|
FLUOCINOLONE 0.01 % TOPICAL CREAM [3183]
|
Facility
|
IP
|
$2.23
|
|
|
Service Code
|
NDC 0713022360
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.45 |
| Max. Negotiated Rate |
$2.01 |
| Rate for Payer: Adventist Health Commercial |
$0.45
|
| Rate for Payer: Blue Shield of California Commercial |
$1.79
|
| Rate for Payer: Blue Shield of California EPN |
$1.12
|
| Rate for Payer: Cash Price |
$1.00
|
| Rate for Payer: Central Health Plan Commercial |
$1.78
|
| Rate for Payer: Cigna of CA HMO |
$1.56
|
| Rate for Payer: Cigna of CA PPO |
$1.56
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1.56
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.89
|
| Rate for Payer: EPIC Health Plan Senior |
$0.89
|
| Rate for Payer: Galaxy Health WC |
$1.90
|
| Rate for Payer: Global Benefits Group Commercial |
$1.34
|
| Rate for Payer: Health Management Network EPO/PPO |
$2.01
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1.42
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1.32
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.45
|
| Rate for Payer: Multiplan Commercial |
$1.67
|
| Rate for Payer: Networks By Design Commercial |
$1.45
|
| Rate for Payer: Prime Health Services Commercial |
$1.90
|
|
|
FLUOCINOLONE 0.01 % TOPICAL CREAM [3183]
|
Facility
|
IP
|
$3.00
|
|
|
Service Code
|
NDC 0713022315
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.60 |
| Max. Negotiated Rate |
$2.70 |
| Rate for Payer: Adventist Health Commercial |
$0.60
|
| Rate for Payer: Blue Shield of California Commercial |
$2.41
|
| Rate for Payer: Blue Shield of California EPN |
$1.51
|
| Rate for Payer: Cash Price |
$1.35
|
| Rate for Payer: Central Health Plan Commercial |
$2.40
|
| Rate for Payer: Cigna of CA HMO |
$2.10
|
| Rate for Payer: Cigna of CA PPO |
$2.10
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$2.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.20
|
| Rate for Payer: EPIC Health Plan Senior |
$1.20
|
| Rate for Payer: Galaxy Health WC |
$2.55
|
| Rate for Payer: Global Benefits Group Commercial |
$1.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$2.70
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1.91
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1.77
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.60
|
| Rate for Payer: Multiplan Commercial |
$2.25
|
| Rate for Payer: Networks By Design Commercial |
$1.95
|
| Rate for Payer: Prime Health Services Commercial |
$2.55
|
|
|
FLUOCINOLONE 0.01 % TOPICAL CREAM [3183]
|
Facility
|
OP
|
$3.00
|
|
|
Service Code
|
NDC 0713022315
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.60 |
| Max. Negotiated Rate |
$2.70 |
| Rate for Payer: Adventist Health Commercial |
$0.60
|
| Rate for Payer: Aetna of CA HMO/PPO |
$1.82
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2.55
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1.65
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2.25
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1.45
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1.75
|
| Rate for Payer: Blue Shield of California Commercial |
$1.90
|
| Rate for Payer: Blue Shield of California EPN |
$1.20
|
| Rate for Payer: Cash Price |
$1.35
|
| Rate for Payer: Central Health Plan Commercial |
$2.40
|
| Rate for Payer: Cigna of CA HMO |
$2.10
|
| Rate for Payer: Cigna of CA PPO |
$2.10
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2.55
|
| Rate for Payer: Dignity Health Medi-Cal |
$2.55
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2.55
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$2.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.20
|
| Rate for Payer: EPIC Health Plan Senior |
$1.20
|
| Rate for Payer: Galaxy Health WC |
$2.55
|
| Rate for Payer: Global Benefits Group Commercial |
$1.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$2.70
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1.91
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1.09
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1.77
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$2.10
|
| Rate for Payer: Multiplan Commercial |
$2.25
|
| Rate for Payer: Networks By Design Commercial |
$1.95
|
| Rate for Payer: Prime Health Services Commercial |
$2.55
|
| Rate for Payer: Riverside University Health System MISP |
$1.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$1.50
|
| Rate for Payer: United Healthcare All Other HMO |
$1.50
|
| Rate for Payer: United Healthcare HMO Rider |
$1.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2.55
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2.55
|
| Rate for Payer: Vantage Medical Group Senior |
$2.55
|
|
|
FLUOCINOLONE 0.01 % TOPICAL CREAM [3183]
|
Facility
|
IP
|
$2.97
|
|
|
Service Code
|
NDC 5256503115
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.59 |
| Max. Negotiated Rate |
$2.67 |
| Rate for Payer: Adventist Health Commercial |
$0.59
|
| Rate for Payer: Blue Shield of California Commercial |
$2.38
|
| Rate for Payer: Blue Shield of California EPN |
$1.50
|
| Rate for Payer: Cash Price |
$1.34
|
| Rate for Payer: Central Health Plan Commercial |
$2.38
|
| Rate for Payer: Cigna of CA HMO |
$2.08
|
| Rate for Payer: Cigna of CA PPO |
$2.08
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$2.08
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.19
|
| Rate for Payer: EPIC Health Plan Senior |
$1.19
|
| Rate for Payer: Galaxy Health WC |
$2.52
|
| Rate for Payer: Global Benefits Group Commercial |
$1.78
|
| Rate for Payer: Health Management Network EPO/PPO |
$2.67
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1.89
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1.75
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.59
|
| Rate for Payer: Multiplan Commercial |
$2.23
|
| Rate for Payer: Networks By Design Commercial |
$1.93
|
| Rate for Payer: Prime Health Services Commercial |
$2.52
|
|
|
FLUOCINOLONE 0.01 % TOPICAL SOLUTION [3186]
|
Facility
|
OP
|
$1.60
|
|
|
Service Code
|
NDC 5256501259
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.32 |
| Max. Negotiated Rate |
$1.44 |
| 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 |
$1.36
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.88
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1.20
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$0.77
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.93
|
| Rate for Payer: Blue Shield of California Commercial |
$1.01
|
| Rate for Payer: Blue Shield of California EPN |
$0.64
|
| Rate for Payer: Cash Price |
$0.72
|
| Rate for Payer: Central Health Plan Commercial |
$1.28
|
| Rate for Payer: Cigna of CA HMO |
$1.12
|
| Rate for Payer: Cigna of CA PPO |
$1.12
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1.36
|
| Rate for Payer: Dignity Health Medi-Cal |
$1.36
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1.36
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1.12
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.64
|
| Rate for Payer: EPIC Health Plan Senior |
$0.64
|
| Rate for Payer: Galaxy Health WC |
$1.36
|
| Rate for Payer: Global Benefits Group Commercial |
$0.96
|
| Rate for Payer: Health Management Network EPO/PPO |
$1.44
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1.02
|
| 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 |
$1.12
|
| Rate for Payer: Multiplan Commercial |
$1.20
|
| Rate for Payer: Networks By Design Commercial |
$1.04
|
| Rate for Payer: Prime Health Services Commercial |
$1.36
|
| Rate for Payer: Riverside University Health System MISP |
$0.64
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.96
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.96
|
| 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 |
$1.36
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1.36
|
| Rate for Payer: Vantage Medical Group Senior |
$1.36
|
|
|
FLUOCINOLONE 0.01 % TOPICAL SOLUTION [3186]
|
Facility
|
IP
|
$1.60
|
|
|
Service Code
|
NDC 5256501259
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.32 |
| Max. Negotiated Rate |
$1.44 |
| 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 |
$0.81
|
| Rate for Payer: Cash Price |
$0.72
|
| Rate for Payer: Central Health Plan Commercial |
$1.28
|
| Rate for Payer: Cigna of CA HMO |
$1.12
|
| Rate for Payer: Cigna of CA PPO |
$1.12
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1.12
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.64
|
| Rate for Payer: EPIC Health Plan Senior |
$0.64
|
| Rate for Payer: Galaxy Health WC |
$1.36
|
| Rate for Payer: Global Benefits Group Commercial |
$0.96
|
| Rate for Payer: Health Management Network EPO/PPO |
$1.44
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1.02
|
| 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 |
$1.20
|
| Rate for Payer: Networks By Design Commercial |
$1.04
|
| Rate for Payer: Prime Health Services Commercial |
$1.36
|
|
|
FLUOCINOLONE 0.025 % TOPICAL OINTMENT [3185]
|
Facility
|
IP
|
$1.69
|
|
|
Service Code
|
NDC 0713022460
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.34 |
| Max. Negotiated Rate |
$1.52 |
| Rate for Payer: Adventist Health Commercial |
$0.34
|
| Rate for Payer: Blue Shield of California Commercial |
$1.36
|
| Rate for Payer: Blue Shield of California EPN |
$0.85
|
| Rate for Payer: Cash Price |
$0.76
|
| Rate for Payer: Central Health Plan Commercial |
$1.35
|
| Rate for Payer: Cigna of CA HMO |
$1.18
|
| Rate for Payer: Cigna of CA PPO |
$1.18
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1.18
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.68
|
| Rate for Payer: EPIC Health Plan Senior |
$0.68
|
| Rate for Payer: Galaxy Health WC |
$1.44
|
| Rate for Payer: Global Benefits Group Commercial |
$1.01
|
| Rate for Payer: Health Management Network EPO/PPO |
$1.52
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1.07
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.34
|
| Rate for Payer: Multiplan Commercial |
$1.27
|
| Rate for Payer: Networks By Design Commercial |
$1.10
|
| Rate for Payer: Prime Health Services Commercial |
$1.44
|
|
|
FLUOCINOLONE 0.025 % TOPICAL OINTMENT [3185]
|
Facility
|
IP
|
$2.25
|
|
|
Service Code
|
NDC 0168006415
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.45 |
| Max. Negotiated Rate |
$2.02 |
| Rate for Payer: Adventist Health Commercial |
$0.45
|
| Rate for Payer: Blue Shield of California Commercial |
$1.80
|
| Rate for Payer: Blue Shield of California EPN |
$1.13
|
| Rate for Payer: Cash Price |
$1.01
|
| Rate for Payer: Central Health Plan Commercial |
$1.80
|
| Rate for Payer: Cigna of CA HMO |
$1.57
|
| Rate for Payer: Cigna of CA PPO |
$1.57
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1.57
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.90
|
| Rate for Payer: EPIC Health Plan Senior |
$0.90
|
| Rate for Payer: Galaxy Health WC |
$1.91
|
| Rate for Payer: Global Benefits Group Commercial |
$1.35
|
| Rate for Payer: Health Management Network EPO/PPO |
$2.02
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1.43
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1.33
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.45
|
| Rate for Payer: Multiplan Commercial |
$1.69
|
| Rate for Payer: Networks By Design Commercial |
$1.46
|
| Rate for Payer: Prime Health Services Commercial |
$1.91
|
|
|
FLUOCINOLONE 0.025 % TOPICAL OINTMENT [3185]
|
Facility
|
IP
|
$2.26
|
|
|
Service Code
|
NDC 0713022415
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.45 |
| Max. Negotiated Rate |
$2.03 |
| Rate for Payer: Adventist Health Commercial |
$0.45
|
| Rate for Payer: Blue Shield of California Commercial |
$1.81
|
| Rate for Payer: Blue Shield of California EPN |
$1.14
|
| Rate for Payer: Cash Price |
$1.02
|
| Rate for Payer: Central Health Plan Commercial |
$1.81
|
| Rate for Payer: Cigna of CA HMO |
$1.58
|
| Rate for Payer: Cigna of CA PPO |
$1.58
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1.58
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.90
|
| Rate for Payer: EPIC Health Plan Senior |
$0.90
|
| Rate for Payer: Galaxy Health WC |
$1.92
|
| Rate for Payer: Global Benefits Group Commercial |
$1.36
|
| Rate for Payer: Health Management Network EPO/PPO |
$2.03
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1.44
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1.33
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.45
|
| Rate for Payer: Multiplan Commercial |
$1.70
|
| Rate for Payer: Networks By Design Commercial |
$1.47
|
| Rate for Payer: Prime Health Services Commercial |
$1.92
|
|
|
FLUOCINOLONE 0.025 % TOPICAL OINTMENT [3185]
|
Facility
|
OP
|
$2.26
|
|
|
Service Code
|
NDC 0713022415
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.45 |
| Max. Negotiated Rate |
$2.03 |
| Rate for Payer: Adventist Health Commercial |
$0.45
|
| Rate for Payer: Aetna of CA HMO/PPO |
$1.37
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1.92
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1.24
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1.70
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1.09
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1.31
|
| Rate for Payer: Blue Shield of California Commercial |
$1.43
|
| Rate for Payer: Blue Shield of California EPN |
$0.90
|
| Rate for Payer: Cash Price |
$1.02
|
| Rate for Payer: Central Health Plan Commercial |
$1.81
|
| Rate for Payer: Cigna of CA HMO |
$1.58
|
| Rate for Payer: Cigna of CA PPO |
$1.58
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1.92
|
| Rate for Payer: Dignity Health Medi-Cal |
$1.92
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1.92
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1.58
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.90
|
| Rate for Payer: EPIC Health Plan Senior |
$0.90
|
| Rate for Payer: Galaxy Health WC |
$1.92
|
| Rate for Payer: Global Benefits Group Commercial |
$1.36
|
| Rate for Payer: Health Management Network EPO/PPO |
$2.03
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1.44
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.82
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1.33
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.45
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$1.58
|
| Rate for Payer: Multiplan Commercial |
$1.70
|
| Rate for Payer: Networks By Design Commercial |
$1.47
|
| Rate for Payer: Prime Health Services Commercial |
$1.92
|
| Rate for Payer: Riverside University Health System MISP |
$0.90
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1.36
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1.36
|
| Rate for Payer: United Healthcare All Other Commercial |
$1.13
|
| Rate for Payer: United Healthcare All Other HMO |
$1.13
|
| Rate for Payer: United Healthcare HMO Rider |
$1.13
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1.13
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1.92
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1.92
|
| Rate for Payer: Vantage Medical Group Senior |
$1.92
|
|
|
FLUOCINOLONE 0.025 % TOPICAL OINTMENT [3185]
|
Facility
|
OP
|
$2.25
|
|
|
Service Code
|
NDC 0168006415
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.45 |
| Max. Negotiated Rate |
$2.02 |
| Rate for Payer: Adventist Health Commercial |
$0.45
|
| Rate for Payer: Aetna of CA HMO/PPO |
$1.37
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1.91
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1.24
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1.69
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1.09
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1.31
|
| Rate for Payer: Blue Shield of California Commercial |
$1.43
|
| Rate for Payer: Blue Shield of California EPN |
$0.90
|
| Rate for Payer: Cash Price |
$1.01
|
| Rate for Payer: Central Health Plan Commercial |
$1.80
|
| Rate for Payer: Cigna of CA HMO |
$1.57
|
| Rate for Payer: Cigna of CA PPO |
$1.57
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1.91
|
| Rate for Payer: Dignity Health Medi-Cal |
$1.91
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1.91
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1.57
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.90
|
| Rate for Payer: EPIC Health Plan Senior |
$0.90
|
| Rate for Payer: Galaxy Health WC |
$1.91
|
| Rate for Payer: Global Benefits Group Commercial |
$1.35
|
| Rate for Payer: Health Management Network EPO/PPO |
$2.02
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1.43
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.82
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1.33
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.45
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$1.57
|
| Rate for Payer: Multiplan Commercial |
$1.69
|
| Rate for Payer: Networks By Design Commercial |
$1.46
|
| Rate for Payer: Prime Health Services Commercial |
$1.91
|
| Rate for Payer: Riverside University Health System MISP |
$0.90
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1.35
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1.35
|
| Rate for Payer: United Healthcare All Other Commercial |
$1.12
|
| Rate for Payer: United Healthcare All Other HMO |
$1.12
|
| Rate for Payer: United Healthcare HMO Rider |
$1.12
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1.12
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1.91
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1.91
|
| Rate for Payer: Vantage Medical Group Senior |
$1.91
|
|
|
FLUOCINOLONE 0.025 % TOPICAL OINTMENT [3185]
|
Facility
|
OP
|
$1.69
|
|
|
Service Code
|
NDC 0713022460
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.34 |
| Max. Negotiated Rate |
$1.52 |
| Rate for Payer: Adventist Health Commercial |
$0.34
|
| Rate for Payer: Aetna of CA HMO/PPO |
$1.03
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1.44
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.93
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1.27
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$0.82
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.98
|
| Rate for Payer: Blue Shield of California Commercial |
$1.07
|
| Rate for Payer: Blue Shield of California EPN |
$0.67
|
| Rate for Payer: Cash Price |
$0.76
|
| Rate for Payer: Central Health Plan Commercial |
$1.35
|
| Rate for Payer: Cigna of CA HMO |
$1.18
|
| Rate for Payer: Cigna of CA PPO |
$1.18
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1.44
|
| Rate for Payer: Dignity Health Medi-Cal |
$1.44
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1.44
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1.18
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.68
|
| Rate for Payer: EPIC Health Plan Senior |
$0.68
|
| Rate for Payer: Galaxy Health WC |
$1.44
|
| Rate for Payer: Global Benefits Group Commercial |
$1.01
|
| Rate for Payer: Health Management Network EPO/PPO |
$1.52
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1.07
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.61
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.34
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$1.18
|
| Rate for Payer: Multiplan Commercial |
$1.27
|
| Rate for Payer: Networks By Design Commercial |
$1.10
|
| Rate for Payer: Prime Health Services Commercial |
$1.44
|
| Rate for Payer: Riverside University Health System MISP |
$0.68
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1.01
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1.01
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.85
|
| Rate for Payer: United Healthcare All Other HMO |
$0.85
|
| Rate for Payer: United Healthcare HMO Rider |
$0.85
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.85
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1.44
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1.44
|
| Rate for Payer: Vantage Medical Group Senior |
$1.44
|
|
|
FLUOCINOLONE 0.18 MG INTRAVITREAL IMPLANT [223628]
|
Facility
|
IP
|
$11,121.60
|
|
|
Service Code
|
HCPCS J7314
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$2,224.32 |
| Max. Negotiated Rate |
$10,009.44 |
| Rate for Payer: Adventist Health Commercial |
$2,224.32
|
| Rate for Payer: Blue Shield of California Commercial |
$8,919.52
|
| Rate for Payer: Blue Shield of California EPN |
$5,605.29
|
| Rate for Payer: Cash Price |
$5,004.72
|
| Rate for Payer: Central Health Plan Commercial |
$8,897.28
|
| Rate for Payer: Cigna of CA HMO |
$7,785.12
|
| Rate for Payer: Cigna of CA PPO |
$7,785.12
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$7,785.12
|
| Rate for Payer: EPIC Health Plan Commercial |
$4,448.64
|
| Rate for Payer: EPIC Health Plan Senior |
$4,448.64
|
| Rate for Payer: Galaxy Health WC |
$9,453.36
|
| Rate for Payer: Global Benefits Group Commercial |
$6,672.96
|
| Rate for Payer: Health Management Network EPO/PPO |
$10,009.44
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$7,062.22
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$6,561.74
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,224.32
|
| Rate for Payer: Multiplan Commercial |
$8,341.20
|
| Rate for Payer: Networks By Design Commercial |
$5,560.80
|
| Rate for Payer: Prime Health Services Commercial |
$9,453.36
|
| Rate for Payer: United Healthcare All Other Commercial |
$4,173.94
|
| Rate for Payer: United Healthcare All Other HMO |
$4,062.72
|
| Rate for Payer: United Healthcare HMO Rider |
$3,974.86
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3,642.32
|
|
|
FLUOCINOLONE 0.18 MG INTRAVITREAL IMPLANT [223628]
|
Facility
|
OP
|
$11,121.60
|
|
|
Service Code
|
HCPCS J7314
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$529.89 |
| Max. Negotiated Rate |
$10,009.44 |
| Rate for Payer: Adventist Health Commercial |
$2,224.32
|
| Rate for Payer: Adventist Health Medi-Cal |
$529.89
|
| Rate for Payer: Aetna of CA HMO/PPO |
$3,250.76
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$794.84
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$582.88
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$529.89
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$947.66
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,182.60
|
| Rate for Payer: Blue Shield of California Commercial |
$659.70
|
| Rate for Payer: Blue Shield of California EPN |
$599.73
|
| Rate for Payer: Cash Price |
$5,004.72
|
| Rate for Payer: Cash Price |
$5,004.72
|
| Rate for Payer: Central Health Plan Commercial |
$8,897.28
|
| Rate for Payer: Cigna of CA HMO |
$7,785.12
|
| Rate for Payer: Cigna of CA PPO |
$7,785.12
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$662.36
|
| Rate for Payer: Dignity Health Medi-Cal |
$582.88
|
| Rate for Payer: Dignity Health Medicare Advantage |
$582.88
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$7,785.12
|
| Rate for Payer: EPIC Health Plan Commercial |
$874.32
|
| Rate for Payer: EPIC Health Plan Senior |
$582.88
|
| Rate for Payer: Galaxy Health WC |
$9,453.36
|
| Rate for Payer: Global Benefits Group Commercial |
$6,672.96
|
| Rate for Payer: Health Management Network EPO/PPO |
$10,009.44
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$869.02
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$911.41
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$529.89
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$7,062.22
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1,006.79
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$741.85
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,224.32
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$710.05
|
| Rate for Payer: Multiplan Commercial |
$8,341.20
|
| Rate for Payer: Networks By Design Commercial |
$5,560.80
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$529.89
|
| Rate for Payer: Prime Health Services Commercial |
$9,453.36
|
| Rate for Payer: Prime Health Services Medicare |
$561.68
|
| Rate for Payer: Riverside University Health System MISP |
$582.88
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$6,672.96
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$6,672.96
|
| Rate for Payer: United Healthcare All Other Commercial |
$4,173.94
|
| Rate for Payer: United Healthcare All Other HMO |
$4,062.72
|
| Rate for Payer: United Healthcare HMO Rider |
$3,974.86
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3,642.32
|
| Rate for Payer: Upland Medical Group Pediatric |
$529.89
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$662.36
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$582.88
|
| Rate for Payer: Vantage Medical Group Senior |
$582.88
|
|
|
FLUOCINOLONE 0.19 MG INTRAVITREAL IMPLANT [208310]
|
Facility
|
OP
|
$11,211.60
|
|
|
Service Code
|
HCPCS J7313
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$516.41 |
| Max. Negotiated Rate |
$10,090.44 |
| Rate for Payer: Adventist Health Commercial |
$2,242.32
|
| Rate for Payer: Adventist Health Medi-Cal |
$516.41
|
| Rate for Payer: Aetna of CA HMO/PPO |
$3,041.28
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$774.62
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$568.05
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$516.41
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$916.65
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,143.90
|
| Rate for Payer: Blue Shield of California Commercial |
$618.32
|
| Rate for Payer: Blue Shield of California EPN |
$562.11
|
| Rate for Payer: Cash Price |
$5,045.22
|
| Rate for Payer: Cash Price |
$5,045.22
|
| Rate for Payer: Central Health Plan Commercial |
$8,969.28
|
| Rate for Payer: Cigna of CA HMO |
$7,848.12
|
| Rate for Payer: Cigna of CA PPO |
$7,848.12
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$645.51
|
| Rate for Payer: Dignity Health Medi-Cal |
$568.05
|
| Rate for Payer: Dignity Health Medicare Advantage |
$568.05
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$7,848.12
|
| Rate for Payer: EPIC Health Plan Commercial |
$852.08
|
| Rate for Payer: EPIC Health Plan Senior |
$568.05
|
| Rate for Payer: Galaxy Health WC |
$9,529.86
|
| Rate for Payer: Global Benefits Group Commercial |
$6,726.96
|
| Rate for Payer: Health Management Network EPO/PPO |
$10,090.44
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$846.91
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$516.41
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$516.41
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$7,119.37
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$964.14
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$722.97
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,242.32
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$691.99
|
| Rate for Payer: Multiplan Commercial |
$8,408.70
|
| Rate for Payer: Networks By Design Commercial |
$5,605.80
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$516.41
|
| Rate for Payer: Prime Health Services Commercial |
$9,529.86
|
| Rate for Payer: Prime Health Services Medicare |
$547.39
|
| Rate for Payer: Riverside University Health System MISP |
$568.05
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$6,726.96
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$6,726.96
|
| Rate for Payer: United Healthcare All Other Commercial |
$4,207.71
|
| Rate for Payer: United Healthcare All Other HMO |
$4,095.60
|
| Rate for Payer: United Healthcare HMO Rider |
$4,007.03
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3,671.80
|
| Rate for Payer: Upland Medical Group Pediatric |
$516.41
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$645.51
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$568.05
|
| Rate for Payer: Vantage Medical Group Senior |
$568.05
|
|
|
FLUOCINOLONE 0.19 MG INTRAVITREAL IMPLANT [208310]
|
Facility
|
IP
|
$11,211.60
|
|
|
Service Code
|
HCPCS J7313
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$2,242.32 |
| Max. Negotiated Rate |
$10,090.44 |
| Rate for Payer: Adventist Health Commercial |
$2,242.32
|
| Rate for Payer: Blue Shield of California Commercial |
$8,991.70
|
| Rate for Payer: Blue Shield of California EPN |
$5,650.65
|
| Rate for Payer: Cash Price |
$5,045.22
|
| Rate for Payer: Central Health Plan Commercial |
$8,969.28
|
| Rate for Payer: Cigna of CA HMO |
$7,848.12
|
| Rate for Payer: Cigna of CA PPO |
$7,848.12
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$7,848.12
|
| Rate for Payer: EPIC Health Plan Commercial |
$4,484.64
|
| Rate for Payer: EPIC Health Plan Senior |
$4,484.64
|
| Rate for Payer: Galaxy Health WC |
$9,529.86
|
| Rate for Payer: Global Benefits Group Commercial |
$6,726.96
|
| Rate for Payer: Health Management Network EPO/PPO |
$10,090.44
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$7,119.37
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$6,614.84
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,242.32
|
| Rate for Payer: Multiplan Commercial |
$8,408.70
|
| Rate for Payer: Networks By Design Commercial |
$5,605.80
|
| Rate for Payer: Prime Health Services Commercial |
$9,529.86
|
| Rate for Payer: United Healthcare All Other Commercial |
$4,207.71
|
| Rate for Payer: United Healthcare All Other HMO |
$4,095.60
|
| Rate for Payer: United Healthcare HMO Rider |
$4,007.03
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3,671.80
|
|
|
FLUOCINONIDE 0.05 % TOPICAL CREAM [3187]
|
Facility
|
OP
|
$2.92
|
|
|
Service Code
|
NDC 0093026215
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.58 |
| Max. Negotiated Rate |
$2.63 |
| Rate for Payer: Adventist Health Commercial |
$0.58
|
| Rate for Payer: Aetna of CA HMO/PPO |
$1.77
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2.48
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1.61
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2.19
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1.41
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1.70
|
| Rate for Payer: Blue Shield of California Commercial |
$1.85
|
| Rate for Payer: Blue Shield of California EPN |
$1.17
|
| Rate for Payer: Cash Price |
$1.31
|
| Rate for Payer: Central Health Plan Commercial |
$2.34
|
| Rate for Payer: Cigna of CA HMO |
$2.04
|
| Rate for Payer: Cigna of CA PPO |
$2.04
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2.48
|
| Rate for Payer: Dignity Health Medi-Cal |
$2.48
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2.48
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$2.04
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.17
|
| Rate for Payer: EPIC Health Plan Senior |
$1.17
|
| Rate for Payer: Galaxy Health WC |
$2.48
|
| Rate for Payer: Global Benefits Group Commercial |
$1.75
|
| Rate for Payer: Health Management Network EPO/PPO |
$2.63
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1.85
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1.06
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1.72
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.58
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$2.04
|
| Rate for Payer: Multiplan Commercial |
$2.19
|
| Rate for Payer: Networks By Design Commercial |
$1.90
|
| Rate for Payer: Prime Health Services Commercial |
$2.48
|
| Rate for Payer: Riverside University Health System MISP |
$1.17
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1.75
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1.75
|
| Rate for Payer: United Healthcare All Other Commercial |
$1.46
|
| Rate for Payer: United Healthcare All Other HMO |
$1.46
|
| Rate for Payer: United Healthcare HMO Rider |
$1.46
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1.46
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2.48
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2.48
|
| Rate for Payer: Vantage Medical Group Senior |
$2.48
|
|
|
FLUOCINONIDE 0.05 % TOPICAL CREAM [3187]
|
Facility
|
OP
|
$2.92
|
|
|
Service Code
|
NDC 5186249415
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.58 |
| Max. Negotiated Rate |
$2.63 |
| Rate for Payer: Adventist Health Commercial |
$0.58
|
| Rate for Payer: Aetna of CA HMO/PPO |
$1.77
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2.48
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1.61
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2.19
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1.41
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1.70
|
| Rate for Payer: Blue Shield of California Commercial |
$1.85
|
| Rate for Payer: Blue Shield of California EPN |
$1.17
|
| Rate for Payer: Cash Price |
$1.31
|
| Rate for Payer: Central Health Plan Commercial |
$2.34
|
| Rate for Payer: Cigna of CA HMO |
$2.04
|
| Rate for Payer: Cigna of CA PPO |
$2.04
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2.48
|
| Rate for Payer: Dignity Health Medi-Cal |
$2.48
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2.48
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$2.04
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.17
|
| Rate for Payer: EPIC Health Plan Senior |
$1.17
|
| Rate for Payer: Galaxy Health WC |
$2.48
|
| Rate for Payer: Global Benefits Group Commercial |
$1.75
|
| Rate for Payer: Health Management Network EPO/PPO |
$2.63
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1.85
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1.06
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1.72
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.58
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$2.04
|
| Rate for Payer: Multiplan Commercial |
$2.19
|
| Rate for Payer: Networks By Design Commercial |
$1.90
|
| Rate for Payer: Prime Health Services Commercial |
$2.48
|
| Rate for Payer: Riverside University Health System MISP |
$1.17
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1.75
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1.75
|
| Rate for Payer: United Healthcare All Other Commercial |
$1.46
|
| Rate for Payer: United Healthcare All Other HMO |
$1.46
|
| Rate for Payer: United Healthcare HMO Rider |
$1.46
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1.46
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2.48
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2.48
|
| Rate for Payer: Vantage Medical Group Senior |
$2.48
|
|
|
FLUOCINONIDE 0.05 % TOPICAL CREAM [3187]
|
Facility
|
IP
|
$1.20
|
|
|
Service Code
|
NDC 5167213861
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.24 |
| Max. Negotiated Rate |
$1.08 |
| Rate for Payer: Adventist Health Commercial |
$0.24
|
| Rate for Payer: Blue Shield of California Commercial |
$0.96
|
| Rate for Payer: Blue Shield of California EPN |
$0.60
|
| Rate for Payer: Cash Price |
$0.54
|
| Rate for Payer: Central Health Plan Commercial |
$0.96
|
| Rate for Payer: Cigna of CA HMO |
$0.84
|
| Rate for Payer: Cigna of CA PPO |
$0.84
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$0.84
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.48
|
| Rate for Payer: EPIC Health Plan Senior |
$0.48
|
| Rate for Payer: Galaxy Health WC |
$1.02
|
| Rate for Payer: Global Benefits Group Commercial |
$0.72
|
| Rate for Payer: Health Management Network EPO/PPO |
$1.08
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$0.76
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$0.71
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.24
|
| Rate for Payer: Multiplan Commercial |
$0.90
|
| Rate for Payer: Networks By Design Commercial |
$0.78
|
| Rate for Payer: Prime Health Services Commercial |
$1.02
|
|
|
FLUOCINONIDE 0.05 % TOPICAL CREAM [3187]
|
Facility
|
OP
|
$1.20
|
|
|
Service Code
|
NDC 5167213861
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.24 |
| Max. Negotiated Rate |
$1.08 |
| Rate for Payer: Adventist Health Commercial |
$0.24
|
| Rate for Payer: Aetna of CA HMO/PPO |
$0.73
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1.02
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.66
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.90
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$0.58
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.70
|
| Rate for Payer: Blue Shield of California Commercial |
$0.76
|
| Rate for Payer: Blue Shield of California EPN |
$0.48
|
| Rate for Payer: Cash Price |
$0.54
|
| Rate for Payer: Central Health Plan Commercial |
$0.96
|
| Rate for Payer: Cigna of CA HMO |
$0.84
|
| Rate for Payer: Cigna of CA PPO |
$0.84
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1.02
|
| Rate for Payer: Dignity Health Medi-Cal |
$1.02
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1.02
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$0.84
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.48
|
| Rate for Payer: EPIC Health Plan Senior |
$0.48
|
| Rate for Payer: Galaxy Health WC |
$1.02
|
| Rate for Payer: Global Benefits Group Commercial |
$0.72
|
| Rate for Payer: Health Management Network EPO/PPO |
$1.08
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$0.76
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.44
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$0.71
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.24
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$0.84
|
| Rate for Payer: Multiplan Commercial |
$0.90
|
| Rate for Payer: Networks By Design Commercial |
$0.78
|
| Rate for Payer: Prime Health Services Commercial |
$1.02
|
| Rate for Payer: Riverside University Health System MISP |
$0.48
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.72
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.72
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.60
|
| Rate for Payer: United Healthcare All Other HMO |
$0.60
|
| Rate for Payer: United Healthcare HMO Rider |
$0.60
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.60
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1.02
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1.02
|
| Rate for Payer: Vantage Medical Group Senior |
$1.02
|
|
|
FLUOCINONIDE 0.05 % TOPICAL CREAM [3187]
|
Facility
|
IP
|
$2.92
|
|
|
Service Code
|
NDC 5186249415
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.58 |
| Max. Negotiated Rate |
$2.63 |
| Rate for Payer: Adventist Health Commercial |
$0.58
|
| Rate for Payer: Blue Shield of California Commercial |
$2.34
|
| Rate for Payer: Blue Shield of California EPN |
$1.47
|
| Rate for Payer: Cash Price |
$1.31
|
| Rate for Payer: Central Health Plan Commercial |
$2.34
|
| Rate for Payer: Cigna of CA HMO |
$2.04
|
| Rate for Payer: Cigna of CA PPO |
$2.04
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$2.04
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.17
|
| Rate for Payer: EPIC Health Plan Senior |
$1.17
|
| Rate for Payer: Galaxy Health WC |
$2.48
|
| Rate for Payer: Global Benefits Group Commercial |
$1.75
|
| Rate for Payer: Health Management Network EPO/PPO |
$2.63
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1.85
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1.72
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.58
|
| Rate for Payer: Multiplan Commercial |
$2.19
|
| Rate for Payer: Networks By Design Commercial |
$1.90
|
| Rate for Payer: Prime Health Services Commercial |
$2.48
|
|
|
FLUOCINONIDE 0.05 % TOPICAL CREAM [3187]
|
Facility
|
IP
|
$2.92
|
|
|
Service Code
|
NDC 0093026215
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.58 |
| Max. Negotiated Rate |
$2.63 |
| Rate for Payer: Adventist Health Commercial |
$0.58
|
| Rate for Payer: Blue Shield of California Commercial |
$2.34
|
| Rate for Payer: Blue Shield of California EPN |
$1.47
|
| Rate for Payer: Cash Price |
$1.31
|
| Rate for Payer: Central Health Plan Commercial |
$2.34
|
| Rate for Payer: Cigna of CA HMO |
$2.04
|
| Rate for Payer: Cigna of CA PPO |
$2.04
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$2.04
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.17
|
| Rate for Payer: EPIC Health Plan Senior |
$1.17
|
| Rate for Payer: Galaxy Health WC |
$2.48
|
| Rate for Payer: Global Benefits Group Commercial |
$1.75
|
| Rate for Payer: Health Management Network EPO/PPO |
$2.63
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1.85
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1.72
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.58
|
| Rate for Payer: Multiplan Commercial |
$2.19
|
| Rate for Payer: Networks By Design Commercial |
$1.90
|
| Rate for Payer: Prime Health Services Commercial |
$2.48
|
|
|
FLUOCINONIDE 0.05 % TOPICAL CREAM. [4083187]
|
Facility
|
OP
|
$3.08
|
|
|
Service Code
|
NDC 5167212541
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.62 |
| Max. Negotiated Rate |
$2.77 |
| Rate for Payer: Adventist Health Commercial |
$0.62
|
| Rate for Payer: Aetna of CA HMO/PPO |
$1.87
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2.62
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1.69
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2.31
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1.49
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1.79
|
| Rate for Payer: Blue Shield of California Commercial |
$1.95
|
| Rate for Payer: Blue Shield of California EPN |
$1.23
|
| Rate for Payer: Cash Price |
$1.39
|
| Rate for Payer: Central Health Plan Commercial |
$2.46
|
| Rate for Payer: Cigna of CA HMO |
$2.16
|
| Rate for Payer: Cigna of CA PPO |
$2.16
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2.62
|
| Rate for Payer: Dignity Health Medi-Cal |
$2.62
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2.62
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$2.16
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.23
|
| Rate for Payer: EPIC Health Plan Senior |
$1.23
|
| Rate for Payer: Galaxy Health WC |
$2.62
|
| Rate for Payer: Global Benefits Group Commercial |
$1.85
|
| Rate for Payer: Health Management Network EPO/PPO |
$2.77
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1.96
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1.12
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1.82
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.62
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$2.16
|
| Rate for Payer: Multiplan Commercial |
$2.31
|
| Rate for Payer: Networks By Design Commercial |
$2.00
|
| Rate for Payer: Prime Health Services Commercial |
$2.62
|
| Rate for Payer: Riverside University Health System MISP |
$1.23
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1.85
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1.85
|
| Rate for Payer: United Healthcare All Other Commercial |
$1.54
|
| Rate for Payer: United Healthcare All Other HMO |
$1.54
|
| Rate for Payer: United Healthcare HMO Rider |
$1.54
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1.54
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2.62
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2.62
|
| Rate for Payer: Vantage Medical Group Senior |
$2.62
|
|
|
FLUOCINONIDE 0.05 % TOPICAL CREAM. [4083187]
|
Facility
|
OP
|
$2.92
|
|
|
Service Code
|
NDC 0093026230
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.58 |
| Max. Negotiated Rate |
$2.63 |
| Rate for Payer: Adventist Health Commercial |
$0.58
|
| Rate for Payer: Aetna of CA HMO/PPO |
$1.77
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2.48
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1.61
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2.19
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1.41
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1.70
|
| Rate for Payer: Blue Shield of California Commercial |
$1.85
|
| Rate for Payer: Blue Shield of California EPN |
$1.17
|
| Rate for Payer: Cash Price |
$1.31
|
| Rate for Payer: Central Health Plan Commercial |
$2.34
|
| Rate for Payer: Cigna of CA HMO |
$2.04
|
| Rate for Payer: Cigna of CA PPO |
$2.04
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2.48
|
| Rate for Payer: Dignity Health Medi-Cal |
$2.48
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2.48
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$2.04
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.17
|
| Rate for Payer: EPIC Health Plan Senior |
$1.17
|
| Rate for Payer: Galaxy Health WC |
$2.48
|
| Rate for Payer: Global Benefits Group Commercial |
$1.75
|
| Rate for Payer: Health Management Network EPO/PPO |
$2.63
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1.85
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1.06
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1.72
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.58
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$2.04
|
| Rate for Payer: Multiplan Commercial |
$2.19
|
| Rate for Payer: Networks By Design Commercial |
$1.90
|
| Rate for Payer: Prime Health Services Commercial |
$2.48
|
| Rate for Payer: Riverside University Health System MISP |
$1.17
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1.75
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1.75
|
| Rate for Payer: United Healthcare All Other Commercial |
$1.46
|
| Rate for Payer: United Healthcare All Other HMO |
$1.46
|
| Rate for Payer: United Healthcare HMO Rider |
$1.46
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1.46
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2.48
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2.48
|
| Rate for Payer: Vantage Medical Group Senior |
$2.48
|
|
|
FLUOCINONIDE 0.05 % TOPICAL CREAM. [4083187]
|
Facility
|
IP
|
$3.08
|
|
|
Service Code
|
NDC 5167212541
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.62 |
| Max. Negotiated Rate |
$2.77 |
| Rate for Payer: Adventist Health Commercial |
$0.62
|
| Rate for Payer: Blue Shield of California Commercial |
$2.47
|
| Rate for Payer: Blue Shield of California EPN |
$1.55
|
| Rate for Payer: Cash Price |
$1.39
|
| Rate for Payer: Central Health Plan Commercial |
$2.46
|
| Rate for Payer: Cigna of CA HMO |
$2.16
|
| Rate for Payer: Cigna of CA PPO |
$2.16
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$2.16
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.23
|
| Rate for Payer: EPIC Health Plan Senior |
$1.23
|
| Rate for Payer: Galaxy Health WC |
$2.62
|
| Rate for Payer: Global Benefits Group Commercial |
$1.85
|
| Rate for Payer: Health Management Network EPO/PPO |
$2.77
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1.96
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1.82
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.62
|
| Rate for Payer: Multiplan Commercial |
$2.31
|
| Rate for Payer: Networks By Design Commercial |
$2.00
|
| Rate for Payer: Prime Health Services Commercial |
$2.62
|
|
