|
PHENYTOIN SODIUM EXTENDED 100 MG CAPSULE [6257]
|
Facility
OP
|
$0.64
|
|
|
Service Code
|
NDC 68084-376-01
|
| Hospital Charge Code |
1710147
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.15 |
| Max. Negotiated Rate |
$0.54 |
| Rate for Payer: Aetna of CA HMO/PPO |
$0.42
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$0.54
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$0.35
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$0.35
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.38
|
| Rate for Payer: BCBS Transplant Transplant |
$0.38
|
| Rate for Payer: Blue Shield of California Commercial |
$0.47
|
| Rate for Payer: Blue Shield of California EPN |
$0.37
|
| Rate for Payer: Cash Price |
$0.29
|
| Rate for Payer: Cigna of CA HMO |
$0.45
|
| Rate for Payer: Cigna of CA PPO |
$0.45
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.54
|
| Rate for Payer: Dignity Health Media |
$0.54
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.54
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.26
|
| Rate for Payer: EPIC Health Plan Transplant |
$0.26
|
| Rate for Payer: Galaxy Health WC |
$0.54
|
| Rate for Payer: Global Benefits Group Commercial |
$0.38
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$0.48
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.43
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.24
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.15
|
| Rate for Payer: Multiplan Commercial |
$0.51
|
| Rate for Payer: Networks By Design Commercial |
$0.42
|
| Rate for Payer: Prime Health Services Commercial |
$0.54
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$0.38
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.38
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.38
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.32
|
| Rate for Payer: United Healthcare All Other HMO |
$0.32
|
| Rate for Payer: United Healthcare HMO Rider |
$0.32
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.32
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.54
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.54
|
| Rate for Payer: Vantage Medical Group Senior |
$0.54
|
|
|
PHENYTOIN SODIUM EXTENDED 100 MG CAPSULE [6257]
|
Facility
OP
|
$0.36
|
|
|
Service Code
|
NDC 65162-212-10
|
| Hospital Charge Code |
1710147
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.09 |
| Max. Negotiated Rate |
$0.31 |
| Rate for Payer: Aetna of CA HMO/PPO |
$0.24
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$0.31
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$0.20
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$0.20
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.21
|
| Rate for Payer: BCBS Transplant Transplant |
$0.22
|
| Rate for Payer: Blue Shield of California Commercial |
$0.27
|
| Rate for Payer: Blue Shield of California EPN |
$0.21
|
| Rate for Payer: Cash Price |
$0.16
|
| Rate for Payer: Cigna of CA HMO |
$0.25
|
| Rate for Payer: Cigna of CA PPO |
$0.25
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.31
|
| Rate for Payer: Dignity Health Media |
$0.31
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.31
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.14
|
| Rate for Payer: EPIC Health Plan Transplant |
$0.14
|
| Rate for Payer: Galaxy Health WC |
$0.31
|
| Rate for Payer: Global Benefits Group Commercial |
$0.22
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$0.27
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.24
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.14
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.09
|
| Rate for Payer: Multiplan Commercial |
$0.29
|
| Rate for Payer: Networks By Design Commercial |
$0.23
|
| Rate for Payer: Prime Health Services Commercial |
$0.31
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$0.22
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.22
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.22
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.18
|
| Rate for Payer: United Healthcare All Other HMO |
$0.18
|
| Rate for Payer: United Healthcare HMO Rider |
$0.18
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.18
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.31
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.31
|
| Rate for Payer: Vantage Medical Group Senior |
$0.31
|
|
|
PHENYTOIN SODIUM EXTENDED 100 MG CAPSULE [6257]
|
Facility
IP
|
$0.36
|
|
|
Service Code
|
NDC 65162-212-10
|
| Hospital Charge Code |
1710147
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.09 |
| Max. Negotiated Rate |
$0.31 |
| Rate for Payer: Blue Shield of California Commercial |
$0.26
|
| Rate for Payer: Blue Shield of California EPN |
$0.18
|
| Rate for Payer: Cash Price |
$0.16
|
| Rate for Payer: Cigna of CA HMO |
$0.25
|
| Rate for Payer: Cigna of CA PPO |
$0.25
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.14
|
| Rate for Payer: Galaxy Health WC |
$0.31
|
| Rate for Payer: Global Benefits Group Commercial |
$0.22
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.24
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.14
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.09
|
| Rate for Payer: Multiplan Commercial |
$0.29
|
| Rate for Payer: Networks By Design Commercial |
$0.23
|
| Rate for Payer: Prime Health Services Commercial |
$0.31
|
|
|
PHENYTOIN SODIUM EXTENDED 100 MG CAPSULE [6257]
|
Facility
OP
|
$0.64
|
|
|
Service Code
|
NDC 68084-376-11
|
| Hospital Charge Code |
1710147
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.15 |
| Max. Negotiated Rate |
$0.54 |
| Rate for Payer: Aetna of CA HMO/PPO |
$0.42
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$0.54
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$0.35
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$0.35
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.38
|
| Rate for Payer: BCBS Transplant Transplant |
$0.38
|
| Rate for Payer: Blue Shield of California Commercial |
$0.47
|
| Rate for Payer: Blue Shield of California EPN |
$0.37
|
| Rate for Payer: Cash Price |
$0.29
|
| Rate for Payer: Cigna of CA HMO |
$0.45
|
| Rate for Payer: Cigna of CA PPO |
$0.45
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.54
|
| Rate for Payer: Dignity Health Media |
$0.54
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.54
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.26
|
| Rate for Payer: EPIC Health Plan Transplant |
$0.26
|
| Rate for Payer: Galaxy Health WC |
$0.54
|
| Rate for Payer: Global Benefits Group Commercial |
$0.38
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$0.48
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.43
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.24
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.15
|
| Rate for Payer: Multiplan Commercial |
$0.51
|
| Rate for Payer: Networks By Design Commercial |
$0.42
|
| Rate for Payer: Prime Health Services Commercial |
$0.54
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$0.38
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.38
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.38
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.32
|
| Rate for Payer: United Healthcare All Other HMO |
$0.32
|
| Rate for Payer: United Healthcare HMO Rider |
$0.32
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.32
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.54
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.54
|
| Rate for Payer: Vantage Medical Group Senior |
$0.54
|
|
|
PHENYTOIN SODIUM EXTENDED 100 MG CAPSULE [6257]
|
Facility
IP
|
$0.62
|
|
|
Service Code
|
NDC 51672-4111-1
|
| Hospital Charge Code |
1710147
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.15 |
| Max. Negotiated Rate |
$0.53 |
| Rate for Payer: Blue Shield of California Commercial |
$0.44
|
| Rate for Payer: Blue Shield of California EPN |
$0.32
|
| Rate for Payer: Cash Price |
$0.28
|
| Rate for Payer: Cigna of CA HMO |
$0.43
|
| Rate for Payer: Cigna of CA PPO |
$0.43
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.25
|
| Rate for Payer: Galaxy Health WC |
$0.53
|
| Rate for Payer: Global Benefits Group Commercial |
$0.37
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.41
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.24
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.15
|
| Rate for Payer: Multiplan Commercial |
$0.50
|
| Rate for Payer: Networks By Design Commercial |
$0.40
|
| Rate for Payer: Prime Health Services Commercial |
$0.53
|
|
|
PHENYTOIN SODIUM EXTENDED 100 MG CAPSULE [6257]
|
Facility
IP
|
$0.64
|
|
|
Service Code
|
NDC 68084-376-11
|
| Hospital Charge Code |
1710147
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.15 |
| Max. Negotiated Rate |
$0.54 |
| Rate for Payer: Blue Shield of California Commercial |
$0.46
|
| Rate for Payer: Blue Shield of California EPN |
$0.33
|
| Rate for Payer: Cash Price |
$0.29
|
| Rate for Payer: Cigna of CA HMO |
$0.45
|
| Rate for Payer: Cigna of CA PPO |
$0.45
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.26
|
| Rate for Payer: Galaxy Health WC |
$0.54
|
| Rate for Payer: Global Benefits Group Commercial |
$0.38
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.43
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.24
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.15
|
| Rate for Payer: Multiplan Commercial |
$0.51
|
| Rate for Payer: Networks By Design Commercial |
$0.42
|
| Rate for Payer: Prime Health Services Commercial |
$0.54
|
|
|
PHENYTOIN SODIUM EXTENDED 30 MG CAPSULE [11019]
|
Facility
IP
|
$1.66
|
|
|
Service Code
|
NDC 0071-3740-66
|
| Hospital Charge Code |
1710163
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.40 |
| Max. Negotiated Rate |
$1.41 |
| Rate for Payer: Blue Shield of California Commercial |
$1.18
|
| Rate for Payer: Blue Shield of California EPN |
$0.85
|
| Rate for Payer: Cash Price |
$0.75
|
| Rate for Payer: Cigna of CA HMO |
$1.16
|
| Rate for Payer: Cigna of CA PPO |
$1.16
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.66
|
| Rate for Payer: Galaxy Health WC |
$1.41
|
| Rate for Payer: Global Benefits Group Commercial |
$1.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1.11
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.63
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.40
|
| Rate for Payer: Multiplan Commercial |
$1.33
|
| Rate for Payer: Networks By Design Commercial |
$1.08
|
| Rate for Payer: Prime Health Services Commercial |
$1.41
|
|
|
PHENYTOIN SODIUM EXTENDED 30 MG CAPSULE [11019]
|
Facility
OP
|
$1.66
|
|
|
Service Code
|
NDC 0071-3740-66
|
| Hospital Charge Code |
1710163
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.40 |
| Max. Negotiated Rate |
$1.41 |
| Rate for Payer: Aetna of CA HMO/PPO |
$1.09
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$1.41
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$0.91
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$0.91
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.99
|
| Rate for Payer: BCBS Transplant Transplant |
$1.00
|
| Rate for Payer: Blue Shield of California Commercial |
$1.22
|
| Rate for Payer: Blue Shield of California EPN |
$0.97
|
| Rate for Payer: Cash Price |
$0.75
|
| Rate for Payer: Cigna of CA HMO |
$1.16
|
| Rate for Payer: Cigna of CA PPO |
$1.16
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1.41
|
| Rate for Payer: Dignity Health Media |
$1.41
|
| Rate for Payer: Dignity Health Medi-Cal |
$1.41
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.66
|
| Rate for Payer: EPIC Health Plan Transplant |
$0.66
|
| Rate for Payer: Galaxy Health WC |
$1.41
|
| Rate for Payer: Global Benefits Group Commercial |
$1.00
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$1.24
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1.11
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.63
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.40
|
| Rate for Payer: Multiplan Commercial |
$1.33
|
| Rate for Payer: Networks By Design Commercial |
$1.08
|
| Rate for Payer: Prime Health Services Commercial |
$1.41
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$1.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.83
|
| Rate for Payer: United Healthcare All Other HMO |
$0.83
|
| Rate for Payer: United Healthcare HMO Rider |
$0.83
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.83
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1.41
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1.41
|
| Rate for Payer: Vantage Medical Group Senior |
$1.41
|
|
|
PHOS-NAK ORAL SOLN CMPND 25 MG/ML (0.8 MMOL/ML) [4080310]
|
Facility
OP
|
$0.04
|
|
|
Service Code
|
NDC 9994-0803-10
|
| Hospital Charge Code |
NDG2867
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.01 |
| Max. Negotiated Rate |
$0.03 |
| Rate for Payer: BCBS Transplant Transplant |
$0.02
|
| Rate for Payer: Aetna of CA HMO/PPO |
$0.03
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$0.03
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$0.02
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$0.02
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.02
|
| Rate for Payer: Blue Shield of California Commercial |
$0.03
|
| Rate for Payer: Blue Shield of California EPN |
$0.02
|
| Rate for Payer: Cash Price |
$0.02
|
| Rate for Payer: Cigna of CA HMO |
$0.03
|
| Rate for Payer: Cigna of CA PPO |
$0.03
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.03
|
| Rate for Payer: Dignity Health Media |
$0.03
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.03
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.02
|
| Rate for Payer: EPIC Health Plan Transplant |
$0.02
|
| Rate for Payer: Galaxy Health WC |
$0.03
|
| Rate for Payer: Global Benefits Group Commercial |
$0.02
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$0.03
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.03
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.02
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.01
|
| Rate for Payer: Multiplan Commercial |
$0.03
|
| Rate for Payer: Networks By Design Commercial |
$0.03
|
| Rate for Payer: Prime Health Services Commercial |
$0.03
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$0.02
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.02
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.02
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.02
|
| Rate for Payer: United Healthcare All Other HMO |
$0.02
|
| Rate for Payer: United Healthcare HMO Rider |
$0.02
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.02
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.03
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.03
|
| Rate for Payer: Vantage Medical Group Senior |
$0.03
|
|
|
PHOS-NAK ORAL SOLN CMPND 25 MG/ML (0.8 MMOL/ML) [4080310]
|
Facility
IP
|
$0.04
|
|
|
Service Code
|
NDC 9994-0803-10
|
| Hospital Charge Code |
NDG2867
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.01 |
| Max. Negotiated Rate |
$0.03 |
| Rate for Payer: Blue Shield of California Commercial |
$0.03
|
| Rate for Payer: Blue Shield of California EPN |
$0.02
|
| Rate for Payer: Cash Price |
$0.02
|
| Rate for Payer: Cigna of CA HMO |
$0.03
|
| Rate for Payer: Cigna of CA PPO |
$0.03
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.02
|
| Rate for Payer: Galaxy Health WC |
$0.03
|
| Rate for Payer: Global Benefits Group Commercial |
$0.02
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.03
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.02
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.01
|
| Rate for Payer: Multiplan Commercial |
$0.03
|
| Rate for Payer: Networks By Design Commercial |
$0.03
|
| Rate for Payer: Prime Health Services Commercial |
$0.03
|
|
|
PHOSPHATE DIALYSIS SOLN WITHOUT DEXTR K 4 MEQ-CA 2.5 MEQ-PO4 1 MMOL/L [212681]
|
Facility
OP
|
$0.01
|
|
|
Service Code
|
NDC 24571-116-06
|
| Hospital Charge Code |
NDG212681
|
|
Hospital Revenue Code
|
250
|
| Max. Negotiated Rate |
$0.01 |
| Rate for Payer: Aetna of CA HMO/PPO |
$0.01
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$0.01
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$0.01
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$0.01
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.01
|
| Rate for Payer: BCBS Transplant Transplant |
$0.01
|
| Rate for Payer: Blue Shield of California Commercial |
$0.01
|
| Rate for Payer: Blue Shield of California EPN |
$0.01
|
| Rate for Payer: Cigna of CA HMO |
$0.01
|
| Rate for Payer: Cigna of CA PPO |
$0.01
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.01
|
| Rate for Payer: Dignity Health Media |
$0.01
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.01
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.00
|
| Rate for Payer: EPIC Health Plan Transplant |
$0.00
|
| Rate for Payer: Galaxy Health WC |
$0.01
|
| Rate for Payer: Global Benefits Group Commercial |
$0.01
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$0.01
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.01
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.00
|
| Rate for Payer: Multiplan Commercial |
$0.01
|
| Rate for Payer: Networks By Design Commercial |
$0.01
|
| Rate for Payer: Prime Health Services Commercial |
$0.01
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.01
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.01
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.01
|
| Rate for Payer: United Healthcare All Other HMO |
$0.01
|
| Rate for Payer: United Healthcare HMO Rider |
$0.01
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.01
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.01
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.01
|
| Rate for Payer: Vantage Medical Group Senior |
$0.01
|
|
|
PHOSPHATE DIALYSIS SOLN WITHOUT DEXTR K 4 MEQ-CA 2.5 MEQ-PO4 1 MMOL/L [212681]
|
Facility
IP
|
$0.01
|
|
|
Service Code
|
NDC 24571-116-05
|
| Hospital Charge Code |
NDG212681
|
|
Hospital Revenue Code
|
250
|
| Max. Negotiated Rate |
$0.01 |
| Rate for Payer: EPIC Health Plan Commercial |
$0.00
|
| Rate for Payer: Blue Shield of California Commercial |
$0.01
|
| Rate for Payer: Blue Shield of California EPN |
$0.01
|
| Rate for Payer: Galaxy Health WC |
$0.01
|
| Rate for Payer: Global Benefits Group Commercial |
$0.01
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.01
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.00
|
| Rate for Payer: Multiplan Commercial |
$0.01
|
| Rate for Payer: Networks By Design Commercial |
$0.01
|
| Rate for Payer: Prime Health Services Commercial |
$0.01
|
|
|
PHOSPHATE DIALYSIS SOLN WITHOUT DEXTR K 4 MEQ-CA 2.5 MEQ-PO4 1 MMOL/L [212681]
|
Facility
IP
|
$0.01
|
|
|
Service Code
|
NDC 24571-116-06
|
| Hospital Charge Code |
NDG212681
|
|
Hospital Revenue Code
|
250
|
| Max. Negotiated Rate |
$0.01 |
| Rate for Payer: Blue Shield of California Commercial |
$0.01
|
| Rate for Payer: Blue Shield of California EPN |
$0.01
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.00
|
| Rate for Payer: Galaxy Health WC |
$0.01
|
| Rate for Payer: Global Benefits Group Commercial |
$0.01
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.01
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.00
|
| Rate for Payer: Multiplan Commercial |
$0.01
|
| Rate for Payer: Networks By Design Commercial |
$0.01
|
| Rate for Payer: Prime Health Services Commercial |
$0.01
|
|
|
PHOSPHATE DIALYSIS SOLN WITHOUT DEXTR K 4 MEQ-CA 2.5 MEQ-PO4 1 MMOL/L [212681]
|
Facility
OP
|
$0.01
|
|
|
Service Code
|
NDC 24571-116-05
|
| Hospital Charge Code |
NDG212681
|
|
Hospital Revenue Code
|
250
|
| Max. Negotiated Rate |
$0.01 |
| Rate for Payer: Aetna of CA HMO/PPO |
$0.01
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$0.01
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$0.01
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$0.01
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.01
|
| Rate for Payer: BCBS Transplant Transplant |
$0.01
|
| Rate for Payer: Blue Shield of California Commercial |
$0.01
|
| Rate for Payer: Blue Shield of California EPN |
$0.01
|
| Rate for Payer: Cigna of CA HMO |
$0.01
|
| Rate for Payer: Cigna of CA PPO |
$0.01
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.01
|
| Rate for Payer: Dignity Health Media |
$0.01
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.01
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.00
|
| Rate for Payer: EPIC Health Plan Transplant |
$0.00
|
| Rate for Payer: Galaxy Health WC |
$0.01
|
| Rate for Payer: Global Benefits Group Commercial |
$0.01
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$0.01
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.01
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.00
|
| Rate for Payer: Multiplan Commercial |
$0.01
|
| Rate for Payer: Networks By Design Commercial |
$0.01
|
| Rate for Payer: Prime Health Services Commercial |
$0.01
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.01
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.01
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.01
|
| Rate for Payer: United Healthcare All Other HMO |
$0.01
|
| Rate for Payer: United Healthcare HMO Rider |
$0.01
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.01
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.01
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.01
|
| Rate for Payer: Vantage Medical Group Senior |
$0.01
|
|
|
PHOSPHATE DIALY SOLN W-OUT CALCIUM,DEX K 4 MEQ-MG 1.5 MEQ-PO4 1 MMOL/L [212682]
|
Facility
IP
|
$0.01
|
|
|
Service Code
|
NDC 24571-117-05
|
| Hospital Charge Code |
NDG212682
|
|
Hospital Revenue Code
|
250
|
| Max. Negotiated Rate |
$0.01 |
| Rate for Payer: Blue Shield of California Commercial |
$0.01
|
| Rate for Payer: Blue Shield of California EPN |
$0.01
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.00
|
| Rate for Payer: Galaxy Health WC |
$0.01
|
| Rate for Payer: Global Benefits Group Commercial |
$0.01
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.01
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.00
|
| Rate for Payer: Multiplan Commercial |
$0.01
|
| Rate for Payer: Networks By Design Commercial |
$0.01
|
| Rate for Payer: Prime Health Services Commercial |
$0.01
|
|
|
PHOSPHATE DIALY SOLN W-OUT CALCIUM,DEX K 4 MEQ-MG 1.5 MEQ-PO4 1 MMOL/L [212682]
|
Facility
OP
|
$0.01
|
|
|
Service Code
|
NDC 24571-117-05
|
| Hospital Charge Code |
NDG212682
|
|
Hospital Revenue Code
|
250
|
| Max. Negotiated Rate |
$0.01 |
| Rate for Payer: Aetna of CA HMO/PPO |
$0.01
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$0.01
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$0.01
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$0.01
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.01
|
| Rate for Payer: BCBS Transplant Transplant |
$0.01
|
| Rate for Payer: Blue Shield of California Commercial |
$0.01
|
| Rate for Payer: Blue Shield of California EPN |
$0.01
|
| Rate for Payer: Cigna of CA HMO |
$0.01
|
| Rate for Payer: Cigna of CA PPO |
$0.01
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.01
|
| Rate for Payer: Dignity Health Media |
$0.01
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.01
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.00
|
| Rate for Payer: EPIC Health Plan Transplant |
$0.00
|
| Rate for Payer: Galaxy Health WC |
$0.01
|
| Rate for Payer: Global Benefits Group Commercial |
$0.01
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$0.01
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.01
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.00
|
| Rate for Payer: Multiplan Commercial |
$0.01
|
| Rate for Payer: Networks By Design Commercial |
$0.01
|
| Rate for Payer: Prime Health Services Commercial |
$0.01
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.01
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.01
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.01
|
| Rate for Payer: United Healthcare All Other HMO |
$0.01
|
| Rate for Payer: United Healthcare HMO Rider |
$0.01
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.01
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.01
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.01
|
| Rate for Payer: Vantage Medical Group Senior |
$0.01
|
|
|
PHOSPHORATED CARBOHYDRATE ORAL SOLUTION [11022]
|
Facility
OP
|
$0.03
|
|
|
Service Code
|
NDC 1093939933
|
| Hospital Charge Code |
1719016
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.01 |
| Max. Negotiated Rate |
$0.03 |
| Rate for Payer: Cash Price |
$0.01
|
| Rate for Payer: Cigna of CA HMO |
$0.02
|
| Rate for Payer: Cigna of CA PPO |
$0.02
|
| Rate for Payer: Aetna of CA HMO/PPO |
$0.02
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$0.03
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$0.02
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$0.02
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.02
|
| Rate for Payer: BCBS Transplant Transplant |
$0.02
|
| Rate for Payer: Blue Shield of California Commercial |
$0.02
|
| Rate for Payer: Blue Shield of California EPN |
$0.02
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.03
|
| Rate for Payer: Dignity Health Media |
$0.03
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.03
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.01
|
| Rate for Payer: EPIC Health Plan Transplant |
$0.01
|
| Rate for Payer: Galaxy Health WC |
$0.03
|
| Rate for Payer: Global Benefits Group Commercial |
$0.02
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$0.02
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.02
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.01
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.01
|
| Rate for Payer: Multiplan Commercial |
$0.02
|
| Rate for Payer: Networks By Design Commercial |
$0.02
|
| Rate for Payer: Prime Health Services Commercial |
$0.03
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$0.02
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.02
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.02
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.02
|
| Rate for Payer: United Healthcare All Other HMO |
$0.02
|
| Rate for Payer: United Healthcare HMO Rider |
$0.02
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.02
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.03
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.03
|
| Rate for Payer: Vantage Medical Group Senior |
$0.03
|
|
|
PHOSPHORATED CARBOHYDRATE ORAL SOLUTION [11022]
|
Facility
IP
|
$0.03
|
|
|
Service Code
|
NDC 1093939933
|
| Hospital Charge Code |
1719016
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.01 |
| Max. Negotiated Rate |
$0.03 |
| Rate for Payer: Blue Shield of California Commercial |
$0.02
|
| Rate for Payer: Blue Shield of California EPN |
$0.02
|
| Rate for Payer: Cash Price |
$0.01
|
| Rate for Payer: Cigna of CA HMO |
$0.02
|
| Rate for Payer: Cigna of CA PPO |
$0.02
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.01
|
| Rate for Payer: Galaxy Health WC |
$0.03
|
| Rate for Payer: Global Benefits Group Commercial |
$0.02
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.02
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.01
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.01
|
| Rate for Payer: Multiplan Commercial |
$0.02
|
| Rate for Payer: Networks By Design Commercial |
$0.02
|
| Rate for Payer: Prime Health Services Commercial |
$0.03
|
|
|
PHYSOSTIGMINE 1 MG/ML INJECTION SOLUTION [6270]
|
Facility
OP
|
$46.97
|
|
|
Service Code
|
NDC 17478-510-02
|
| Hospital Charge Code |
1720007
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$11.27 |
| Max. Negotiated Rate |
$39.92 |
| Rate for Payer: Aetna of CA HMO/PPO |
$30.81
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$39.92
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$25.83
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$25.83
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$27.98
|
| Rate for Payer: BCBS Transplant Transplant |
$28.18
|
| Rate for Payer: Blue Shield of California Commercial |
$34.62
|
| Rate for Payer: Blue Shield of California EPN |
$27.43
|
| Rate for Payer: Cash Price |
$21.14
|
| Rate for Payer: Cash Price |
$21.14
|
| Rate for Payer: Cigna of CA HMO |
$30.06
|
| Rate for Payer: Cigna of CA PPO |
$34.76
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$39.92
|
| Rate for Payer: Dignity Health Media |
$39.92
|
| Rate for Payer: Dignity Health Medi-Cal |
$39.92
|
| Rate for Payer: EPIC Health Plan Commercial |
$18.79
|
| Rate for Payer: EPIC Health Plan Transplant |
$18.79
|
| Rate for Payer: Galaxy Health WC |
$39.92
|
| Rate for Payer: Global Benefits Group Commercial |
$28.18
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$35.23
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$31.33
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$17.90
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$11.27
|
| Rate for Payer: Multiplan Commercial |
$37.58
|
| Rate for Payer: Networks By Design Commercial |
$30.53
|
| Rate for Payer: Prime Health Services Commercial |
$39.92
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$28.18
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$28.18
|
| Rate for Payer: United Healthcare All Other Commercial |
$23.48
|
| Rate for Payer: United Healthcare All Other HMO |
$23.48
|
| Rate for Payer: United Healthcare HMO Rider |
$23.48
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$23.48
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$39.92
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$39.92
|
| Rate for Payer: Vantage Medical Group Senior |
$39.92
|
|
|
PHYSOSTIGMINE 1 MG/ML INJECTION SOLUTION [6270]
|
Facility
IP
|
$46.97
|
|
|
Service Code
|
NDC 17478-510-02
|
| Hospital Charge Code |
1720007
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$11.27 |
| Max. Negotiated Rate |
$39.92 |
| Rate for Payer: Blue Shield of California Commercial |
$33.44
|
| Rate for Payer: Blue Shield of California EPN |
$24.05
|
| Rate for Payer: Cash Price |
$21.14
|
| Rate for Payer: EPIC Health Plan Commercial |
$18.79
|
| Rate for Payer: Galaxy Health WC |
$39.92
|
| Rate for Payer: Global Benefits Group Commercial |
$28.18
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$31.33
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$17.90
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$11.27
|
| Rate for Payer: Multiplan Commercial |
$37.58
|
| Rate for Payer: Networks By Design Commercial |
$30.53
|
| Rate for Payer: Prime Health Services Commercial |
$39.92
|
|
|
PHYTONADIONE (VITAMIN K1) 10 MG/ML INJECTION SOLUTION [11023]
|
Facility
IP
|
$58.76
|
|
|
Service Code
|
CPT J3430
|
| Hospital Charge Code |
1720131
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$14.10 |
| Max. Negotiated Rate |
$49.95 |
| Rate for Payer: Multiplan Commercial |
$41.06
|
| Rate for Payer: Multiplan Commercial |
$47.01
|
| Rate for Payer: Networks By Design Commercial |
$29.38
|
| Rate for Payer: Networks By Design Commercial |
$25.66
|
| Rate for Payer: Blue Shield of California Commercial |
$41.84
|
| Rate for Payer: Blue Shield of California Commercial |
$36.54
|
| Rate for Payer: Blue Shield of California EPN |
$30.09
|
| Rate for Payer: Blue Shield of California EPN |
$26.28
|
| Rate for Payer: Cash Price |
$23.09
|
| Rate for Payer: Cash Price |
$26.44
|
| Rate for Payer: Cigna of CA HMO |
$41.13
|
| Rate for Payer: Cigna of CA HMO |
$35.92
|
| Rate for Payer: Cigna of CA PPO |
$35.92
|
| Rate for Payer: Cigna of CA PPO |
$41.13
|
| Rate for Payer: EPIC Health Plan Commercial |
$20.53
|
| Rate for Payer: EPIC Health Plan Commercial |
$23.50
|
| Rate for Payer: EPIC Health Plan Transplant |
$20.53
|
| Rate for Payer: EPIC Health Plan Transplant |
$23.50
|
| Rate for Payer: Galaxy Health WC |
$43.62
|
| Rate for Payer: Galaxy Health WC |
$49.95
|
| Rate for Payer: Global Benefits Group Commercial |
$30.79
|
| Rate for Payer: Global Benefits Group Commercial |
$35.26
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$39.19
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$34.23
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$22.39
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$19.55
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$12.32
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$14.10
|
| Rate for Payer: Prime Health Services Commercial |
$43.62
|
| Rate for Payer: Prime Health Services Commercial |
$49.95
|
|
|
PHYTONADIONE (VITAMIN K1) 10 MG/ML INJECTION SOLUTION [11023]
|
Facility
OP
|
$51.32
|
|
|
Service Code
|
CPT J3430
|
| Hospital Charge Code |
1720131
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$5.10 |
| Max. Negotiated Rate |
$43.62 |
| Rate for Payer: Aetna of CA HMO/PPO |
$18.25
|
| Rate for Payer: Aetna of CA HMO/PPO |
$18.25
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$43.62
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$49.95
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$32.32
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$28.23
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$32.32
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$28.23
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$9.26
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$9.26
|
| Rate for Payer: BCBS Transplant Transplant |
$30.79
|
| Rate for Payer: BCBS Transplant Transplant |
$35.26
|
| Rate for Payer: Blue Shield of California Commercial |
$43.31
|
| Rate for Payer: Blue Shield of California Commercial |
$37.82
|
| Rate for Payer: Blue Shield of California EPN |
$5.10
|
| Rate for Payer: Blue Shield of California EPN |
$5.10
|
| Rate for Payer: Cash Price |
$23.09
|
| Rate for Payer: Cash Price |
$23.09
|
| Rate for Payer: Cash Price |
$26.44
|
| Rate for Payer: Cash Price |
$26.44
|
| Rate for Payer: Cigna of CA HMO |
$35.92
|
| Rate for Payer: Cigna of CA HMO |
$41.13
|
| Rate for Payer: Cigna of CA PPO |
$35.92
|
| Rate for Payer: Cigna of CA PPO |
$41.13
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$43.62
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$49.95
|
| Rate for Payer: Dignity Health Media |
$43.62
|
| Rate for Payer: Dignity Health Media |
$49.95
|
| Rate for Payer: Dignity Health Medi-Cal |
$49.95
|
| Rate for Payer: Dignity Health Medi-Cal |
$43.62
|
| Rate for Payer: EPIC Health Plan Commercial |
$23.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$20.53
|
| Rate for Payer: EPIC Health Plan Transplant |
$20.53
|
| Rate for Payer: EPIC Health Plan Transplant |
$23.50
|
| Rate for Payer: Galaxy Health WC |
$49.95
|
| Rate for Payer: Galaxy Health WC |
$43.62
|
| Rate for Payer: Global Benefits Group Commercial |
$30.79
|
| Rate for Payer: Global Benefits Group Commercial |
$35.26
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$38.49
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$44.07
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$39.19
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$34.23
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$13.98
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$13.98
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$12.32
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$14.10
|
| Rate for Payer: Multiplan Commercial |
$41.06
|
| Rate for Payer: Multiplan Commercial |
$47.01
|
| Rate for Payer: Networks By Design Commercial |
$25.66
|
| Rate for Payer: Networks By Design Commercial |
$29.38
|
| Rate for Payer: Prime Health Services Commercial |
$49.95
|
| Rate for Payer: Prime Health Services Commercial |
$43.62
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$35.26
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$30.79
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$30.79
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$35.26
|
| Rate for Payer: United Healthcare All Other Commercial |
$29.38
|
| Rate for Payer: United Healthcare All Other Commercial |
$25.66
|
| Rate for Payer: United Healthcare All Other HMO |
$29.38
|
| Rate for Payer: United Healthcare All Other HMO |
$25.66
|
| Rate for Payer: United Healthcare HMO Rider |
$29.38
|
| Rate for Payer: United Healthcare HMO Rider |
$25.66
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$25.66
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$29.38
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$43.62
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$49.95
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$49.95
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$43.62
|
| Rate for Payer: Vantage Medical Group Senior |
$49.95
|
| Rate for Payer: Vantage Medical Group Senior |
$43.62
|
|
|
PHYTONADIONE (VITAMIN K1) 1 MG/0.5 ML INJECTION SOLUTION [110478]
|
Facility
IP
|
$11.39
|
|
|
Service Code
|
CPT J3430
|
| Hospital Charge Code |
NDG110478
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$2.73 |
| Max. Negotiated Rate |
$9.68 |
| Rate for Payer: Blue Shield of California Commercial |
$8.11
|
| Rate for Payer: Blue Shield of California EPN |
$5.83
|
| Rate for Payer: Cash Price |
$5.13
|
| Rate for Payer: Cigna of CA HMO |
$7.97
|
| Rate for Payer: Cigna of CA PPO |
$7.97
|
| Rate for Payer: EPIC Health Plan Commercial |
$4.56
|
| Rate for Payer: EPIC Health Plan Transplant |
$4.56
|
| Rate for Payer: Galaxy Health WC |
$9.68
|
| Rate for Payer: Global Benefits Group Commercial |
$6.83
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$7.60
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4.34
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.73
|
| Rate for Payer: Multiplan Commercial |
$9.11
|
| Rate for Payer: Networks By Design Commercial |
$5.70
|
| Rate for Payer: Prime Health Services Commercial |
$9.68
|
|
|
PHYTONADIONE (VITAMIN K1) 1 MG/0.5 ML INJECTION SOLUTION [110478]
|
Facility
OP
|
$11.39
|
|
|
Service Code
|
CPT J3430
|
| Hospital Charge Code |
NDG110478
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$2.73 |
| Max. Negotiated Rate |
$18.25 |
| Rate for Payer: Aetna of CA HMO/PPO |
$18.25
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$9.68
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$6.26
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$6.26
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$9.26
|
| Rate for Payer: BCBS Transplant Transplant |
$6.83
|
| Rate for Payer: Blue Shield of California Commercial |
$8.39
|
| Rate for Payer: Blue Shield of California EPN |
$5.10
|
| Rate for Payer: Cash Price |
$5.13
|
| Rate for Payer: Cash Price |
$5.13
|
| Rate for Payer: Cigna of CA HMO |
$7.97
|
| Rate for Payer: Cigna of CA PPO |
$7.97
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$9.68
|
| Rate for Payer: Dignity Health Media |
$9.68
|
| Rate for Payer: Dignity Health Medi-Cal |
$9.68
|
| Rate for Payer: EPIC Health Plan Commercial |
$4.56
|
| Rate for Payer: EPIC Health Plan Transplant |
$4.56
|
| Rate for Payer: Galaxy Health WC |
$9.68
|
| Rate for Payer: Global Benefits Group Commercial |
$6.83
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$8.54
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$7.60
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$13.98
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.73
|
| Rate for Payer: Multiplan Commercial |
$9.11
|
| Rate for Payer: Networks By Design Commercial |
$5.70
|
| Rate for Payer: Prime Health Services Commercial |
$9.68
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$6.83
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$6.83
|
| Rate for Payer: United Healthcare All Other Commercial |
$5.70
|
| Rate for Payer: United Healthcare All Other HMO |
$5.70
|
| Rate for Payer: United Healthcare HMO Rider |
$5.70
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$5.70
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$9.68
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$9.68
|
| Rate for Payer: Vantage Medical Group Senior |
$9.68
|
|
|
PHYTONADIONE (VITAMIN K1) 1 MG/0.5 ML INJECTION SYRINGE [6271]
|
Facility
IP
|
$59.35
|
|
|
Service Code
|
CPT J3430
|
| Hospital Charge Code |
1720082
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$14.24 |
| Max. Negotiated Rate |
$50.45 |
| Rate for Payer: Blue Shield of California Commercial |
$42.26
|
| Rate for Payer: Blue Shield of California EPN |
$30.39
|
| Rate for Payer: Cash Price |
$26.71
|
| Rate for Payer: Cigna of CA HMO |
$41.54
|
| Rate for Payer: Cigna of CA PPO |
$41.54
|
| Rate for Payer: EPIC Health Plan Commercial |
$23.74
|
| Rate for Payer: EPIC Health Plan Transplant |
$23.74
|
| Rate for Payer: Galaxy Health WC |
$50.45
|
| Rate for Payer: Global Benefits Group Commercial |
$35.61
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$39.59
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$22.61
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$14.24
|
| Rate for Payer: Multiplan Commercial |
$47.48
|
| Rate for Payer: Networks By Design Commercial |
$29.68
|
| Rate for Payer: Prime Health Services Commercial |
$50.45
|
|
