|
FLUOCINOLONE 0.01 % TOPICAL CREAM [3183]
|
Facility
|
OP
|
$3.00
|
|
|
Service Code
|
NDC 0713-0223-15
|
| Hospital Charge Code |
1743274
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.60 |
| Max. Negotiated Rate |
$2.70 |
| 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 |
$1.65
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1.45
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1.77
|
| Rate for Payer: Blue Distinction Transplant |
$1.80
|
| Rate for Payer: Blue Shield of California Commercial |
$1.89
|
| Rate for Payer: Blue Shield of California EPN |
$1.47
|
| 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 Media |
$2.55
|
| Rate for Payer: Dignity Health Medi-Cal |
$2.55
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.20
|
| Rate for Payer: EPIC Health Plan Transplant |
$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: Health Plan of Nevada (Sierra) Other |
$2.25
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$1.05
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2.00
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1.14
|
| 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
|
| 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 Medi-Cal |
$2.55
|
| Rate for Payer: Vantage Medical Group Senior |
$2.55
|
|
|
FLUOCINOLONE 0.01 % TOPICAL CREAM [3183]
|
Facility
|
IP
|
$3.00
|
|
|
Service Code
|
NDC 0713-0223-15
|
| Hospital Charge Code |
1743274
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.60 |
| Max. Negotiated Rate |
$2.70 |
| Rate for Payer: Blue Shield of California Commercial |
$2.25
|
| Rate for Payer: Blue Shield of California EPN |
$1.60
|
| 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: EPIC Health Plan Commercial |
$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 Permanente of CA Commercial/Self Funded |
$2.00
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1.14
|
| 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
|
$2.23
|
|
|
Service Code
|
NDC 0713-0223-60
|
| Hospital Charge Code |
1743169
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.45 |
| Max. Negotiated Rate |
$2.01 |
| Rate for Payer: Aetna of CA HMO/PPO |
$1.35
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1.90
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1.23
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1.23
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1.08
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1.32
|
| Rate for Payer: Blue Distinction Transplant |
$1.34
|
| Rate for Payer: Blue Shield of California Commercial |
$1.40
|
| Rate for Payer: Blue Shield of California EPN |
$1.09
|
| 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: Dignity Health Commercial/Exchange |
$1.90
|
| Rate for Payer: Dignity Health Media |
$1.90
|
| Rate for Payer: Dignity Health Medi-Cal |
$1.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.89
|
| Rate for Payer: EPIC Health Plan Transplant |
$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: Health Plan of Nevada (Sierra) Other |
$1.67
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$0.78
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1.49
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.85
|
| 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
|
| Rate for Payer: Riverside University Health System MISP |
$0.89
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1.34
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1.34
|
| 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 Medi-Cal |
$1.90
|
| Rate for Payer: Vantage Medical Group Senior |
$1.90
|
|
|
FLUOCINOLONE 0.01 % TOPICAL CREAM [3183]
|
Facility
|
IP
|
$2.97
|
|
|
Service Code
|
NDC 52565-031-15
|
| Hospital Charge Code |
1743274
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.59 |
| Max. Negotiated Rate |
$2.67 |
| Rate for Payer: Blue Shield of California Commercial |
$2.23
|
| Rate for Payer: Blue Shield of California EPN |
$1.59
|
| 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: EPIC Health Plan Commercial |
$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 Permanente of CA Commercial/Self Funded |
$1.98
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1.13
|
| 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 CREAM [3183]
|
Facility
|
OP
|
$2.97
|
|
|
Service Code
|
NDC 52565-031-15
|
| Hospital Charge Code |
1743274
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.59 |
| Max. Negotiated Rate |
$2.67 |
| Rate for Payer: Aetna of CA HMO/PPO |
$1.80
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2.52
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1.63
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1.63
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1.44
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1.75
|
| Rate for Payer: Blue Distinction Transplant |
$1.78
|
| Rate for Payer: Blue Shield of California Commercial |
$1.87
|
| Rate for Payer: Blue Shield of California EPN |
$1.45
|
| 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: Dignity Health Commercial/Exchange |
$2.52
|
| Rate for Payer: Dignity Health Media |
$2.52
|
| Rate for Payer: Dignity Health Medi-Cal |
$2.52
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.19
|
| Rate for Payer: EPIC Health Plan Transplant |
$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: Health Plan of Nevada (Sierra) Other |
$2.23
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$1.04
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1.98
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1.13
|
| 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
|
| Rate for Payer: Riverside University Health System MISP |
$1.19
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1.78
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1.78
|
| Rate for Payer: United Healthcare All Other Commercial |
$1.48
|
| Rate for Payer: United Healthcare All Other HMO |
$1.48
|
| Rate for Payer: United Healthcare HMO Rider |
$1.48
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1.48
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2.52
|
| Rate for Payer: Vantage Medical Group Senior |
$2.52
|
|
|
FLUOCINOLONE 0.01 % TOPICAL CREAM [3183]
|
Facility
|
IP
|
$2.23
|
|
|
Service Code
|
NDC 0713-0223-60
|
| Hospital Charge Code |
1743169
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.45 |
| Max. Negotiated Rate |
$2.01 |
| Rate for Payer: Blue Shield of California Commercial |
$1.67
|
| Rate for Payer: Blue Shield of California EPN |
$1.19
|
| 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: EPIC Health Plan Commercial |
$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 Permanente of CA Commercial/Self Funded |
$1.49
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.85
|
| 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 SOLUTION [3186]
|
Facility
|
OP
|
$1.60
|
|
|
Service Code
|
NDC 52565-012-59
|
| Hospital Charge Code |
1743114
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.32 |
| Max. Negotiated Rate |
$1.44 |
| 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 |
$0.88
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$0.77
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.95
|
| Rate for Payer: Blue Distinction Transplant |
$0.96
|
| Rate for Payer: Blue Shield of California Commercial |
$1.01
|
| Rate for Payer: Blue Shield of California EPN |
$0.78
|
| 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 Media |
$1.36
|
| Rate for Payer: Dignity Health Medi-Cal |
$1.36
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.64
|
| Rate for Payer: EPIC Health Plan Transplant |
$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: Health Plan of Nevada (Sierra) Other |
$1.20
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$0.56
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1.07
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.61
|
| 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
|
| 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 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 52565-012-59
|
| Hospital Charge Code |
1743114
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.32 |
| Max. Negotiated Rate |
$1.44 |
| Rate for Payer: Blue Shield of California Commercial |
$1.20
|
| Rate for Payer: Blue Shield of California EPN |
$0.85
|
| 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: EPIC Health Plan Commercial |
$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 Permanente of CA Commercial/Self Funded |
$1.07
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.61
|
| 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
|
OP
|
$1.69
|
|
|
Service Code
|
NDC 0713-0224-60
|
| Hospital Charge Code |
1743208
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.34 |
| Max. Negotiated Rate |
$1.52 |
| 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 |
$0.93
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$0.82
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1.00
|
| Rate for Payer: Blue Distinction Transplant |
$1.01
|
| Rate for Payer: Blue Shield of California Commercial |
$1.06
|
| Rate for Payer: Blue Shield of California EPN |
$0.83
|
| 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 Media |
$1.44
|
| Rate for Payer: Dignity Health Medi-Cal |
$1.44
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.68
|
| Rate for Payer: EPIC Health Plan Transplant |
$0.68
|
| Rate for Payer: Galaxy Health WC |
$1.44
|
| Rate for Payer: Global Benefits Group Commercial |
$1.01
|
| Rate for Payer: Health Management Network EPO/PPO |
$1.52
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$1.27
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$0.59
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1.13
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.64
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.34
|
| 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
|
| 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 Medi-Cal |
$1.44
|
| Rate for Payer: Vantage Medical Group Senior |
$1.44
|
|
|
FLUOCINOLONE 0.025 % TOPICAL OINTMENT [3185]
|
Facility
|
IP
|
$1.69
|
|
|
Service Code
|
NDC 0713-0224-60
|
| Hospital Charge Code |
1743208
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.34 |
| Max. Negotiated Rate |
$1.52 |
| Rate for Payer: Blue Shield of California Commercial |
$1.27
|
| Rate for Payer: Blue Shield of California EPN |
$0.90
|
| 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: EPIC Health Plan Commercial |
$0.68
|
| Rate for Payer: Galaxy Health WC |
$1.44
|
| Rate for Payer: Global Benefits Group Commercial |
$1.01
|
| Rate for Payer: Health Management Network EPO/PPO |
$1.52
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1.13
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.64
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.34
|
| 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
|
$2.26
|
|
|
Service Code
|
NDC 0713-0224-15
|
| Hospital Charge Code |
1743235
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.45 |
| Max. Negotiated Rate |
$2.03 |
| Rate for Payer: Blue Shield of California Commercial |
$1.70
|
| Rate for Payer: Blue Shield of California EPN |
$1.21
|
| 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: EPIC Health Plan Commercial |
$0.90
|
| Rate for Payer: Galaxy Health WC |
$1.92
|
| Rate for Payer: Global Benefits Group Commercial |
$1.36
|
| Rate for Payer: Health Management Network EPO/PPO |
$2.03
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1.51
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.86
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.45
|
| 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
|
IP
|
$2.25
|
|
|
Service Code
|
NDC 0168-0064-15
|
| Hospital Charge Code |
1743235
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.45 |
| Max. Negotiated Rate |
$2.02 |
| Rate for Payer: Blue Shield of California Commercial |
$1.69
|
| Rate for Payer: Blue Shield of California EPN |
$1.20
|
| Rate for Payer: Cash Price |
$1.01
|
| Rate for Payer: Central Health Plan Commercial |
$1.80
|
| Rate for Payer: Cigna of CA HMO |
$1.58
|
| Rate for Payer: Cigna of CA PPO |
$1.58
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.90
|
| Rate for Payer: Galaxy Health WC |
$1.91
|
| Rate for Payer: Global Benefits Group Commercial |
$1.35
|
| Rate for Payer: Health Management Network EPO/PPO |
$2.02
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1.50
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.86
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.45
|
| 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
|
OP
|
$2.25
|
|
|
Service Code
|
NDC 0168-0064-15
|
| Hospital Charge Code |
1743235
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.45 |
| Max. Negotiated Rate |
$2.02 |
| 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 |
$1.24
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1.09
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1.33
|
| Rate for Payer: Blue Distinction Transplant |
$1.35
|
| Rate for Payer: Blue Shield of California Commercial |
$1.42
|
| Rate for Payer: Blue Shield of California EPN |
$1.10
|
| Rate for Payer: Cash Price |
$1.01
|
| Rate for Payer: Central Health Plan Commercial |
$1.80
|
| 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 |
$1.91
|
| Rate for Payer: Dignity Health Media |
$1.91
|
| Rate for Payer: Dignity Health Medi-Cal |
$1.91
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.90
|
| Rate for Payer: EPIC Health Plan Transplant |
$0.90
|
| Rate for Payer: Galaxy Health WC |
$1.91
|
| Rate for Payer: Global Benefits Group Commercial |
$1.35
|
| Rate for Payer: Health Management Network EPO/PPO |
$2.02
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$1.69
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$0.79
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1.50
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.86
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.45
|
| 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
|
| 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 Medi-Cal |
$1.91
|
| Rate for Payer: Vantage Medical Group Senior |
$1.91
|
|
|
FLUOCINOLONE 0.025 % TOPICAL OINTMENT [3185]
|
Facility
|
OP
|
$2.26
|
|
|
Service Code
|
NDC 0713-0224-15
|
| Hospital Charge Code |
1743235
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.45 |
| Max. Negotiated Rate |
$2.03 |
| 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 |
$1.24
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1.09
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1.34
|
| Rate for Payer: Blue Distinction Transplant |
$1.36
|
| Rate for Payer: Blue Shield of California Commercial |
$1.42
|
| Rate for Payer: Blue Shield of California EPN |
$1.11
|
| 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 Media |
$1.92
|
| Rate for Payer: Dignity Health Medi-Cal |
$1.92
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.90
|
| Rate for Payer: EPIC Health Plan Transplant |
$0.90
|
| Rate for Payer: Galaxy Health WC |
$1.92
|
| Rate for Payer: Global Benefits Group Commercial |
$1.36
|
| Rate for Payer: Health Management Network EPO/PPO |
$2.03
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$1.70
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$0.79
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1.51
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.86
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.45
|
| 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
|
| 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 Medi-Cal |
$1.92
|
| Rate for Payer: Vantage Medical Group Senior |
$1.92
|
|
|
FLUOCINOLONE 0.18 MG INTRAVITREAL IMPLANT [223628]
|
Facility
|
OP
|
$10,795.20
|
|
|
Service Code
|
CPT J7314
|
| Hospital Charge Code |
ERX223628
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$529.00 |
| Max. Negotiated Rate |
$9,715.68 |
| Rate for Payer: Adventist Health Medi-Cal |
$529.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$3,278.24
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$661.25
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$581.90
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$581.90
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$947.66
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,037.59
|
| Rate for Payer: Blue Distinction Transplant |
$6,477.12
|
| Rate for Payer: Blue Shield of California Commercial |
$6,790.18
|
| Rate for Payer: Blue Shield of California EPN |
$5,278.85
|
| Rate for Payer: Caremore Medicare Advantage |
$529.00
|
| Rate for Payer: Cash Price |
$4,857.84
|
| Rate for Payer: Cash Price |
$4,857.84
|
| Rate for Payer: Central Health Plan Commercial |
$8,636.16
|
| Rate for Payer: Cigna of CA HMO |
$7,556.64
|
| Rate for Payer: Cigna of CA PPO |
$7,556.64
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$793.50
|
| Rate for Payer: Dignity Health Media |
$529.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$581.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$714.15
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$529.00
|
| Rate for Payer: EPIC Health Plan Transplant |
$529.00
|
| Rate for Payer: Galaxy Health WC |
$9,175.92
|
| Rate for Payer: Global Benefits Group Commercial |
$6,477.12
|
| Rate for Payer: Health Management Network EPO/PPO |
$9,715.68
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$8,096.40
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$867.56
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$872.85
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$529.00
|
| Rate for Payer: InnovAge PACE Commercial |
$793.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$7,200.40
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,005.10
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$529.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,159.04
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$708.86
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$708.86
|
| Rate for Payer: Multiplan Commercial |
$8,096.40
|
| Rate for Payer: Networks By Design Commercial |
$5,397.60
|
| Rate for Payer: Prime Health Services Commercial |
$9,175.92
|
| Rate for Payer: Prime Health Services Medicare |
$560.74
|
| Rate for Payer: Riverside University Health System MISP |
$581.90
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$6,477.12
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$6,477.12
|
| Rate for Payer: United Healthcare All Other Commercial |
$5,397.60
|
| Rate for Payer: United Healthcare All Other HMO |
$5,397.60
|
| Rate for Payer: United Healthcare HMO Rider |
$5,397.60
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$5,397.60
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$793.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$581.90
|
| Rate for Payer: Vantage Medical Group Senior |
$529.00
|
|
|
FLUOCINOLONE 0.18 MG INTRAVITREAL IMPLANT [223628]
|
Facility
|
IP
|
$10,795.20
|
|
|
Service Code
|
CPT J7314
|
| Hospital Charge Code |
ERX223628
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$2,159.04 |
| Max. Negotiated Rate |
$9,715.68 |
| Rate for Payer: Blue Shield of California Commercial |
$8,096.40
|
| Rate for Payer: Blue Shield of California EPN |
$5,764.64
|
| Rate for Payer: Cash Price |
$4,857.84
|
| Rate for Payer: Central Health Plan Commercial |
$8,636.16
|
| Rate for Payer: Cigna of CA HMO |
$7,556.64
|
| Rate for Payer: Cigna of CA PPO |
$7,556.64
|
| Rate for Payer: EPIC Health Plan Commercial |
$4,318.08
|
| Rate for Payer: EPIC Health Plan Transplant |
$4,318.08
|
| Rate for Payer: Galaxy Health WC |
$9,175.92
|
| Rate for Payer: Global Benefits Group Commercial |
$6,477.12
|
| Rate for Payer: Health Management Network EPO/PPO |
$9,715.68
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$7,200.40
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4,112.97
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,159.04
|
| Rate for Payer: Multiplan Commercial |
$8,096.40
|
| Rate for Payer: Networks By Design Commercial |
$5,397.60
|
| Rate for Payer: Prime Health Services Commercial |
$9,175.92
|
| Rate for Payer: United Healthcare All Other Commercial |
$4,076.27
|
| Rate for Payer: United Healthcare All Other HMO |
$3,981.27
|
| Rate for Payer: United Healthcare HMO Rider |
$3,894.91
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3,562.42
|
|
|
FLUOCINOLONE 0.19 MG INTRAVITREAL IMPLANT [208310]
|
Facility
|
OP
|
$10,560.00
|
|
|
Service Code
|
CPT J7313
|
| Hospital Charge Code |
ERX208310
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$490.95 |
| Max. Negotiated Rate |
$9,504.00 |
| Rate for Payer: Adventist Health Medi-Cal |
$490.95
|
| Rate for Payer: Aetna of CA HMO/PPO |
$3,042.45
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$613.68
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$540.04
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$540.04
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$916.65
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,003.64
|
| Rate for Payer: Blue Distinction Transplant |
$6,336.00
|
| Rate for Payer: Blue Shield of California Commercial |
$611.37
|
| Rate for Payer: Blue Shield of California EPN |
$555.79
|
| Rate for Payer: Caremore Medicare Advantage |
$490.95
|
| Rate for Payer: Cash Price |
$4,752.00
|
| Rate for Payer: Cash Price |
$4,752.00
|
| Rate for Payer: Central Health Plan Commercial |
$8,448.00
|
| Rate for Payer: Cigna of CA HMO |
$7,392.00
|
| Rate for Payer: Cigna of CA PPO |
$7,392.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$736.42
|
| Rate for Payer: Dignity Health Media |
$490.95
|
| Rate for Payer: Dignity Health Medi-Cal |
$540.04
|
| Rate for Payer: EPIC Health Plan Commercial |
$662.78
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$490.95
|
| Rate for Payer: EPIC Health Plan Transplant |
$490.95
|
| Rate for Payer: Galaxy Health WC |
$8,976.00
|
| Rate for Payer: Global Benefits Group Commercial |
$6,336.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$9,504.00
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$7,920.00
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$805.15
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$810.06
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$490.95
|
| Rate for Payer: InnovAge PACE Commercial |
$736.42
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$7,043.52
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$932.80
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$490.95
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,112.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$657.87
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$657.87
|
| Rate for Payer: Multiplan Commercial |
$7,920.00
|
| Rate for Payer: Networks By Design Commercial |
$5,280.00
|
| Rate for Payer: Prime Health Services Commercial |
$8,976.00
|
| Rate for Payer: Prime Health Services Medicare |
$520.40
|
| Rate for Payer: Riverside University Health System MISP |
$540.04
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$6,336.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$6,336.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$5,280.00
|
| Rate for Payer: United Healthcare All Other HMO |
$5,280.00
|
| Rate for Payer: United Healthcare HMO Rider |
$5,280.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$5,280.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$736.42
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$540.04
|
| Rate for Payer: Vantage Medical Group Senior |
$490.95
|
|
|
FLUOCINOLONE 0.19 MG INTRAVITREAL IMPLANT [208310]
|
Facility
|
IP
|
$10,560.00
|
|
|
Service Code
|
CPT J7313
|
| Hospital Charge Code |
ERX208310
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$2,112.00 |
| Max. Negotiated Rate |
$9,504.00 |
| Rate for Payer: Blue Shield of California Commercial |
$7,920.00
|
| Rate for Payer: Blue Shield of California EPN |
$5,639.04
|
| Rate for Payer: Cash Price |
$4,752.00
|
| Rate for Payer: Central Health Plan Commercial |
$8,448.00
|
| Rate for Payer: Cigna of CA HMO |
$7,392.00
|
| Rate for Payer: Cigna of CA PPO |
$7,392.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$4,224.00
|
| Rate for Payer: EPIC Health Plan Transplant |
$4,224.00
|
| Rate for Payer: Galaxy Health WC |
$8,976.00
|
| Rate for Payer: Global Benefits Group Commercial |
$6,336.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$9,504.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$7,043.52
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4,023.36
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,112.00
|
| Rate for Payer: Multiplan Commercial |
$7,920.00
|
| Rate for Payer: Networks By Design Commercial |
$5,280.00
|
| Rate for Payer: Prime Health Services Commercial |
$8,976.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$3,987.46
|
| Rate for Payer: United Healthcare All Other HMO |
$3,894.53
|
| Rate for Payer: United Healthcare HMO Rider |
$3,810.05
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3,484.80
|
|
|
FLUOCINONIDE 0.05 % TOPICAL CREAM [3187]
|
Facility
|
OP
|
$2.92
|
|
|
Service Code
|
NDC 0093-0262-15
|
| Hospital Charge Code |
1743410
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.58 |
| Max. Negotiated Rate |
$2.63 |
| 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 |
$1.61
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1.41
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1.73
|
| Rate for Payer: Blue Distinction Transplant |
$1.75
|
| Rate for Payer: Blue Shield of California Commercial |
$1.84
|
| Rate for Payer: Blue Shield of California EPN |
$1.43
|
| 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 Media |
$2.48
|
| Rate for Payer: Dignity Health Medi-Cal |
$2.48
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.17
|
| Rate for Payer: EPIC Health Plan Transplant |
$1.17
|
| Rate for Payer: Galaxy Health WC |
$2.48
|
| Rate for Payer: Global Benefits Group Commercial |
$1.75
|
| Rate for Payer: Health Management Network EPO/PPO |
$2.63
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$2.19
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$1.02
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1.95
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1.11
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.58
|
| 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
|
| 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 Medi-Cal |
$2.48
|
| Rate for Payer: Vantage Medical Group Senior |
$2.48
|
|
|
FLUOCINONIDE 0.05 % TOPICAL CREAM [3187]
|
Facility
|
IP
|
$2.92
|
|
|
Service Code
|
NDC 51862-494-15
|
| Hospital Charge Code |
1743410
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.58 |
| Max. Negotiated Rate |
$2.63 |
| Rate for Payer: Blue Shield of California Commercial |
$2.19
|
| Rate for Payer: Blue Shield of California EPN |
$1.56
|
| 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: EPIC Health Plan Commercial |
$1.17
|
| Rate for Payer: Galaxy Health WC |
$2.48
|
| Rate for Payer: Global Benefits Group Commercial |
$1.75
|
| Rate for Payer: Health Management Network EPO/PPO |
$2.63
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1.95
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1.11
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.58
|
| 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 0093-0262-15
|
| Hospital Charge Code |
1743410
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.58 |
| Max. Negotiated Rate |
$2.63 |
| Rate for Payer: Blue Shield of California Commercial |
$2.19
|
| Rate for Payer: Blue Shield of California EPN |
$1.56
|
| 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: EPIC Health Plan Commercial |
$1.17
|
| Rate for Payer: Galaxy Health WC |
$2.48
|
| Rate for Payer: Global Benefits Group Commercial |
$1.75
|
| Rate for Payer: Health Management Network EPO/PPO |
$2.63
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1.95
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1.11
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.58
|
| 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
|
OP
|
$1.20
|
|
|
Service Code
|
NDC 51672-1386-1
|
| Hospital Charge Code |
1743410
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.24 |
| Max. Negotiated Rate |
$1.08 |
| 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 |
$0.66
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$0.58
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.71
|
| Rate for Payer: Blue Distinction Transplant |
$0.72
|
| Rate for Payer: Blue Shield of California Commercial |
$0.75
|
| Rate for Payer: Blue Shield of California EPN |
$0.59
|
| 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 Media |
$1.02
|
| Rate for Payer: Dignity Health Medi-Cal |
$1.02
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.48
|
| Rate for Payer: EPIC Health Plan Transplant |
$0.48
|
| Rate for Payer: Galaxy Health WC |
$1.02
|
| Rate for Payer: Global Benefits Group Commercial |
$0.72
|
| Rate for Payer: Health Management Network EPO/PPO |
$1.08
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$0.90
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$0.42
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.80
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.46
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.24
|
| 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
|
| 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 Medi-Cal |
$1.02
|
| Rate for Payer: Vantage Medical Group Senior |
$1.02
|
|
|
FLUOCINONIDE 0.05 % TOPICAL CREAM [3187]
|
Facility
|
IP
|
$1.20
|
|
|
Service Code
|
NDC 51672-1386-1
|
| Hospital Charge Code |
1743410
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.24 |
| Max. Negotiated Rate |
$1.08 |
| Rate for Payer: Blue Shield of California Commercial |
$0.90
|
| Rate for Payer: Blue Shield of California EPN |
$0.64
|
| 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: EPIC Health Plan Commercial |
$0.48
|
| Rate for Payer: Galaxy Health WC |
$1.02
|
| Rate for Payer: Global Benefits Group Commercial |
$0.72
|
| Rate for Payer: Health Management Network EPO/PPO |
$1.08
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.80
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.46
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.24
|
| 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
|
$2.92
|
|
|
Service Code
|
NDC 51862-494-15
|
| Hospital Charge Code |
1743410
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.58 |
| Max. Negotiated Rate |
$2.63 |
| 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 |
$1.61
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1.41
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1.73
|
| Rate for Payer: Blue Distinction Transplant |
$1.75
|
| Rate for Payer: Blue Shield of California Commercial |
$1.84
|
| Rate for Payer: Blue Shield of California EPN |
$1.43
|
| 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 Media |
$2.48
|
| Rate for Payer: Dignity Health Medi-Cal |
$2.48
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.17
|
| Rate for Payer: EPIC Health Plan Transplant |
$1.17
|
| Rate for Payer: Galaxy Health WC |
$2.48
|
| Rate for Payer: Global Benefits Group Commercial |
$1.75
|
| Rate for Payer: Health Management Network EPO/PPO |
$2.63
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$2.19
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$1.02
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1.95
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1.11
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.58
|
| 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
|
| 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 Medi-Cal |
$2.48
|
| Rate for Payer: Vantage Medical Group Senior |
$2.48
|
|
|
FLUOCINONIDE 0.05 % TOPICAL CREAM. [4083187]
|
Facility
|
OP
|
$2.92
|
|
|
Service Code
|
NDC 0093-0262-30
|
| Hospital Charge Code |
1743039
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.58 |
| Max. Negotiated Rate |
$2.63 |
| 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 |
$1.61
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1.41
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1.73
|
| Rate for Payer: Blue Distinction Transplant |
$1.75
|
| Rate for Payer: Blue Shield of California Commercial |
$1.84
|
| Rate for Payer: Blue Shield of California EPN |
$1.43
|
| 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 Media |
$2.48
|
| Rate for Payer: Dignity Health Medi-Cal |
$2.48
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.17
|
| Rate for Payer: EPIC Health Plan Transplant |
$1.17
|
| Rate for Payer: Galaxy Health WC |
$2.48
|
| Rate for Payer: Global Benefits Group Commercial |
$1.75
|
| Rate for Payer: Health Management Network EPO/PPO |
$2.63
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$2.19
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$1.02
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1.95
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1.11
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.58
|
| 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
|
| 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 Medi-Cal |
$2.48
|
| Rate for Payer: Vantage Medical Group Senior |
$2.48
|
|
