|
DOCETAXEL 160 MG/16 ML (10 MG/ML) INTRAVENOUS SOLUTION [108908]
|
Facility
|
IP
|
$20.48
|
|
|
Service Code
|
CPT J9171
|
| Hospital Charge Code |
NDG108908
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$11.26 |
| Max. Negotiated Rate |
$16.38 |
| Rate for Payer: Cash Price |
$9.22
|
| Rate for Payer: Cash Price |
$19.39
|
| Rate for Payer: Cash Price |
$10.80
|
| Rate for Payer: Cigna of CA HMO/PPO |
$16.38
|
| Rate for Payer: Cigna of CA HMO/PPO |
$19.20
|
| Rate for Payer: Cigna of CA HMO/PPO |
$34.47
|
| Rate for Payer: Health Smart Auto/Commercial |
$14.40
|
| Rate for Payer: Health Smart Auto/Commercial |
$25.85
|
| Rate for Payer: Health Smart Auto/Commercial |
$12.29
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$11.26
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$23.70
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$13.20
|
| Rate for Payer: Multiplan Beech St/Commercial/PHCS |
$32.32
|
| Rate for Payer: Multiplan Beech St/Commercial/PHCS |
$18.00
|
| Rate for Payer: Multiplan Beech St/Commercial/PHCS |
$15.36
|
|
|
DOCETAXEL 160 MG/16 ML (10 MG/ML) INTRAVENOUS SOLUTION [108908]
|
Facility
|
OP
|
$20.48
|
|
|
Service Code
|
CPT J9171
|
| Hospital Charge Code |
NDG108908
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$11.26 |
| Max. Negotiated Rate |
$15.36 |
| Rate for Payer: Aetna of CA EPO/HMO/POS/PPO |
$12.29
|
| Rate for Payer: Aetna of CA EPO/HMO/POS/PPO |
$14.40
|
| Rate for Payer: Aetna of CA EPO/HMO/POS/PPO |
$25.85
|
| Rate for Payer: Aetna of CA Government/Medicare |
$25.85
|
| Rate for Payer: Aetna of CA Government/Medicare |
$14.40
|
| Rate for Payer: Aetna of CA Government/Medicare |
$12.29
|
| Rate for Payer: Cash Price |
$10.80
|
| Rate for Payer: Cash Price |
$9.22
|
| Rate for Payer: Cash Price |
$19.39
|
| Rate for Payer: Health Smart Auto/Commercial |
$25.85
|
| Rate for Payer: Health Smart Auto/Commercial |
$14.40
|
| Rate for Payer: Health Smart Auto/Commercial |
$12.29
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage |
$14.40
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage |
$12.29
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage |
$25.85
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$23.70
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$13.20
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$11.26
|
| Rate for Payer: Multiplan Beech St/Commercial/PHCS |
$18.00
|
| Rate for Payer: Multiplan Beech St/Commercial/PHCS |
$32.32
|
| Rate for Payer: Multiplan Beech St/Commercial/PHCS |
$15.36
|
|
|
DOCETAXEL 160 MG/8 ML (20 MG/ML) INTRAVENOUS SOLUTION [196796]
|
Facility
|
OP
|
$25.50
|
|
|
Service Code
|
CPT J9171
|
| Hospital Charge Code |
NDG196796
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$14.02 |
| Max. Negotiated Rate |
$19.12 |
| Rate for Payer: Aetna of CA EPO/HMO/POS/PPO |
$15.30
|
| Rate for Payer: Aetna of CA Government/Medicare |
$15.30
|
| Rate for Payer: Cash Price |
$11.48
|
| Rate for Payer: Health Smart Auto/Commercial |
$15.30
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage |
$15.30
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$14.02
|
| Rate for Payer: Multiplan Beech St/Commercial/PHCS |
$19.12
|
|
|
DOCETAXEL 160 MG/8 ML (20 MG/ML) INTRAVENOUS SOLUTION [196796]
|
Facility
|
IP
|
$25.50
|
|
|
Service Code
|
CPT J9171
|
| Hospital Charge Code |
NDG196796
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$14.02 |
| Max. Negotiated Rate |
$20.40 |
| Rate for Payer: Cash Price |
$11.48
|
| Rate for Payer: Cigna of CA HMO/PPO |
$20.40
|
| Rate for Payer: Health Smart Auto/Commercial |
$15.30
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$14.02
|
| Rate for Payer: Multiplan Beech St/Commercial/PHCS |
$19.12
|
|
|
DOCETAXEL 20 MG/2 ML (10 MG/ML) INTRAVENOUS SOLUTION [108910]
|
Facility
|
OP
|
$43.09
|
|
|
Service Code
|
CPT J9171
|
| Hospital Charge Code |
NDG108910
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$23.70 |
| Max. Negotiated Rate |
$32.32 |
| Rate for Payer: Aetna of CA EPO/HMO/POS/PPO |
$25.85
|
| Rate for Payer: Aetna of CA Government/Medicare |
$25.85
|
| Rate for Payer: Cash Price |
$19.39
|
| Rate for Payer: Health Smart Auto/Commercial |
$25.85
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage |
$25.85
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$23.70
|
| Rate for Payer: Multiplan Beech St/Commercial/PHCS |
$32.32
|
|
|
DOCETAXEL 20 MG/2 ML (10 MG/ML) INTRAVENOUS SOLUTION [108910]
|
Facility
|
IP
|
$43.09
|
|
|
Service Code
|
CPT J9171
|
| Hospital Charge Code |
NDG108910
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$23.70 |
| Max. Negotiated Rate |
$34.47 |
| Rate for Payer: Cash Price |
$19.39
|
| Rate for Payer: Cigna of CA HMO/PPO |
$34.47
|
| Rate for Payer: Health Smart Auto/Commercial |
$25.85
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$23.70
|
| Rate for Payer: Multiplan Beech St/Commercial/PHCS |
$32.32
|
|
|
DOCETAXEL 20 MG/ML (1 ML) INTRAVENOUS SOLUTION [106443]
|
Facility
|
OP
|
$30.00
|
|
|
Service Code
|
CPT J9171
|
| Hospital Charge Code |
1755764
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$16.50 |
| Max. Negotiated Rate |
$22.50 |
| Rate for Payer: Aetna of CA EPO/HMO/POS/PPO |
$18.00
|
| Rate for Payer: Aetna of CA Government/Medicare |
$18.00
|
| Rate for Payer: Cash Price |
$13.50
|
| Rate for Payer: Health Smart Auto/Commercial |
$18.00
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage |
$18.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$16.50
|
| Rate for Payer: Multiplan Beech St/Commercial/PHCS |
$22.50
|
|
|
DOCETAXEL 20 MG/ML (1 ML) INTRAVENOUS SOLUTION [106443]
|
Facility
|
IP
|
$30.00
|
|
|
Service Code
|
CPT J9171
|
| Hospital Charge Code |
1755764
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$16.50 |
| Max. Negotiated Rate |
$24.00 |
| Rate for Payer: Cash Price |
$13.50
|
| Rate for Payer: Cigna of CA HMO/PPO |
$24.00
|
| Rate for Payer: Health Smart Auto/Commercial |
$18.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$16.50
|
| Rate for Payer: Multiplan Beech St/Commercial/PHCS |
$22.50
|
|
|
DOCETAXEL 80 MG/4 ML (20 MG/ML) INTRAVENOUS SOLUTION [108122]
|
Facility
|
OP
|
$25.50
|
|
|
Service Code
|
CPT J9171
|
| Hospital Charge Code |
1755766
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$14.02 |
| Max. Negotiated Rate |
$19.12 |
| Rate for Payer: Aetna of CA EPO/HMO/POS/PPO |
$78.30
|
| Rate for Payer: Aetna of CA EPO/HMO/POS/PPO |
$15.30
|
| Rate for Payer: Aetna of CA Government/Medicare |
$78.30
|
| Rate for Payer: Aetna of CA Government/Medicare |
$15.30
|
| Rate for Payer: Cash Price |
$11.48
|
| Rate for Payer: Cash Price |
$58.73
|
| Rate for Payer: Health Smart Auto/Commercial |
$78.30
|
| Rate for Payer: Health Smart Auto/Commercial |
$15.30
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage |
$15.30
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage |
$78.30
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$14.02
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$71.78
|
| Rate for Payer: Multiplan Beech St/Commercial/PHCS |
$97.88
|
| Rate for Payer: Multiplan Beech St/Commercial/PHCS |
$19.12
|
|
|
DOCETAXEL 80 MG/4 ML (20 MG/ML) INTRAVENOUS SOLUTION [108122]
|
Facility
|
IP
|
$25.50
|
|
|
Service Code
|
CPT J9171
|
| Hospital Charge Code |
1755766
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$14.02 |
| Max. Negotiated Rate |
$20.40 |
| Rate for Payer: Cash Price |
$11.48
|
| Rate for Payer: Cash Price |
$58.73
|
| Rate for Payer: Cigna of CA HMO/PPO |
$20.40
|
| Rate for Payer: Cigna of CA HMO/PPO |
$104.40
|
| Rate for Payer: Health Smart Auto/Commercial |
$78.30
|
| Rate for Payer: Health Smart Auto/Commercial |
$15.30
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$71.78
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$14.02
|
| Rate for Payer: Multiplan Beech St/Commercial/PHCS |
$19.12
|
| Rate for Payer: Multiplan Beech St/Commercial/PHCS |
$97.88
|
|
|
DOCETAXEL 80 MG/8 ML (10 MG/ML) INTRAVENOUS SOLUTION [108907]
|
Facility
|
OP
|
$43.09
|
|
|
Service Code
|
CPT J9171
|
| Hospital Charge Code |
NDG108907
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$23.70 |
| Max. Negotiated Rate |
$32.32 |
| Rate for Payer: Aetna of CA EPO/HMO/POS/PPO |
$14.40
|
| Rate for Payer: Aetna of CA EPO/HMO/POS/PPO |
$25.85
|
| Rate for Payer: Aetna of CA Government/Medicare |
$14.40
|
| Rate for Payer: Aetna of CA Government/Medicare |
$25.85
|
| Rate for Payer: Cash Price |
$10.80
|
| Rate for Payer: Cash Price |
$19.39
|
| Rate for Payer: Health Smart Auto/Commercial |
$25.85
|
| Rate for Payer: Health Smart Auto/Commercial |
$14.40
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage |
$14.40
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage |
$25.85
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$23.70
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$13.20
|
| Rate for Payer: Multiplan Beech St/Commercial/PHCS |
$18.00
|
| Rate for Payer: Multiplan Beech St/Commercial/PHCS |
$32.32
|
|
|
DOCETAXEL 80 MG/8 ML (10 MG/ML) INTRAVENOUS SOLUTION [108907]
|
Facility
|
IP
|
$24.00
|
|
|
Service Code
|
CPT J9171
|
| Hospital Charge Code |
NDG108907
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$13.20 |
| Max. Negotiated Rate |
$19.20 |
| Rate for Payer: Cash Price |
$10.80
|
| Rate for Payer: Cash Price |
$19.39
|
| Rate for Payer: Cigna of CA HMO/PPO |
$19.20
|
| Rate for Payer: Cigna of CA HMO/PPO |
$34.47
|
| Rate for Payer: Health Smart Auto/Commercial |
$14.40
|
| Rate for Payer: Health Smart Auto/Commercial |
$25.85
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$23.70
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$13.20
|
| Rate for Payer: Multiplan Beech St/Commercial/PHCS |
$32.32
|
| Rate for Payer: Multiplan Beech St/Commercial/PHCS |
$18.00
|
|
|
DOCOSANOL 10 % TOPICAL CREAM [29287]
|
Facility
|
OP
|
$8.02
|
|
|
Service Code
|
NDC 61269-981-35
|
| Hospital Charge Code |
1743703
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$4.41 |
| Max. Negotiated Rate |
$6.02 |
| Rate for Payer: Aetna of CA EPO/HMO/POS/PPO |
$4.81
|
| Rate for Payer: Aetna of CA Government/Medicare |
$4.81
|
| Rate for Payer: Cash Price |
$3.61
|
| Rate for Payer: Health Smart Auto/Commercial |
$4.81
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage |
$4.81
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.41
|
| Rate for Payer: Multiplan Beech St/Commercial/PHCS |
$6.02
|
|
|
DOCOSANOL 10 % TOPICAL CREAM [29287]
|
Facility
|
OP
|
$8.39
|
|
|
Service Code
|
NDC 46122-624-07
|
| Hospital Charge Code |
1743703
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$4.61 |
| Max. Negotiated Rate |
$6.29 |
| Rate for Payer: Aetna of CA EPO/HMO/POS/PPO |
$5.03
|
| Rate for Payer: Aetna of CA Government/Medicare |
$5.03
|
| Rate for Payer: Cash Price |
$3.78
|
| Rate for Payer: Health Smart Auto/Commercial |
$5.03
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage |
$5.03
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.61
|
| Rate for Payer: Multiplan Beech St/Commercial/PHCS |
$6.29
|
|
|
DOCOSANOL 10 % TOPICAL CREAM [29287]
|
Facility
|
IP
|
$9.28
|
|
|
Service Code
|
NDC 0766-0801-00
|
| Hospital Charge Code |
1743703
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$5.10 |
| Max. Negotiated Rate |
$7.42 |
| Rate for Payer: Cash Price |
$4.18
|
| Rate for Payer: Cigna of CA HMO/PPO |
$7.42
|
| Rate for Payer: Health Smart Auto/Commercial |
$5.57
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5.10
|
| Rate for Payer: Multiplan Beech St/Commercial/PHCS |
$6.96
|
|
|
DOCOSANOL 10 % TOPICAL CREAM [29287]
|
Facility
|
OP
|
$8.39
|
|
|
Service Code
|
NDC 46122-681-07
|
| Hospital Charge Code |
1743703
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$4.61 |
| Max. Negotiated Rate |
$6.29 |
| Rate for Payer: Health Smart Auto/Commercial |
$5.03
|
| Rate for Payer: Cash Price |
$3.78
|
| Rate for Payer: Aetna of CA EPO/HMO/POS/PPO |
$5.03
|
| Rate for Payer: Aetna of CA Government/Medicare |
$5.03
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage |
$5.03
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.61
|
| Rate for Payer: Multiplan Beech St/Commercial/PHCS |
$6.29
|
|
|
DOCOSANOL 10 % TOPICAL CREAM [29287]
|
Facility
|
IP
|
$8.39
|
|
|
Service Code
|
NDC 46122-624-07
|
| Hospital Charge Code |
1743703
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$4.61 |
| Max. Negotiated Rate |
$6.71 |
| Rate for Payer: Cash Price |
$3.78
|
| Rate for Payer: Cigna of CA HMO/PPO |
$6.71
|
| Rate for Payer: Health Smart Auto/Commercial |
$5.03
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.61
|
| Rate for Payer: Multiplan Beech St/Commercial/PHCS |
$6.29
|
|
|
DOCOSANOL 10 % TOPICAL CREAM [29287]
|
Facility
|
IP
|
$9.28
|
|
|
Service Code
|
NDC 766080155
|
| Hospital Charge Code |
1743703
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$5.10 |
| Max. Negotiated Rate |
$7.42 |
| Rate for Payer: Cash Price |
$4.18
|
| Rate for Payer: Cigna of CA HMO/PPO |
$7.42
|
| Rate for Payer: Health Smart Auto/Commercial |
$5.57
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5.10
|
| Rate for Payer: Multiplan Beech St/Commercial/PHCS |
$6.96
|
|
|
DOCOSANOL 10 % TOPICAL CREAM [29287]
|
Facility
|
IP
|
$9.28
|
|
|
Service Code
|
NDC 0135-0200-01
|
| Hospital Charge Code |
1743703
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$5.10 |
| Max. Negotiated Rate |
$7.42 |
| Rate for Payer: Cash Price |
$4.18
|
| Rate for Payer: Cigna of CA HMO/PPO |
$7.42
|
| Rate for Payer: Health Smart Auto/Commercial |
$5.57
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5.10
|
| Rate for Payer: Multiplan Beech St/Commercial/PHCS |
$6.96
|
|
|
DOCOSANOL 10 % TOPICAL CREAM [29287]
|
Facility
|
IP
|
$8.39
|
|
|
Service Code
|
NDC 46122-681-07
|
| Hospital Charge Code |
1743703
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$4.61 |
| Max. Negotiated Rate |
$6.71 |
| Rate for Payer: Cash Price |
$3.78
|
| Rate for Payer: Cigna of CA HMO/PPO |
$6.71
|
| Rate for Payer: Health Smart Auto/Commercial |
$5.03
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.61
|
| Rate for Payer: Multiplan Beech St/Commercial/PHCS |
$6.29
|
|
|
DOCOSANOL 10 % TOPICAL CREAM [29287]
|
Facility
|
IP
|
$8.02
|
|
|
Service Code
|
NDC 61269-981-35
|
| Hospital Charge Code |
1743703
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$4.41 |
| Max. Negotiated Rate |
$6.42 |
| Rate for Payer: Cash Price |
$3.61
|
| Rate for Payer: Cigna of CA HMO/PPO |
$6.42
|
| Rate for Payer: Health Smart Auto/Commercial |
$4.81
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.41
|
| Rate for Payer: Multiplan Beech St/Commercial/PHCS |
$6.02
|
|
|
DOCOSANOL 10 % TOPICAL CREAM [29287]
|
Facility
|
OP
|
$9.28
|
|
|
Service Code
|
NDC 766080155
|
| Hospital Charge Code |
1743703
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$5.10 |
| Max. Negotiated Rate |
$6.96 |
| Rate for Payer: Aetna of CA EPO/HMO/POS/PPO |
$5.57
|
| Rate for Payer: Aetna of CA Government/Medicare |
$5.57
|
| Rate for Payer: Cash Price |
$4.18
|
| Rate for Payer: Health Smart Auto/Commercial |
$5.57
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage |
$5.57
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5.10
|
| Rate for Payer: Multiplan Beech St/Commercial/PHCS |
$6.96
|
|
|
DOCOSANOL 10 % TOPICAL CREAM [29287]
|
Facility
|
OP
|
$9.28
|
|
|
Service Code
|
NDC 0135-0200-01
|
| Hospital Charge Code |
1743703
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$5.10 |
| Max. Negotiated Rate |
$6.96 |
| Rate for Payer: Aetna of CA EPO/HMO/POS/PPO |
$5.57
|
| Rate for Payer: Aetna of CA Government/Medicare |
$5.57
|
| Rate for Payer: Cash Price |
$4.18
|
| Rate for Payer: Health Smart Auto/Commercial |
$5.57
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage |
$5.57
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5.10
|
| Rate for Payer: Multiplan Beech St/Commercial/PHCS |
$6.96
|
|
|
DOCOSANOL 10 % TOPICAL CREAM [29287]
|
Facility
|
OP
|
$9.28
|
|
|
Service Code
|
NDC 0766-0801-00
|
| Hospital Charge Code |
1743703
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$5.10 |
| Max. Negotiated Rate |
$6.96 |
| Rate for Payer: Aetna of CA EPO/HMO/POS/PPO |
$5.57
|
| Rate for Payer: Aetna of CA Government/Medicare |
$5.57
|
| Rate for Payer: Cash Price |
$4.18
|
| Rate for Payer: Health Smart Auto/Commercial |
$5.57
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage |
$5.57
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5.10
|
| Rate for Payer: Multiplan Beech St/Commercial/PHCS |
$6.96
|
|
|
DOCUSATE SODIUM 100 MG CAPSULE [2566]
|
Facility
|
OP
|
$0.02
|
|
|
Service Code
|
NDC 6961804410
|
| Hospital Charge Code |
1710247
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.01 |
| Max. Negotiated Rate |
$0.02 |
| Rate for Payer: Aetna of CA EPO/HMO/POS/PPO |
$0.01
|
| Rate for Payer: Aetna of CA Government/Medicare |
$0.01
|
| Rate for Payer: Cash Price |
$0.01
|
| Rate for Payer: Health Smart Auto/Commercial |
$0.01
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage |
$0.01
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.01
|
| Rate for Payer: Multiplan Beech St/Commercial/PHCS |
$0.02
|
|
