|
SELENIUM SULFIDE 2.25 % SHAMPOO [40158]
|
Facility
IP
|
$0.75
|
|
|
Service Code
|
NDC 42192-152-06
|
| Hospital Charge Code |
NDG40158
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.18 |
| Max. Negotiated Rate |
$0.64 |
| Rate for Payer: Blue Shield of California Commercial |
$0.53
|
| Rate for Payer: Blue Shield of California EPN |
$0.38
|
| Rate for Payer: Cash Price |
$0.34
|
| Rate for Payer: Cigna of CA HMO |
$0.53
|
| Rate for Payer: Cigna of CA PPO |
$0.53
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.30
|
| Rate for Payer: Galaxy Health WC |
$0.64
|
| Rate for Payer: Global Benefits Group Commercial |
$0.45
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.50
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.29
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.18
|
| Rate for Payer: Multiplan Commercial |
$0.60
|
| Rate for Payer: Networks By Design Commercial |
$0.49
|
| Rate for Payer: Prime Health Services Commercial |
$0.64
|
|
|
SELENIUM SULFIDE 2.25 % SHAMPOO [40158]
|
Facility
OP
|
$0.75
|
|
|
Service Code
|
NDC 42192-152-06
|
| Hospital Charge Code |
NDG40158
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.18 |
| Max. Negotiated Rate |
$0.64 |
| Rate for Payer: Aetna of CA HMO/PPO |
$0.49
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$0.64
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$0.41
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$0.41
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.45
|
| Rate for Payer: BCBS Transplant Transplant |
$0.45
|
| Rate for Payer: Blue Shield of California Commercial |
$0.55
|
| Rate for Payer: Blue Shield of California EPN |
$0.44
|
| Rate for Payer: Cash Price |
$0.34
|
| Rate for Payer: Cigna of CA HMO |
$0.53
|
| Rate for Payer: Cigna of CA PPO |
$0.53
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.64
|
| Rate for Payer: Dignity Health Media |
$0.64
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.64
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.30
|
| Rate for Payer: EPIC Health Plan Transplant |
$0.30
|
| Rate for Payer: Galaxy Health WC |
$0.64
|
| Rate for Payer: Global Benefits Group Commercial |
$0.45
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$0.56
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.50
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.29
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.18
|
| Rate for Payer: Multiplan Commercial |
$0.60
|
| Rate for Payer: Networks By Design Commercial |
$0.49
|
| Rate for Payer: Prime Health Services Commercial |
$0.64
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$0.45
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.45
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.45
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.38
|
| Rate for Payer: United Healthcare All Other HMO |
$0.38
|
| Rate for Payer: United Healthcare HMO Rider |
$0.38
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.38
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.64
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.64
|
| Rate for Payer: Vantage Medical Group Senior |
$0.64
|
|
|
SELEXIPAG 200 MCG TABLET [212415]
|
Facility
OP
|
$271.97
|
|
|
Service Code
|
CPT C9399
|
| Hospital Charge Code |
ERX212415
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$65.27 |
| Max. Negotiated Rate |
$231.17 |
| Rate for Payer: Networks By Design Commercial |
$176.78
|
| Rate for Payer: Aetna of CA HMO/PPO |
$178.39
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$231.17
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$149.58
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$149.58
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$162.04
|
| Rate for Payer: BCBS Transplant Transplant |
$163.18
|
| Rate for Payer: Blue Shield of California Commercial |
$200.44
|
| Rate for Payer: Blue Shield of California EPN |
$158.83
|
| Rate for Payer: Cash Price |
$122.39
|
| Rate for Payer: Cigna of CA HMO |
$190.38
|
| Rate for Payer: Cigna of CA PPO |
$190.38
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$231.17
|
| Rate for Payer: Dignity Health Media |
$231.17
|
| Rate for Payer: Dignity Health Medi-Cal |
$231.17
|
| Rate for Payer: EPIC Health Plan Commercial |
$108.79
|
| Rate for Payer: EPIC Health Plan Transplant |
$108.79
|
| Rate for Payer: Galaxy Health WC |
$231.17
|
| Rate for Payer: Global Benefits Group Commercial |
$163.18
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$203.98
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$181.40
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$103.62
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$65.27
|
| Rate for Payer: Multiplan Commercial |
$217.58
|
| Rate for Payer: Prime Health Services Commercial |
$231.17
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$163.18
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$163.18
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$163.18
|
| Rate for Payer: United Healthcare All Other Commercial |
$135.98
|
| Rate for Payer: United Healthcare All Other HMO |
$135.98
|
| Rate for Payer: United Healthcare HMO Rider |
$135.98
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$135.98
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$231.17
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$231.17
|
| Rate for Payer: Vantage Medical Group Senior |
$231.17
|
|
|
SELEXIPAG 200 MCG TABLET [212415]
|
Facility
IP
|
$271.97
|
|
|
Service Code
|
CPT C9399
|
| Hospital Charge Code |
ERX212415
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$65.27 |
| Max. Negotiated Rate |
$231.17 |
| Rate for Payer: Blue Shield of California Commercial |
$193.64
|
| Rate for Payer: Blue Shield of California EPN |
$139.25
|
| Rate for Payer: Cash Price |
$122.39
|
| Rate for Payer: Cigna of CA HMO |
$190.38
|
| Rate for Payer: Cigna of CA PPO |
$190.38
|
| Rate for Payer: EPIC Health Plan Commercial |
$108.79
|
| Rate for Payer: Galaxy Health WC |
$231.17
|
| Rate for Payer: Global Benefits Group Commercial |
$163.18
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$181.40
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$103.62
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$65.27
|
| Rate for Payer: Multiplan Commercial |
$217.58
|
| Rate for Payer: Networks By Design Commercial |
$176.78
|
| Rate for Payer: Prime Health Services Commercial |
$231.17
|
|
|
SELEXIPAG 400 MCG TABLET [212416]
|
Facility
IP
|
$422.95
|
|
|
Service Code
|
CPT C9399
|
| Hospital Charge Code |
ERX212416
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$101.51 |
| Max. Negotiated Rate |
$359.51 |
| Rate for Payer: Blue Shield of California Commercial |
$301.14
|
| Rate for Payer: Blue Shield of California EPN |
$216.55
|
| Rate for Payer: Cash Price |
$190.33
|
| Rate for Payer: Cigna of CA HMO |
$296.06
|
| Rate for Payer: Cigna of CA PPO |
$296.06
|
| Rate for Payer: EPIC Health Plan Commercial |
$169.18
|
| Rate for Payer: Galaxy Health WC |
$359.51
|
| Rate for Payer: Global Benefits Group Commercial |
$253.77
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$282.11
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$161.14
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$101.51
|
| Rate for Payer: Multiplan Commercial |
$338.36
|
| Rate for Payer: Networks By Design Commercial |
$274.92
|
| Rate for Payer: Prime Health Services Commercial |
$359.51
|
|
|
SELEXIPAG 400 MCG TABLET [212416]
|
Facility
OP
|
$422.95
|
|
|
Service Code
|
CPT C9399
|
| Hospital Charge Code |
ERX212416
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$101.51 |
| Max. Negotiated Rate |
$359.51 |
| Rate for Payer: Aetna of CA HMO/PPO |
$277.41
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$359.51
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$232.62
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$232.62
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$251.99
|
| Rate for Payer: BCBS Transplant Transplant |
$253.77
|
| Rate for Payer: Blue Shield of California Commercial |
$311.71
|
| Rate for Payer: Blue Shield of California EPN |
$247.00
|
| Rate for Payer: Cash Price |
$190.33
|
| Rate for Payer: Cigna of CA HMO |
$296.06
|
| Rate for Payer: Cigna of CA PPO |
$296.06
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$359.51
|
| Rate for Payer: Dignity Health Media |
$359.51
|
| Rate for Payer: Dignity Health Medi-Cal |
$359.51
|
| Rate for Payer: EPIC Health Plan Commercial |
$169.18
|
| Rate for Payer: EPIC Health Plan Transplant |
$169.18
|
| Rate for Payer: Galaxy Health WC |
$359.51
|
| Rate for Payer: Global Benefits Group Commercial |
$253.77
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$317.21
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$282.11
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$161.14
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$101.51
|
| Rate for Payer: Multiplan Commercial |
$338.36
|
| Rate for Payer: Networks By Design Commercial |
$274.92
|
| Rate for Payer: Prime Health Services Commercial |
$359.51
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$253.77
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$253.77
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$253.77
|
| Rate for Payer: United Healthcare All Other Commercial |
$211.48
|
| Rate for Payer: United Healthcare All Other HMO |
$211.48
|
| Rate for Payer: United Healthcare HMO Rider |
$211.48
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$211.48
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$359.51
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$359.51
|
| Rate for Payer: Vantage Medical Group Senior |
$359.51
|
|
|
SELPERCATINIB 40 MG CAPSULE [228076]
|
Facility
IP
|
$141.46
|
|
|
Service Code
|
NDC 0002-3977-60
|
| Hospital Charge Code |
ERX228076
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$33.95 |
| Max. Negotiated Rate |
$120.24 |
| Rate for Payer: Blue Shield of California Commercial |
$100.72
|
| Rate for Payer: Blue Shield of California EPN |
$72.43
|
| Rate for Payer: Cash Price |
$63.66
|
| Rate for Payer: Cigna of CA HMO |
$99.02
|
| Rate for Payer: Cigna of CA PPO |
$99.02
|
| Rate for Payer: EPIC Health Plan Commercial |
$56.58
|
| Rate for Payer: Galaxy Health WC |
$120.24
|
| Rate for Payer: Global Benefits Group Commercial |
$84.88
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$94.35
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$53.90
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$33.95
|
| Rate for Payer: Multiplan Commercial |
$113.17
|
| Rate for Payer: Networks By Design Commercial |
$91.95
|
| Rate for Payer: Prime Health Services Commercial |
$120.24
|
|
|
SELPERCATINIB 40 MG CAPSULE [228076]
|
Facility
OP
|
$141.46
|
|
|
Service Code
|
NDC 0002-3977-60
|
| Hospital Charge Code |
ERX228076
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$33.95 |
| Max. Negotiated Rate |
$120.24 |
| Rate for Payer: Aetna of CA HMO/PPO |
$92.78
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$120.24
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$77.80
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$77.80
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$84.28
|
| Rate for Payer: BCBS Transplant Transplant |
$84.88
|
| Rate for Payer: Blue Shield of California Commercial |
$104.26
|
| Rate for Payer: Blue Shield of California EPN |
$82.61
|
| Rate for Payer: Cash Price |
$63.66
|
| Rate for Payer: Cigna of CA HMO |
$99.02
|
| Rate for Payer: Cigna of CA PPO |
$99.02
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$120.24
|
| Rate for Payer: Dignity Health Media |
$120.24
|
| Rate for Payer: Dignity Health Medi-Cal |
$120.24
|
| Rate for Payer: EPIC Health Plan Commercial |
$56.58
|
| Rate for Payer: EPIC Health Plan Transplant |
$56.58
|
| Rate for Payer: Galaxy Health WC |
$120.24
|
| Rate for Payer: Global Benefits Group Commercial |
$84.88
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$106.10
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$94.35
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$53.90
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$33.95
|
| Rate for Payer: Multiplan Commercial |
$113.17
|
| Rate for Payer: Networks By Design Commercial |
$91.95
|
| Rate for Payer: Prime Health Services Commercial |
$120.24
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$84.88
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$84.88
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$84.88
|
| Rate for Payer: United Healthcare All Other Commercial |
$70.73
|
| Rate for Payer: United Healthcare All Other HMO |
$70.73
|
| Rate for Payer: United Healthcare HMO Rider |
$70.73
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$70.73
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$120.24
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$120.24
|
| Rate for Payer: Vantage Medical Group Senior |
$120.24
|
|
|
SELPERCATINIB 80 MG CAPSULE [228077]
|
Facility
IP
|
$212.18
|
|
|
Service Code
|
NDC 0002-2980-60
|
| Hospital Charge Code |
ERX228077
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$50.92 |
| Max. Negotiated Rate |
$180.35 |
| Rate for Payer: Blue Shield of California Commercial |
$151.07
|
| Rate for Payer: Blue Shield of California EPN |
$108.64
|
| Rate for Payer: Cash Price |
$95.48
|
| Rate for Payer: Cigna of CA HMO |
$148.53
|
| Rate for Payer: Cigna of CA PPO |
$148.53
|
| Rate for Payer: EPIC Health Plan Commercial |
$84.87
|
| Rate for Payer: Galaxy Health WC |
$180.35
|
| Rate for Payer: Global Benefits Group Commercial |
$127.31
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$141.52
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$80.84
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$50.92
|
| Rate for Payer: Multiplan Commercial |
$169.74
|
| Rate for Payer: Networks By Design Commercial |
$137.92
|
| Rate for Payer: Prime Health Services Commercial |
$180.35
|
|
|
SELPERCATINIB 80 MG CAPSULE [228077]
|
Facility
IP
|
$212.18
|
|
|
Service Code
|
NDC 0002-2980-26
|
| Hospital Charge Code |
ERX228077
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$50.92 |
| Max. Negotiated Rate |
$180.35 |
| Rate for Payer: Blue Shield of California Commercial |
$151.07
|
| Rate for Payer: Blue Shield of California EPN |
$108.64
|
| Rate for Payer: Cash Price |
$95.48
|
| Rate for Payer: Cigna of CA HMO |
$148.53
|
| Rate for Payer: Cigna of CA PPO |
$148.53
|
| Rate for Payer: EPIC Health Plan Commercial |
$84.87
|
| Rate for Payer: Galaxy Health WC |
$180.35
|
| Rate for Payer: Global Benefits Group Commercial |
$127.31
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$141.52
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$80.84
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$50.92
|
| Rate for Payer: Multiplan Commercial |
$169.74
|
| Rate for Payer: Networks By Design Commercial |
$137.92
|
| Rate for Payer: Prime Health Services Commercial |
$180.35
|
|
|
SELPERCATINIB 80 MG CAPSULE [228077]
|
Facility
OP
|
$212.18
|
|
|
Service Code
|
NDC 0002-2980-26
|
| Hospital Charge Code |
ERX228077
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$50.92 |
| Max. Negotiated Rate |
$180.35 |
| Rate for Payer: Aetna of CA HMO/PPO |
$139.17
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$180.35
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$116.70
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$116.70
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$126.42
|
| Rate for Payer: BCBS Transplant Transplant |
$127.31
|
| Rate for Payer: Blue Shield of California Commercial |
$156.38
|
| Rate for Payer: Blue Shield of California EPN |
$123.91
|
| Rate for Payer: Cash Price |
$95.48
|
| Rate for Payer: Cigna of CA HMO |
$148.53
|
| Rate for Payer: Cigna of CA PPO |
$148.53
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$180.35
|
| Rate for Payer: Dignity Health Media |
$180.35
|
| Rate for Payer: Dignity Health Medi-Cal |
$180.35
|
| Rate for Payer: EPIC Health Plan Commercial |
$84.87
|
| Rate for Payer: EPIC Health Plan Transplant |
$84.87
|
| Rate for Payer: Galaxy Health WC |
$180.35
|
| Rate for Payer: Global Benefits Group Commercial |
$127.31
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$159.14
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$141.52
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$80.84
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$50.92
|
| Rate for Payer: Multiplan Commercial |
$169.74
|
| Rate for Payer: Networks By Design Commercial |
$137.92
|
| Rate for Payer: Prime Health Services Commercial |
$180.35
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$127.31
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$127.31
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$127.31
|
| Rate for Payer: United Healthcare All Other Commercial |
$106.09
|
| Rate for Payer: United Healthcare All Other HMO |
$106.09
|
| Rate for Payer: United Healthcare HMO Rider |
$106.09
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$106.09
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$180.35
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$180.35
|
| Rate for Payer: Vantage Medical Group Senior |
$180.35
|
|
|
SELPERCATINIB 80 MG CAPSULE [228077]
|
Facility
OP
|
$212.18
|
|
|
Service Code
|
NDC 0002-2980-60
|
| Hospital Charge Code |
ERX228077
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$50.92 |
| Max. Negotiated Rate |
$180.35 |
| Rate for Payer: Aetna of CA HMO/PPO |
$139.17
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$180.35
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$116.70
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$116.70
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$126.42
|
| Rate for Payer: BCBS Transplant Transplant |
$127.31
|
| Rate for Payer: Blue Shield of California Commercial |
$156.38
|
| Rate for Payer: Blue Shield of California EPN |
$123.91
|
| Rate for Payer: Cash Price |
$95.48
|
| Rate for Payer: Cigna of CA HMO |
$148.53
|
| Rate for Payer: Cigna of CA PPO |
$148.53
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$180.35
|
| Rate for Payer: Dignity Health Media |
$180.35
|
| Rate for Payer: Dignity Health Medi-Cal |
$180.35
|
| Rate for Payer: EPIC Health Plan Commercial |
$84.87
|
| Rate for Payer: EPIC Health Plan Transplant |
$84.87
|
| Rate for Payer: Galaxy Health WC |
$180.35
|
| Rate for Payer: Global Benefits Group Commercial |
$127.31
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$159.14
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$141.52
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$80.84
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$50.92
|
| Rate for Payer: Multiplan Commercial |
$169.74
|
| Rate for Payer: Networks By Design Commercial |
$137.92
|
| Rate for Payer: Prime Health Services Commercial |
$180.35
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$127.31
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$127.31
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$127.31
|
| Rate for Payer: United Healthcare All Other Commercial |
$106.09
|
| Rate for Payer: United Healthcare All Other HMO |
$106.09
|
| Rate for Payer: United Healthcare HMO Rider |
$106.09
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$106.09
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$180.35
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$180.35
|
| Rate for Payer: Vantage Medical Group Senior |
$180.35
|
|
|
SENNA LEAF EXTRACT 176 MG/5 ML ORAL SYRUP [117388]
|
Facility
OP
|
$0.06
|
|
|
Service Code
|
NDC 121072208
|
| Hospital Charge Code |
NDG117388
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.01 |
| Max. Negotiated Rate |
$0.05 |
| Rate for Payer: Aetna of CA HMO/PPO |
$0.04
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$0.05
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$0.03
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$0.03
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.04
|
| Rate for Payer: BCBS Transplant Transplant |
$0.04
|
| Rate for Payer: Blue Shield of California Commercial |
$0.04
|
| Rate for Payer: Blue Shield of California EPN |
$0.04
|
| Rate for Payer: Cash Price |
$0.03
|
| Rate for Payer: Cigna of CA HMO |
$0.04
|
| Rate for Payer: Cigna of CA PPO |
$0.04
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.05
|
| Rate for Payer: Dignity Health Media |
$0.05
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.05
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.02
|
| Rate for Payer: EPIC Health Plan Transplant |
$0.02
|
| Rate for Payer: Galaxy Health WC |
$0.05
|
| Rate for Payer: Global Benefits Group Commercial |
$0.04
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$0.05
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.04
|
| 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 |
$0.05
|
| Rate for Payer: Networks By Design Commercial |
$0.04
|
| Rate for Payer: Prime Health Services Commercial |
$0.05
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$0.04
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.04
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.04
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.03
|
| Rate for Payer: United Healthcare All Other HMO |
$0.03
|
| Rate for Payer: United Healthcare HMO Rider |
$0.03
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.03
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.05
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.05
|
| Rate for Payer: Vantage Medical Group Senior |
$0.05
|
|
|
SENNA LEAF EXTRACT 176 MG/5 ML ORAL SYRUP [117388]
|
Facility
IP
|
$0.06
|
|
|
Service Code
|
NDC 121072208
|
| Hospital Charge Code |
NDG117388
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.01 |
| Max. Negotiated Rate |
$0.05 |
| Rate for Payer: Blue Shield of California Commercial |
$0.04
|
| Rate for Payer: Blue Shield of California EPN |
$0.03
|
| Rate for Payer: Cash Price |
$0.03
|
| Rate for Payer: Cigna of CA HMO |
$0.04
|
| Rate for Payer: Cigna of CA PPO |
$0.04
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.02
|
| Rate for Payer: Galaxy Health WC |
$0.05
|
| Rate for Payer: Global Benefits Group Commercial |
$0.04
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.04
|
| 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 |
$0.05
|
| Rate for Payer: Networks By Design Commercial |
$0.04
|
| Rate for Payer: Prime Health Services Commercial |
$0.05
|
|
|
SENNOSIDES 8.6 MG-DOCUSATE SODIUM 50 MG TABLET [24216]
|
Facility
IP
|
$0.17
|
|
|
Service Code
|
NDC 60687-622-11
|
| Hospital Charge Code |
1710268
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.04 |
| Max. Negotiated Rate |
$0.14 |
| Rate for Payer: Blue Shield of California Commercial |
$0.12
|
| Rate for Payer: Blue Shield of California EPN |
$0.09
|
| Rate for Payer: Cash Price |
$0.08
|
| Rate for Payer: Cigna of CA HMO |
$0.12
|
| Rate for Payer: Cigna of CA PPO |
$0.12
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.07
|
| Rate for Payer: Galaxy Health WC |
$0.14
|
| Rate for Payer: Global Benefits Group Commercial |
$0.10
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.11
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.06
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.04
|
| Rate for Payer: Multiplan Commercial |
$0.14
|
| Rate for Payer: Networks By Design Commercial |
$0.11
|
| Rate for Payer: Prime Health Services Commercial |
$0.14
|
|
|
SENNOSIDES 8.6 MG-DOCUSATE SODIUM 50 MG TABLET [24216]
|
Facility
IP
|
$0.06
|
|
|
Service Code
|
NDC 46122-669-78
|
| Hospital Charge Code |
1710268
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.01 |
| Max. Negotiated Rate |
$0.05 |
| Rate for Payer: Blue Shield of California Commercial |
$0.04
|
| Rate for Payer: Blue Shield of California EPN |
$0.03
|
| Rate for Payer: Cash Price |
$0.03
|
| Rate for Payer: Cigna of CA HMO |
$0.04
|
| Rate for Payer: Cigna of CA PPO |
$0.04
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.02
|
| Rate for Payer: Galaxy Health WC |
$0.05
|
| Rate for Payer: Global Benefits Group Commercial |
$0.04
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.04
|
| 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 |
$0.05
|
| Rate for Payer: Networks By Design Commercial |
$0.04
|
| Rate for Payer: Prime Health Services Commercial |
$0.05
|
|
|
SENNOSIDES 8.6 MG-DOCUSATE SODIUM 50 MG TABLET [24216]
|
Facility
OP
|
$0.17
|
|
|
Service Code
|
NDC 60687-622-11
|
| Hospital Charge Code |
1710268
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.04 |
| Max. Negotiated Rate |
$0.14 |
| Rate for Payer: Aetna of CA HMO/PPO |
$0.11
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$0.14
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$0.09
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$0.09
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.10
|
| Rate for Payer: BCBS Transplant Transplant |
$0.10
|
| Rate for Payer: Blue Shield of California Commercial |
$0.13
|
| Rate for Payer: Blue Shield of California EPN |
$0.10
|
| Rate for Payer: Cash Price |
$0.08
|
| Rate for Payer: Cigna of CA HMO |
$0.12
|
| Rate for Payer: Cigna of CA PPO |
$0.12
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.14
|
| Rate for Payer: Dignity Health Media |
$0.14
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.14
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.07
|
| Rate for Payer: EPIC Health Plan Transplant |
$0.07
|
| Rate for Payer: Galaxy Health WC |
$0.14
|
| Rate for Payer: Global Benefits Group Commercial |
$0.10
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$0.13
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.11
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.06
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.04
|
| Rate for Payer: Multiplan Commercial |
$0.14
|
| Rate for Payer: Networks By Design Commercial |
$0.11
|
| Rate for Payer: Prime Health Services Commercial |
$0.14
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$0.10
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.10
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.10
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.09
|
| Rate for Payer: United Healthcare All Other HMO |
$0.09
|
| Rate for Payer: United Healthcare HMO Rider |
$0.09
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.09
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.14
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.14
|
| Rate for Payer: Vantage Medical Group Senior |
$0.14
|
|
|
SENNOSIDES 8.6 MG-DOCUSATE SODIUM 50 MG TABLET [24216]
|
Facility
IP
|
$0.17
|
|
|
Service Code
|
NDC 60687-622-01
|
| Hospital Charge Code |
1710268
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.04 |
| Max. Negotiated Rate |
$0.14 |
| Rate for Payer: Blue Shield of California Commercial |
$0.12
|
| Rate for Payer: Blue Shield of California EPN |
$0.09
|
| Rate for Payer: Cash Price |
$0.08
|
| Rate for Payer: Cigna of CA HMO |
$0.12
|
| Rate for Payer: Cigna of CA PPO |
$0.12
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.07
|
| Rate for Payer: Galaxy Health WC |
$0.14
|
| Rate for Payer: Global Benefits Group Commercial |
$0.10
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.11
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.06
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.04
|
| Rate for Payer: Multiplan Commercial |
$0.14
|
| Rate for Payer: Networks By Design Commercial |
$0.11
|
| Rate for Payer: Prime Health Services Commercial |
$0.14
|
|
|
SENNOSIDES 8.6 MG-DOCUSATE SODIUM 50 MG TABLET [24216]
|
Facility
IP
|
$0.02
|
|
|
Service Code
|
NDC 69618-065-01
|
| Hospital Charge Code |
1710268
|
|
Hospital Revenue Code
|
259
|
| Max. Negotiated Rate |
$0.02 |
| Rate for Payer: Blue Shield of California Commercial |
$0.01
|
| Rate for Payer: Blue Shield of California EPN |
$0.01
|
| Rate for Payer: Cash Price |
$0.01
|
| Rate for Payer: Cigna of CA HMO |
$0.01
|
| Rate for Payer: Cigna of CA PPO |
$0.01
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.01
|
| Rate for Payer: Galaxy Health WC |
$0.02
|
| 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 |
$0.01
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.00
|
| Rate for Payer: Multiplan Commercial |
$0.02
|
| Rate for Payer: Networks By Design Commercial |
$0.01
|
| Rate for Payer: Prime Health Services Commercial |
$0.02
|
|
|
SENNOSIDES 8.6 MG-DOCUSATE SODIUM 50 MG TABLET [24216]
|
Facility
OP
|
$0.34
|
|
|
Service Code
|
NDC 67618-110-60
|
| Hospital Charge Code |
1710268
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.08 |
| Max. Negotiated Rate |
$0.29 |
| Rate for Payer: Aetna of CA HMO/PPO |
$0.22
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$0.29
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$0.19
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$0.19
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.20
|
| Rate for Payer: BCBS Transplant Transplant |
$0.20
|
| Rate for Payer: Blue Shield of California Commercial |
$0.25
|
| Rate for Payer: Blue Shield of California EPN |
$0.20
|
| Rate for Payer: Cash Price |
$0.15
|
| Rate for Payer: Cigna of CA HMO |
$0.24
|
| Rate for Payer: Cigna of CA PPO |
$0.24
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.29
|
| Rate for Payer: Dignity Health Media |
$0.29
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.29
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.14
|
| Rate for Payer: EPIC Health Plan Transplant |
$0.14
|
| Rate for Payer: Galaxy Health WC |
$0.29
|
| Rate for Payer: Global Benefits Group Commercial |
$0.20
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$0.26
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.23
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.13
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.08
|
| Rate for Payer: Multiplan Commercial |
$0.27
|
| Rate for Payer: Networks By Design Commercial |
$0.22
|
| Rate for Payer: Prime Health Services Commercial |
$0.29
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$0.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.17
|
| Rate for Payer: United Healthcare All Other HMO |
$0.17
|
| Rate for Payer: United Healthcare HMO Rider |
$0.17
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.17
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.29
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.29
|
| Rate for Payer: Vantage Medical Group Senior |
$0.29
|
|
|
SENNOSIDES 8.6 MG-DOCUSATE SODIUM 50 MG TABLET [24216]
|
Facility
IP
|
$0.03
|
|
|
Service Code
|
NDC 0536-1248-01
|
| Hospital Charge Code |
1710268
|
|
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
|
|
|
SENNOSIDES 8.6 MG-DOCUSATE SODIUM 50 MG TABLET [24216]
|
Facility
OP
|
$0.02
|
|
|
Service Code
|
NDC 69618-065-01
|
| Hospital Charge Code |
1710268
|
|
Hospital Revenue Code
|
259
|
| Max. Negotiated Rate |
$0.02 |
| Rate for Payer: Aetna of CA HMO/PPO |
$0.01
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$0.02
|
| 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: Cash Price |
$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 |
$0.02
|
| Rate for Payer: Dignity Health Media |
$0.02
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.02
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.01
|
| Rate for Payer: EPIC Health Plan Transplant |
$0.01
|
| Rate for Payer: Galaxy Health WC |
$0.02
|
| Rate for Payer: Global Benefits Group Commercial |
$0.01
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$0.02
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.01
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.01
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.00
|
| Rate for Payer: Multiplan Commercial |
$0.02
|
| Rate for Payer: Networks By Design Commercial |
$0.01
|
| Rate for Payer: Prime Health Services Commercial |
$0.02
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$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 |
$0.02
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.02
|
| Rate for Payer: Vantage Medical Group Senior |
$0.02
|
|
|
SENNOSIDES 8.6 MG-DOCUSATE SODIUM 50 MG TABLET [24216]
|
Facility
IP
|
$0.03
|
|
|
Service Code
|
NDC 57896-555-01
|
| Hospital Charge Code |
1710268
|
|
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
|
|
|
SENNOSIDES 8.6 MG-DOCUSATE SODIUM 50 MG TABLET [24216]
|
Facility
IP
|
$0.34
|
|
|
Service Code
|
NDC 67618-110-60
|
| Hospital Charge Code |
1710268
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.08 |
| Max. Negotiated Rate |
$0.29 |
| Rate for Payer: Blue Shield of California Commercial |
$0.24
|
| Rate for Payer: Blue Shield of California EPN |
$0.17
|
| Rate for Payer: Cash Price |
$0.15
|
| Rate for Payer: Cigna of CA HMO |
$0.24
|
| Rate for Payer: Cigna of CA PPO |
$0.24
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.14
|
| Rate for Payer: Galaxy Health WC |
$0.29
|
| Rate for Payer: Global Benefits Group Commercial |
$0.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.23
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.13
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.08
|
| Rate for Payer: Multiplan Commercial |
$0.27
|
| Rate for Payer: Networks By Design Commercial |
$0.22
|
| Rate for Payer: Prime Health Services Commercial |
$0.29
|
|
|
SENNOSIDES 8.6 MG-DOCUSATE SODIUM 50 MG TABLET [24216]
|
Facility
OP
|
$0.03
|
|
|
Service Code
|
NDC 0536-1248-01
|
| Hospital Charge Code |
1710268
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.01 |
| Max. Negotiated Rate |
$0.03 |
| 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: 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: 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
|
|
