|
SOTALOL ORAL SUSPENSION COMPOUND 5 MG/ML [4080338]
|
Facility
|
OP
|
$0.13
|
|
|
Service Code
|
NDC 9994-0803-38
|
| Hospital Charge Code |
1715999
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.03 |
| Max. Negotiated Rate |
$0.11 |
| Rate for Payer: Aetna of CA HMO/PPO |
$0.09
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.11
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.07
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.07
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.08
|
| Rate for Payer: Blue Distinction Transplant |
$0.08
|
| Rate for Payer: Blue Shield of California Commercial |
$0.10
|
| Rate for Payer: Blue Shield of California EPN |
$0.08
|
| Rate for Payer: Cash Price |
$0.06
|
| Rate for Payer: Cigna of CA HMO |
$0.09
|
| Rate for Payer: Cigna of CA PPO |
$0.09
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.11
|
| Rate for Payer: Dignity Health Media |
$0.11
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.11
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.05
|
| Rate for Payer: EPIC Health Plan Transplant |
$0.05
|
| Rate for Payer: Galaxy Health WC |
$0.11
|
| Rate for Payer: Global Benefits Group Commercial |
$0.08
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$0.10
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.09
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.05
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.03
|
| Rate for Payer: Multiplan Commercial |
$0.10
|
| Rate for Payer: Networks By Design Commercial |
$0.08
|
| Rate for Payer: Prime Health Services Commercial |
$0.11
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.08
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.08
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.07
|
| Rate for Payer: United Healthcare All Other HMO |
$0.07
|
| Rate for Payer: United Healthcare HMO Rider |
$0.07
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.07
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.11
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.11
|
| Rate for Payer: Vantage Medical Group Senior |
$0.11
|
|
|
SOTALOL ORAL SUSPENSION COMPOUND 5 MG/ML [4080338]
|
Facility
|
IP
|
$0.13
|
|
|
Service Code
|
NDC 9994-0803-38
|
| Hospital Charge Code |
1715999
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.03 |
| Max. Negotiated Rate |
$0.11 |
| Rate for Payer: Blue Shield of California Commercial |
$0.09
|
| Rate for Payer: Blue Shield of California EPN |
$0.07
|
| Rate for Payer: Cash Price |
$0.06
|
| Rate for Payer: Cigna of CA HMO |
$0.09
|
| Rate for Payer: Cigna of CA PPO |
$0.09
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.05
|
| Rate for Payer: Galaxy Health WC |
$0.11
|
| Rate for Payer: Global Benefits Group Commercial |
$0.08
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.09
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.05
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.03
|
| Rate for Payer: Multiplan Commercial |
$0.10
|
| Rate for Payer: Networks By Design Commercial |
$0.08
|
| Rate for Payer: Prime Health Services Commercial |
$0.11
|
|
|
SOTORASIB 120 MG TABLET [231933]
|
Facility
|
IP
|
$100.55
|
|
|
Service Code
|
NDC 55513-488-24
|
| Hospital Charge Code |
ERX231933
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$24.13 |
| Max. Negotiated Rate |
$85.47 |
| Rate for Payer: Blue Shield of California Commercial |
$71.59
|
| Rate for Payer: Blue Shield of California EPN |
$51.48
|
| Rate for Payer: Cash Price |
$45.25
|
| Rate for Payer: Cigna of CA HMO |
$70.38
|
| Rate for Payer: Cigna of CA PPO |
$70.38
|
| Rate for Payer: EPIC Health Plan Commercial |
$40.22
|
| Rate for Payer: Galaxy Health WC |
$85.47
|
| Rate for Payer: Global Benefits Group Commercial |
$60.33
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$67.07
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$38.31
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$24.13
|
| Rate for Payer: Multiplan Commercial |
$80.44
|
| Rate for Payer: Networks By Design Commercial |
$65.36
|
| Rate for Payer: Prime Health Services Commercial |
$85.47
|
|
|
SOTORASIB 120 MG TABLET [231933]
|
Facility
|
IP
|
$100.55
|
|
|
Service Code
|
NDC 55513-488-40
|
| Hospital Charge Code |
ERX231933
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$24.13 |
| Max. Negotiated Rate |
$85.47 |
| Rate for Payer: Blue Shield of California Commercial |
$71.59
|
| Rate for Payer: Blue Shield of California EPN |
$51.48
|
| Rate for Payer: Cash Price |
$45.25
|
| Rate for Payer: Cigna of CA HMO |
$70.38
|
| Rate for Payer: Cigna of CA PPO |
$70.38
|
| Rate for Payer: EPIC Health Plan Commercial |
$40.22
|
| Rate for Payer: Galaxy Health WC |
$85.47
|
| Rate for Payer: Global Benefits Group Commercial |
$60.33
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$67.07
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$38.31
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$24.13
|
| Rate for Payer: Multiplan Commercial |
$80.44
|
| Rate for Payer: Networks By Design Commercial |
$65.36
|
| Rate for Payer: Prime Health Services Commercial |
$85.47
|
|
|
SOTORASIB 120 MG TABLET [231933]
|
Facility
|
OP
|
$100.55
|
|
|
Service Code
|
NDC 55513-488-24
|
| Hospital Charge Code |
ERX231933
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$24.13 |
| Max. Negotiated Rate |
$85.47 |
| Rate for Payer: Aetna of CA HMO/PPO |
$65.95
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$85.47
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$55.30
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$55.30
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$59.91
|
| Rate for Payer: Blue Distinction Transplant |
$60.33
|
| Rate for Payer: Blue Shield of California Commercial |
$74.11
|
| Rate for Payer: Blue Shield of California EPN |
$58.72
|
| Rate for Payer: Cash Price |
$45.25
|
| Rate for Payer: Cigna of CA HMO |
$70.38
|
| Rate for Payer: Cigna of CA PPO |
$70.38
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$85.47
|
| Rate for Payer: Dignity Health Media |
$85.47
|
| Rate for Payer: Dignity Health Medi-Cal |
$85.47
|
| Rate for Payer: EPIC Health Plan Commercial |
$40.22
|
| Rate for Payer: EPIC Health Plan Transplant |
$40.22
|
| Rate for Payer: Galaxy Health WC |
$85.47
|
| Rate for Payer: Global Benefits Group Commercial |
$60.33
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$75.41
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$67.07
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$38.31
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$24.13
|
| Rate for Payer: Multiplan Commercial |
$80.44
|
| Rate for Payer: Networks By Design Commercial |
$65.36
|
| Rate for Payer: Prime Health Services Commercial |
$85.47
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$60.33
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$60.33
|
| Rate for Payer: United Healthcare All Other Commercial |
$50.28
|
| Rate for Payer: United Healthcare All Other HMO |
$50.28
|
| Rate for Payer: United Healthcare HMO Rider |
$50.28
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$50.28
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$85.47
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$85.47
|
| Rate for Payer: Vantage Medical Group Senior |
$85.47
|
|
|
SOTORASIB 120 MG TABLET [231933]
|
Facility
|
OP
|
$100.55
|
|
|
Service Code
|
NDC 55513-488-40
|
| Hospital Charge Code |
ERX231933
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$24.13 |
| Max. Negotiated Rate |
$85.47 |
| Rate for Payer: Aetna of CA HMO/PPO |
$65.95
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$85.47
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$55.30
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$55.30
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$59.91
|
| Rate for Payer: Blue Distinction Transplant |
$60.33
|
| Rate for Payer: Blue Shield of California Commercial |
$74.11
|
| Rate for Payer: Blue Shield of California EPN |
$58.72
|
| Rate for Payer: Cash Price |
$45.25
|
| Rate for Payer: Cigna of CA HMO |
$70.38
|
| Rate for Payer: Cigna of CA PPO |
$70.38
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$85.47
|
| Rate for Payer: Dignity Health Media |
$85.47
|
| Rate for Payer: Dignity Health Medi-Cal |
$85.47
|
| Rate for Payer: EPIC Health Plan Commercial |
$40.22
|
| Rate for Payer: EPIC Health Plan Transplant |
$40.22
|
| Rate for Payer: Galaxy Health WC |
$85.47
|
| Rate for Payer: Global Benefits Group Commercial |
$60.33
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$75.41
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$67.07
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$38.31
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$24.13
|
| Rate for Payer: Multiplan Commercial |
$80.44
|
| Rate for Payer: Networks By Design Commercial |
$65.36
|
| Rate for Payer: Prime Health Services Commercial |
$85.47
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$60.33
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$60.33
|
| Rate for Payer: United Healthcare All Other Commercial |
$50.28
|
| Rate for Payer: United Healthcare All Other HMO |
$50.28
|
| Rate for Payer: United Healthcare HMO Rider |
$50.28
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$50.28
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$85.47
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$85.47
|
| Rate for Payer: Vantage Medical Group Senior |
$85.47
|
|
|
SOTROVIMAB 500 MG/8 ML (62.5 MG/ML) INTRAVENOUS SOLUTION (EUA) [231935]
|
Facility
|
OP
|
$315.00
|
|
|
Service Code
|
CPT Q0247
|
| Hospital Charge Code |
NDG231935
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.07 |
| Max. Negotiated Rate |
$4,476.12 |
| Rate for Payer: Aetna of CA HMO/PPO |
$0.07
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$267.75
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$173.25
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$173.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,476.12
|
| Rate for Payer: Blue Distinction Transplant |
$189.00
|
| Rate for Payer: Blue Shield of California Commercial |
$232.16
|
| Rate for Payer: Blue Shield of California EPN |
$183.96
|
| Rate for Payer: Cash Price |
$141.75
|
| Rate for Payer: Cash Price |
$141.75
|
| Rate for Payer: Cigna of CA HMO |
$220.50
|
| Rate for Payer: Cigna of CA PPO |
$220.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$267.75
|
| Rate for Payer: Dignity Health Media |
$267.75
|
| Rate for Payer: Dignity Health Medi-Cal |
$267.75
|
| Rate for Payer: EPIC Health Plan Commercial |
$126.00
|
| Rate for Payer: EPIC Health Plan Transplant |
$126.00
|
| Rate for Payer: Galaxy Health WC |
$267.75
|
| Rate for Payer: Global Benefits Group Commercial |
$189.00
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$236.25
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$210.10
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$120.02
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$75.60
|
| Rate for Payer: Multiplan Commercial |
$252.00
|
| Rate for Payer: Networks By Design Commercial |
$157.50
|
| Rate for Payer: Prime Health Services Commercial |
$267.75
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$189.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$189.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$157.50
|
| Rate for Payer: United Healthcare All Other HMO |
$157.50
|
| Rate for Payer: United Healthcare HMO Rider |
$157.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$157.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$267.75
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$267.75
|
| Rate for Payer: Vantage Medical Group Senior |
$267.75
|
|
|
SOTROVIMAB 500 MG/8 ML (62.5 MG/ML) INTRAVENOUS SOLUTION (EUA) [231935]
|
Facility
|
IP
|
$315.00
|
|
|
Service Code
|
CPT Q0247
|
| Hospital Charge Code |
NDG231935
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$75.60 |
| Max. Negotiated Rate |
$267.75 |
| Rate for Payer: Blue Shield of California Commercial |
$224.28
|
| Rate for Payer: Blue Shield of California EPN |
$161.28
|
| Rate for Payer: Cash Price |
$141.75
|
| Rate for Payer: Cigna of CA HMO |
$220.50
|
| Rate for Payer: Cigna of CA PPO |
$220.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$126.00
|
| Rate for Payer: EPIC Health Plan Transplant |
$126.00
|
| Rate for Payer: Galaxy Health WC |
$267.75
|
| Rate for Payer: Global Benefits Group Commercial |
$189.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$210.10
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$120.02
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$75.60
|
| Rate for Payer: Multiplan Commercial |
$252.00
|
| Rate for Payer: Networks By Design Commercial |
$157.50
|
| Rate for Payer: Prime Health Services Commercial |
$267.75
|
| Rate for Payer: United Healthcare All Other Commercial |
$118.94
|
| Rate for Payer: United Healthcare All Other HMO |
$116.17
|
| Rate for Payer: United Healthcare HMO Rider |
$113.65
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$103.95
|
|
|
SPINAL DISORDERS AND INJURIES
|
Facility
|
IP
|
$19,421.15
|
|
|
Service Code
|
APR-DRG 0402
|
| Min. Negotiated Rate |
$14,898.07 |
| Max. Negotiated Rate |
$19,421.15 |
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$14,898.07
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$19,421.15
|
|
|
SPINAL DISORDERS AND INJURIES
|
Facility
|
IP
|
$13,808.16
|
|
|
Service Code
|
APR-DRG 0401
|
| Min. Negotiated Rate |
$10,592.31 |
| Max. Negotiated Rate |
$13,808.16 |
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$10,592.31
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$13,808.16
|
|
|
SPINAL DISORDERS AND INJURIES
|
Facility
|
IP
|
$43,724.66
|
|
|
Service Code
|
APR-DRG 0404
|
| Min. Negotiated Rate |
$33,541.42 |
| Max. Negotiated Rate |
$43,724.66 |
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$33,541.42
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$43,724.66
|
|
|
SPINAL DISORDERS AND INJURIES
|
Facility
|
IP
|
$26,970.78
|
|
|
Service Code
|
APR-DRG 0403
|
| Min. Negotiated Rate |
$20,689.43 |
| Max. Negotiated Rate |
$26,970.78 |
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$20,689.43
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$26,970.78
|
|
|
SPINAL FUSION AND OTHER BACK AND NECK PROCEDURES EXCEPT FOR DISC PROCEDURES
|
Facility
|
IP
|
$46,044.33
|
|
|
Service Code
|
APR-DRG 3213
|
| Min. Negotiated Rate |
$35,320.85 |
| Max. Negotiated Rate |
$46,044.33 |
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$35,320.85
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$46,044.33
|
|
|
SPINAL FUSION AND OTHER BACK AND NECK PROCEDURES EXCEPT FOR DISC PROCEDURES
|
Facility
|
IP
|
$33,449.23
|
|
|
Service Code
|
APR-DRG 3212
|
| Min. Negotiated Rate |
$25,659.08 |
| Max. Negotiated Rate |
$33,449.23 |
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$25,659.08
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$33,449.23
|
|
|
SPINAL FUSION AND OTHER BACK AND NECK PROCEDURES EXCEPT FOR DISC PROCEDURES
|
Facility
|
IP
|
$27,577.30
|
|
|
Service Code
|
APR-DRG 3211
|
| Min. Negotiated Rate |
$21,154.69 |
| Max. Negotiated Rate |
$27,577.30 |
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$21,154.69
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$27,577.30
|
|
|
SPINAL FUSION AND OTHER BACK AND NECK PROCEDURES EXCEPT FOR DISC PROCEDURES
|
Facility
|
IP
|
$71,986.52
|
|
|
Service Code
|
APR-DRG 3214
|
| Min. Negotiated Rate |
$55,221.24 |
| Max. Negotiated Rate |
$71,986.52 |
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$55,221.24
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$71,986.52
|
|
|
SPINAL PROCEDURES
|
Facility
|
IP
|
$24,707.85
|
|
|
Service Code
|
APR-DRG 0231
|
| Min. Negotiated Rate |
$18,953.52 |
| Max. Negotiated Rate |
$24,707.85 |
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$18,953.52
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$24,707.85
|
|
|
SPINAL PROCEDURES
|
Facility
|
IP
|
$92,861.91
|
|
|
Service Code
|
APR-DRG 0234
|
| Min. Negotiated Rate |
$71,234.86 |
| Max. Negotiated Rate |
$92,861.91 |
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$71,234.86
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$92,861.91
|
|
|
SPINAL PROCEDURES
|
Facility
|
IP
|
$33,873.09
|
|
|
Service Code
|
APR-DRG 0232
|
| Min. Negotiated Rate |
$25,984.22 |
| Max. Negotiated Rate |
$33,873.09 |
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$25,984.22
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$33,873.09
|
|
|
SPINAL PROCEDURES
|
Facility
|
IP
|
$57,062.85
|
|
|
Service Code
|
APR-DRG 0233
|
| Min. Negotiated Rate |
$43,773.21 |
| Max. Negotiated Rate |
$57,062.85 |
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$43,773.21
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$57,062.85
|
|
|
SPIRONOLACTONE 100 MG TABLET [11425]
|
Facility
|
OP
|
$0.64
|
|
|
Service Code
|
NDC 53746-515-01
|
| Hospital Charge Code |
1710137
|
|
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: Alpha Care Medical Group Commercial/Exchange |
$0.54
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.35
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.35
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.38
|
| Rate for Payer: Blue Distinction 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) 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: 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
|
|
|
SPIRONOLACTONE 100 MG TABLET [11425]
|
Facility
|
IP
|
$0.57
|
|
|
Service Code
|
NDC 53489-329-01
|
| Hospital Charge Code |
1710137
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.14 |
| Max. Negotiated Rate |
$0.48 |
| Rate for Payer: Blue Shield of California Commercial |
$0.41
|
| Rate for Payer: Blue Shield of California EPN |
$0.29
|
| Rate for Payer: Cash Price |
$0.26
|
| Rate for Payer: Cigna of CA HMO |
$0.40
|
| Rate for Payer: Cigna of CA PPO |
$0.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.23
|
| Rate for Payer: Galaxy Health WC |
$0.48
|
| Rate for Payer: Global Benefits Group Commercial |
$0.34
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.38
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.22
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.14
|
| Rate for Payer: Multiplan Commercial |
$0.46
|
| Rate for Payer: Networks By Design Commercial |
$0.37
|
| Rate for Payer: Prime Health Services Commercial |
$0.48
|
|
|
SPIRONOLACTONE 100 MG TABLET [11425]
|
Facility
|
IP
|
$0.47
|
|
|
Service Code
|
NDC 59746-218-01
|
| Hospital Charge Code |
1710137
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.11 |
| Max. Negotiated Rate |
$0.40 |
| Rate for Payer: Blue Shield of California Commercial |
$0.33
|
| Rate for Payer: Blue Shield of California EPN |
$0.24
|
| Rate for Payer: Cash Price |
$0.21
|
| Rate for Payer: Cigna of CA HMO |
$0.33
|
| Rate for Payer: Cigna of CA PPO |
$0.33
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.19
|
| Rate for Payer: Galaxy Health WC |
$0.40
|
| Rate for Payer: Global Benefits Group Commercial |
$0.28
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.31
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.18
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.11
|
| Rate for Payer: Multiplan Commercial |
$0.38
|
| Rate for Payer: Networks By Design Commercial |
$0.31
|
| Rate for Payer: Prime Health Services Commercial |
$0.40
|
|
|
SPIRONOLACTONE 100 MG TABLET [11425]
|
Facility
|
IP
|
$0.64
|
|
|
Service Code
|
NDC 53746-515-01
|
| Hospital Charge Code |
1710137
|
|
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
|
|
|
SPIRONOLACTONE 100 MG TABLET [11425]
|
Facility
|
OP
|
$0.57
|
|
|
Service Code
|
NDC 53489-329-01
|
| Hospital Charge Code |
1710137
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.14 |
| Max. Negotiated Rate |
$0.48 |
| Rate for Payer: Aetna of CA HMO/PPO |
$0.37
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.48
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.31
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.31
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.34
|
| Rate for Payer: Blue Distinction Transplant |
$0.34
|
| Rate for Payer: Blue Shield of California Commercial |
$0.42
|
| Rate for Payer: Blue Shield of California EPN |
$0.33
|
| Rate for Payer: Cash Price |
$0.26
|
| Rate for Payer: Cigna of CA HMO |
$0.40
|
| Rate for Payer: Cigna of CA PPO |
$0.40
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.48
|
| Rate for Payer: Dignity Health Media |
$0.48
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.48
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.23
|
| Rate for Payer: EPIC Health Plan Transplant |
$0.23
|
| Rate for Payer: Galaxy Health WC |
$0.48
|
| Rate for Payer: Global Benefits Group Commercial |
$0.34
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$0.43
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.38
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.22
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.14
|
| Rate for Payer: Multiplan Commercial |
$0.46
|
| Rate for Payer: Networks By Design Commercial |
$0.37
|
| Rate for Payer: Prime Health Services Commercial |
$0.48
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.34
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.34
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.29
|
| Rate for Payer: United Healthcare All Other HMO |
$0.29
|
| Rate for Payer: United Healthcare HMO Rider |
$0.29
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.29
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.48
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.48
|
| Rate for Payer: Vantage Medical Group Senior |
$0.48
|
|
