|
FLUOXETINE 20 MG CAPSULE [10070]
|
Facility
|
IP
|
$0.07
|
|
|
Service Code
|
NDC 5011164801
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.01 |
| Max. Negotiated Rate |
$0.06 |
| Rate for Payer: Adventist Health Commercial |
$0.01
|
| Rate for Payer: Blue Shield of California Commercial |
$0.06
|
| Rate for Payer: Blue Shield of California EPN |
$0.04
|
| Rate for Payer: Cash Price |
$0.03
|
| Rate for Payer: Central Health Plan Commercial |
$0.06
|
| Rate for Payer: Cigna of CA HMO |
$0.05
|
| Rate for Payer: Cigna of CA PPO |
$0.05
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$0.05
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.03
|
| Rate for Payer: EPIC Health Plan Senior |
$0.03
|
| Rate for Payer: Galaxy Health WC |
$0.06
|
| Rate for Payer: Global Benefits Group Commercial |
$0.04
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.06
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$0.04
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$0.04
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.01
|
| Rate for Payer: Multiplan Commercial |
$0.05
|
| Rate for Payer: Networks By Design Commercial |
$0.05
|
| Rate for Payer: Prime Health Services Commercial |
$0.06
|
|
|
FLUOXETINE 20 MG TABLET [17463]
|
Facility
|
OP
|
$0.38
|
|
|
Service Code
|
NDC 5965130930
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.08 |
| Max. Negotiated Rate |
$0.34 |
| Rate for Payer: Adventist Health Commercial |
$0.08
|
| Rate for Payer: Aetna of CA HMO/PPO |
$0.23
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.32
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.21
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.29
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$0.18
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.22
|
| Rate for Payer: Blue Shield of California Commercial |
$0.24
|
| Rate for Payer: Blue Shield of California EPN |
$0.15
|
| Rate for Payer: Cash Price |
$0.17
|
| Rate for Payer: Central Health Plan Commercial |
$0.30
|
| Rate for Payer: Cigna of CA HMO |
$0.27
|
| Rate for Payer: Cigna of CA PPO |
$0.27
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.32
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.32
|
| Rate for Payer: Dignity Health Medicare Advantage |
$0.32
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$0.27
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.15
|
| Rate for Payer: EPIC Health Plan Senior |
$0.15
|
| Rate for Payer: Galaxy Health WC |
$0.32
|
| Rate for Payer: Global Benefits Group Commercial |
$0.23
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.34
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$0.24
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.14
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$0.22
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.08
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$0.27
|
| Rate for Payer: Multiplan Commercial |
$0.29
|
| Rate for Payer: Networks By Design Commercial |
$0.25
|
| Rate for Payer: Prime Health Services Commercial |
$0.32
|
| Rate for Payer: Riverside University Health System MISP |
$0.15
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.23
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.23
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.19
|
| Rate for Payer: United Healthcare All Other HMO |
$0.19
|
| Rate for Payer: United Healthcare HMO Rider |
$0.19
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.19
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.32
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.32
|
| Rate for Payer: Vantage Medical Group Senior |
$0.32
|
|
|
FLUOXETINE 20 MG TABLET [17463]
|
Facility
|
IP
|
$0.38
|
|
|
Service Code
|
NDC 5965130930
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.08 |
| Max. Negotiated Rate |
$0.34 |
| Rate for Payer: Adventist Health Commercial |
$0.08
|
| Rate for Payer: Blue Shield of California Commercial |
$0.30
|
| Rate for Payer: Blue Shield of California EPN |
$0.19
|
| Rate for Payer: Cash Price |
$0.17
|
| Rate for Payer: Central Health Plan Commercial |
$0.30
|
| Rate for Payer: Cigna of CA HMO |
$0.27
|
| Rate for Payer: Cigna of CA PPO |
$0.27
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$0.27
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.15
|
| Rate for Payer: EPIC Health Plan Senior |
$0.15
|
| Rate for Payer: Galaxy Health WC |
$0.32
|
| Rate for Payer: Global Benefits Group Commercial |
$0.23
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.34
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$0.24
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$0.22
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.08
|
| Rate for Payer: Multiplan Commercial |
$0.29
|
| Rate for Payer: Networks By Design Commercial |
$0.25
|
| Rate for Payer: Prime Health Services Commercial |
$0.32
|
|
|
FLUPHENAZINE 2.5 MG/5 ML ORAL ELIXIR [10072]
|
Facility
|
IP
|
$0.64
|
|
|
Service Code
|
NDC 0121065402
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.13 |
| Max. Negotiated Rate |
$0.58 |
| Rate for Payer: Adventist Health Commercial |
$0.13
|
| Rate for Payer: Blue Shield of California Commercial |
$0.51
|
| Rate for Payer: Blue Shield of California EPN |
$0.32
|
| Rate for Payer: Cash Price |
$0.29
|
| Rate for Payer: Central Health Plan Commercial |
$0.51
|
| Rate for Payer: Cigna of CA HMO |
$0.45
|
| Rate for Payer: Cigna of CA PPO |
$0.45
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$0.45
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.26
|
| Rate for Payer: EPIC Health Plan Senior |
$0.26
|
| Rate for Payer: Galaxy Health WC |
$0.54
|
| Rate for Payer: Global Benefits Group Commercial |
$0.38
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.58
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$0.41
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$0.38
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.13
|
| Rate for Payer: Multiplan Commercial |
$0.48
|
| Rate for Payer: Networks By Design Commercial |
$0.42
|
| Rate for Payer: Prime Health Services Commercial |
$0.54
|
|
|
FLUPHENAZINE 2.5 MG/5 ML ORAL ELIXIR [10072]
|
Facility
|
OP
|
$0.64
|
|
|
Service Code
|
NDC 0121065402
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.13 |
| Max. Negotiated Rate |
$0.58 |
| Rate for Payer: Adventist Health Commercial |
$0.13
|
| Rate for Payer: Aetna of CA HMO/PPO |
$0.39
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.54
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.35
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.48
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$0.31
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.37
|
| Rate for Payer: Blue Shield of California Commercial |
$0.41
|
| Rate for Payer: Blue Shield of California EPN |
$0.26
|
| Rate for Payer: Cash Price |
$0.29
|
| Rate for Payer: Central Health Plan Commercial |
$0.51
|
| Rate for Payer: Cigna of CA HMO |
$0.45
|
| Rate for Payer: Cigna of CA PPO |
$0.45
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.54
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.54
|
| Rate for Payer: Dignity Health Medicare Advantage |
$0.54
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$0.45
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.26
|
| Rate for Payer: EPIC Health Plan Senior |
$0.26
|
| Rate for Payer: Galaxy Health WC |
$0.54
|
| Rate for Payer: Global Benefits Group Commercial |
$0.38
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.58
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$0.41
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.23
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$0.38
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.13
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$0.45
|
| Rate for Payer: Multiplan Commercial |
$0.48
|
| Rate for Payer: Networks By Design Commercial |
$0.42
|
| Rate for Payer: Prime Health Services Commercial |
$0.54
|
| Rate for Payer: Riverside University Health System MISP |
$0.26
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.38
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.38
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.32
|
| Rate for Payer: United Healthcare All Other HMO |
$0.32
|
| Rate for Payer: United Healthcare HMO Rider |
$0.32
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.32
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.54
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.54
|
| Rate for Payer: Vantage Medical Group Senior |
$0.54
|
|
|
FLUPHENAZINE 2.5 MG TABLET [3220]
|
Facility
|
OP
|
$8.89
|
|
|
Service Code
|
NDC 0904715861
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$1.78 |
| Max. Negotiated Rate |
$8.00 |
| Rate for Payer: Adventist Health Commercial |
$1.78
|
| Rate for Payer: Aetna of CA HMO/PPO |
$5.40
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$7.56
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4.89
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$6.67
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$4.30
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5.17
|
| Rate for Payer: Blue Shield of California Commercial |
$5.64
|
| Rate for Payer: Blue Shield of California EPN |
$3.55
|
| Rate for Payer: Cash Price |
$4.00
|
| Rate for Payer: Central Health Plan Commercial |
$7.11
|
| Rate for Payer: Cigna of CA HMO |
$6.22
|
| Rate for Payer: Cigna of CA PPO |
$6.22
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$7.56
|
| Rate for Payer: Dignity Health Medi-Cal |
$7.56
|
| Rate for Payer: Dignity Health Medicare Advantage |
$7.56
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$6.22
|
| Rate for Payer: EPIC Health Plan Commercial |
$3.56
|
| Rate for Payer: EPIC Health Plan Senior |
$3.56
|
| Rate for Payer: Galaxy Health WC |
$7.56
|
| Rate for Payer: Global Benefits Group Commercial |
$5.33
|
| Rate for Payer: Health Management Network EPO/PPO |
$8.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$5.65
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$3.23
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$5.25
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.78
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$6.22
|
| Rate for Payer: Multiplan Commercial |
$6.67
|
| Rate for Payer: Networks By Design Commercial |
$5.78
|
| Rate for Payer: Prime Health Services Commercial |
$7.56
|
| Rate for Payer: Riverside University Health System MISP |
$3.56
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$5.33
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$5.33
|
| Rate for Payer: United Healthcare All Other Commercial |
$4.45
|
| Rate for Payer: United Healthcare All Other HMO |
$4.45
|
| Rate for Payer: United Healthcare HMO Rider |
$4.45
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$4.45
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$7.56
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$7.56
|
| Rate for Payer: Vantage Medical Group Senior |
$7.56
|
|
|
FLUPHENAZINE 2.5 MG TABLET [3220]
|
Facility
|
OP
|
$1.28
|
|
|
Service Code
|
NDC 5167242341
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.26 |
| Max. Negotiated Rate |
$1.15 |
| Rate for Payer: Adventist Health Commercial |
$0.26
|
| Rate for Payer: Aetna of CA HMO/PPO |
$0.78
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1.09
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.70
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.96
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$0.62
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.74
|
| Rate for Payer: Blue Shield of California Commercial |
$0.81
|
| Rate for Payer: Blue Shield of California EPN |
$0.51
|
| Rate for Payer: Cash Price |
$0.58
|
| Rate for Payer: Central Health Plan Commercial |
$1.02
|
| Rate for Payer: Cigna of CA HMO |
$0.90
|
| Rate for Payer: Cigna of CA PPO |
$0.90
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1.09
|
| Rate for Payer: Dignity Health Medi-Cal |
$1.09
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1.09
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$0.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.51
|
| Rate for Payer: EPIC Health Plan Senior |
$0.51
|
| Rate for Payer: Galaxy Health WC |
$1.09
|
| Rate for Payer: Global Benefits Group Commercial |
$0.77
|
| Rate for Payer: Health Management Network EPO/PPO |
$1.15
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$0.81
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.46
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$0.76
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.26
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$0.90
|
| Rate for Payer: Multiplan Commercial |
$0.96
|
| Rate for Payer: Networks By Design Commercial |
$0.83
|
| Rate for Payer: Prime Health Services Commercial |
$1.09
|
| Rate for Payer: Riverside University Health System MISP |
$0.51
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.77
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.77
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.64
|
| Rate for Payer: United Healthcare All Other HMO |
$0.64
|
| Rate for Payer: United Healthcare HMO Rider |
$0.64
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.64
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1.09
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1.09
|
| Rate for Payer: Vantage Medical Group Senior |
$1.09
|
|
|
FLUPHENAZINE 2.5 MG TABLET [3220]
|
Facility
|
IP
|
$1.28
|
|
|
Service Code
|
NDC 6923816791
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.26 |
| Max. Negotiated Rate |
$1.15 |
| Rate for Payer: Adventist Health Commercial |
$0.26
|
| Rate for Payer: Blue Shield of California Commercial |
$1.03
|
| Rate for Payer: Blue Shield of California EPN |
$0.65
|
| Rate for Payer: Cash Price |
$0.58
|
| Rate for Payer: Central Health Plan Commercial |
$1.02
|
| Rate for Payer: Cigna of CA HMO |
$0.90
|
| Rate for Payer: Cigna of CA PPO |
$0.90
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$0.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.51
|
| Rate for Payer: EPIC Health Plan Senior |
$0.51
|
| Rate for Payer: Galaxy Health WC |
$1.09
|
| Rate for Payer: Global Benefits Group Commercial |
$0.77
|
| Rate for Payer: Health Management Network EPO/PPO |
$1.15
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$0.81
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$0.76
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.26
|
| Rate for Payer: Multiplan Commercial |
$0.96
|
| Rate for Payer: Networks By Design Commercial |
$0.83
|
| Rate for Payer: Prime Health Services Commercial |
$1.09
|
|
|
FLUPHENAZINE 2.5 MG TABLET [3220]
|
Facility
|
IP
|
$4.34
|
|
|
Service Code
|
NDC 5026836711
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.87 |
| Max. Negotiated Rate |
$3.91 |
| Rate for Payer: Adventist Health Commercial |
$0.87
|
| Rate for Payer: Blue Shield of California Commercial |
$3.48
|
| Rate for Payer: Blue Shield of California EPN |
$2.19
|
| Rate for Payer: Cash Price |
$1.95
|
| Rate for Payer: Central Health Plan Commercial |
$3.47
|
| Rate for Payer: Cigna of CA HMO |
$3.04
|
| Rate for Payer: Cigna of CA PPO |
$3.04
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$3.04
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.74
|
| Rate for Payer: EPIC Health Plan Senior |
$1.74
|
| Rate for Payer: Galaxy Health WC |
$3.69
|
| Rate for Payer: Global Benefits Group Commercial |
$2.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$3.91
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$2.76
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2.56
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.87
|
| Rate for Payer: Multiplan Commercial |
$3.25
|
| Rate for Payer: Networks By Design Commercial |
$2.82
|
| Rate for Payer: Prime Health Services Commercial |
$3.69
|
|
|
FLUPHENAZINE 2.5 MG TABLET [3220]
|
Facility
|
OP
|
$4.34
|
|
|
Service Code
|
NDC 5026836715
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.87 |
| Max. Negotiated Rate |
$3.91 |
| Rate for Payer: Adventist Health Commercial |
$0.87
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2.64
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3.69
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2.39
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$3.25
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$2.10
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2.52
|
| Rate for Payer: Blue Shield of California Commercial |
$2.75
|
| Rate for Payer: Blue Shield of California EPN |
$1.73
|
| Rate for Payer: Cash Price |
$1.95
|
| Rate for Payer: Central Health Plan Commercial |
$3.47
|
| Rate for Payer: Cigna of CA HMO |
$3.04
|
| Rate for Payer: Cigna of CA PPO |
$3.04
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3.69
|
| Rate for Payer: Dignity Health Medi-Cal |
$3.69
|
| Rate for Payer: Dignity Health Medicare Advantage |
$3.69
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$3.04
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.74
|
| Rate for Payer: EPIC Health Plan Senior |
$1.74
|
| Rate for Payer: Galaxy Health WC |
$3.69
|
| Rate for Payer: Global Benefits Group Commercial |
$2.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$3.91
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$2.76
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1.58
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2.56
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.87
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$3.04
|
| Rate for Payer: Multiplan Commercial |
$3.25
|
| Rate for Payer: Networks By Design Commercial |
$2.82
|
| Rate for Payer: Prime Health Services Commercial |
$3.69
|
| Rate for Payer: Riverside University Health System MISP |
$1.74
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$2.17
|
| Rate for Payer: United Healthcare All Other HMO |
$2.17
|
| Rate for Payer: United Healthcare HMO Rider |
$2.17
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2.17
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3.69
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$3.69
|
| Rate for Payer: Vantage Medical Group Senior |
$3.69
|
|
|
FLUPHENAZINE 2.5 MG TABLET [3220]
|
Facility
|
OP
|
$1.28
|
|
|
Service Code
|
NDC 6923816791
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.26 |
| Max. Negotiated Rate |
$1.15 |
| Rate for Payer: Adventist Health Commercial |
$0.26
|
| Rate for Payer: Aetna of CA HMO/PPO |
$0.78
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1.09
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.70
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.96
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$0.62
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.74
|
| Rate for Payer: Blue Shield of California Commercial |
$0.81
|
| Rate for Payer: Blue Shield of California EPN |
$0.51
|
| Rate for Payer: Cash Price |
$0.58
|
| Rate for Payer: Central Health Plan Commercial |
$1.02
|
| Rate for Payer: Cigna of CA HMO |
$0.90
|
| Rate for Payer: Cigna of CA PPO |
$0.90
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1.09
|
| Rate for Payer: Dignity Health Medi-Cal |
$1.09
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1.09
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$0.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.51
|
| Rate for Payer: EPIC Health Plan Senior |
$0.51
|
| Rate for Payer: Galaxy Health WC |
$1.09
|
| Rate for Payer: Global Benefits Group Commercial |
$0.77
|
| Rate for Payer: Health Management Network EPO/PPO |
$1.15
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$0.81
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.46
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$0.76
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.26
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$0.90
|
| Rate for Payer: Multiplan Commercial |
$0.96
|
| Rate for Payer: Networks By Design Commercial |
$0.83
|
| Rate for Payer: Prime Health Services Commercial |
$1.09
|
| Rate for Payer: Riverside University Health System MISP |
$0.51
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.77
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.77
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.64
|
| Rate for Payer: United Healthcare All Other HMO |
$0.64
|
| Rate for Payer: United Healthcare HMO Rider |
$0.64
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.64
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1.09
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1.09
|
| Rate for Payer: Vantage Medical Group Senior |
$1.09
|
|
|
FLUPHENAZINE 2.5 MG TABLET [3220]
|
Facility
|
IP
|
$2.78
|
|
|
Service Code
|
NDC 0527178901
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.56 |
| Max. Negotiated Rate |
$2.50 |
| Rate for Payer: Adventist Health Commercial |
$0.56
|
| Rate for Payer: Blue Shield of California Commercial |
$2.23
|
| Rate for Payer: Blue Shield of California EPN |
$1.40
|
| Rate for Payer: Cash Price |
$1.25
|
| Rate for Payer: Central Health Plan Commercial |
$2.22
|
| Rate for Payer: Cigna of CA HMO |
$1.95
|
| Rate for Payer: Cigna of CA PPO |
$1.95
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1.95
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.11
|
| Rate for Payer: EPIC Health Plan Senior |
$1.11
|
| Rate for Payer: Galaxy Health WC |
$2.36
|
| Rate for Payer: Global Benefits Group Commercial |
$1.67
|
| Rate for Payer: Health Management Network EPO/PPO |
$2.50
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1.77
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1.64
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.56
|
| Rate for Payer: Multiplan Commercial |
$2.08
|
| Rate for Payer: Networks By Design Commercial |
$1.81
|
| Rate for Payer: Prime Health Services Commercial |
$2.36
|
|
|
FLUPHENAZINE 2.5 MG TABLET [3220]
|
Facility
|
IP
|
$4.34
|
|
|
Service Code
|
NDC 5026836715
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.87 |
| Max. Negotiated Rate |
$3.91 |
| Rate for Payer: Adventist Health Commercial |
$0.87
|
| Rate for Payer: Blue Shield of California Commercial |
$3.48
|
| Rate for Payer: Blue Shield of California EPN |
$2.19
|
| Rate for Payer: Cash Price |
$1.95
|
| Rate for Payer: Central Health Plan Commercial |
$3.47
|
| Rate for Payer: Cigna of CA HMO |
$3.04
|
| Rate for Payer: Cigna of CA PPO |
$3.04
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$3.04
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.74
|
| Rate for Payer: EPIC Health Plan Senior |
$1.74
|
| Rate for Payer: Galaxy Health WC |
$3.69
|
| Rate for Payer: Global Benefits Group Commercial |
$2.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$3.91
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$2.76
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2.56
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.87
|
| Rate for Payer: Multiplan Commercial |
$3.25
|
| Rate for Payer: Networks By Design Commercial |
$2.82
|
| Rate for Payer: Prime Health Services Commercial |
$3.69
|
|
|
FLUPHENAZINE 2.5 MG TABLET [3220]
|
Facility
|
OP
|
$4.34
|
|
|
Service Code
|
NDC 5026836711
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.87 |
| Max. Negotiated Rate |
$3.91 |
| Rate for Payer: Adventist Health Commercial |
$0.87
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2.64
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3.69
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2.39
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$3.25
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$2.10
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2.52
|
| Rate for Payer: Blue Shield of California Commercial |
$2.75
|
| Rate for Payer: Blue Shield of California EPN |
$1.73
|
| Rate for Payer: Cash Price |
$1.95
|
| Rate for Payer: Central Health Plan Commercial |
$3.47
|
| Rate for Payer: Cigna of CA HMO |
$3.04
|
| Rate for Payer: Cigna of CA PPO |
$3.04
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3.69
|
| Rate for Payer: Dignity Health Medi-Cal |
$3.69
|
| Rate for Payer: Dignity Health Medicare Advantage |
$3.69
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$3.04
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.74
|
| Rate for Payer: EPIC Health Plan Senior |
$1.74
|
| Rate for Payer: Galaxy Health WC |
$3.69
|
| Rate for Payer: Global Benefits Group Commercial |
$2.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$3.91
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$2.76
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1.58
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2.56
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.87
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$3.04
|
| Rate for Payer: Multiplan Commercial |
$3.25
|
| Rate for Payer: Networks By Design Commercial |
$2.82
|
| Rate for Payer: Prime Health Services Commercial |
$3.69
|
| Rate for Payer: Riverside University Health System MISP |
$1.74
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$2.17
|
| Rate for Payer: United Healthcare All Other HMO |
$2.17
|
| Rate for Payer: United Healthcare HMO Rider |
$2.17
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2.17
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3.69
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$3.69
|
| Rate for Payer: Vantage Medical Group Senior |
$3.69
|
|
|
FLUPHENAZINE 2.5 MG TABLET [3220]
|
Facility
|
IP
|
$1.28
|
|
|
Service Code
|
NDC 5167242341
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.26 |
| Max. Negotiated Rate |
$1.15 |
| Rate for Payer: Adventist Health Commercial |
$0.26
|
| Rate for Payer: Blue Shield of California Commercial |
$1.03
|
| Rate for Payer: Blue Shield of California EPN |
$0.65
|
| Rate for Payer: Cash Price |
$0.58
|
| Rate for Payer: Central Health Plan Commercial |
$1.02
|
| Rate for Payer: Cigna of CA HMO |
$0.90
|
| Rate for Payer: Cigna of CA PPO |
$0.90
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$0.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.51
|
| Rate for Payer: EPIC Health Plan Senior |
$0.51
|
| Rate for Payer: Galaxy Health WC |
$1.09
|
| Rate for Payer: Global Benefits Group Commercial |
$0.77
|
| Rate for Payer: Health Management Network EPO/PPO |
$1.15
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$0.81
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$0.76
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.26
|
| Rate for Payer: Multiplan Commercial |
$0.96
|
| Rate for Payer: Networks By Design Commercial |
$0.83
|
| Rate for Payer: Prime Health Services Commercial |
$1.09
|
|
|
FLUPHENAZINE 2.5 MG TABLET [3220]
|
Facility
|
IP
|
$8.89
|
|
|
Service Code
|
NDC 0904715861
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$1.78 |
| Max. Negotiated Rate |
$8.00 |
| Rate for Payer: Adventist Health Commercial |
$1.78
|
| Rate for Payer: Blue Shield of California Commercial |
$7.13
|
| Rate for Payer: Blue Shield of California EPN |
$4.48
|
| Rate for Payer: Cash Price |
$4.00
|
| Rate for Payer: Central Health Plan Commercial |
$7.11
|
| Rate for Payer: Cigna of CA HMO |
$6.22
|
| Rate for Payer: Cigna of CA PPO |
$6.22
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$6.22
|
| Rate for Payer: EPIC Health Plan Commercial |
$3.56
|
| Rate for Payer: EPIC Health Plan Senior |
$3.56
|
| Rate for Payer: Galaxy Health WC |
$7.56
|
| Rate for Payer: Global Benefits Group Commercial |
$5.33
|
| Rate for Payer: Health Management Network EPO/PPO |
$8.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$5.65
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$5.25
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.78
|
| Rate for Payer: Multiplan Commercial |
$6.67
|
| Rate for Payer: Networks By Design Commercial |
$5.78
|
| Rate for Payer: Prime Health Services Commercial |
$7.56
|
|
|
FLUPHENAZINE 2.5 MG TABLET [3220]
|
Facility
|
OP
|
$2.78
|
|
|
Service Code
|
NDC 0527178901
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.56 |
| Max. Negotiated Rate |
$2.50 |
| Rate for Payer: Adventist Health Commercial |
$0.56
|
| Rate for Payer: Aetna of CA HMO/PPO |
$1.69
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2.36
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1.53
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2.08
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1.35
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1.62
|
| Rate for Payer: Blue Shield of California Commercial |
$1.76
|
| Rate for Payer: Blue Shield of California EPN |
$1.11
|
| Rate for Payer: Cash Price |
$1.25
|
| Rate for Payer: Central Health Plan Commercial |
$2.22
|
| Rate for Payer: Cigna of CA HMO |
$1.95
|
| Rate for Payer: Cigna of CA PPO |
$1.95
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2.36
|
| Rate for Payer: Dignity Health Medi-Cal |
$2.36
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2.36
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1.95
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.11
|
| Rate for Payer: EPIC Health Plan Senior |
$1.11
|
| Rate for Payer: Galaxy Health WC |
$2.36
|
| Rate for Payer: Global Benefits Group Commercial |
$1.67
|
| Rate for Payer: Health Management Network EPO/PPO |
$2.50
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1.77
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1.01
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1.64
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.56
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$1.95
|
| Rate for Payer: Multiplan Commercial |
$2.08
|
| Rate for Payer: Networks By Design Commercial |
$1.81
|
| Rate for Payer: Prime Health Services Commercial |
$2.36
|
| Rate for Payer: Riverside University Health System MISP |
$1.11
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1.67
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1.67
|
| Rate for Payer: United Healthcare All Other Commercial |
$1.39
|
| Rate for Payer: United Healthcare All Other HMO |
$1.39
|
| Rate for Payer: United Healthcare HMO Rider |
$1.39
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1.39
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2.36
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2.36
|
| Rate for Payer: Vantage Medical Group Senior |
$2.36
|
|
|
FLUPHENAZINE DECANOATE 25 MG/ML INJECTION SOLUTION [3215]
|
Facility
|
OP
|
$29.04
|
|
|
Service Code
|
HCPCS J2680
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$5.78 |
| Max. Negotiated Rate |
$123.42 |
| Rate for Payer: Adventist Health Commercial |
$5.81
|
| Rate for Payer: Aetna of CA HMO/PPO |
$54.73
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$24.68
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$15.97
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$21.78
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$98.90
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$123.42
|
| Rate for Payer: Blue Shield of California Commercial |
$30.17
|
| Rate for Payer: Blue Shield of California EPN |
$27.43
|
| Rate for Payer: Cash Price |
$13.07
|
| Rate for Payer: Cash Price |
$13.07
|
| Rate for Payer: Central Health Plan Commercial |
$23.23
|
| Rate for Payer: Cigna of CA HMO |
$20.33
|
| Rate for Payer: Cigna of CA PPO |
$20.33
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$24.68
|
| Rate for Payer: Dignity Health Medi-Cal |
$24.68
|
| Rate for Payer: Dignity Health Medicare Advantage |
$24.68
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$20.33
|
| Rate for Payer: EPIC Health Plan Commercial |
$11.62
|
| Rate for Payer: EPIC Health Plan Senior |
$11.62
|
| Rate for Payer: Galaxy Health WC |
$24.68
|
| Rate for Payer: Global Benefits Group Commercial |
$17.42
|
| Rate for Payer: Health Management Network EPO/PPO |
$26.14
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$5.78
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$18.44
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$20.25
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$17.13
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5.81
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$20.33
|
| Rate for Payer: Multiplan Commercial |
$21.78
|
| Rate for Payer: Networks By Design Commercial |
$14.52
|
| Rate for Payer: Prime Health Services Commercial |
$24.68
|
| Rate for Payer: Riverside University Health System MISP |
$11.62
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$17.42
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$17.42
|
| Rate for Payer: United Healthcare All Other Commercial |
$10.90
|
| Rate for Payer: United Healthcare All Other HMO |
$10.61
|
| Rate for Payer: United Healthcare HMO Rider |
$10.38
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$9.51
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$24.68
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$24.68
|
| Rate for Payer: Vantage Medical Group Senior |
$24.68
|
|
|
FLUPHENAZINE DECANOATE 25 MG/ML INJECTION SOLUTION [3215]
|
Facility
|
IP
|
$29.04
|
|
|
Service Code
|
HCPCS J2680
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$5.81 |
| Max. Negotiated Rate |
$26.14 |
| Rate for Payer: Adventist Health Commercial |
$5.81
|
| Rate for Payer: Blue Shield of California Commercial |
$23.29
|
| Rate for Payer: Blue Shield of California EPN |
$14.64
|
| Rate for Payer: Cash Price |
$13.07
|
| Rate for Payer: Central Health Plan Commercial |
$23.23
|
| Rate for Payer: Cigna of CA HMO |
$20.33
|
| Rate for Payer: Cigna of CA PPO |
$20.33
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$20.33
|
| Rate for Payer: EPIC Health Plan Commercial |
$11.62
|
| Rate for Payer: EPIC Health Plan Senior |
$11.62
|
| Rate for Payer: Galaxy Health WC |
$24.68
|
| Rate for Payer: Global Benefits Group Commercial |
$17.42
|
| Rate for Payer: Health Management Network EPO/PPO |
$26.14
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$18.44
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$17.13
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5.81
|
| Rate for Payer: Multiplan Commercial |
$21.78
|
| Rate for Payer: Networks By Design Commercial |
$14.52
|
| Rate for Payer: Prime Health Services Commercial |
$24.68
|
| Rate for Payer: United Healthcare All Other Commercial |
$10.90
|
| Rate for Payer: United Healthcare All Other HMO |
$10.61
|
| Rate for Payer: United Healthcare HMO Rider |
$10.38
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$9.51
|
|
|
FLUTICASONE 250 MCG-SALMETEROL 50 MCG/DOSE BLISTR POWDR FOR INHALATION [26538]
|
Facility
|
IP
|
$3.92
|
|
|
Service Code
|
NDC 0173069600
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.78 |
| Max. Negotiated Rate |
$3.53 |
| Rate for Payer: Adventist Health Commercial |
$0.78
|
| Rate for Payer: Blue Shield of California Commercial |
$3.14
|
| Rate for Payer: Blue Shield of California EPN |
$1.98
|
| Rate for Payer: Cash Price |
$1.76
|
| Rate for Payer: Central Health Plan Commercial |
$3.14
|
| Rate for Payer: Cigna of CA HMO |
$2.74
|
| Rate for Payer: Cigna of CA PPO |
$2.74
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$2.74
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.57
|
| Rate for Payer: EPIC Health Plan Senior |
$1.57
|
| Rate for Payer: Galaxy Health WC |
$3.33
|
| Rate for Payer: Global Benefits Group Commercial |
$2.35
|
| Rate for Payer: Health Management Network EPO/PPO |
$3.53
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$2.49
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2.31
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.78
|
| Rate for Payer: Multiplan Commercial |
$2.94
|
| Rate for Payer: Networks By Design Commercial |
$2.55
|
| Rate for Payer: Prime Health Services Commercial |
$3.33
|
|
|
FLUTICASONE 250 MCG-SALMETEROL 50 MCG/DOSE BLISTR POWDR FOR INHALATION [26538]
|
Facility
|
OP
|
$3.92
|
|
|
Service Code
|
NDC 0173069600
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.78 |
| Max. Negotiated Rate |
$3.53 |
| Rate for Payer: Adventist Health Commercial |
$0.78
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2.38
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3.33
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2.16
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2.94
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1.90
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2.28
|
| Rate for Payer: Blue Shield of California Commercial |
$2.49
|
| Rate for Payer: Blue Shield of California EPN |
$1.56
|
| Rate for Payer: Cash Price |
$1.76
|
| Rate for Payer: Central Health Plan Commercial |
$3.14
|
| Rate for Payer: Cigna of CA HMO |
$2.74
|
| Rate for Payer: Cigna of CA PPO |
$2.74
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3.33
|
| Rate for Payer: Dignity Health Medi-Cal |
$3.33
|
| Rate for Payer: Dignity Health Medicare Advantage |
$3.33
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$2.74
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.57
|
| Rate for Payer: EPIC Health Plan Senior |
$1.57
|
| Rate for Payer: Galaxy Health WC |
$3.33
|
| Rate for Payer: Global Benefits Group Commercial |
$2.35
|
| Rate for Payer: Health Management Network EPO/PPO |
$3.53
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$2.49
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1.42
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2.31
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.78
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$2.74
|
| Rate for Payer: Multiplan Commercial |
$2.94
|
| Rate for Payer: Networks By Design Commercial |
$2.55
|
| Rate for Payer: Prime Health Services Commercial |
$3.33
|
| Rate for Payer: Riverside University Health System MISP |
$1.57
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2.35
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2.35
|
| Rate for Payer: United Healthcare All Other Commercial |
$1.96
|
| Rate for Payer: United Healthcare All Other HMO |
$1.96
|
| Rate for Payer: United Healthcare HMO Rider |
$1.96
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1.96
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3.33
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$3.33
|
| Rate for Payer: Vantage Medical Group Senior |
$3.33
|
|
|
FLUTICASONE 500 MCG-SALMETEROL 50 MCG/DOSE BLISTR POWDR FOR INHALATION [104566]
|
Facility
|
OP
|
$5.30
|
|
|
Service Code
|
NDC 0173069700
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$1.06 |
| Max. Negotiated Rate |
$4.77 |
| Rate for Payer: Adventist Health Commercial |
$1.06
|
| Rate for Payer: Aetna of CA HMO/PPO |
$3.22
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$4.50
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2.92
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$3.98
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$2.57
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3.08
|
| Rate for Payer: Blue Shield of California Commercial |
$3.36
|
| Rate for Payer: Blue Shield of California EPN |
$2.11
|
| Rate for Payer: Cash Price |
$2.38
|
| Rate for Payer: Central Health Plan Commercial |
$4.24
|
| Rate for Payer: Cigna of CA HMO |
$3.71
|
| Rate for Payer: Cigna of CA PPO |
$3.71
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$4.50
|
| Rate for Payer: Dignity Health Medi-Cal |
$4.50
|
| Rate for Payer: Dignity Health Medicare Advantage |
$4.50
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$3.71
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.12
|
| Rate for Payer: EPIC Health Plan Senior |
$2.12
|
| Rate for Payer: Galaxy Health WC |
$4.50
|
| Rate for Payer: Global Benefits Group Commercial |
$3.18
|
| Rate for Payer: Health Management Network EPO/PPO |
$4.77
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$3.37
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1.92
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$3.13
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.06
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$3.71
|
| Rate for Payer: Multiplan Commercial |
$3.98
|
| Rate for Payer: Networks By Design Commercial |
$3.44
|
| Rate for Payer: Prime Health Services Commercial |
$4.50
|
| Rate for Payer: Riverside University Health System MISP |
$2.12
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3.18
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$3.18
|
| Rate for Payer: United Healthcare All Other Commercial |
$2.65
|
| Rate for Payer: United Healthcare All Other HMO |
$2.65
|
| Rate for Payer: United Healthcare HMO Rider |
$2.65
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2.65
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$4.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4.50
|
| Rate for Payer: Vantage Medical Group Senior |
$4.50
|
|
|
FLUTICASONE 500 MCG-SALMETEROL 50 MCG/DOSE BLISTR POWDR FOR INHALATION [104566]
|
Facility
|
IP
|
$5.30
|
|
|
Service Code
|
NDC 0173069700
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$1.06 |
| Max. Negotiated Rate |
$4.77 |
| Rate for Payer: Adventist Health Commercial |
$1.06
|
| Rate for Payer: Blue Shield of California Commercial |
$4.25
|
| Rate for Payer: Blue Shield of California EPN |
$2.67
|
| Rate for Payer: Cash Price |
$2.38
|
| Rate for Payer: Central Health Plan Commercial |
$4.24
|
| Rate for Payer: Cigna of CA HMO |
$3.71
|
| Rate for Payer: Cigna of CA PPO |
$3.71
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$3.71
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.12
|
| Rate for Payer: EPIC Health Plan Senior |
$2.12
|
| Rate for Payer: Galaxy Health WC |
$4.50
|
| Rate for Payer: Global Benefits Group Commercial |
$3.18
|
| Rate for Payer: Health Management Network EPO/PPO |
$4.77
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$3.37
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$3.13
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.06
|
| Rate for Payer: Multiplan Commercial |
$3.98
|
| Rate for Payer: Networks By Design Commercial |
$3.44
|
| Rate for Payer: Prime Health Services Commercial |
$4.50
|
|
|
FLUTICASONE PROPIONATE 110 MCG/ACTUATION HFA AEROSOL INHALER [40698]
|
Facility
|
OP
|
$17.80
|
|
|
Service Code
|
NDC 6699307996
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$3.56 |
| Max. Negotiated Rate |
$16.02 |
| Rate for Payer: Adventist Health Commercial |
$3.56
|
| Rate for Payer: Aetna of CA HMO/PPO |
$10.81
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$15.13
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$9.79
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$13.35
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$8.62
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$10.35
|
| Rate for Payer: Blue Shield of California Commercial |
$11.29
|
| Rate for Payer: Blue Shield of California EPN |
$7.10
|
| Rate for Payer: Cash Price |
$8.01
|
| Rate for Payer: Central Health Plan Commercial |
$14.24
|
| Rate for Payer: Cigna of CA HMO |
$12.46
|
| Rate for Payer: Cigna of CA PPO |
$12.46
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$15.13
|
| Rate for Payer: Dignity Health Medi-Cal |
$15.13
|
| Rate for Payer: Dignity Health Medicare Advantage |
$15.13
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$12.46
|
| Rate for Payer: EPIC Health Plan Commercial |
$7.12
|
| Rate for Payer: EPIC Health Plan Senior |
$7.12
|
| Rate for Payer: Galaxy Health WC |
$15.13
|
| Rate for Payer: Global Benefits Group Commercial |
$10.68
|
| Rate for Payer: Health Management Network EPO/PPO |
$16.02
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$11.30
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$6.46
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$10.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.56
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$12.46
|
| Rate for Payer: Multiplan Commercial |
$13.35
|
| Rate for Payer: Networks By Design Commercial |
$11.57
|
| Rate for Payer: Prime Health Services Commercial |
$15.13
|
| Rate for Payer: Riverside University Health System MISP |
$7.12
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$10.68
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$10.68
|
| Rate for Payer: United Healthcare All Other Commercial |
$8.90
|
| Rate for Payer: United Healthcare All Other HMO |
$8.90
|
| Rate for Payer: United Healthcare HMO Rider |
$8.90
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$8.90
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$15.13
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$15.13
|
| Rate for Payer: Vantage Medical Group Senior |
$15.13
|
|
|
FLUTICASONE PROPIONATE 110 MCG/ACTUATION HFA AEROSOL INHALER [40698]
|
Facility
|
IP
|
$17.80
|
|
|
Service Code
|
NDC 6699307996
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$3.56 |
| Max. Negotiated Rate |
$16.02 |
| Rate for Payer: Adventist Health Commercial |
$3.56
|
| Rate for Payer: Blue Shield of California Commercial |
$14.28
|
| Rate for Payer: Blue Shield of California EPN |
$8.97
|
| Rate for Payer: Cash Price |
$8.01
|
| Rate for Payer: Central Health Plan Commercial |
$14.24
|
| Rate for Payer: Cigna of CA HMO |
$12.46
|
| Rate for Payer: Cigna of CA PPO |
$12.46
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$12.46
|
| Rate for Payer: EPIC Health Plan Commercial |
$7.12
|
| Rate for Payer: EPIC Health Plan Senior |
$7.12
|
| Rate for Payer: Galaxy Health WC |
$15.13
|
| Rate for Payer: Global Benefits Group Commercial |
$10.68
|
| Rate for Payer: Health Management Network EPO/PPO |
$16.02
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$11.30
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$10.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.56
|
| Rate for Payer: Multiplan Commercial |
$13.35
|
| Rate for Payer: Networks By Design Commercial |
$11.57
|
| Rate for Payer: Prime Health Services Commercial |
$15.13
|
|
