commercial |
$1,317.84
|
| Rate for Payer: Adventist Health Medi-Cal |
$322.27
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$402.84
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$354.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$354.50
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$727.32
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$907.63
|
| Rate for Payer: Blue Shield of California Commercial |
$4,151.20
|
| Rate for Payer: Blue Shield of California EPN |
$2,615.91
|
| Rate for Payer: Cash Price |
$2,965.14
|
| Rate for Payer: Cash Price |
$2,965.14
|
| Rate for Payer: Central Health Plan Commercial |
$5,271.36
|
| Rate for Payer: Cigna of CA HMO |
$4,217.09
|
| Rate for Payer: Cigna of CA PPO |
$4,876.01
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$402.84
|
| Rate for Payer: Dignity Health Medi-Cal |
$354.50
|
| Rate for Payer: Dignity Health Medicare Advantage |
$354.50
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$4,612.44
|
| Rate for Payer: EPIC Health Plan Commercial |
$531.75
|
| Rate for Payer: EPIC Health Plan Senior |
$354.50
|
| Rate for Payer: Galaxy Health WC |
$5,600.82
|
| Rate for Payer: Global Benefits Group Commercial |
$3,953.52
|
| Rate for Payer: Health Management Network EPO/PPO |
$5,930.28
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$528.52
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$322.27
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$4,184.14
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$451.18
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,317.84
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$431.84
|
| Rate for Payer: Multiplan Commercial |
$4,941.90
|
| Rate for Payer: Networks By Design Commercial |
$4,282.98
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$322.27
|
| Rate for Payer: Prime Health Services Commercial |
$5,600.82
|
| Rate for Payer: Prime Health Services Medicare |
$341.61
|
| Rate for Payer: Riverside University Health System MISP |
$354.50
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3,953.52
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$3,953.52
|
| Rate for Payer: United Healthcare All Other Commercial |
$2,472.93
|
| Rate for Payer: United Healthcare All Other HMO |
$2,407.03
|
| Rate for Payer: United Healthcare HMO Rider |
$2,354.98
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,157.96
|
| Rate for Payer: Upland Medical Group Pediatric |
$322.27
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$402.84
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$354.50
|
| Rate for Payer: Vantage Medical Group Senior |
$354.50
|
|
|
FLUCONAZOLE 100 MG TABLET [10044]
|
Facility
|
OP
|
$1.59
|
|
|
Service Code
|
NDC 0904650006
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.32 |
| Max. Negotiated Rate |
$1.43 |
| Rate for Payer: Adventist Health Commercial |
$0.32
|
| Rate for Payer: Aetna of CA HMO/PPO |
$0.97
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1.35
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.87
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1.19
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$0.77
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.92
|
| Rate for Payer: Blue Shield of California Commercial |
$1.01
|
| Rate for Payer: Blue Shield of California EPN |
$0.63
|
| Rate for Payer: Cash Price |
$0.72
|
| Rate for Payer: Central Health Plan Commercial |
$1.27
|
| Rate for Payer: Cigna of CA HMO |
$1.11
|
| Rate for Payer: Cigna of CA PPO |
$1.11
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1.35
|
| Rate for Payer: Dignity Health Medi-Cal |
$1.35
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1.35
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1.11
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.64
|
| Rate for Payer: EPIC Health Plan Senior |
$0.64
|
| Rate for Payer: Galaxy Health WC |
$1.35
|
| Rate for Payer: Global Benefits Group Commercial |
$0.95
|
| Rate for Payer: Health Management Network EPO/PPO |
$1.43
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1.01
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.58
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$0.94
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.32
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$1.11
|
| Rate for Payer: Multiplan Commercial |
$1.19
|
| Rate for Payer: Networks By Design Commercial |
$1.03
|
| Rate for Payer: Prime Health Services Commercial |
$1.35
|
| Rate for Payer: Riverside University Health System MISP |
$0.64
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.95
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.95
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.80
|
| Rate for Payer: United Healthcare All Other HMO |
$0.80
|
| Rate for Payer: United Healthcare HMO Rider |
$0.80
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.80
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1.35
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1.35
|
| Rate for Payer: Vantage Medical Group Senior |
$1.35
|
|
|
FLUCONAZOLE 100 MG TABLET [10044]
|
Facility
|
OP
|
$0.60
|
|
|
Service Code
|
NDC 5723700430
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.12 |
| Max. Negotiated Rate |
$0.54 |
| Rate for Payer: Adventist Health Commercial |
$0.12
|
| Rate for Payer: Aetna of CA HMO/PPO |
$0.36
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.51
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.33
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.45
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$0.29
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.35
|
| Rate for Payer: Blue Shield of California Commercial |
$0.38
|
| Rate for Payer: Blue Shield of California EPN |
$0.24
|
| Rate for Payer: Cash Price |
$0.27
|
| Rate for Payer: Central Health Plan Commercial |
$0.48
|
| Rate for Payer: Cigna of CA HMO |
$0.42
|
| Rate for Payer: Cigna of CA PPO |
$0.42
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.51
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.51
|
| Rate for Payer: Dignity Health Medicare Advantage |
$0.51
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$0.42
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.24
|
| Rate for Payer: EPIC Health Plan Senior |
$0.24
|
| Rate for Payer: Galaxy Health WC |
$0.51
|
| Rate for Payer: Global Benefits Group Commercial |
$0.36
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.54
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$0.38
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.22
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$0.35
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.12
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$0.42
|
| Rate for Payer: Multiplan Commercial |
$0.45
|
| Rate for Payer: Networks By Design Commercial |
$0.39
|
| Rate for Payer: Prime Health Services Commercial |
$0.51
|
| Rate for Payer: Riverside University Health System MISP |
$0.24
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.36
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.36
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.30
|
| Rate for Payer: United Healthcare All Other HMO |
$0.30
|
| Rate for Payer: United Healthcare HMO Rider |
$0.30
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.30
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.51
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.51
|
| Rate for Payer: Vantage Medical Group Senior |
$0.51
|
|
|
FLUCONAZOLE 100 MG TABLET [10044]
|
Facility
|
IP
|
$1.59
|
|
|
Service Code
|
NDC 0904650006
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.32 |
| Max. Negotiated Rate |
$1.43 |
| Rate for Payer: Adventist Health Commercial |
$0.32
|
| Rate for Payer: Blue Shield of California Commercial |
$1.28
|
| Rate for Payer: Blue Shield of California EPN |
$0.80
|
| Rate for Payer: Cash Price |
$0.72
|
| Rate for Payer: Central Health Plan Commercial |
$1.27
|
| Rate for Payer: Cigna of CA HMO |
$1.11
|
| Rate for Payer: Cigna of CA PPO |
$1.11
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1.11
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.64
|
| Rate for Payer: EPIC Health Plan Senior |
$0.64
|
| Rate for Payer: Galaxy Health WC |
$1.35
|
| Rate for Payer: Global Benefits Group Commercial |
$0.95
|
| Rate for Payer: Health Management Network EPO/PPO |
$1.43
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1.01
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$0.94
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.32
|
| Rate for Payer: Multiplan Commercial |
$1.19
|
| Rate for Payer: Networks By Design Commercial |
$1.03
|
| Rate for Payer: Prime Health Services Commercial |
$1.35
|
|
|
FLUCONAZOLE 100 MG TABLET [10044]
|
Facility
|
IP
|
$0.59
|
|
|
Service Code
|
NDC 7071011383
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.12 |
| Max. Negotiated Rate |
$0.53 |
| Rate for Payer: Adventist Health Commercial |
$0.12
|
| Rate for Payer: Blue Shield of California Commercial |
$0.47
|
| Rate for Payer: Blue Shield of California EPN |
$0.30
|
| Rate for Payer: Cash Price |
$0.27
|
| Rate for Payer: Central Health Plan Commercial |
$0.47
|
| Rate for Payer: Cigna of CA HMO |
$0.41
|
| Rate for Payer: Cigna of CA PPO |
$0.41
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$0.41
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.24
|
| Rate for Payer: EPIC Health Plan Senior |
$0.24
|
| Rate for Payer: Galaxy Health WC |
$0.50
|
| Rate for Payer: Global Benefits Group Commercial |
$0.35
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.53
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$0.37
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$0.35
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.12
|
| Rate for Payer: Multiplan Commercial |
$0.44
|
| Rate for Payer: Networks By Design Commercial |
$0.38
|
| Rate for Payer: Prime Health Services Commercial |
$0.50
|
|
|
FLUCONAZOLE 100 MG TABLET [10044]
|
Facility
|
OP
|
$1.79
|
|
|
Service Code
|
NDC 6800125204
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.36 |
| Max. Negotiated Rate |
$1.61 |
| Rate for Payer: Adventist Health Commercial |
$0.36
|
| Rate for Payer: Aetna of CA HMO/PPO |
$1.09
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1.52
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.98
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1.34
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$0.87
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1.04
|
| Rate for Payer: Blue Shield of California Commercial |
$1.13
|
| Rate for Payer: Blue Shield of California EPN |
$0.71
|
| Rate for Payer: Cash Price |
$0.81
|
| Rate for Payer: Central Health Plan Commercial |
$1.43
|
| Rate for Payer: Cigna of CA HMO |
$1.25
|
| Rate for Payer: Cigna of CA PPO |
$1.25
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1.52
|
| Rate for Payer: Dignity Health Medi-Cal |
$1.52
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1.52
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1.25
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.72
|
| Rate for Payer: EPIC Health Plan Senior |
$0.72
|
| Rate for Payer: Galaxy Health WC |
$1.52
|
| Rate for Payer: Global Benefits Group Commercial |
$1.07
|
| Rate for Payer: Health Management Network EPO/PPO |
$1.61
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1.14
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.65
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1.06
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.36
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$1.25
|
| Rate for Payer: Multiplan Commercial |
$1.34
|
| Rate for Payer: Networks By Design Commercial |
$1.16
|
| Rate for Payer: Prime Health Services Commercial |
$1.52
|
| Rate for Payer: Riverside University Health System MISP |
$0.72
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1.07
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1.07
|
| 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 |
$1.52
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1.52
|
| Rate for Payer: Vantage Medical Group Senior |
$1.52
|
|
|
FLUCONAZOLE 100 MG TABLET [10044]
|
Facility
|
IP
|
$0.60
|
|
|
Service Code
|
NDC 5723700430
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.12 |
| Max. Negotiated Rate |
$0.54 |
| Rate for Payer: Adventist Health Commercial |
$0.12
|
| Rate for Payer: Blue Shield of California Commercial |
$0.48
|
| Rate for Payer: Blue Shield of California EPN |
$0.30
|
| Rate for Payer: Cash Price |
$0.27
|
| Rate for Payer: Central Health Plan Commercial |
$0.48
|
| Rate for Payer: Cigna of CA HMO |
$0.42
|
| Rate for Payer: Cigna of CA PPO |
$0.42
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$0.42
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.24
|
| Rate for Payer: EPIC Health Plan Senior |
$0.24
|
| Rate for Payer: Galaxy Health WC |
$0.51
|
| Rate for Payer: Global Benefits Group Commercial |
$0.36
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.54
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$0.38
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$0.35
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.12
|
| Rate for Payer: Multiplan Commercial |
$0.45
|
| Rate for Payer: Networks By Design Commercial |
$0.39
|
| Rate for Payer: Prime Health Services Commercial |
$0.51
|
|
|
FLUCONAZOLE 100 MG TABLET [10044]
|
Facility
|
OP
|
$0.59
|
|
|
Service Code
|
NDC 7071011383
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.12 |
| Max. Negotiated Rate |
$0.53 |
| Rate for Payer: Adventist Health Commercial |
$0.12
|
| Rate for Payer: Aetna of CA HMO/PPO |
$0.36
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.50
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.32
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.44
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$0.29
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.34
|
| Rate for Payer: Blue Shield of California Commercial |
$0.37
|
| Rate for Payer: Blue Shield of California EPN |
$0.24
|
| Rate for Payer: Cash Price |
$0.27
|
| Rate for Payer: Central Health Plan Commercial |
$0.47
|
| Rate for Payer: Cigna of CA HMO |
$0.41
|
| Rate for Payer: Cigna of CA PPO |
$0.41
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.50
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.50
|
| Rate for Payer: Dignity Health Medicare Advantage |
$0.50
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$0.41
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.24
|
| Rate for Payer: EPIC Health Plan Senior |
$0.24
|
| Rate for Payer: Galaxy Health WC |
$0.50
|
| Rate for Payer: Global Benefits Group Commercial |
$0.35
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.53
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$0.37
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.21
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$0.35
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.12
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$0.41
|
| Rate for Payer: Multiplan Commercial |
$0.44
|
| Rate for Payer: Networks By Design Commercial |
$0.38
|
| Rate for Payer: Prime Health Services Commercial |
$0.50
|
| Rate for Payer: Riverside University Health System MISP |
$0.24
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.35
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.35
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.30
|
| Rate for Payer: United Healthcare All Other HMO |
$0.30
|
| Rate for Payer: United Healthcare HMO Rider |
$0.30
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.30
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.50
|
| Rate for Payer: Vantage Medical Group Senior |
$0.50
|
|
|
FLUCONAZOLE 100 MG TABLET [10044]
|
Facility
|
IP
|
$1.79
|
|
|
Service Code
|
NDC 6800125204
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.36 |
| Max. Negotiated Rate |
$1.61 |
| Rate for Payer: Adventist Health Commercial |
$0.36
|
| Rate for Payer: Blue Shield of California Commercial |
$1.44
|
| Rate for Payer: Blue Shield of California EPN |
$0.90
|
| Rate for Payer: Cash Price |
$0.81
|
| Rate for Payer: Central Health Plan Commercial |
$1.43
|
| Rate for Payer: Cigna of CA HMO |
$1.25
|
| Rate for Payer: Cigna of CA PPO |
$1.25
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1.25
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.72
|
| Rate for Payer: EPIC Health Plan Senior |
$0.72
|
| Rate for Payer: Galaxy Health WC |
$1.52
|
| Rate for Payer: Global Benefits Group Commercial |
$1.07
|
| Rate for Payer: Health Management Network EPO/PPO |
$1.61
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1.14
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1.06
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.36
|
| Rate for Payer: Multiplan Commercial |
$1.34
|
| Rate for Payer: Networks By Design Commercial |
$1.16
|
| Rate for Payer: Prime Health Services Commercial |
$1.52
|
|
|
FLUCONAZOLE 10 MG/ML ORAL SUSPENSION [14232]
|
Facility
|
OP
|
$0.69
|
|
|
Service Code
|
NDC 5723714935
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.14 |
| Max. Negotiated Rate |
$0.62 |
| Rate for Payer: Adventist Health Commercial |
$0.14
|
| Rate for Payer: Aetna of CA HMO/PPO |
$0.42
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.59
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.38
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.52
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$0.33
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.40
|
| Rate for Payer: Blue Shield of California Commercial |
$0.44
|
| Rate for Payer: Blue Shield of California EPN |
$0.28
|
| Rate for Payer: Cash Price |
$0.31
|
| Rate for Payer: Central Health Plan Commercial |
$0.55
|
| 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 Medi-Cal |
$0.59
|
| Rate for Payer: Dignity Health Medicare Advantage |
$0.59
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$0.48
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.28
|
| Rate for Payer: EPIC Health Plan Senior |
$0.28
|
| Rate for Payer: Galaxy Health WC |
$0.59
|
| Rate for Payer: Global Benefits Group Commercial |
$0.41
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.62
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$0.44
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.25
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$0.41
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.14
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$0.48
|
| Rate for Payer: Multiplan Commercial |
$0.52
|
| Rate for Payer: Networks By Design Commercial |
$0.45
|
| Rate for Payer: Prime Health Services Commercial |
$0.59
|
| Rate for Payer: Riverside University Health System MISP |
$0.28
|
| 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
|
|
|
FLUCONAZOLE 10 MG/ML ORAL SUSPENSION [14232]
|
Facility
|
IP
|
$0.69
|
|
|
Service Code
|
NDC 5723714935
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.14 |
| Max. Negotiated Rate |
$0.62 |
| Rate for Payer: Adventist Health Commercial |
$0.14
|
| Rate for Payer: Blue Shield of California Commercial |
$0.55
|
| Rate for Payer: Blue Shield of California EPN |
$0.35
|
| Rate for Payer: Cash Price |
$0.31
|
| Rate for Payer: Central Health Plan Commercial |
$0.55
|
| Rate for Payer: Cigna of CA HMO |
$0.48
|
| Rate for Payer: Cigna of CA PPO |
$0.48
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$0.48
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.28
|
| Rate for Payer: EPIC Health Plan Senior |
$0.28
|
| Rate for Payer: Galaxy Health WC |
$0.59
|
| Rate for Payer: Global Benefits Group Commercial |
$0.41
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.62
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$0.44
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$0.41
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.14
|
| Rate for Payer: Multiplan Commercial |
$0.52
|
| Rate for Payer: Networks By Design Commercial |
$0.45
|
| Rate for Payer: Prime Health Services Commercial |
$0.59
|
|
|
FLUCONAZOLE 150 MG TABLET [13577]
|
Facility
|
OP
|
$2.42
|
|
|
Service Code
|
NDC 6800125344
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.48 |
| Max. Negotiated Rate |
$2.18 |
| Rate for Payer: Adventist Health Commercial |
$0.48
|
| Rate for Payer: Aetna of CA HMO/PPO |
$1.47
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2.06
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1.33
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1.81
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1.17
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1.41
|
| Rate for Payer: Blue Shield of California Commercial |
$1.53
|
| Rate for Payer: Blue Shield of California EPN |
$0.97
|
| Rate for Payer: Cash Price |
$1.09
|
| Rate for Payer: Central Health Plan Commercial |
$1.94
|
| Rate for Payer: Cigna of CA HMO |
$1.69
|
| Rate for Payer: Cigna of CA PPO |
$1.69
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2.06
|
| Rate for Payer: Dignity Health Medi-Cal |
$2.06
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2.06
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1.69
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.97
|
| Rate for Payer: EPIC Health Plan Senior |
$0.97
|
| Rate for Payer: Galaxy Health WC |
$2.06
|
| Rate for Payer: Global Benefits Group Commercial |
$1.45
|
| Rate for Payer: Health Management Network EPO/PPO |
$2.18
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1.54
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.88
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1.43
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.48
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$1.69
|
| Rate for Payer: Multiplan Commercial |
$1.81
|
| Rate for Payer: Networks By Design Commercial |
$1.57
|
| Rate for Payer: Prime Health Services Commercial |
$2.06
|
| Rate for Payer: Riverside University Health System MISP |
$0.97
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1.45
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1.45
|
| Rate for Payer: United Healthcare All Other Commercial |
$1.21
|
| Rate for Payer: United Healthcare All Other HMO |
$1.21
|
| Rate for Payer: United Healthcare HMO Rider |
$1.21
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1.21
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2.06
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2.06
|
| Rate for Payer: Vantage Medical Group Senior |
$2.06
|
|
|
FLUCONAZOLE 150 MG TABLET [13577]
|
Facility
|
IP
|
$1.35
|
|
|
Service Code
|
NDC 5723700511
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.27 |
| Max. Negotiated Rate |
$1.22 |
| Rate for Payer: Adventist Health Commercial |
$0.27
|
| Rate for Payer: Blue Shield of California Commercial |
$1.08
|
| Rate for Payer: Blue Shield of California EPN |
$0.68
|
| Rate for Payer: Cash Price |
$0.61
|
| Rate for Payer: Central Health Plan Commercial |
$1.08
|
| Rate for Payer: Cigna of CA HMO |
$0.95
|
| Rate for Payer: Cigna of CA PPO |
$0.95
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$0.95
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.54
|
| Rate for Payer: EPIC Health Plan Senior |
$0.54
|
| Rate for Payer: Galaxy Health WC |
$1.15
|
| Rate for Payer: Global Benefits Group Commercial |
$0.81
|
| Rate for Payer: Health Management Network EPO/PPO |
$1.22
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$0.86
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$0.80
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.27
|
| Rate for Payer: Multiplan Commercial |
$1.01
|
| Rate for Payer: Networks By Design Commercial |
$0.88
|
| Rate for Payer: Prime Health Services Commercial |
$1.15
|
|
|
FLUCONAZOLE 150 MG TABLET [13577]
|
Facility
|
IP
|
$2.42
|
|
|
Service Code
|
NDC 6800125344
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.48 |
| Max. Negotiated Rate |
$2.18 |
| Rate for Payer: Adventist Health Commercial |
$0.48
|
| Rate for Payer: Blue Shield of California Commercial |
$1.94
|
| Rate for Payer: Blue Shield of California EPN |
$1.22
|
| Rate for Payer: Cash Price |
$1.09
|
| Rate for Payer: Central Health Plan Commercial |
$1.94
|
| Rate for Payer: Cigna of CA HMO |
$1.69
|
| Rate for Payer: Cigna of CA PPO |
$1.69
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1.69
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.97
|
| Rate for Payer: EPIC Health Plan Senior |
$0.97
|
| Rate for Payer: Galaxy Health WC |
$2.06
|
| Rate for Payer: Global Benefits Group Commercial |
$1.45
|
| Rate for Payer: Health Management Network EPO/PPO |
$2.18
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1.54
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1.43
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.48
|
| Rate for Payer: Multiplan Commercial |
$1.81
|
| Rate for Payer: Networks By Design Commercial |
$1.57
|
| Rate for Payer: Prime Health Services Commercial |
$2.06
|
|
|
FLUCONAZOLE 150 MG TABLET [13577]
|
Facility
|
OP
|
$1.35
|
|
|
Service Code
|
NDC 5723700511
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.27 |
| Max. Negotiated Rate |
$1.22 |
| Rate for Payer: Adventist Health Commercial |
$0.27
|
| Rate for Payer: Aetna of CA HMO/PPO |
$0.82
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1.15
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.74
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1.01
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$0.65
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.79
|
| Rate for Payer: Blue Shield of California Commercial |
$0.86
|
| Rate for Payer: Blue Shield of California EPN |
$0.54
|
| Rate for Payer: Cash Price |
$0.61
|
| Rate for Payer: Central Health Plan Commercial |
$1.08
|
| Rate for Payer: Cigna of CA HMO |
$0.95
|
| Rate for Payer: Cigna of CA PPO |
$0.95
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1.15
|
| Rate for Payer: Dignity Health Medi-Cal |
$1.15
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1.15
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$0.95
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.54
|
| Rate for Payer: EPIC Health Plan Senior |
$0.54
|
| Rate for Payer: Galaxy Health WC |
$1.15
|
| Rate for Payer: Global Benefits Group Commercial |
$0.81
|
| Rate for Payer: Health Management Network EPO/PPO |
$1.22
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$0.86
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.49
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$0.80
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.27
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$0.95
|
| Rate for Payer: Multiplan Commercial |
$1.01
|
| Rate for Payer: Networks By Design Commercial |
$0.88
|
| Rate for Payer: Prime Health Services Commercial |
$1.15
|
| Rate for Payer: Riverside University Health System MISP |
$0.54
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.81
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.81
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.68
|
| Rate for Payer: United Healthcare All Other HMO |
$0.68
|
| Rate for Payer: United Healthcare HMO Rider |
$0.68
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.68
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1.15
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1.15
|
| Rate for Payer: Vantage Medical Group Senior |
$1.15
|
|
|
FLUCONAZOLE 200 MG/100 ML IN SOD. CHLORIDE (ISO) INTRAVENOUS PIGGYBACK [10049]
|
Facility
|
IP
|
$0.22
|
|
|
Service Code
|
HCPCS J1450
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.04 |
| Max. Negotiated Rate |
$0.20 |
| Rate for Payer: Adventist Health Commercial |
$0.04
|
| Rate for Payer: Adventist Health Commercial |
$0.02
|
| Rate for Payer: Blue Shield of California Commercial |
$0.18
|
| Rate for Payer: Blue Shield of California Commercial |
$0.09
|
| Rate for Payer: Blue Shield of California EPN |
$0.06
|
| Rate for Payer: Blue Shield of California EPN |
$0.11
|
| Rate for Payer: Cash Price |
$0.10
|
| Rate for Payer: Cash Price |
$0.05
|
| Rate for Payer: Central Health Plan Commercial |
$0.18
|
| Rate for Payer: Central Health Plan Commercial |
$0.09
|
| Rate for Payer: Cigna of CA HMO |
$0.08
|
| Rate for Payer: Cigna of CA HMO |
$0.15
|
| Rate for Payer: Cigna of CA PPO |
$0.08
|
| Rate for Payer: Cigna of CA PPO |
$0.15
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$0.08
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$0.15
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.04
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.09
|
| Rate for Payer: EPIC Health Plan Senior |
$0.04
|
| Rate for Payer: EPIC Health Plan Senior |
$0.09
|
| Rate for Payer: Galaxy Health WC |
$0.19
|
| Rate for Payer: Galaxy Health WC |
$0.09
|
| Rate for Payer: Global Benefits Group Commercial |
$0.07
|
| Rate for Payer: Global Benefits Group Commercial |
$0.13
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.10
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.20
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$0.14
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$0.07
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$0.06
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$0.13
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.04
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.02
|
| Rate for Payer: Multiplan Commercial |
$0.08
|
| Rate for Payer: Multiplan Commercial |
$0.17
|
| Rate for Payer: Networks By Design Commercial |
$0.06
|
| Rate for Payer: Networks By Design Commercial |
$0.11
|
| Rate for Payer: Prime Health Services Commercial |
$0.19
|
| Rate for Payer: Prime Health Services Commercial |
$0.09
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.04
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.08
|
| Rate for Payer: United Healthcare All Other HMO |
$0.08
|
| Rate for Payer: United Healthcare All Other HMO |
$0.04
|
| Rate for Payer: United Healthcare HMO Rider |
$0.04
|
| Rate for Payer: United Healthcare HMO Rider |
$0.08
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.04
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.07
|
|
|
FLUCONAZOLE 200 MG/100 ML IN SOD. CHLORIDE (ISO) INTRAVENOUS PIGGYBACK [10049]
|
Facility
|
OP
|
$0.11
|
|
|
Service Code
|
HCPCS J1450
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.02 |
| Max. Negotiated Rate |
$200.90 |
| Rate for Payer: Adventist Health Commercial |
$0.02
|
| Rate for Payer: Adventist Health Commercial |
$0.04
|
| Rate for Payer: Aetna of CA HMO/PPO |
$22.15
|
| Rate for Payer: Aetna of CA HMO/PPO |
$22.15
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.09
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.19
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.12
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.06
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.17
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.08
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$160.99
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$160.99
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$200.90
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$200.90
|
| Rate for Payer: Blue Shield of California Commercial |
$9.90
|
| Rate for Payer: Blue Shield of California Commercial |
$9.90
|
| Rate for Payer: Blue Shield of California EPN |
$9.00
|
| Rate for Payer: Blue Shield of California EPN |
$9.00
|
| Rate for Payer: Cash Price |
$0.05
|
| Rate for Payer: Cash Price |
$0.10
|
| Rate for Payer: Cash Price |
$0.05
|
| Rate for Payer: Cash Price |
$0.10
|
| Rate for Payer: Central Health Plan Commercial |
$0.18
|
| Rate for Payer: Central Health Plan Commercial |
$0.09
|
| Rate for Payer: Cigna of CA HMO |
$0.08
|
| Rate for Payer: Cigna of CA HMO |
$0.15
|
| Rate for Payer: Cigna of CA PPO |
$0.08
|
| Rate for Payer: Cigna of CA PPO |
$0.15
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.19
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.09
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.09
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.19
|
| Rate for Payer: Dignity Health Medicare Advantage |
$0.19
|
| Rate for Payer: Dignity Health Medicare Advantage |
$0.09
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$0.08
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$0.15
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.09
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.04
|
| Rate for Payer: EPIC Health Plan Senior |
$0.09
|
| Rate for Payer: EPIC Health Plan Senior |
$0.04
|
| Rate for Payer: Galaxy Health WC |
$0.09
|
| Rate for Payer: Galaxy Health WC |
$0.19
|
| Rate for Payer: Global Benefits Group Commercial |
$0.13
|
| Rate for Payer: Global Benefits Group Commercial |
$0.07
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.10
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.20
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$6.11
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$6.11
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$0.14
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$0.07
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.04
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.08
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$0.13
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$0.06
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.04
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.02
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$0.15
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$0.08
|
| Rate for Payer: Multiplan Commercial |
$0.17
|
| Rate for Payer: Multiplan Commercial |
$0.08
|
| Rate for Payer: Networks By Design Commercial |
$0.11
|
| Rate for Payer: Networks By Design Commercial |
$0.06
|
| Rate for Payer: Prime Health Services Commercial |
$0.19
|
| Rate for Payer: Prime Health Services Commercial |
$0.09
|
| Rate for Payer: Riverside University Health System MISP |
$0.04
|
| Rate for Payer: Riverside University Health System MISP |
$0.09
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.13
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.07
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.13
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.07
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.04
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.08
|
| Rate for Payer: United Healthcare All Other HMO |
$0.08
|
| Rate for Payer: United Healthcare All Other HMO |
$0.04
|
| Rate for Payer: United Healthcare HMO Rider |
$0.08
|
| Rate for Payer: United Healthcare HMO Rider |
$0.04
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.07
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.04
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.09
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.19
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.09
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.19
|
| Rate for Payer: Vantage Medical Group Senior |
$0.19
|
| Rate for Payer: Vantage Medical Group Senior |
$0.09
|
|
|
FLUCONAZOLE 200 MG TABLET [10045]
|
Facility
|
IP
|
$3.23
|
|
|
Service Code
|
NDC 6808473511
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.65 |
| Max. Negotiated Rate |
$2.91 |
| Rate for Payer: Adventist Health Commercial |
$0.65
|
| Rate for Payer: Blue Shield of California Commercial |
$2.59
|
| Rate for Payer: Blue Shield of California EPN |
$1.63
|
| Rate for Payer: Cash Price |
$1.45
|
| Rate for Payer: Central Health Plan Commercial |
$2.58
|
| Rate for Payer: Cigna of CA HMO |
$2.26
|
| Rate for Payer: Cigna of CA PPO |
$2.26
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$2.26
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.29
|
| Rate for Payer: EPIC Health Plan Senior |
$1.29
|
| Rate for Payer: Galaxy Health WC |
$2.75
|
| Rate for Payer: Global Benefits Group Commercial |
$1.94
|
| Rate for Payer: Health Management Network EPO/PPO |
$2.91
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$2.05
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1.91
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.65
|
| Rate for Payer: Multiplan Commercial |
$2.42
|
| Rate for Payer: Networks By Design Commercial |
$2.10
|
| Rate for Payer: Prime Health Services Commercial |
$2.75
|
|
