|
CALCITRIOL 1 MCG/ML ORAL SOLUTION [16218]
|
Facility
|
IP
|
$11.46
|
|
|
Service Code
|
NDC 0054-3120-41
|
| Hospital Charge Code |
1715185
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$6.30 |
| Max. Negotiated Rate |
$9.17 |
| Rate for Payer: Cash Price |
$5.16
|
| Rate for Payer: Cigna of CA HMO/PPO |
$9.17
|
| Rate for Payer: Health Smart Auto/Commercial |
$6.88
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6.30
|
| Rate for Payer: Multiplan Beech St/Commercial/PHCS |
$8.60
|
|
|
CALCITRIOL 1 MCG/ML ORAL SOLUTION [16218]
|
Facility
|
IP
|
$6.00
|
|
|
Service Code
|
NDC 64980-447-15
|
| Hospital Charge Code |
1715185
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$3.30 |
| Max. Negotiated Rate |
$4.80 |
| Rate for Payer: Cash Price |
$2.70
|
| Rate for Payer: Cigna of CA HMO/PPO |
$4.80
|
| Rate for Payer: Health Smart Auto/Commercial |
$3.60
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.30
|
| Rate for Payer: Multiplan Beech St/Commercial/PHCS |
$4.50
|
|
|
CALCITRIOL 1 MCG/ML ORAL SOLUTION [16218]
|
Facility
|
OP
|
$10.88
|
|
|
Service Code
|
NDC 63304-241-59
|
| Hospital Charge Code |
1715185
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$5.98 |
| Max. Negotiated Rate |
$8.16 |
| Rate for Payer: Aetna of CA EPO/HMO/POS/PPO |
$6.53
|
| Rate for Payer: Aetna of CA Government/Medicare |
$6.53
|
| Rate for Payer: Cash Price |
$4.90
|
| Rate for Payer: Health Smart Auto/Commercial |
$6.53
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage |
$6.53
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5.98
|
| Rate for Payer: Multiplan Beech St/Commercial/PHCS |
$8.16
|
|
|
CALCITRIOL 1 MCG/ML ORAL SOLUTION [16218]
|
Facility
|
IP
|
$10.88
|
|
|
Service Code
|
NDC 63304-241-59
|
| Hospital Charge Code |
1715185
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$5.98 |
| Max. Negotiated Rate |
$8.70 |
| Rate for Payer: Cash Price |
$4.90
|
| Rate for Payer: Cigna of CA HMO/PPO |
$8.70
|
| Rate for Payer: Health Smart Auto/Commercial |
$6.53
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5.98
|
| Rate for Payer: Multiplan Beech St/Commercial/PHCS |
$8.16
|
|
|
CALCITRIOL 1 MCG/ML ORAL SOLUTION [16218]
|
Facility
|
OP
|
$6.00
|
|
|
Service Code
|
NDC 64980-447-15
|
| Hospital Charge Code |
1715185
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$3.30 |
| Max. Negotiated Rate |
$4.50 |
| Rate for Payer: Aetna of CA EPO/HMO/POS/PPO |
$3.60
|
| Rate for Payer: Aetna of CA Government/Medicare |
$3.60
|
| Rate for Payer: Cash Price |
$2.70
|
| Rate for Payer: Health Smart Auto/Commercial |
$3.60
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage |
$3.60
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.30
|
| Rate for Payer: Multiplan Beech St/Commercial/PHCS |
$4.50
|
|
|
CALCIUM ACETATE 667 MG TABLET [226892]
|
Facility
|
IP
|
$0.16
|
|
|
Service Code
|
NDC 7132180320
|
| Hospital Charge Code |
ERX226892
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.09 |
| Max. Negotiated Rate |
$0.13 |
| Rate for Payer: Cash Price |
$0.07
|
| Rate for Payer: Cigna of CA HMO/PPO |
$0.13
|
| Rate for Payer: Health Smart Auto/Commercial |
$0.10
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.09
|
| Rate for Payer: Multiplan Beech St/Commercial/PHCS |
$0.12
|
|
|
CALCIUM ACETATE 667 MG TABLET [226892]
|
Facility
|
OP
|
$0.16
|
|
|
Service Code
|
NDC 7132180320
|
| Hospital Charge Code |
ERX226892
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.09 |
| Max. Negotiated Rate |
$0.12 |
| Rate for Payer: Aetna of CA EPO/HMO/POS/PPO |
$0.10
|
| Rate for Payer: Aetna of CA Government/Medicare |
$0.10
|
| Rate for Payer: Cash Price |
$0.07
|
| Rate for Payer: Health Smart Auto/Commercial |
$0.10
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage |
$0.10
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.09
|
| Rate for Payer: Multiplan Beech St/Commercial/PHCS |
$0.12
|
|
|
CALCIUM ACETATE 952 MG-ALUMINUM SULFATE 1,347 MG TOPICAL POWDER PACKET [192164]
|
Facility
|
OP
|
$0.74
|
|
|
Service Code
|
NDC 51224-162-99
|
| Hospital Charge Code |
ERX192205
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.41 |
| Max. Negotiated Rate |
$0.56 |
| Rate for Payer: Aetna of CA EPO/HMO/POS/PPO |
$0.44
|
| Rate for Payer: Aetna of CA Government/Medicare |
$0.44
|
| Rate for Payer: Cash Price |
$0.33
|
| Rate for Payer: Health Smart Auto/Commercial |
$0.44
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage |
$0.44
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.41
|
| Rate for Payer: Multiplan Beech St/Commercial/PHCS |
$0.56
|
|
|
CALCIUM ACETATE 952 MG-ALUMINUM SULFATE 1,347 MG TOPICAL POWDER PACKET [192164]
|
Facility
|
IP
|
$0.74
|
|
|
Service Code
|
NDC 51224-162-99
|
| Hospital Charge Code |
ERX192205
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.41 |
| Max. Negotiated Rate |
$0.59 |
| Rate for Payer: Cash Price |
$0.33
|
| Rate for Payer: Cigna of CA HMO/PPO |
$0.59
|
| Rate for Payer: Health Smart Auto/Commercial |
$0.44
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.41
|
| Rate for Payer: Multiplan Beech St/Commercial/PHCS |
$0.56
|
|
|
CALCIUM ACETATE(PHOSPHATE BINDERS) 667 MG CAPSULE [30961]
|
Facility
|
IP
|
$0.30
|
|
|
Service Code
|
NDC 16571-813-20
|
| Hospital Charge Code |
1711506
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.17 |
| Max. Negotiated Rate |
$0.24 |
| Rate for Payer: Cash Price |
$0.14
|
| Rate for Payer: Cigna of CA HMO/PPO |
$0.24
|
| Rate for Payer: Health Smart Auto/Commercial |
$0.18
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.17
|
| Rate for Payer: Multiplan Beech St/Commercial/PHCS |
$0.23
|
|
|
CALCIUM ACETATE(PHOSPHATE BINDERS) 667 MG CAPSULE [30961]
|
Facility
|
OP
|
$0.30
|
|
|
Service Code
|
NDC 16571-813-20
|
| Hospital Charge Code |
1711506
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.17 |
| Max. Negotiated Rate |
$0.23 |
| Rate for Payer: Aetna of CA EPO/HMO/POS/PPO |
$0.18
|
| Rate for Payer: Aetna of CA Government/Medicare |
$0.18
|
| Rate for Payer: Cash Price |
$0.14
|
| Rate for Payer: Health Smart Auto/Commercial |
$0.18
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage |
$0.18
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.17
|
| Rate for Payer: Multiplan Beech St/Commercial/PHCS |
$0.23
|
|
|
CALCIUM ACETATE(PHOSPHATE BINDERS) 667 MG CAPSULE [30961]
|
Facility
|
IP
|
$0.30
|
|
|
Service Code
|
NDC 23155-531-02
|
| Hospital Charge Code |
1711506
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.17 |
| Max. Negotiated Rate |
$0.24 |
| Rate for Payer: Cash Price |
$0.14
|
| Rate for Payer: Cigna of CA HMO/PPO |
$0.24
|
| Rate for Payer: Health Smart Auto/Commercial |
$0.18
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.17
|
| Rate for Payer: Multiplan Beech St/Commercial/PHCS |
$0.23
|
|
|
CALCIUM ACETATE(PHOSPHATE BINDERS) 667 MG CAPSULE [30961]
|
Facility
|
OP
|
$0.84
|
|
|
Service Code
|
NDC 29033-026-02
|
| Hospital Charge Code |
1711506
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.46 |
| Max. Negotiated Rate |
$0.63 |
| Rate for Payer: Aetna of CA EPO/HMO/POS/PPO |
$0.50
|
| Rate for Payer: Aetna of CA Government/Medicare |
$0.50
|
| Rate for Payer: Cash Price |
$0.38
|
| Rate for Payer: Health Smart Auto/Commercial |
$0.50
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage |
$0.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.46
|
| Rate for Payer: Multiplan Beech St/Commercial/PHCS |
$0.63
|
|
|
CALCIUM ACETATE(PHOSPHATE BINDERS) 667 MG CAPSULE [30961]
|
Facility
|
IP
|
$1.68
|
|
|
Service Code
|
NDC 68084-479-01
|
| Hospital Charge Code |
1711506
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.92 |
| Max. Negotiated Rate |
$1.34 |
| Rate for Payer: Cash Price |
$0.76
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1.34
|
| Rate for Payer: Health Smart Auto/Commercial |
$1.01
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.92
|
| Rate for Payer: Multiplan Beech St/Commercial/PHCS |
$1.26
|
|
|
CALCIUM ACETATE(PHOSPHATE BINDERS) 667 MG CAPSULE [30961]
|
Facility
|
IP
|
$0.76
|
|
|
Service Code
|
NDC 0781-2081-02
|
| Hospital Charge Code |
1711506
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.42 |
| Max. Negotiated Rate |
$0.61 |
| Rate for Payer: Cash Price |
$0.34
|
| Rate for Payer: Cigna of CA HMO/PPO |
$0.61
|
| Rate for Payer: Health Smart Auto/Commercial |
$0.46
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.42
|
| Rate for Payer: Multiplan Beech St/Commercial/PHCS |
$0.57
|
|
|
CALCIUM ACETATE(PHOSPHATE BINDERS) 667 MG CAPSULE [30961]
|
Facility
|
OP
|
$0.76
|
|
|
Service Code
|
NDC 0781-2081-02
|
| Hospital Charge Code |
1711506
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.42 |
| Max. Negotiated Rate |
$0.57 |
| Rate for Payer: Aetna of CA EPO/HMO/POS/PPO |
$0.46
|
| Rate for Payer: Aetna of CA Government/Medicare |
$0.46
|
| Rate for Payer: Cash Price |
$0.34
|
| Rate for Payer: Health Smart Auto/Commercial |
$0.46
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage |
$0.46
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.42
|
| Rate for Payer: Multiplan Beech St/Commercial/PHCS |
$0.57
|
|
|
CALCIUM ACETATE(PHOSPHATE BINDERS) 667 MG CAPSULE [30961]
|
Facility
|
IP
|
$1.68
|
|
|
Service Code
|
NDC 68084-479-11
|
| Hospital Charge Code |
1711506
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.92 |
| Max. Negotiated Rate |
$1.34 |
| Rate for Payer: Cash Price |
$0.76
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1.34
|
| Rate for Payer: Health Smart Auto/Commercial |
$1.01
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.92
|
| Rate for Payer: Multiplan Beech St/Commercial/PHCS |
$1.26
|
|
|
CALCIUM ACETATE(PHOSPHATE BINDERS) 667 MG CAPSULE [30961]
|
Facility
|
OP
|
$1.68
|
|
|
Service Code
|
NDC 68084-479-01
|
| Hospital Charge Code |
1711506
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.92 |
| Max. Negotiated Rate |
$1.26 |
| Rate for Payer: Aetna of CA EPO/HMO/POS/PPO |
$1.01
|
| Rate for Payer: Aetna of CA Government/Medicare |
$1.01
|
| Rate for Payer: Cash Price |
$0.76
|
| Rate for Payer: Health Smart Auto/Commercial |
$1.01
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage |
$1.01
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.92
|
| Rate for Payer: Multiplan Beech St/Commercial/PHCS |
$1.26
|
|
|
CALCIUM ACETATE(PHOSPHATE BINDERS) 667 MG CAPSULE [30961]
|
Facility
|
IP
|
$0.84
|
|
|
Service Code
|
NDC 29033-026-02
|
| Hospital Charge Code |
1711506
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.46 |
| Max. Negotiated Rate |
$0.67 |
| Rate for Payer: Cash Price |
$0.38
|
| Rate for Payer: Cigna of CA HMO/PPO |
$0.67
|
| Rate for Payer: Health Smart Auto/Commercial |
$0.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.46
|
| Rate for Payer: Multiplan Beech St/Commercial/PHCS |
$0.63
|
|
|
CALCIUM ACETATE(PHOSPHATE BINDERS) 667 MG CAPSULE [30961]
|
Facility
|
OP
|
$1.68
|
|
|
Service Code
|
NDC 68084-479-11
|
| Hospital Charge Code |
1711506
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.92 |
| Max. Negotiated Rate |
$1.26 |
| Rate for Payer: Aetna of CA EPO/HMO/POS/PPO |
$1.01
|
| Rate for Payer: Aetna of CA Government/Medicare |
$1.01
|
| Rate for Payer: Cash Price |
$0.76
|
| Rate for Payer: Health Smart Auto/Commercial |
$1.01
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage |
$1.01
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.92
|
| Rate for Payer: Multiplan Beech St/Commercial/PHCS |
$1.26
|
|
|
CALCIUM ACETATE(PHOSPHATE BINDERS) 667 MG CAPSULE [30961]
|
Facility
|
OP
|
$0.30
|
|
|
Service Code
|
NDC 23155-531-02
|
| Hospital Charge Code |
1711506
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.17 |
| Max. Negotiated Rate |
$0.23 |
| Rate for Payer: Aetna of CA EPO/HMO/POS/PPO |
$0.18
|
| Rate for Payer: Aetna of CA Government/Medicare |
$0.18
|
| Rate for Payer: Cash Price |
$0.14
|
| Rate for Payer: Health Smart Auto/Commercial |
$0.18
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage |
$0.18
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.17
|
| Rate for Payer: Multiplan Beech St/Commercial/PHCS |
$0.23
|
|
|
CALCIUM CARBONATE 200 MG CALCIUM (500 MG) CHEWABLE TABLET [9385]
|
Facility
|
OP
|
$0.02
|
|
|
Service Code
|
NDC 0536-1007-15
|
| Hospital Charge Code |
1712416
|
|
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
|
|
|
CALCIUM CARBONATE 200 MG CALCIUM (500 MG) CHEWABLE TABLET [9385]
|
Facility
|
IP
|
$0.02
|
|
|
Service Code
|
NDC 8770190081
|
| Hospital Charge Code |
1712416
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.01 |
| Max. Negotiated Rate |
$0.02 |
| Rate for Payer: Cash Price |
$0.01
|
| Rate for Payer: Cigna of CA HMO/PPO |
$0.02
|
| Rate for Payer: Health Smart Auto/Commercial |
$0.01
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.01
|
| Rate for Payer: Multiplan Beech St/Commercial/PHCS |
$0.02
|
|
|
CALCIUM CARBONATE 200 MG CALCIUM (500 MG) CHEWABLE TABLET [9385]
|
Facility
|
IP
|
$0.02
|
|
|
Service Code
|
NDC 24385-478-47
|
| Hospital Charge Code |
1712416
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.01 |
| Max. Negotiated Rate |
$0.02 |
| Rate for Payer: Cash Price |
$0.01
|
| Rate for Payer: Cigna of CA HMO/PPO |
$0.02
|
| Rate for Payer: Health Smart Auto/Commercial |
$0.01
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.01
|
| Rate for Payer: Multiplan Beech St/Commercial/PHCS |
$0.02
|
|
|
CALCIUM CARBONATE 200 MG CALCIUM (500 MG) CHEWABLE TABLET [9385]
|
Facility
|
OP
|
$0.02
|
|
|
Service Code
|
NDC 0904-6412-92
|
| Hospital Charge Code |
1712416
|
|
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
|
|
