|
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 |
$0.31 |
| Max. Negotiated Rate |
$1.44 |
| Rate for Payer: Adventist Health Commercial |
$0.34
|
| Rate for Payer: Aetna of CA Gatekeeper |
$0.90
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1.16
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$1.44
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$0.93
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$1.27
|
| Rate for Payer: Blue Shield of California Commercial |
$1.05
|
| Rate for Payer: Blue Shield of California EPN |
$0.99
|
| Rate for Payer: Cash Price |
$0.76
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1.10
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1.44
|
| Rate for Payer: Dignity Health Medi-Cal |
$1.44
|
| Rate for Payer: Dignity Health Senior |
$1.44
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.08
|
| Rate for Payer: Heritage Provider Network Commercial |
$1.05
|
| Rate for Payer: Heritage Provider Network Senior |
$1.05
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$0.81
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.31
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.42
|
| Rate for Payer: Multiplan Commercial |
$1.27
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1.44
|
| Rate for Payer: Vantage Medical Group Senior |
$1.44
|
|
|
FLUOCINOLONE 0.18 MG INTRAVITREAL IMPLANT [223628]
|
Facility
OP
|
$10,795.20
|
|
|
Service Code
|
CPT J7314
|
| Hospital Charge Code |
ERX223628
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$504.22 |
| Max. Negotiated Rate |
$8,096.40 |
| Rate for Payer: Adventist Health Commercial |
$2,159.04
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1,299.55
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$7,416.30
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$661.25
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$581.90
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$581.90
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,023.32
|
| Rate for Payer: Blue Shield of California Commercial |
$504.22
|
| Rate for Payer: Blue Shield of California EPN |
$504.22
|
| Rate for Payer: Cash Price |
$4,857.84
|
| Rate for Payer: Cash Price |
$4,857.84
|
| Rate for Payer: Cigna of CA HMO/PPO |
$4,965.79
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$793.50
|
| Rate for Payer: Dignity Health Medi-Cal |
$581.90
|
| Rate for Payer: Dignity Health Senior |
$581.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$6,908.93
|
| Rate for Payer: EPIC Health Plan Medicare |
$529.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$4,998.18
|
| Rate for Payer: Heritage Provider Network Senior |
$4,998.18
|
| Rate for Payer: Humana Medicare |
$529.00
|
| Rate for Payer: IEHP Medi-Cal |
$825.24
|
| Rate for Payer: IEHP Medicare Advantage |
$529.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$1,005.10
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,953.93
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$624.22
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,698.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$666.54
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$666.54
|
| Rate for Payer: Multiplan Commercial |
$8,096.40
|
| Rate for Payer: TriValley Medical Group Commercial |
$581.90
|
| Rate for Payer: TriValley Medical Group Senior |
$529.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$3,935.93
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$3,606.68
|
| 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 |
$1,953.93 |
| Max. Negotiated Rate |
$8,096.40 |
| Rate for Payer: Adventist Health Commercial |
$2,159.04
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$7,416.30
|
| Rate for Payer: Cash Price |
$4,857.84
|
| Rate for Payer: Cigna of CA HMO/PPO |
$4,965.79
|
| Rate for Payer: EPIC Health Plan Commercial |
$5,829.41
|
| Rate for Payer: Heritage Provider Network Commercial |
$7,308.35
|
| Rate for Payer: Heritage Provider Network Senior |
$7,308.35
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,953.93
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,698.80
|
| Rate for Payer: Multiplan Commercial |
$8,096.40
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$3,935.93
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$3,606.68
|
|
|
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 |
$1,911.36 |
| Max. Negotiated Rate |
$7,920.00 |
| Rate for Payer: Adventist Health Commercial |
$2,112.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$7,254.72
|
| Rate for Payer: Cash Price |
$4,752.00
|
| Rate for Payer: Cigna of CA HMO/PPO |
$4,857.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$5,702.40
|
| Rate for Payer: Heritage Provider Network Commercial |
$7,149.12
|
| Rate for Payer: Heritage Provider Network Senior |
$7,149.12
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,911.36
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,640.00
|
| Rate for Payer: Multiplan Commercial |
$7,920.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$3,850.18
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$3,528.10
|
|
|
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 |
$472.42 |
| Max. Negotiated Rate |
$7,920.00 |
| Rate for Payer: Adventist Health Commercial |
$2,112.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1,206.08
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$7,254.72
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$613.68
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$540.04
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$540.04
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$989.84
|
| Rate for Payer: Blue Shield of California Commercial |
$472.42
|
| Rate for Payer: Blue Shield of California EPN |
$472.42
|
| Rate for Payer: Cash Price |
$4,752.00
|
| Rate for Payer: Cash Price |
$4,752.00
|
| Rate for Payer: Cigna of CA HMO/PPO |
$4,857.60
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$736.42
|
| Rate for Payer: Dignity Health Medi-Cal |
$540.04
|
| Rate for Payer: Dignity Health Senior |
$540.04
|
| Rate for Payer: EPIC Health Plan Commercial |
$6,758.40
|
| Rate for Payer: EPIC Health Plan Medicare |
$490.95
|
| Rate for Payer: Heritage Provider Network Commercial |
$4,889.28
|
| Rate for Payer: Heritage Provider Network Senior |
$4,889.28
|
| Rate for Payer: Humana Medicare |
$490.95
|
| Rate for Payer: IEHP Medi-Cal |
$765.88
|
| Rate for Payer: IEHP Medicare Advantage |
$490.95
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$932.80
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,911.36
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$579.32
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,640.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$618.59
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$618.59
|
| Rate for Payer: Multiplan Commercial |
$7,920.00
|
| Rate for Payer: TriValley Medical Group Commercial |
$540.04
|
| Rate for Payer: TriValley Medical Group Senior |
$490.95
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$3,850.18
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$3,528.10
|
| 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
|
|
|
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 |
$0.53 |
| Max. Negotiated Rate |
$2.48 |
| Rate for Payer: Adventist Health Commercial |
$0.58
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1.56
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2.01
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$2.48
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$1.61
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$2.19
|
| Rate for Payer: Blue Shield of California Commercial |
$1.81
|
| Rate for Payer: Blue Shield of California EPN |
$1.71
|
| Rate for Payer: Cash Price |
$1.31
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1.90
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2.48
|
| Rate for Payer: Dignity Health Medi-Cal |
$2.48
|
| Rate for Payer: Dignity Health Senior |
$2.48
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.87
|
| Rate for Payer: Heritage Provider Network Commercial |
$1.81
|
| Rate for Payer: Heritage Provider Network Senior |
$1.81
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$1.41
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.53
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.73
|
| Rate for Payer: Multiplan Commercial |
$2.19
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2.48
|
| Rate for Payer: Vantage Medical Group Senior |
$2.48
|
|
|
FLUOCINONIDE 0.05 % TOPICAL CREAM [3187]
|
Facility
OP
|
$2.92
|
|
|
Service Code
|
NDC 0093-0262-15
|
| Hospital Charge Code |
1743410
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.53 |
| Max. Negotiated Rate |
$2.48 |
| Rate for Payer: Adventist Health Commercial |
$0.58
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1.56
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2.01
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$2.48
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$1.61
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$2.19
|
| Rate for Payer: Blue Shield of California Commercial |
$1.81
|
| Rate for Payer: Blue Shield of California EPN |
$1.71
|
| Rate for Payer: Cash Price |
$1.31
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1.90
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2.48
|
| Rate for Payer: Dignity Health Medi-Cal |
$2.48
|
| Rate for Payer: Dignity Health Senior |
$2.48
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.87
|
| Rate for Payer: Heritage Provider Network Commercial |
$1.81
|
| Rate for Payer: Heritage Provider Network Senior |
$1.81
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$1.41
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.53
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.73
|
| Rate for Payer: Multiplan Commercial |
$2.19
|
| 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 0093-0262-15
|
| Hospital Charge Code |
1743410
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.53 |
| Max. Negotiated Rate |
$2.19 |
| Rate for Payer: Adventist Health Commercial |
$0.58
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2.01
|
| Rate for Payer: Cash Price |
$1.31
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.58
|
| Rate for Payer: Heritage Provider Network Commercial |
$1.98
|
| Rate for Payer: Heritage Provider Network Senior |
$1.98
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.53
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.73
|
| Rate for Payer: Multiplan Commercial |
$2.19
|
|
|
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 |
$0.53 |
| Max. Negotiated Rate |
$2.19 |
| Rate for Payer: Adventist Health Commercial |
$0.58
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2.01
|
| Rate for Payer: Cash Price |
$1.31
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.58
|
| Rate for Payer: Heritage Provider Network Commercial |
$1.98
|
| Rate for Payer: Heritage Provider Network Senior |
$1.98
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.53
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.73
|
| Rate for Payer: Multiplan Commercial |
$2.19
|
|
|
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 |
$0.22 |
| 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
|
|
|
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 |
$0.22 |
| 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: AlphaCare Medical Group Commercial/Exchange |
$1.02
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$0.66
|
| Rate for Payer: AlphaCare 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: Vantage Medical Group Medi-Cal |
$1.02
|
| Rate for Payer: Vantage Medical Group Senior |
$1.02
|
|
|
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 |
$0.53 |
| Max. Negotiated Rate |
$2.48 |
| Rate for Payer: Adventist Health Commercial |
$0.58
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1.56
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2.01
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$2.48
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$1.61
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$2.19
|
| Rate for Payer: Blue Shield of California Commercial |
$1.81
|
| Rate for Payer: Blue Shield of California EPN |
$1.71
|
| Rate for Payer: Cash Price |
$1.31
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1.90
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2.48
|
| Rate for Payer: Dignity Health Medi-Cal |
$2.48
|
| Rate for Payer: Dignity Health Senior |
$2.48
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.87
|
| Rate for Payer: Heritage Provider Network Commercial |
$1.81
|
| Rate for Payer: Heritage Provider Network Senior |
$1.81
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$1.41
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.53
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.73
|
| Rate for Payer: Multiplan Commercial |
$2.19
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2.48
|
| Rate for Payer: Vantage Medical Group Senior |
$2.48
|
|
|
FLUOCINONIDE 0.05 % TOPICAL CREAM. [4083187]
|
Facility
IP
|
$2.92
|
|
|
Service Code
|
NDC 0093-0262-30
|
| Hospital Charge Code |
1743039
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.53 |
| Max. Negotiated Rate |
$2.19 |
| Rate for Payer: Adventist Health Commercial |
$0.58
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2.01
|
| Rate for Payer: Cash Price |
$1.31
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.58
|
| Rate for Payer: Heritage Provider Network Commercial |
$1.98
|
| Rate for Payer: Heritage Provider Network Senior |
$1.98
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.53
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.73
|
| Rate for Payer: Multiplan Commercial |
$2.19
|
|
|
FLUOCINONIDE 0.05 % TOPICAL CREAM. [4083187]
|
Facility
OP
|
$3.08
|
|
|
Service Code
|
NDC 51672-1254-1
|
| Hospital Charge Code |
1743410
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.56 |
| Max. Negotiated Rate |
$2.62 |
| Rate for Payer: Adventist Health Commercial |
$0.62
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1.65
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2.12
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$2.62
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$1.69
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$2.31
|
| Rate for Payer: Blue Shield of California Commercial |
$1.91
|
| Rate for Payer: Blue Shield of California EPN |
$1.81
|
| Rate for Payer: Cash Price |
$1.39
|
| Rate for Payer: Cigna of CA HMO/PPO |
$2.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2.62
|
| Rate for Payer: Dignity Health Medi-Cal |
$2.62
|
| Rate for Payer: Dignity Health Senior |
$2.62
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.97
|
| Rate for Payer: Heritage Provider Network Commercial |
$1.91
|
| Rate for Payer: Heritage Provider Network Senior |
$1.91
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$1.48
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.56
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.77
|
| Rate for Payer: Multiplan Commercial |
$2.31
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2.62
|
| Rate for Payer: Vantage Medical Group Senior |
$2.62
|
|
|
FLUOCINONIDE 0.05 % TOPICAL CREAM. [4083187]
|
Facility
IP
|
$3.08
|
|
|
Service Code
|
NDC 51672-1254-1
|
| Hospital Charge Code |
1743410
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.56 |
| Max. Negotiated Rate |
$2.31 |
| Rate for Payer: Adventist Health Commercial |
$0.62
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2.12
|
| Rate for Payer: Cash Price |
$1.39
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.66
|
| Rate for Payer: Heritage Provider Network Commercial |
$2.09
|
| Rate for Payer: Heritage Provider Network Senior |
$2.09
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.56
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.77
|
| Rate for Payer: Multiplan Commercial |
$2.31
|
|
|
FLUOCINONIDE 0.05 % TOPICAL OINTMENT [3189]
|
Facility
IP
|
$0.78
|
|
|
Service Code
|
NDC 51672-1264-3
|
| Hospital Charge Code |
1743029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.14 |
| Max. Negotiated Rate |
$0.59 |
| Rate for Payer: Adventist Health Commercial |
$0.16
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$0.54
|
| Rate for Payer: Cash Price |
$0.35
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.42
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.53
|
| Rate for Payer: Heritage Provider Network Senior |
$0.53
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.14
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.20
|
| Rate for Payer: Multiplan Commercial |
$0.59
|
|
|
FLUOCINONIDE 0.05 % TOPICAL OINTMENT [3189]
|
Facility
OP
|
$4.53
|
|
|
Service Code
|
NDC 0093-0264-92
|
| Hospital Charge Code |
1743029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.82 |
| Max. Negotiated Rate |
$3.85 |
| Rate for Payer: Adventist Health Commercial |
$0.91
|
| Rate for Payer: Aetna of CA Gatekeeper |
$2.42
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$3.11
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$3.85
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$2.49
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$3.40
|
| Rate for Payer: Blue Shield of California Commercial |
$2.81
|
| Rate for Payer: Blue Shield of California EPN |
$2.66
|
| Rate for Payer: Cash Price |
$2.04
|
| Rate for Payer: Cigna of CA HMO/PPO |
$2.94
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3.85
|
| Rate for Payer: Dignity Health Medi-Cal |
$3.85
|
| Rate for Payer: Dignity Health Senior |
$3.85
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.90
|
| Rate for Payer: Heritage Provider Network Commercial |
$2.80
|
| Rate for Payer: Heritage Provider Network Senior |
$2.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$2.18
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.82
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.13
|
| Rate for Payer: Multiplan Commercial |
$3.40
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$3.85
|
| Rate for Payer: Vantage Medical Group Senior |
$3.85
|
|
|
FLUOCINONIDE 0.05 % TOPICAL OINTMENT [3189]
|
Facility
OP
|
$0.78
|
|
|
Service Code
|
NDC 51672-1264-3
|
| Hospital Charge Code |
1743029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.14 |
| Max. Negotiated Rate |
$0.66 |
| Rate for Payer: Adventist Health Commercial |
$0.16
|
| Rate for Payer: Aetna of CA Gatekeeper |
$0.42
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$0.54
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$0.66
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$0.43
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$0.59
|
| Rate for Payer: Blue Shield of California Commercial |
$0.48
|
| Rate for Payer: Blue Shield of California EPN |
$0.46
|
| Rate for Payer: Cash Price |
$0.35
|
| Rate for Payer: Cigna of CA HMO/PPO |
$0.51
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.66
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.66
|
| Rate for Payer: Dignity Health Senior |
$0.66
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.50
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.48
|
| Rate for Payer: Heritage Provider Network Senior |
$0.48
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$0.38
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.14
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.20
|
| Rate for Payer: Multiplan Commercial |
$0.59
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.66
|
| Rate for Payer: Vantage Medical Group Senior |
$0.66
|
|
|
FLUOCINONIDE 0.05 % TOPICAL OINTMENT [3189]
|
Facility
IP
|
$4.53
|
|
|
Service Code
|
NDC 0093-0264-92
|
| Hospital Charge Code |
1743029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.82 |
| Max. Negotiated Rate |
$3.40 |
| Rate for Payer: Adventist Health Commercial |
$0.91
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$3.11
|
| Rate for Payer: Cash Price |
$2.04
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.45
|
| Rate for Payer: Heritage Provider Network Commercial |
$3.07
|
| Rate for Payer: Heritage Provider Network Senior |
$3.07
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.82
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.13
|
| Rate for Payer: Multiplan Commercial |
$3.40
|
|
|
FLUOCINONIDE 0.05 % TOPICAL OINTMENT [3189]
|
Facility
OP
|
$1.48
|
|
|
Service Code
|
NDC 52565-040-15
|
| Hospital Charge Code |
1743019
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.27 |
| Max. Negotiated Rate |
$1.26 |
| Rate for Payer: Adventist Health Commercial |
$0.30
|
| Rate for Payer: Aetna of CA Gatekeeper |
$0.79
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1.02
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$1.26
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$0.81
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$1.11
|
| Rate for Payer: Blue Shield of California Commercial |
$0.92
|
| Rate for Payer: Blue Shield of California EPN |
$0.87
|
| Rate for Payer: Cash Price |
$0.67
|
| Rate for Payer: Cigna of CA HMO/PPO |
$0.96
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1.26
|
| Rate for Payer: Dignity Health Medi-Cal |
$1.26
|
| Rate for Payer: Dignity Health Senior |
$1.26
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.95
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.92
|
| Rate for Payer: Heritage Provider Network Senior |
$0.92
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$0.71
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.27
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.37
|
| Rate for Payer: Multiplan Commercial |
$1.11
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1.26
|
| Rate for Payer: Vantage Medical Group Senior |
$1.26
|
|
|
FLUOCINONIDE 0.05 % TOPICAL OINTMENT [3189]
|
Facility
IP
|
$1.48
|
|
|
Service Code
|
NDC 51672-1264-1
|
| Hospital Charge Code |
1743019
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.27 |
| Max. Negotiated Rate |
$1.11 |
| Rate for Payer: Adventist Health Commercial |
$0.30
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1.02
|
| Rate for Payer: Cash Price |
$0.67
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.80
|
| Rate for Payer: Heritage Provider Network Commercial |
$1.00
|
| Rate for Payer: Heritage Provider Network Senior |
$1.00
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.27
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.37
|
| Rate for Payer: Multiplan Commercial |
$1.11
|
|
|
FLUOCINONIDE 0.05 % TOPICAL OINTMENT [3189]
|
Facility
IP
|
$1.48
|
|
|
Service Code
|
NDC 52565-040-15
|
| Hospital Charge Code |
1743019
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.27 |
| Max. Negotiated Rate |
$1.11 |
| Rate for Payer: Adventist Health Commercial |
$0.30
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1.02
|
| Rate for Payer: Cash Price |
$0.67
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.80
|
| Rate for Payer: Heritage Provider Network Commercial |
$1.00
|
| Rate for Payer: Heritage Provider Network Senior |
$1.00
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.27
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.37
|
| Rate for Payer: Multiplan Commercial |
$1.11
|
|
|
FLUOCINONIDE 0.05 % TOPICAL OINTMENT [3189]
|
Facility
OP
|
$1.48
|
|
|
Service Code
|
NDC 51672-1264-1
|
| Hospital Charge Code |
1743019
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.27 |
| Max. Negotiated Rate |
$1.26 |
| Rate for Payer: Adventist Health Commercial |
$0.30
|
| Rate for Payer: Aetna of CA Gatekeeper |
$0.79
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1.02
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$1.26
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$0.81
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$1.11
|
| Rate for Payer: Blue Shield of California Commercial |
$0.92
|
| Rate for Payer: Blue Shield of California EPN |
$0.87
|
| Rate for Payer: Cash Price |
$0.67
|
| Rate for Payer: Cigna of CA HMO/PPO |
$0.96
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1.26
|
| Rate for Payer: Dignity Health Medi-Cal |
$1.26
|
| Rate for Payer: Dignity Health Senior |
$1.26
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.95
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.92
|
| Rate for Payer: Heritage Provider Network Senior |
$0.92
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$0.71
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.27
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.37
|
| Rate for Payer: Multiplan Commercial |
$1.11
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1.26
|
| Rate for Payer: Vantage Medical Group Senior |
$1.26
|
|
|
FLUOCINONIDE 0.05 % TOPICAL SOLUTION [3190]
|
Facility
OP
|
$1.20
|
|
|
Service Code
|
NDC 51672-1273-2
|
| Hospital Charge Code |
NDG3190
|
|
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: AlphaCare Medical Group Commercial/Exchange |
$1.02
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$0.66
|
| Rate for Payer: AlphaCare 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: Vantage Medical Group Medi-Cal |
$1.02
|
| Rate for Payer: Vantage Medical Group Senior |
$1.02
|
|
|
FLUOCINONIDE 0.05 % TOPICAL SOLUTION [3190]
|
Facility
OP
|
$1.16
|
|
|
Service Code
|
NDC 51672-1273-4
|
| Hospital Charge Code |
1743430
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.21 |
| Max. Negotiated Rate |
$0.99 |
| Rate for Payer: Adventist Health Commercial |
$0.23
|
| Rate for Payer: Aetna of CA Gatekeeper |
$0.62
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$0.80
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$0.99
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$0.64
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$0.87
|
| Rate for Payer: Blue Shield of California Commercial |
$0.72
|
| Rate for Payer: Blue Shield of California EPN |
$0.68
|
| Rate for Payer: Cash Price |
$0.52
|
| Rate for Payer: Cigna of CA HMO/PPO |
$0.75
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.99
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.99
|
| Rate for Payer: Dignity Health Senior |
$0.99
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.74
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.72
|
| Rate for Payer: Heritage Provider Network Senior |
$0.72
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$0.56
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.21
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.29
|
| Rate for Payer: Multiplan Commercial |
$0.87
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.99
|
| Rate for Payer: Vantage Medical Group Senior |
$0.99
|
|
