|
FLUPHENAZINE 2.5 MG TABLET [3220]
|
Facility
|
IP
|
$1.29
|
|
|
Service Code
|
NDC 69238-1679-1
|
| Hospital Charge Code |
1710622
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.26 |
| Max. Negotiated Rate |
$1.16 |
| Rate for Payer: Blue Shield of California Commercial |
$0.97
|
| Rate for Payer: Blue Shield of California EPN |
$0.69
|
| Rate for Payer: Cash Price |
$0.58
|
| Rate for Payer: Central Health Plan Commercial |
$1.03
|
| Rate for Payer: Cigna of CA HMO |
$0.90
|
| Rate for Payer: Cigna of CA PPO |
$0.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.52
|
| Rate for Payer: Galaxy Health WC |
$1.10
|
| Rate for Payer: Global Benefits Group Commercial |
$0.77
|
| Rate for Payer: Health Management Network EPO/PPO |
$1.16
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.86
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.49
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.26
|
| Rate for Payer: Multiplan Commercial |
$0.97
|
| Rate for Payer: Networks By Design Commercial |
$0.84
|
| Rate for Payer: Prime Health Services Commercial |
$1.10
|
|
|
FLUPHENAZINE 2.5 MG TABLET [3220]
|
Facility
|
IP
|
$2.78
|
|
|
Service Code
|
NDC 0527-1789-01
|
| Hospital Charge Code |
1710622
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.56 |
| Max. Negotiated Rate |
$2.50 |
| Rate for Payer: Blue Shield of California Commercial |
$2.08
|
| Rate for Payer: Blue Shield of California EPN |
$1.48
|
| 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: EPIC Health Plan Commercial |
$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 Permanente of CA Commercial/Self Funded |
$1.85
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1.06
|
| 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
|
OP
|
$1.29
|
|
|
Service Code
|
NDC 69238-1679-1
|
| Hospital Charge Code |
1710622
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.26 |
| Max. Negotiated Rate |
$1.16 |
| Rate for Payer: Aetna of CA HMO/PPO |
$0.78
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1.10
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.71
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.71
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$0.62
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.76
|
| Rate for Payer: Blue Distinction Transplant |
$0.77
|
| Rate for Payer: Blue Shield of California Commercial |
$0.81
|
| Rate for Payer: Blue Shield of California EPN |
$0.63
|
| Rate for Payer: Cash Price |
$0.58
|
| Rate for Payer: Central Health Plan Commercial |
$1.03
|
| 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 |
$1.10
|
| Rate for Payer: Dignity Health Media |
$1.10
|
| Rate for Payer: Dignity Health Medi-Cal |
$1.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.52
|
| Rate for Payer: EPIC Health Plan Transplant |
$0.52
|
| Rate for Payer: Galaxy Health WC |
$1.10
|
| Rate for Payer: Global Benefits Group Commercial |
$0.77
|
| Rate for Payer: Health Management Network EPO/PPO |
$1.16
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$0.97
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$0.45
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.86
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.49
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.26
|
| Rate for Payer: Multiplan Commercial |
$0.97
|
| Rate for Payer: Networks By Design Commercial |
$0.84
|
| Rate for Payer: Prime Health Services Commercial |
$1.10
|
| Rate for Payer: Riverside University Health System MISP |
$0.52
|
| 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 |
$0.65
|
| Rate for Payer: United Healthcare All Other HMO |
$0.65
|
| Rate for Payer: United Healthcare HMO Rider |
$0.65
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.65
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1.10
|
| Rate for Payer: Vantage Medical Group Senior |
$1.10
|
|
|
FLUPHENAZINE DECANOATE 25 MG/ML INJECTION SOLUTION [3215]
|
Facility
|
OP
|
$29.04
|
|
|
Service Code
|
CPT J2680
|
| Hospital Charge Code |
1720193
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$5.81 |
| Max. Negotiated Rate |
$108.29 |
| Rate for Payer: Aetna of CA HMO/PPO |
$56.69
|
| 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 |
$15.97
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$98.90
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$108.29
|
| Rate for Payer: Blue Distinction Transplant |
$17.42
|
| Rate for Payer: Blue Shield of California Commercial |
$31.94
|
| Rate for Payer: Blue Shield of California EPN |
$29.04
|
| 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 Media |
$24.68
|
| Rate for Payer: Dignity Health Medi-Cal |
$24.68
|
| Rate for Payer: EPIC Health Plan Commercial |
$11.62
|
| Rate for Payer: EPIC Health Plan Transplant |
$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: Health Plan of Nevada (Sierra) Other |
$21.78
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$8.92
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$19.37
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$25.86
|
| 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: 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 |
$14.52
|
| Rate for Payer: United Healthcare All Other HMO |
$14.52
|
| Rate for Payer: United Healthcare HMO Rider |
$14.52
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$14.52
|
| 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
|
CPT J2680
|
| Hospital Charge Code |
1720193
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$5.81 |
| Max. Negotiated Rate |
$26.14 |
| Rate for Payer: Blue Shield of California Commercial |
$21.78
|
| Rate for Payer: Blue Shield of California EPN |
$15.51
|
| 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: EPIC Health Plan Commercial |
$11.62
|
| Rate for Payer: EPIC Health Plan Transplant |
$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 Permanente of CA Commercial/Self Funded |
$19.37
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$11.06
|
| 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 |
$10.97
|
| Rate for Payer: United Healthcare All Other HMO |
$10.71
|
| Rate for Payer: United Healthcare HMO Rider |
$10.48
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$9.58
|
|
|
FLURAZEPAM 15 MG CAPSULE [3223]
|
Facility
|
OP
|
$0.60
|
|
|
Service Code
|
NDC 0378-4415-01
|
| Hospital Charge Code |
1730039
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.12 |
| Max. Negotiated Rate |
$0.54 |
| Rate for Payer: Aetna of CA HMO/PPO |
$0.36
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.51
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.33
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.33
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$0.29
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.35
|
| Rate for Payer: Blue Distinction Transplant |
$0.36
|
| Rate for Payer: Blue Shield of California Commercial |
$0.38
|
| Rate for Payer: Blue Shield of California EPN |
$0.29
|
| Rate for Payer: Cash Price |
$0.27
|
| Rate for Payer: Central Health Plan Commercial |
$0.48
|
| Rate for Payer: Cigna of CA HMO |
$0.42
|
| Rate for Payer: Cigna of CA PPO |
$0.42
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.51
|
| Rate for Payer: Dignity Health Media |
$0.51
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.51
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.24
|
| Rate for Payer: EPIC Health Plan Transplant |
$0.24
|
| Rate for Payer: Galaxy Health WC |
$0.51
|
| Rate for Payer: Global Benefits Group Commercial |
$0.36
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.54
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$0.45
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$0.21
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.40
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.23
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.12
|
| Rate for Payer: Multiplan Commercial |
$0.45
|
| Rate for Payer: Networks By Design Commercial |
$0.39
|
| Rate for Payer: Prime Health Services Commercial |
$0.51
|
| Rate for Payer: Riverside University Health System MISP |
$0.24
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.36
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.36
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.30
|
| Rate for Payer: United Healthcare All Other HMO |
$0.30
|
| Rate for Payer: United Healthcare HMO Rider |
$0.30
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.30
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.51
|
| Rate for Payer: Vantage Medical Group Senior |
$0.51
|
|
|
FLURAZEPAM 15 MG CAPSULE [3223]
|
Facility
|
IP
|
$0.60
|
|
|
Service Code
|
NDC 0378-4415-01
|
| Hospital Charge Code |
1730039
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.12 |
| Max. Negotiated Rate |
$0.54 |
| Rate for Payer: Blue Shield of California Commercial |
$0.45
|
| Rate for Payer: Blue Shield of California EPN |
$0.32
|
| Rate for Payer: Cash Price |
$0.27
|
| Rate for Payer: Central Health Plan Commercial |
$0.48
|
| Rate for Payer: Cigna of CA HMO |
$0.42
|
| Rate for Payer: Cigna of CA PPO |
$0.42
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.24
|
| Rate for Payer: Galaxy Health WC |
$0.51
|
| Rate for Payer: Global Benefits Group Commercial |
$0.36
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.54
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.40
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.23
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.12
|
| Rate for Payer: Multiplan Commercial |
$0.45
|
| Rate for Payer: Networks By Design Commercial |
$0.39
|
| Rate for Payer: Prime Health Services Commercial |
$0.51
|
|
|
FLUTICASONE 250 MCG-SALMETEROL 50 MCG/DOSE BLISTR POWDR FOR INHALATION [26538]
|
Facility
|
OP
|
$7.88
|
|
|
Service Code
|
NDC 0173-0696-00
|
| Hospital Charge Code |
1744100
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$1.58 |
| Max. Negotiated Rate |
$7.09 |
| Rate for Payer: Aetna of CA HMO/PPO |
$4.79
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$6.70
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4.33
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4.33
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$3.82
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4.66
|
| Rate for Payer: Blue Distinction Transplant |
$4.73
|
| Rate for Payer: Blue Shield of California Commercial |
$4.96
|
| Rate for Payer: Blue Shield of California EPN |
$3.85
|
| Rate for Payer: Cash Price |
$3.55
|
| Rate for Payer: Central Health Plan Commercial |
$6.30
|
| Rate for Payer: Cigna of CA HMO |
$5.52
|
| Rate for Payer: Cigna of CA PPO |
$5.52
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$6.70
|
| Rate for Payer: Dignity Health Media |
$6.70
|
| Rate for Payer: Dignity Health Medi-Cal |
$6.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$3.15
|
| Rate for Payer: EPIC Health Plan Transplant |
$3.15
|
| Rate for Payer: Galaxy Health WC |
$6.70
|
| Rate for Payer: Global Benefits Group Commercial |
$4.73
|
| Rate for Payer: Health Management Network EPO/PPO |
$7.09
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$5.91
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$2.76
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$5.26
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.58
|
| Rate for Payer: Multiplan Commercial |
$5.91
|
| Rate for Payer: Networks By Design Commercial |
$5.12
|
| Rate for Payer: Prime Health Services Commercial |
$6.70
|
| Rate for Payer: Riverside University Health System MISP |
$3.15
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$4.73
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$4.73
|
| Rate for Payer: United Healthcare All Other Commercial |
$3.94
|
| Rate for Payer: United Healthcare All Other HMO |
$3.94
|
| Rate for Payer: United Healthcare HMO Rider |
$3.94
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3.94
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$6.70
|
| Rate for Payer: Vantage Medical Group Senior |
$6.70
|
|
|
FLUTICASONE 250 MCG-SALMETEROL 50 MCG/DOSE BLISTR POWDR FOR INHALATION [26538]
|
Facility
|
IP
|
$7.88
|
|
|
Service Code
|
NDC 0173-0696-00
|
| Hospital Charge Code |
1744100
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$1.58 |
| Max. Negotiated Rate |
$7.09 |
| Rate for Payer: Blue Shield of California Commercial |
$5.91
|
| Rate for Payer: Blue Shield of California EPN |
$4.21
|
| Rate for Payer: Cash Price |
$3.55
|
| Rate for Payer: Central Health Plan Commercial |
$6.30
|
| Rate for Payer: Cigna of CA HMO |
$5.52
|
| Rate for Payer: Cigna of CA PPO |
$5.52
|
| Rate for Payer: EPIC Health Plan Commercial |
$3.15
|
| Rate for Payer: Galaxy Health WC |
$6.70
|
| Rate for Payer: Global Benefits Group Commercial |
$4.73
|
| Rate for Payer: Health Management Network EPO/PPO |
$7.09
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$5.26
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.58
|
| Rate for Payer: Multiplan Commercial |
$5.91
|
| Rate for Payer: Networks By Design Commercial |
$5.12
|
| Rate for Payer: Prime Health Services Commercial |
$6.70
|
|
|
FLUTICASONE 500 MCG-SALMETEROL 50 MCG/DOSE BLISTR POWDR FOR INHALATION [104566]
|
Facility
|
OP
|
$10.36
|
|
|
Service Code
|
NDC 0173-0697-00
|
| Hospital Charge Code |
1744101
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$2.07 |
| Max. Negotiated Rate |
$9.32 |
| Rate for Payer: Aetna of CA HMO/PPO |
$6.29
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$8.81
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$5.70
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$5.70
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$5.02
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$6.12
|
| Rate for Payer: Blue Distinction Transplant |
$6.22
|
| Rate for Payer: Blue Shield of California Commercial |
$6.52
|
| Rate for Payer: Blue Shield of California EPN |
$5.07
|
| Rate for Payer: Cash Price |
$4.66
|
| Rate for Payer: Central Health Plan Commercial |
$8.29
|
| Rate for Payer: Cigna of CA HMO |
$7.25
|
| Rate for Payer: Cigna of CA PPO |
$7.25
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$8.81
|
| Rate for Payer: Dignity Health Media |
$8.81
|
| Rate for Payer: Dignity Health Medi-Cal |
$8.81
|
| Rate for Payer: EPIC Health Plan Commercial |
$4.14
|
| Rate for Payer: EPIC Health Plan Transplant |
$4.14
|
| Rate for Payer: Galaxy Health WC |
$8.81
|
| Rate for Payer: Global Benefits Group Commercial |
$6.22
|
| Rate for Payer: Health Management Network EPO/PPO |
$9.32
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$7.77
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$3.63
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$6.91
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3.95
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.07
|
| Rate for Payer: Multiplan Commercial |
$7.77
|
| Rate for Payer: Networks By Design Commercial |
$6.73
|
| Rate for Payer: Prime Health Services Commercial |
$8.81
|
| Rate for Payer: Riverside University Health System MISP |
$4.14
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$6.22
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$6.22
|
| Rate for Payer: United Healthcare All Other Commercial |
$5.18
|
| Rate for Payer: United Healthcare All Other HMO |
$5.18
|
| Rate for Payer: United Healthcare HMO Rider |
$5.18
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$5.18
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$8.81
|
| Rate for Payer: Vantage Medical Group Senior |
$8.81
|
|
|
FLUTICASONE 500 MCG-SALMETEROL 50 MCG/DOSE BLISTR POWDR FOR INHALATION [104566]
|
Facility
|
IP
|
$10.36
|
|
|
Service Code
|
NDC 0173-0697-00
|
| Hospital Charge Code |
1744101
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$2.07 |
| Max. Negotiated Rate |
$9.32 |
| Rate for Payer: Blue Shield of California Commercial |
$7.77
|
| Rate for Payer: Blue Shield of California EPN |
$5.53
|
| Rate for Payer: Cash Price |
$4.66
|
| Rate for Payer: Central Health Plan Commercial |
$8.29
|
| Rate for Payer: Cigna of CA HMO |
$7.25
|
| Rate for Payer: Cigna of CA PPO |
$7.25
|
| Rate for Payer: EPIC Health Plan Commercial |
$4.14
|
| Rate for Payer: Galaxy Health WC |
$8.81
|
| Rate for Payer: Global Benefits Group Commercial |
$6.22
|
| Rate for Payer: Health Management Network EPO/PPO |
$9.32
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$6.91
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3.95
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.07
|
| Rate for Payer: Multiplan Commercial |
$7.77
|
| Rate for Payer: Networks By Design Commercial |
$6.73
|
| Rate for Payer: Prime Health Services Commercial |
$8.81
|
|
|
FLUTICASONE PROPIONATE 110 MCG/ACTUATION HFA AEROSOL INHALER [40698]
|
Facility
|
OP
|
$27.38
|
|
|
Service Code
|
NDC 0173-0719-20
|
| Hospital Charge Code |
NDG40698
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$5.48 |
| Max. Negotiated Rate |
$24.64 |
| Rate for Payer: Aetna of CA HMO/PPO |
$16.63
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$23.27
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$15.06
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$15.06
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$13.26
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$16.18
|
| Rate for Payer: Blue Distinction Transplant |
$16.43
|
| Rate for Payer: Blue Shield of California Commercial |
$17.22
|
| Rate for Payer: Blue Shield of California EPN |
$13.39
|
| Rate for Payer: Cash Price |
$12.32
|
| Rate for Payer: Central Health Plan Commercial |
$21.90
|
| Rate for Payer: Cigna of CA HMO |
$19.17
|
| Rate for Payer: Cigna of CA PPO |
$19.17
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$23.27
|
| Rate for Payer: Dignity Health Media |
$23.27
|
| Rate for Payer: Dignity Health Medi-Cal |
$23.27
|
| Rate for Payer: EPIC Health Plan Commercial |
$10.95
|
| Rate for Payer: EPIC Health Plan Transplant |
$10.95
|
| Rate for Payer: Galaxy Health WC |
$23.27
|
| Rate for Payer: Global Benefits Group Commercial |
$16.43
|
| Rate for Payer: Health Management Network EPO/PPO |
$24.64
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$20.54
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$9.58
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$18.26
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$10.43
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5.48
|
| Rate for Payer: Multiplan Commercial |
$20.54
|
| Rate for Payer: Networks By Design Commercial |
$17.80
|
| Rate for Payer: Prime Health Services Commercial |
$23.27
|
| Rate for Payer: Riverside University Health System MISP |
$10.95
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$16.43
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$16.43
|
| Rate for Payer: United Healthcare All Other Commercial |
$13.69
|
| Rate for Payer: United Healthcare All Other HMO |
$13.69
|
| Rate for Payer: United Healthcare HMO Rider |
$13.69
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$13.69
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$23.27
|
| Rate for Payer: Vantage Medical Group Senior |
$23.27
|
|
|
FLUTICASONE PROPIONATE 110 MCG/ACTUATION HFA AEROSOL INHALER [40698]
|
Facility
|
IP
|
$27.38
|
|
|
Service Code
|
NDC 0173-0719-20
|
| Hospital Charge Code |
NDG40698
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$5.48 |
| Max. Negotiated Rate |
$24.64 |
| Rate for Payer: Blue Shield of California Commercial |
$20.54
|
| Rate for Payer: Blue Shield of California EPN |
$14.62
|
| Rate for Payer: Cash Price |
$12.32
|
| Rate for Payer: Central Health Plan Commercial |
$21.90
|
| Rate for Payer: Cigna of CA HMO |
$19.17
|
| Rate for Payer: Cigna of CA PPO |
$19.17
|
| Rate for Payer: EPIC Health Plan Commercial |
$10.95
|
| Rate for Payer: Galaxy Health WC |
$23.27
|
| Rate for Payer: Global Benefits Group Commercial |
$16.43
|
| Rate for Payer: Health Management Network EPO/PPO |
$24.64
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$18.26
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$10.43
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5.48
|
| Rate for Payer: Multiplan Commercial |
$20.54
|
| Rate for Payer: Networks By Design Commercial |
$17.80
|
| Rate for Payer: Prime Health Services Commercial |
$23.27
|
|
|
FLUTICASONE PROPIONATE 220 MCG/ACTUATION HFA AEROSOL INHALER [40699]
|
Facility
|
OP
|
$42.53
|
|
|
Service Code
|
NDC 0173-0720-20
|
| Hospital Charge Code |
NDG40699
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$8.51 |
| Max. Negotiated Rate |
$38.28 |
| Rate for Payer: Aetna of CA HMO/PPO |
$25.83
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$36.15
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$23.39
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$23.39
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$20.59
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$25.13
|
| Rate for Payer: Blue Distinction Transplant |
$25.52
|
| Rate for Payer: Blue Shield of California Commercial |
$26.75
|
| Rate for Payer: Blue Shield of California EPN |
$20.80
|
| Rate for Payer: Cash Price |
$19.14
|
| Rate for Payer: Central Health Plan Commercial |
$34.02
|
| Rate for Payer: Cigna of CA HMO |
$29.77
|
| Rate for Payer: Cigna of CA PPO |
$29.77
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$36.15
|
| Rate for Payer: Dignity Health Media |
$36.15
|
| Rate for Payer: Dignity Health Medi-Cal |
$36.15
|
| Rate for Payer: EPIC Health Plan Commercial |
$17.01
|
| Rate for Payer: EPIC Health Plan Transplant |
$17.01
|
| Rate for Payer: Galaxy Health WC |
$36.15
|
| Rate for Payer: Global Benefits Group Commercial |
$25.52
|
| Rate for Payer: Health Management Network EPO/PPO |
$38.28
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$31.90
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$14.89
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$28.37
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$16.20
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$8.51
|
| Rate for Payer: Multiplan Commercial |
$31.90
|
| Rate for Payer: Networks By Design Commercial |
$27.64
|
| Rate for Payer: Prime Health Services Commercial |
$36.15
|
| Rate for Payer: Riverside University Health System MISP |
$17.01
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$25.52
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$25.52
|
| Rate for Payer: United Healthcare All Other Commercial |
$21.26
|
| Rate for Payer: United Healthcare All Other HMO |
$21.26
|
| Rate for Payer: United Healthcare HMO Rider |
$21.26
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$21.26
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$36.15
|
| Rate for Payer: Vantage Medical Group Senior |
$36.15
|
|
|
FLUTICASONE PROPIONATE 220 MCG/ACTUATION HFA AEROSOL INHALER [40699]
|
Facility
|
IP
|
$42.53
|
|
|
Service Code
|
NDC 0173-0720-20
|
| Hospital Charge Code |
NDG40699
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$8.51 |
| Max. Negotiated Rate |
$38.28 |
| Rate for Payer: Blue Shield of California Commercial |
$31.90
|
| Rate for Payer: Blue Shield of California EPN |
$22.71
|
| Rate for Payer: Cash Price |
$19.14
|
| Rate for Payer: Central Health Plan Commercial |
$34.02
|
| Rate for Payer: Cigna of CA HMO |
$29.77
|
| Rate for Payer: Cigna of CA PPO |
$29.77
|
| Rate for Payer: EPIC Health Plan Commercial |
$17.01
|
| Rate for Payer: Galaxy Health WC |
$36.15
|
| Rate for Payer: Global Benefits Group Commercial |
$25.52
|
| Rate for Payer: Health Management Network EPO/PPO |
$38.28
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$28.37
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$16.20
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$8.51
|
| Rate for Payer: Multiplan Commercial |
$31.90
|
| Rate for Payer: Networks By Design Commercial |
$27.64
|
| Rate for Payer: Prime Health Services Commercial |
$36.15
|
|
|
FLUTICASONE PROPIONATE 44 MCG/ACTUATION HFA AEROSOL INHALER [40697]
|
Facility
|
IP
|
$23.16
|
|
|
Service Code
|
NDC 0173-0718-20
|
| Hospital Charge Code |
NDG40697
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$4.63 |
| Max. Negotiated Rate |
$20.84 |
| Rate for Payer: Blue Shield of California Commercial |
$17.37
|
| Rate for Payer: Blue Shield of California EPN |
$12.37
|
| Rate for Payer: Cash Price |
$10.42
|
| Rate for Payer: Central Health Plan Commercial |
$18.53
|
| Rate for Payer: Cigna of CA HMO |
$16.21
|
| Rate for Payer: Cigna of CA PPO |
$16.21
|
| Rate for Payer: EPIC Health Plan Commercial |
$9.26
|
| Rate for Payer: Galaxy Health WC |
$19.69
|
| Rate for Payer: Global Benefits Group Commercial |
$13.90
|
| Rate for Payer: Health Management Network EPO/PPO |
$20.84
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$15.45
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$8.82
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.63
|
| Rate for Payer: Multiplan Commercial |
$17.37
|
| Rate for Payer: Networks By Design Commercial |
$15.05
|
| Rate for Payer: Prime Health Services Commercial |
$19.69
|
|
|
FLUTICASONE PROPIONATE 44 MCG/ACTUATION HFA AEROSOL INHALER [40697]
|
Facility
|
OP
|
$23.16
|
|
|
Service Code
|
NDC 0173-0718-20
|
| Hospital Charge Code |
NDG40697
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$4.63 |
| Max. Negotiated Rate |
$20.84 |
| Rate for Payer: Aetna of CA HMO/PPO |
$14.07
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$19.69
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$12.74
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$12.74
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$11.21
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13.68
|
| Rate for Payer: Blue Distinction Transplant |
$13.90
|
| Rate for Payer: Blue Shield of California Commercial |
$14.57
|
| Rate for Payer: Blue Shield of California EPN |
$11.33
|
| Rate for Payer: Cash Price |
$10.42
|
| Rate for Payer: Central Health Plan Commercial |
$18.53
|
| Rate for Payer: Cigna of CA HMO |
$16.21
|
| Rate for Payer: Cigna of CA PPO |
$16.21
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$19.69
|
| Rate for Payer: Dignity Health Media |
$19.69
|
| Rate for Payer: Dignity Health Medi-Cal |
$19.69
|
| Rate for Payer: EPIC Health Plan Commercial |
$9.26
|
| Rate for Payer: EPIC Health Plan Transplant |
$9.26
|
| Rate for Payer: Galaxy Health WC |
$19.69
|
| Rate for Payer: Global Benefits Group Commercial |
$13.90
|
| Rate for Payer: Health Management Network EPO/PPO |
$20.84
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$17.37
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$8.11
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$15.45
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$8.82
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.63
|
| Rate for Payer: Multiplan Commercial |
$17.37
|
| Rate for Payer: Networks By Design Commercial |
$15.05
|
| Rate for Payer: Prime Health Services Commercial |
$19.69
|
| Rate for Payer: Riverside University Health System MISP |
$9.26
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$13.90
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$13.90
|
| Rate for Payer: United Healthcare All Other Commercial |
$11.58
|
| Rate for Payer: United Healthcare All Other HMO |
$11.58
|
| Rate for Payer: United Healthcare HMO Rider |
$11.58
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$11.58
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$19.69
|
| Rate for Payer: Vantage Medical Group Senior |
$19.69
|
|
|
FLUTICASONE PROPIONATE 50 MCG/ACTUATION NASAL SPRAY,SUSPENSION [70536]
|
Facility
|
IP
|
$1.35
|
|
|
Service Code
|
NDC 60505-0829-1
|
| Hospital Charge Code |
1744080
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.27 |
| Max. Negotiated Rate |
$1.22 |
| Rate for Payer: Blue Shield of California Commercial |
$1.01
|
| Rate for Payer: Blue Shield of California EPN |
$0.72
|
| Rate for Payer: Cash Price |
$0.61
|
| Rate for Payer: Central Health Plan Commercial |
$1.08
|
| Rate for Payer: Cigna of CA HMO |
$0.95
|
| Rate for Payer: Cigna of CA PPO |
$0.95
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.54
|
| Rate for Payer: Galaxy Health WC |
$1.15
|
| Rate for Payer: Global Benefits Group Commercial |
$0.81
|
| Rate for Payer: Health Management Network EPO/PPO |
$1.22
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.90
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.51
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.27
|
| Rate for Payer: Multiplan Commercial |
$1.01
|
| Rate for Payer: Networks By Design Commercial |
$0.88
|
| Rate for Payer: Prime Health Services Commercial |
$1.15
|
|
|
FLUTICASONE PROPIONATE 50 MCG/ACTUATION NASAL SPRAY,SUSPENSION [70536]
|
Facility
|
OP
|
$0.83
|
|
|
Service Code
|
NDC 60432-264-15
|
| Hospital Charge Code |
1744080
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.17 |
| Max. Negotiated Rate |
$0.75 |
| Rate for Payer: Aetna of CA HMO/PPO |
$0.50
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.71
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.46
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.46
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$0.40
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.49
|
| Rate for Payer: Blue Distinction Transplant |
$0.50
|
| Rate for Payer: Blue Shield of California Commercial |
$0.52
|
| Rate for Payer: Blue Shield of California EPN |
$0.41
|
| Rate for Payer: Cash Price |
$0.37
|
| Rate for Payer: Central Health Plan Commercial |
$0.66
|
| Rate for Payer: Cigna of CA HMO |
$0.58
|
| Rate for Payer: Cigna of CA PPO |
$0.58
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.71
|
| Rate for Payer: Dignity Health Media |
$0.71
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.71
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.33
|
| Rate for Payer: EPIC Health Plan Transplant |
$0.33
|
| Rate for Payer: Galaxy Health WC |
$0.71
|
| Rate for Payer: Global Benefits Group Commercial |
$0.50
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.75
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$0.62
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$0.29
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.55
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.32
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.17
|
| Rate for Payer: Multiplan Commercial |
$0.62
|
| Rate for Payer: Networks By Design Commercial |
$0.54
|
| Rate for Payer: Prime Health Services Commercial |
$0.71
|
| Rate for Payer: Riverside University Health System MISP |
$0.33
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.50
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.50
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.42
|
| Rate for Payer: United Healthcare All Other HMO |
$0.42
|
| Rate for Payer: United Healthcare HMO Rider |
$0.42
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.42
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.71
|
| Rate for Payer: Vantage Medical Group Senior |
$0.71
|
|
|
FLUTICASONE PROPIONATE 50 MCG/ACTUATION NASAL SPRAY,SUSPENSION [70536]
|
Facility
|
IP
|
$0.83
|
|
|
Service Code
|
NDC 60432-264-15
|
| Hospital Charge Code |
1744080
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.17 |
| Max. Negotiated Rate |
$0.75 |
| Rate for Payer: Blue Shield of California Commercial |
$0.62
|
| Rate for Payer: Blue Shield of California EPN |
$0.44
|
| Rate for Payer: Cash Price |
$0.37
|
| Rate for Payer: Central Health Plan Commercial |
$0.66
|
| Rate for Payer: Cigna of CA HMO |
$0.58
|
| Rate for Payer: Cigna of CA PPO |
$0.58
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.33
|
| Rate for Payer: Galaxy Health WC |
$0.71
|
| Rate for Payer: Global Benefits Group Commercial |
$0.50
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.75
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.55
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.32
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.17
|
| Rate for Payer: Multiplan Commercial |
$0.62
|
| Rate for Payer: Networks By Design Commercial |
$0.54
|
| Rate for Payer: Prime Health Services Commercial |
$0.71
|
|
|
FLUTICASONE PROPIONATE 50 MCG/ACTUATION NASAL SPRAY,SUSPENSION [70536]
|
Facility
|
OP
|
$1.35
|
|
|
Service Code
|
NDC 60505-0829-1
|
| Hospital Charge Code |
1744080
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.27 |
| Max. Negotiated Rate |
$1.22 |
| Rate for Payer: Aetna of CA HMO/PPO |
$0.82
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1.15
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.74
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.74
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$0.65
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.80
|
| Rate for Payer: Blue Distinction Transplant |
$0.81
|
| Rate for Payer: Blue Shield of California Commercial |
$0.85
|
| Rate for Payer: Blue Shield of California EPN |
$0.66
|
| Rate for Payer: Cash Price |
$0.61
|
| Rate for Payer: Central Health Plan Commercial |
$1.08
|
| Rate for Payer: Cigna of CA HMO |
$0.95
|
| Rate for Payer: Cigna of CA PPO |
$0.95
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1.15
|
| Rate for Payer: Dignity Health Media |
$1.15
|
| Rate for Payer: Dignity Health Medi-Cal |
$1.15
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.54
|
| Rate for Payer: EPIC Health Plan Transplant |
$0.54
|
| Rate for Payer: Galaxy Health WC |
$1.15
|
| Rate for Payer: Global Benefits Group Commercial |
$0.81
|
| Rate for Payer: Health Management Network EPO/PPO |
$1.22
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$1.01
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$0.47
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.90
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.51
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.27
|
| Rate for Payer: Multiplan Commercial |
$1.01
|
| Rate for Payer: Networks By Design Commercial |
$0.88
|
| Rate for Payer: Prime Health Services Commercial |
$1.15
|
| Rate for Payer: Riverside University Health System MISP |
$0.54
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.81
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.81
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.68
|
| Rate for Payer: United Healthcare All Other HMO |
$0.68
|
| Rate for Payer: United Healthcare HMO Rider |
$0.68
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.68
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1.15
|
| Rate for Payer: Vantage Medical Group Senior |
$1.15
|
|
|
FLU VACCINE QS 2023-24(6MOS UP)(PF) 60 MCG(15 MCGX4)/0.5 ML IM SYRINGE [238760]
|
Facility
|
OP
|
$45.55
|
|
|
Service Code
|
CPT 90686
|
| Hospital Charge Code |
NDG238760
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$9.11 |
| Max. Negotiated Rate |
$137.13 |
| Rate for Payer: Aetna of CA HMO/PPO |
$137.13
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$38.72
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$25.05
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$25.05
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$35.46
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$38.82
|
| Rate for Payer: Blue Distinction Transplant |
$27.33
|
| Rate for Payer: Blue Shield of California Commercial |
$22.67
|
| Rate for Payer: Blue Shield of California EPN |
$20.61
|
| Rate for Payer: Cash Price |
$20.50
|
| Rate for Payer: Cash Price |
$20.50
|
| Rate for Payer: Central Health Plan Commercial |
$36.44
|
| Rate for Payer: Cigna of CA HMO |
$31.88
|
| Rate for Payer: Cigna of CA PPO |
$31.88
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$38.72
|
| Rate for Payer: Dignity Health Media |
$38.72
|
| Rate for Payer: Dignity Health Medi-Cal |
$38.72
|
| Rate for Payer: EPIC Health Plan Commercial |
$18.22
|
| Rate for Payer: EPIC Health Plan Transplant |
$18.22
|
| Rate for Payer: Galaxy Health WC |
$38.72
|
| Rate for Payer: Global Benefits Group Commercial |
$27.33
|
| Rate for Payer: Health Management Network EPO/PPO |
$41.00
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$34.16
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$22.35
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$30.38
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$50.94
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$9.11
|
| Rate for Payer: Multiplan Commercial |
$34.16
|
| Rate for Payer: Networks By Design Commercial |
$22.78
|
| Rate for Payer: Prime Health Services Commercial |
$38.72
|
| Rate for Payer: Riverside University Health System MISP |
$18.22
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$27.33
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$27.33
|
| Rate for Payer: United Healthcare All Other Commercial |
$22.78
|
| Rate for Payer: United Healthcare All Other HMO |
$22.78
|
| Rate for Payer: United Healthcare HMO Rider |
$22.78
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$22.78
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$38.72
|
| Rate for Payer: Vantage Medical Group Senior |
$38.72
|
|
|
FLU VACCINE QS 2023-24(6MOS UP)(PF) 60 MCG(15 MCGX4)/0.5 ML IM SYRINGE [238760]
|
Facility
|
IP
|
$45.55
|
|
|
Service Code
|
CPT 90686
|
| Hospital Charge Code |
NDG238760
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$9.11 |
| Max. Negotiated Rate |
$41.00 |
| Rate for Payer: Blue Shield of California Commercial |
$34.16
|
| Rate for Payer: Blue Shield of California EPN |
$24.32
|
| Rate for Payer: Cash Price |
$20.50
|
| Rate for Payer: Central Health Plan Commercial |
$36.44
|
| Rate for Payer: Cigna of CA HMO |
$31.88
|
| Rate for Payer: Cigna of CA PPO |
$31.88
|
| Rate for Payer: EPIC Health Plan Commercial |
$18.22
|
| Rate for Payer: EPIC Health Plan Transplant |
$18.22
|
| Rate for Payer: Galaxy Health WC |
$38.72
|
| Rate for Payer: Global Benefits Group Commercial |
$27.33
|
| Rate for Payer: Health Management Network EPO/PPO |
$41.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$30.38
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$17.35
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$9.11
|
| Rate for Payer: Multiplan Commercial |
$34.16
|
| Rate for Payer: Networks By Design Commercial |
$22.78
|
| Rate for Payer: Prime Health Services Commercial |
$38.72
|
| Rate for Payer: United Healthcare All Other Commercial |
$17.20
|
| Rate for Payer: United Healthcare All Other HMO |
$16.80
|
| Rate for Payer: United Healthcare HMO Rider |
$16.43
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$15.03
|
|
|
FLU VACCINE QV2023(18YR UP)RCMB(PF)180 MCG(45 MCGX4)/0.5 ML IM SYRINGE [238762]
|
Facility
|
OP
|
$153.03
|
|
|
Service Code
|
CPT 90682
|
| Hospital Charge Code |
RX238762
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$30.61 |
| Max. Negotiated Rate |
$450.36 |
| Rate for Payer: Aetna of CA HMO/PPO |
$450.36
|
| Rate for Payer: Aetna of CA HMO/PPO |
$450.36
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$130.07
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$130.08
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$84.17
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$84.16
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$84.17
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$84.16
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$189.88
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$189.88
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$90.41
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$90.40
|
| Rate for Payer: Blue Distinction Transplant |
$91.81
|
| Rate for Payer: Blue Distinction Transplant |
$91.82
|
| Rate for Payer: Blue Shield of California Commercial |
$70.61
|
| Rate for Payer: Blue Shield of California Commercial |
$70.61
|
| Rate for Payer: Blue Shield of California EPN |
$64.19
|
| Rate for Payer: Blue Shield of California EPN |
$64.19
|
| Rate for Payer: Cash Price |
$68.86
|
| Rate for Payer: Cash Price |
$68.86
|
| Rate for Payer: Cash Price |
$68.86
|
| Rate for Payer: Cash Price |
$68.86
|
| Rate for Payer: Central Health Plan Commercial |
$122.42
|
| Rate for Payer: Central Health Plan Commercial |
$122.42
|
| Rate for Payer: Cigna of CA HMO |
$107.11
|
| Rate for Payer: Cigna of CA HMO |
$107.12
|
| Rate for Payer: Cigna of CA PPO |
$107.12
|
| Rate for Payer: Cigna of CA PPO |
$107.11
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$130.08
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$130.07
|
| Rate for Payer: Dignity Health Media |
$130.07
|
| Rate for Payer: Dignity Health Media |
$130.08
|
| Rate for Payer: Dignity Health Medi-Cal |
$130.08
|
| Rate for Payer: Dignity Health Medi-Cal |
$130.07
|
| Rate for Payer: EPIC Health Plan Commercial |
$61.21
|
| Rate for Payer: EPIC Health Plan Commercial |
$61.21
|
| Rate for Payer: EPIC Health Plan Transplant |
$61.21
|
| Rate for Payer: EPIC Health Plan Transplant |
$61.21
|
| Rate for Payer: Galaxy Health WC |
$130.07
|
| Rate for Payer: Galaxy Health WC |
$130.08
|
| Rate for Payer: Global Benefits Group Commercial |
$91.82
|
| Rate for Payer: Global Benefits Group Commercial |
$91.81
|
| Rate for Payer: Health Management Network EPO/PPO |
$137.73
|
| Rate for Payer: Health Management Network EPO/PPO |
$137.72
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$114.76
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$114.77
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$73.40
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$73.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$102.06
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$102.07
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$147.93
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$147.93
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$30.61
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$30.60
|
| Rate for Payer: Multiplan Commercial |
$114.77
|
| Rate for Payer: Multiplan Commercial |
$114.76
|
| Rate for Payer: Networks By Design Commercial |
$76.51
|
| Rate for Payer: Networks By Design Commercial |
$76.52
|
| Rate for Payer: Prime Health Services Commercial |
$130.07
|
| Rate for Payer: Prime Health Services Commercial |
$130.08
|
| Rate for Payer: Riverside University Health System MISP |
$61.21
|
| Rate for Payer: Riverside University Health System MISP |
$61.21
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$91.82
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$91.81
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$91.81
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$91.82
|
| Rate for Payer: United Healthcare All Other Commercial |
$76.52
|
| Rate for Payer: United Healthcare All Other Commercial |
$76.51
|
| Rate for Payer: United Healthcare All Other HMO |
$76.51
|
| Rate for Payer: United Healthcare All Other HMO |
$76.52
|
| Rate for Payer: United Healthcare HMO Rider |
$76.52
|
| Rate for Payer: United Healthcare HMO Rider |
$76.51
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$76.52
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$76.51
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$130.07
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$130.08
|
| Rate for Payer: Vantage Medical Group Senior |
$130.07
|
| Rate for Payer: Vantage Medical Group Senior |
$130.08
|
|
|
FLU VACCINE QV2023(18YR UP)RCMB(PF)180 MCG(45 MCGX4)/0.5 ML IM SYRINGE [238762]
|
Facility
|
IP
|
$153.02
|
|
|
Service Code
|
CPT 90682
|
| Hospital Charge Code |
RX238762
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$30.60 |
| Max. Negotiated Rate |
$137.72 |
| Rate for Payer: Blue Shield of California Commercial |
$114.76
|
| Rate for Payer: Blue Shield of California Commercial |
$114.77
|
| Rate for Payer: Blue Shield of California EPN |
$81.72
|
| Rate for Payer: Blue Shield of California EPN |
$81.71
|
| Rate for Payer: Cash Price |
$68.86
|
| Rate for Payer: Cash Price |
$68.86
|
| Rate for Payer: Central Health Plan Commercial |
$122.42
|
| Rate for Payer: Central Health Plan Commercial |
$122.42
|
| Rate for Payer: Cigna of CA HMO |
$107.11
|
| Rate for Payer: Cigna of CA HMO |
$107.12
|
| Rate for Payer: Cigna of CA PPO |
$107.12
|
| Rate for Payer: Cigna of CA PPO |
$107.11
|
| Rate for Payer: EPIC Health Plan Commercial |
$61.21
|
| Rate for Payer: EPIC Health Plan Commercial |
$61.21
|
| Rate for Payer: EPIC Health Plan Transplant |
$61.21
|
| Rate for Payer: EPIC Health Plan Transplant |
$61.21
|
| Rate for Payer: Galaxy Health WC |
$130.08
|
| Rate for Payer: Galaxy Health WC |
$130.07
|
| Rate for Payer: Global Benefits Group Commercial |
$91.81
|
| Rate for Payer: Global Benefits Group Commercial |
$91.82
|
| Rate for Payer: Health Management Network EPO/PPO |
$137.72
|
| Rate for Payer: Health Management Network EPO/PPO |
$137.73
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$102.06
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$102.07
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$58.30
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$58.30
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$30.61
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$30.60
|
| Rate for Payer: Multiplan Commercial |
$114.76
|
| Rate for Payer: Multiplan Commercial |
$114.77
|
| Rate for Payer: Networks By Design Commercial |
$76.52
|
| Rate for Payer: Networks By Design Commercial |
$76.51
|
| Rate for Payer: Prime Health Services Commercial |
$130.07
|
| Rate for Payer: Prime Health Services Commercial |
$130.08
|
| Rate for Payer: United Healthcare All Other Commercial |
$57.78
|
| Rate for Payer: United Healthcare All Other Commercial |
$57.78
|
| Rate for Payer: United Healthcare All Other HMO |
$56.44
|
| Rate for Payer: United Healthcare All Other HMO |
$56.43
|
| Rate for Payer: United Healthcare HMO Rider |
$55.21
|
| Rate for Payer: United Healthcare HMO Rider |
$55.21
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$50.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$50.50
|
|
