|
FLORBETAPIR F-18 10 MCI (370 MBQ) INTRAVENOUS SOLUTION [196481]
|
Facility
|
IP
|
$342.12
|
|
|
Service Code
|
CPT A9586
|
| Hospital Charge Code |
ERX196481
|
|
Hospital Revenue Code
|
343
|
| Min. Negotiated Rate |
$61.92 |
| Max. Negotiated Rate |
$256.59 |
| Rate for Payer: Adventist Health Commercial |
$68.42
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$235.04
|
| Rate for Payer: Cash Price |
$153.95
|
| Rate for Payer: EPIC Health Plan Commercial |
$184.74
|
| Rate for Payer: Heritage Provider Network Commercial |
$231.62
|
| Rate for Payer: Heritage Provider Network Senior |
$231.62
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$61.92
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$85.53
|
| Rate for Payer: Multiplan Commercial |
$256.59
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$124.74
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$114.30
|
|
|
FLUCICLOVINE F18 10 MCI (370 MBQ) INTRAVENOUS SOLUTION [219653]
|
Facility
|
OP
|
$5,760.00
|
|
|
Service Code
|
CPT A9588
|
| Hospital Charge Code |
ERX219653
|
|
Hospital Revenue Code
|
343
|
| Min. Negotiated Rate |
$785.39 |
| Max. Negotiated Rate |
$4,896.00 |
| Rate for Payer: Adventist Health Commercial |
$1,152.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$4,896.00
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$3,168.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4,320.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$785.39
|
| Rate for Payer: Blue Shield of California Commercial |
$3,576.96
|
| Rate for Payer: Blue Shield of California EPN |
$3,381.12
|
| Rate for Payer: Cash Price |
$2,592.00
|
| Rate for Payer: Cash Price |
$2,592.00
|
| Rate for Payer: Cigna of CA HMO/PPO |
$3,744.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$4,896.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,896.00
|
| Rate for Payer: Dignity Health Senior |
$4,896.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,686.40
|
| Rate for Payer: Heritage Provider Network Commercial |
$3,565.44
|
| Rate for Payer: Heritage Provider Network Senior |
$3,565.44
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$2,776.32
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,042.56
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,440.00
|
| Rate for Payer: Multiplan Commercial |
$4,320.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$2,100.10
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$1,924.42
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,896.00
|
| Rate for Payer: Vantage Medical Group Senior |
$4,896.00
|
|
|
FLUCICLOVINE F18 10 MCI (370 MBQ) INTRAVENOUS SOLUTION [219653]
|
Facility
|
IP
|
$5,760.00
|
|
|
Service Code
|
CPT A9588
|
| Hospital Charge Code |
ERX219653
|
|
Hospital Revenue Code
|
343
|
| Min. Negotiated Rate |
$1,042.56 |
| Max. Negotiated Rate |
$4,320.00 |
| Rate for Payer: Adventist Health Commercial |
$1,152.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$3,957.12
|
| Rate for Payer: Cash Price |
$2,592.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,110.40
|
| Rate for Payer: Heritage Provider Network Commercial |
$3,899.52
|
| Rate for Payer: Heritage Provider Network Senior |
$3,899.52
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,042.56
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,440.00
|
| Rate for Payer: Multiplan Commercial |
$4,320.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$2,100.10
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$1,924.42
|
|
|
FLUCONAZOLE 100 MG TABLET [10044]
|
Facility
|
IP
|
$1.79
|
|
|
Service Code
|
NDC 68001-252-04
|
| Hospital Charge Code |
1711488
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.32 |
| Max. Negotiated Rate |
$1.34 |
| Rate for Payer: Adventist Health Commercial |
$0.36
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1.23
|
| Rate for Payer: Cash Price |
$0.81
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.97
|
| Rate for Payer: Heritage Provider Network Commercial |
$1.21
|
| Rate for Payer: Heritage Provider Network Senior |
$1.21
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.32
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.45
|
| Rate for Payer: Multiplan Commercial |
$1.34
|
|
|
FLUCONAZOLE 100 MG TABLET [10044]
|
Facility
|
OP
|
$1.20
|
|
|
Service Code
|
NDC 67405-602-03
|
| Hospital Charge Code |
1711488
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.22 |
| Max. Negotiated Rate |
$1.02 |
| Rate for Payer: Adventist Health Commercial |
$0.24
|
| Rate for Payer: Aetna of CA Gatekeeper |
$0.64
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$0.82
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1.02
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.66
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.90
|
| Rate for Payer: Blue Shield of California Commercial |
$0.75
|
| Rate for Payer: Blue Shield of California EPN |
$0.70
|
| Rate for Payer: Cash Price |
$0.54
|
| Rate for Payer: Cigna of CA HMO/PPO |
$0.78
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1.02
|
| Rate for Payer: Dignity Health Medi-Cal |
$1.02
|
| Rate for Payer: Dignity Health Senior |
$1.02
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.77
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.74
|
| Rate for Payer: Heritage Provider Network Senior |
$0.74
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$0.58
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.22
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.30
|
| Rate for Payer: Multiplan Commercial |
$0.90
|
| Rate for Payer: TriValley Medical Group Commercial |
$0.48
|
| Rate for Payer: TriValley Medical Group Senior |
$0.48
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1.02
|
| Rate for Payer: Vantage Medical Group Senior |
$1.02
|
|
|
FLUCONAZOLE 100 MG TABLET [10044]
|
Facility
|
OP
|
$0.84
|
|
|
Service Code
|
NDC 70710-1138-3
|
| Hospital Charge Code |
1711488
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.15 |
| Max. Negotiated Rate |
$0.71 |
| Rate for Payer: Adventist Health Commercial |
$0.17
|
| Rate for Payer: Aetna of CA Gatekeeper |
$0.45
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$0.58
|
| 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 |
$0.63
|
| Rate for Payer: Blue Shield of California Commercial |
$0.52
|
| Rate for Payer: Blue Shield of California EPN |
$0.49
|
| Rate for Payer: Cash Price |
$0.38
|
| Rate for Payer: Cigna of CA HMO/PPO |
$0.55
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.71
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.71
|
| Rate for Payer: Dignity Health Senior |
$0.71
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.54
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.52
|
| Rate for Payer: Heritage Provider Network Senior |
$0.52
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$0.40
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.15
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.21
|
| Rate for Payer: Multiplan Commercial |
$0.63
|
| Rate for Payer: TriValley Medical Group Commercial |
$0.34
|
| Rate for Payer: TriValley Medical Group Senior |
$0.34
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.71
|
| Rate for Payer: Vantage Medical Group Senior |
$0.71
|
|
|
FLUCONAZOLE 100 MG TABLET [10044]
|
Facility
|
IP
|
$1.20
|
|
|
Service Code
|
NDC 67405-602-03
|
| Hospital Charge Code |
1711488
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.22 |
| Max. Negotiated Rate |
$0.90 |
| Rate for Payer: Adventist Health Commercial |
$0.24
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$0.82
|
| Rate for Payer: Cash Price |
$0.54
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.65
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.81
|
| Rate for Payer: Heritage Provider Network Senior |
$0.81
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.22
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.30
|
| Rate for Payer: Multiplan Commercial |
$0.90
|
|
|
FLUCONAZOLE 100 MG TABLET [10044]
|
Facility
|
OP
|
$1.79
|
|
|
Service Code
|
NDC 68001-252-04
|
| Hospital Charge Code |
1711488
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.32 |
| Max. Negotiated Rate |
$1.52 |
| Rate for Payer: Adventist Health Commercial |
$0.36
|
| Rate for Payer: Aetna of CA Gatekeeper |
$0.96
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1.23
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1.52
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.98
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1.34
|
| Rate for Payer: Blue Shield of California Commercial |
$1.11
|
| Rate for Payer: Blue Shield of California EPN |
$1.05
|
| Rate for Payer: Cash Price |
$0.81
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1.16
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1.52
|
| Rate for Payer: Dignity Health Medi-Cal |
$1.52
|
| Rate for Payer: Dignity Health Senior |
$1.52
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.15
|
| Rate for Payer: Heritage Provider Network Commercial |
$1.11
|
| Rate for Payer: Heritage Provider Network Senior |
$1.11
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$0.86
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.32
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.45
|
| Rate for Payer: Multiplan Commercial |
$1.34
|
| Rate for Payer: TriValley Medical Group Commercial |
$0.72
|
| Rate for Payer: TriValley Medical Group Senior |
$0.72
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1.52
|
| Rate for Payer: Vantage Medical Group Senior |
$1.52
|
|
|
FLUCONAZOLE 100 MG TABLET [10044]
|
Facility
|
OP
|
$0.60
|
|
|
Service Code
|
NDC 57237-004-30
|
| Hospital Charge Code |
1711488
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.11 |
| Max. Negotiated Rate |
$0.51 |
| Rate for Payer: Adventist Health Commercial |
$0.12
|
| Rate for Payer: Aetna of CA Gatekeeper |
$0.32
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$0.41
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.51
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.33
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.45
|
| Rate for Payer: Blue Shield of California Commercial |
$0.37
|
| Rate for Payer: Blue Shield of California EPN |
$0.35
|
| Rate for Payer: Cash Price |
$0.27
|
| Rate for Payer: Cigna of CA HMO/PPO |
$0.39
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.51
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.51
|
| Rate for Payer: Dignity Health Senior |
$0.51
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.38
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.37
|
| Rate for Payer: Heritage Provider Network Senior |
$0.37
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$0.29
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.11
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.15
|
| Rate for Payer: Multiplan Commercial |
$0.45
|
| Rate for Payer: TriValley Medical Group Commercial |
$0.24
|
| Rate for Payer: TriValley Medical Group Senior |
$0.24
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.51
|
| Rate for Payer: Vantage Medical Group Senior |
$0.51
|
|
|
FLUCONAZOLE 100 MG TABLET [10044]
|
Facility
|
IP
|
$0.84
|
|
|
Service Code
|
NDC 70710-1138-3
|
| Hospital Charge Code |
1711488
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.15 |
| Max. Negotiated Rate |
$0.63 |
| Rate for Payer: Adventist Health Commercial |
$0.17
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$0.58
|
| Rate for Payer: Cash Price |
$0.38
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.45
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.57
|
| Rate for Payer: Heritage Provider Network Senior |
$0.57
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.15
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.21
|
| Rate for Payer: Multiplan Commercial |
$0.63
|
|
|
FLUCONAZOLE 100 MG TABLET [10044]
|
Facility
|
IP
|
$0.60
|
|
|
Service Code
|
NDC 57237-004-30
|
| Hospital Charge Code |
1711488
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.11 |
| Max. Negotiated Rate |
$0.45 |
| Rate for Payer: Adventist Health Commercial |
$0.12
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$0.41
|
| Rate for Payer: Cash Price |
$0.27
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.32
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.41
|
| Rate for Payer: Heritage Provider Network Senior |
$0.41
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.11
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.15
|
| Rate for Payer: Multiplan Commercial |
$0.45
|
|
|
FLUCONAZOLE 10 MG/ML ORAL SUSPENSION [14232]
|
Facility
|
OP
|
$0.69
|
|
|
Service Code
|
NDC 57237-149-35
|
| Hospital Charge Code |
1715959
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.12 |
| Max. Negotiated Rate |
$0.59 |
| Rate for Payer: Adventist Health Commercial |
$0.14
|
| Rate for Payer: Aetna of CA Gatekeeper |
$0.37
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$0.47
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.59
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.38
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.52
|
| Rate for Payer: Blue Shield of California Commercial |
$0.43
|
| Rate for Payer: Blue Shield of California EPN |
$0.41
|
| Rate for Payer: Cash Price |
$0.31
|
| Rate for Payer: Cigna of CA HMO/PPO |
$0.45
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.59
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.59
|
| Rate for Payer: Dignity Health Senior |
$0.59
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.44
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.43
|
| Rate for Payer: Heritage Provider Network Senior |
$0.43
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$0.33
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.12
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.17
|
| Rate for Payer: Multiplan Commercial |
$0.52
|
| Rate for Payer: TriValley Medical Group Commercial |
$0.28
|
| Rate for Payer: TriValley Medical Group Senior |
$0.28
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.59
|
| Rate for Payer: Vantage Medical Group Senior |
$0.59
|
|
|
FLUCONAZOLE 10 MG/ML ORAL SUSPENSION [14232]
|
Facility
|
IP
|
$0.69
|
|
|
Service Code
|
NDC 57237-149-35
|
| Hospital Charge Code |
1715959
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.12 |
| Max. Negotiated Rate |
$0.52 |
| Rate for Payer: Adventist Health Commercial |
$0.14
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$0.47
|
| Rate for Payer: Cash Price |
$0.31
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.37
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.47
|
| Rate for Payer: Heritage Provider Network Senior |
$0.47
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.12
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.17
|
| Rate for Payer: Multiplan Commercial |
$0.52
|
|
|
FLUCONAZOLE 150 MG TABLET [13577]
|
Facility
|
IP
|
$2.42
|
|
|
Service Code
|
NDC 68001-253-20
|
| Hospital Charge Code |
1711795
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.44 |
| Max. Negotiated Rate |
$1.82 |
| Rate for Payer: Adventist Health Commercial |
$0.48
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1.66
|
| Rate for Payer: Cash Price |
$1.09
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.31
|
| Rate for Payer: Heritage Provider Network Commercial |
$1.64
|
| Rate for Payer: Heritage Provider Network Senior |
$1.64
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.44
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.61
|
| Rate for Payer: Multiplan Commercial |
$1.82
|
|
|
FLUCONAZOLE 150 MG TABLET [13577]
|
Facility
|
OP
|
$2.42
|
|
|
Service Code
|
NDC 68001-253-44
|
| Hospital Charge Code |
1711795
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.44 |
| Max. Negotiated Rate |
$2.06 |
| Rate for Payer: Adventist Health Commercial |
$0.48
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1.29
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1.66
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2.06
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1.33
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1.82
|
| Rate for Payer: Blue Shield of California Commercial |
$1.50
|
| Rate for Payer: Blue Shield of California EPN |
$1.42
|
| Rate for Payer: Cash Price |
$1.09
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1.57
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2.06
|
| Rate for Payer: Dignity Health Medi-Cal |
$2.06
|
| Rate for Payer: Dignity Health Senior |
$2.06
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.55
|
| Rate for Payer: Heritage Provider Network Commercial |
$1.50
|
| Rate for Payer: Heritage Provider Network Senior |
$1.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$1.17
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.44
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.61
|
| Rate for Payer: Multiplan Commercial |
$1.82
|
| Rate for Payer: TriValley Medical Group Commercial |
$0.97
|
| Rate for Payer: TriValley Medical Group Senior |
$0.97
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2.06
|
| Rate for Payer: Vantage Medical Group Senior |
$2.06
|
|
|
FLUCONAZOLE 150 MG TABLET [13577]
|
Facility
|
IP
|
$2.42
|
|
|
Service Code
|
NDC 68001-253-44
|
| Hospital Charge Code |
1711795
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.44 |
| Max. Negotiated Rate |
$1.82 |
| Rate for Payer: Adventist Health Commercial |
$0.48
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1.66
|
| Rate for Payer: Cash Price |
$1.09
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.31
|
| Rate for Payer: Heritage Provider Network Commercial |
$1.64
|
| Rate for Payer: Heritage Provider Network Senior |
$1.64
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.44
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.61
|
| Rate for Payer: Multiplan Commercial |
$1.82
|
|
|
FLUCONAZOLE 150 MG TABLET [13577]
|
Facility
|
OP
|
$2.42
|
|
|
Service Code
|
NDC 68001-253-20
|
| Hospital Charge Code |
1711795
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.44 |
| Max. Negotiated Rate |
$2.06 |
| Rate for Payer: Adventist Health Commercial |
$0.48
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1.29
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1.66
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2.06
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1.33
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1.82
|
| Rate for Payer: Blue Shield of California Commercial |
$1.50
|
| Rate for Payer: Blue Shield of California EPN |
$1.42
|
| Rate for Payer: Cash Price |
$1.09
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1.57
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2.06
|
| Rate for Payer: Dignity Health Medi-Cal |
$2.06
|
| Rate for Payer: Dignity Health Senior |
$2.06
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.55
|
| Rate for Payer: Heritage Provider Network Commercial |
$1.50
|
| Rate for Payer: Heritage Provider Network Senior |
$1.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$1.17
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.44
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.61
|
| Rate for Payer: Multiplan Commercial |
$1.82
|
| Rate for Payer: TriValley Medical Group Commercial |
$0.97
|
| Rate for Payer: TriValley Medical Group Senior |
$0.97
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2.06
|
| Rate for Payer: Vantage Medical Group Senior |
$2.06
|
|
|
FLUCONAZOLE 200 MG/100 ML IN SOD. CHLORIDE (ISO) INTRAVENOUS PIGGYBACK [10049]
|
Facility
|
OP
|
$0.22
|
|
|
Service Code
|
CPT J1450
|
| Hospital Charge Code |
NDG10049
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.04 |
| Max. Negotiated Rate |
$173.84 |
| Rate for Payer: Adventist Health Commercial |
$0.04
|
| Rate for Payer: Adventist Health Commercial |
$0.01
|
| Rate for Payer: Adventist Health Commercial |
$0.02
|
| Rate for Payer: Aetna of CA Gatekeeper |
$6.86
|
| Rate for Payer: Aetna of CA Gatekeeper |
$6.86
|
| Rate for Payer: Aetna of CA Gatekeeper |
$6.86
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$0.05
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$0.08
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$0.15
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.06
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.19
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.09
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.04
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.06
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.12
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.05
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.08
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.17
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$173.84
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$173.84
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$173.84
|
| Rate for Payer: Blue Shield of California Commercial |
$7.65
|
| Rate for Payer: Blue Shield of California Commercial |
$7.65
|
| Rate for Payer: Blue Shield of California Commercial |
$7.65
|
| Rate for Payer: Blue Shield of California EPN |
$7.65
|
| Rate for Payer: Blue Shield of California EPN |
$7.65
|
| Rate for Payer: Blue Shield of California EPN |
$7.65
|
| Rate for Payer: Cash Price |
$0.03
|
| Rate for Payer: Cash Price |
$0.10
|
| Rate for Payer: Cash Price |
$0.10
|
| Rate for Payer: Cash Price |
$0.03
|
| Rate for Payer: Cash Price |
$0.05
|
| Rate for Payer: Cash Price |
$0.05
|
| Rate for Payer: Cigna of CA HMO/PPO |
$0.10
|
| Rate for Payer: Cigna of CA HMO/PPO |
$0.05
|
| Rate for Payer: Cigna of CA HMO/PPO |
$0.03
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.09
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.06
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.19
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.19
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.06
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.09
|
| Rate for Payer: Dignity Health Senior |
$0.06
|
| Rate for Payer: Dignity Health Senior |
$0.09
|
| Rate for Payer: Dignity Health Senior |
$0.19
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.14
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.04
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.07
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.05
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.03
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.10
|
| Rate for Payer: Heritage Provider Network Senior |
$0.10
|
| Rate for Payer: Heritage Provider Network Senior |
$0.03
|
| Rate for Payer: Heritage Provider Network Senior |
$0.05
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$0.05
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$0.03
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$0.11
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.01
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.04
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.02
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.02
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.03
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.06
|
| Rate for Payer: Multiplan Commercial |
$0.05
|
| Rate for Payer: Multiplan Commercial |
$0.17
|
| Rate for Payer: Multiplan Commercial |
$0.08
|
| Rate for Payer: TriValley Medical Group Commercial |
$0.09
|
| Rate for Payer: TriValley Medical Group Commercial |
$0.04
|
| Rate for Payer: TriValley Medical Group Commercial |
$0.03
|
| Rate for Payer: TriValley Medical Group Senior |
$0.03
|
| Rate for Payer: TriValley Medical Group Senior |
$0.09
|
| Rate for Payer: TriValley Medical Group Senior |
$0.04
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$0.04
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$0.08
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$0.03
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$0.04
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$0.02
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$0.07
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.09
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.19
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.06
|
| Rate for Payer: Vantage Medical Group Senior |
$0.06
|
| Rate for Payer: Vantage Medical Group Senior |
$0.09
|
| Rate for Payer: Vantage Medical Group Senior |
$0.19
|
|
|
FLUCONAZOLE 200 MG/100 ML IN SOD. CHLORIDE (ISO) INTRAVENOUS PIGGYBACK [10049]
|
Facility
|
IP
|
$0.22
|
|
|
Service Code
|
CPT J1450
|
| Hospital Charge Code |
NDG10049
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.04 |
| Max. Negotiated Rate |
$0.17 |
| Rate for Payer: Adventist Health Commercial |
$0.04
|
| Rate for Payer: Adventist Health Commercial |
$0.01
|
| Rate for Payer: Adventist Health Commercial |
$0.02
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$0.15
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$0.08
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$0.05
|
| Rate for Payer: Cash Price |
$0.10
|
| Rate for Payer: Cash Price |
$0.05
|
| Rate for Payer: Cash Price |
$0.03
|
| Rate for Payer: Cigna of CA HMO/PPO |
$0.10
|
| Rate for Payer: Cigna of CA HMO/PPO |
$0.03
|
| Rate for Payer: Cigna of CA HMO/PPO |
$0.05
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.04
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.06
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.12
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.15
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.05
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.07
|
| Rate for Payer: Heritage Provider Network Senior |
$0.07
|
| Rate for Payer: Heritage Provider Network Senior |
$0.05
|
| Rate for Payer: Heritage Provider Network Senior |
$0.15
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.02
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.04
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.01
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.03
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.02
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.06
|
| Rate for Payer: Multiplan Commercial |
$0.17
|
| Rate for Payer: Multiplan Commercial |
$0.05
|
| Rate for Payer: Multiplan Commercial |
$0.08
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$0.03
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$0.08
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$0.04
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$0.07
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$0.02
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$0.04
|
|
|
FLUCONAZOLE 200 MG TABLET [10045]
|
Facility
|
OP
|
$3.46
|
|
|
Service Code
|
NDC 55111-146-30
|
| Hospital Charge Code |
1711489
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.63 |
| Max. Negotiated Rate |
$2.94 |
| Rate for Payer: Adventist Health Commercial |
$0.69
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1.85
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2.38
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2.94
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1.90
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2.60
|
| Rate for Payer: Blue Shield of California Commercial |
$2.15
|
| Rate for Payer: Blue Shield of California EPN |
$2.03
|
| Rate for Payer: Cash Price |
$1.56
|
| Rate for Payer: Cigna of CA HMO/PPO |
$2.25
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2.94
|
| Rate for Payer: Dignity Health Medi-Cal |
$2.94
|
| Rate for Payer: Dignity Health Senior |
$2.94
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.21
|
| Rate for Payer: Heritage Provider Network Commercial |
$2.14
|
| Rate for Payer: Heritage Provider Network Senior |
$2.14
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$1.67
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.63
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.87
|
| Rate for Payer: Multiplan Commercial |
$2.60
|
| Rate for Payer: TriValley Medical Group Commercial |
$1.38
|
| Rate for Payer: TriValley Medical Group Senior |
$1.38
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2.94
|
| Rate for Payer: Vantage Medical Group Senior |
$2.94
|
|
|
FLUCONAZOLE 200 MG TABLET [10045]
|
Facility
|
IP
|
$1.60
|
|
|
Service Code
|
NDC 67405-604-03
|
| Hospital Charge Code |
1711489
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.29 |
| Max. Negotiated Rate |
$1.20 |
| Rate for Payer: Adventist Health Commercial |
$0.32
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1.10
|
| Rate for Payer: Cash Price |
$0.72
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.86
|
| Rate for Payer: Heritage Provider Network Commercial |
$1.08
|
| Rate for Payer: Heritage Provider Network Senior |
$1.08
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.29
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.40
|
| Rate for Payer: Multiplan Commercial |
$1.20
|
|
|
FLUCONAZOLE 200 MG TABLET [10045]
|
Facility
|
OP
|
$2.30
|
|
|
Service Code
|
NDC 68001-254-04
|
| Hospital Charge Code |
1711489
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.42 |
| Max. Negotiated Rate |
$1.96 |
| Rate for Payer: Adventist Health Commercial |
$0.46
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1.23
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1.58
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1.96
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1.26
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1.72
|
| Rate for Payer: Blue Shield of California Commercial |
$1.43
|
| Rate for Payer: Blue Shield of California EPN |
$1.35
|
| Rate for Payer: Cash Price |
$1.04
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1.96
|
| Rate for Payer: Dignity Health Medi-Cal |
$1.96
|
| Rate for Payer: Dignity Health Senior |
$1.96
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.47
|
| Rate for Payer: Heritage Provider Network Commercial |
$1.42
|
| Rate for Payer: Heritage Provider Network Senior |
$1.42
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$1.11
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.42
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.58
|
| Rate for Payer: Multiplan Commercial |
$1.72
|
| Rate for Payer: TriValley Medical Group Commercial |
$0.92
|
| Rate for Payer: TriValley Medical Group Senior |
$0.92
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1.96
|
| Rate for Payer: Vantage Medical Group Senior |
$1.96
|
|
|
FLUCONAZOLE 200 MG TABLET [10045]
|
Facility
|
IP
|
$1.60
|
|
|
Service Code
|
NDC 68462-104-30
|
| Hospital Charge Code |
1711489
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.29 |
| Max. Negotiated Rate |
$1.20 |
| Rate for Payer: Adventist Health Commercial |
$0.32
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1.10
|
| Rate for Payer: Cash Price |
$0.72
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.86
|
| Rate for Payer: Heritage Provider Network Commercial |
$1.08
|
| Rate for Payer: Heritage Provider Network Senior |
$1.08
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.29
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.40
|
| Rate for Payer: Multiplan Commercial |
$1.20
|
|
|
FLUCONAZOLE 200 MG TABLET [10045]
|
Facility
|
OP
|
$1.12
|
|
|
Service Code
|
NDC 70710-1140-3
|
| Hospital Charge Code |
1711489
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.20 |
| Max. Negotiated Rate |
$0.95 |
| Rate for Payer: Adventist Health Commercial |
$0.22
|
| Rate for Payer: Aetna of CA Gatekeeper |
$0.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$0.77
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.95
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.62
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.84
|
| Rate for Payer: Blue Shield of California Commercial |
$0.70
|
| Rate for Payer: Blue Shield of California EPN |
$0.66
|
| Rate for Payer: Cash Price |
$0.50
|
| Rate for Payer: Cigna of CA HMO/PPO |
$0.73
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.95
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.95
|
| Rate for Payer: Dignity Health Senior |
$0.95
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.72
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.69
|
| Rate for Payer: Heritage Provider Network Senior |
$0.69
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$0.54
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.20
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.28
|
| Rate for Payer: Multiplan Commercial |
$0.84
|
| Rate for Payer: TriValley Medical Group Commercial |
$0.45
|
| Rate for Payer: TriValley Medical Group Senior |
$0.45
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.95
|
| Rate for Payer: Vantage Medical Group Senior |
$0.95
|
|
|
FLUCONAZOLE 200 MG TABLET [10045]
|
Facility
|
IP
|
$1.12
|
|
|
Service Code
|
NDC 70710-1140-3
|
| Hospital Charge Code |
1711489
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.20 |
| Max. Negotiated Rate |
$0.84 |
| Rate for Payer: Adventist Health Commercial |
$0.22
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$0.77
|
| Rate for Payer: Cash Price |
$0.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.60
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.76
|
| Rate for Payer: Heritage Provider Network Senior |
$0.76
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.20
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.28
|
| Rate for Payer: Multiplan Commercial |
$0.84
|
|
