|
SEVELAMER CARBONATE 2.4 GRAM ORAL POWDER PACKET [99695]
|
Facility
OP
|
$11.35
|
|
|
Service Code
|
NDC 43598-479-01
|
| Hospital Charge Code |
1712470
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$2.72 |
| Max. Negotiated Rate |
$9.65 |
| Rate for Payer: Aetna of CA HMO/PPO |
$7.44
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$9.65
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$6.24
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$6.24
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$6.76
|
| Rate for Payer: BCBS Transplant Transplant |
$6.81
|
| Rate for Payer: Blue Shield of California Commercial |
$8.36
|
| Rate for Payer: Blue Shield of California EPN |
$6.63
|
| Rate for Payer: Cash Price |
$5.11
|
| Rate for Payer: Cigna of CA HMO |
$7.94
|
| Rate for Payer: Cigna of CA PPO |
$7.94
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$9.65
|
| Rate for Payer: Dignity Health Media |
$9.65
|
| Rate for Payer: Dignity Health Medi-Cal |
$9.65
|
| Rate for Payer: EPIC Health Plan Commercial |
$4.54
|
| Rate for Payer: EPIC Health Plan Transplant |
$4.54
|
| Rate for Payer: Galaxy Health WC |
$9.65
|
| Rate for Payer: Global Benefits Group Commercial |
$6.81
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$8.51
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$7.57
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4.32
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.72
|
| Rate for Payer: Multiplan Commercial |
$9.08
|
| Rate for Payer: Networks By Design Commercial |
$7.38
|
| Rate for Payer: Prime Health Services Commercial |
$9.65
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$6.81
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$6.81
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$6.81
|
| Rate for Payer: United Healthcare All Other Commercial |
$5.68
|
| Rate for Payer: United Healthcare All Other HMO |
$5.68
|
| Rate for Payer: United Healthcare HMO Rider |
$5.68
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$5.68
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$9.65
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$9.65
|
| Rate for Payer: Vantage Medical Group Senior |
$9.65
|
|
|
SEVELAMER CARBONATE 2.4 GRAM ORAL POWDER PACKET [99695]
|
Facility
IP
|
$11.35
|
|
|
Service Code
|
NDC 43598-479-01
|
| Hospital Charge Code |
1712470
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$2.72 |
| Max. Negotiated Rate |
$9.65 |
| Rate for Payer: Blue Shield of California Commercial |
$8.08
|
| Rate for Payer: Blue Shield of California EPN |
$5.81
|
| Rate for Payer: Cash Price |
$5.11
|
| Rate for Payer: Cigna of CA HMO |
$7.94
|
| Rate for Payer: Cigna of CA PPO |
$7.94
|
| Rate for Payer: EPIC Health Plan Commercial |
$4.54
|
| Rate for Payer: Galaxy Health WC |
$9.65
|
| Rate for Payer: Global Benefits Group Commercial |
$6.81
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$7.57
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4.32
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.72
|
| Rate for Payer: Multiplan Commercial |
$9.08
|
| Rate for Payer: Networks By Design Commercial |
$7.38
|
| Rate for Payer: Prime Health Services Commercial |
$9.65
|
|
|
SEVELAMER CARBONATE 2.4 GRAM ORAL POWDER PACKET [99695]
|
Facility
OP
|
$21.42
|
|
|
Service Code
|
NDC 58468-0131-2
|
| Hospital Charge Code |
1712470
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$5.14 |
| Max. Negotiated Rate |
$18.21 |
| Rate for Payer: Aetna of CA HMO/PPO |
$14.05
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$18.21
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$11.78
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$11.78
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$12.76
|
| Rate for Payer: BCBS Transplant Transplant |
$12.85
|
| Rate for Payer: Blue Shield of California Commercial |
$15.79
|
| Rate for Payer: Blue Shield of California EPN |
$12.51
|
| Rate for Payer: Cash Price |
$9.64
|
| Rate for Payer: Cigna of CA HMO |
$14.99
|
| Rate for Payer: Cigna of CA PPO |
$14.99
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$18.21
|
| Rate for Payer: Dignity Health Media |
$18.21
|
| Rate for Payer: Dignity Health Medi-Cal |
$18.21
|
| Rate for Payer: EPIC Health Plan Commercial |
$8.57
|
| Rate for Payer: EPIC Health Plan Transplant |
$8.57
|
| Rate for Payer: Galaxy Health WC |
$18.21
|
| Rate for Payer: Global Benefits Group Commercial |
$12.85
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$16.06
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$14.29
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$8.16
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5.14
|
| Rate for Payer: Multiplan Commercial |
$17.14
|
| Rate for Payer: Networks By Design Commercial |
$13.92
|
| Rate for Payer: Prime Health Services Commercial |
$18.21
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$12.85
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$12.85
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$12.85
|
| Rate for Payer: United Healthcare All Other Commercial |
$10.71
|
| Rate for Payer: United Healthcare All Other HMO |
$10.71
|
| Rate for Payer: United Healthcare HMO Rider |
$10.71
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$10.71
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$18.21
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$18.21
|
| Rate for Payer: Vantage Medical Group Senior |
$18.21
|
|
|
SEVELAMER CARBONATE 2.4 GRAM ORAL POWDER PACKET [99695]
|
Facility
OP
|
$11.35
|
|
|
Service Code
|
NDC 0955-1054-01
|
| Hospital Charge Code |
1712470
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$2.72 |
| Max. Negotiated Rate |
$9.65 |
| Rate for Payer: BCBS Transplant Transplant |
$6.81
|
| Rate for Payer: Aetna of CA HMO/PPO |
$7.44
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$9.65
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$6.24
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$6.24
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$6.76
|
| Rate for Payer: Blue Shield of California Commercial |
$8.36
|
| Rate for Payer: Blue Shield of California EPN |
$6.63
|
| Rate for Payer: Cash Price |
$5.11
|
| Rate for Payer: Cigna of CA HMO |
$7.94
|
| Rate for Payer: Cigna of CA PPO |
$7.94
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$9.65
|
| Rate for Payer: Dignity Health Media |
$9.65
|
| Rate for Payer: Dignity Health Medi-Cal |
$9.65
|
| Rate for Payer: EPIC Health Plan Commercial |
$4.54
|
| Rate for Payer: EPIC Health Plan Transplant |
$4.54
|
| Rate for Payer: Galaxy Health WC |
$9.65
|
| Rate for Payer: Global Benefits Group Commercial |
$6.81
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$8.51
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$7.57
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4.32
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.72
|
| Rate for Payer: Multiplan Commercial |
$9.08
|
| Rate for Payer: Networks By Design Commercial |
$7.38
|
| Rate for Payer: Prime Health Services Commercial |
$9.65
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$6.81
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$6.81
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$6.81
|
| Rate for Payer: United Healthcare All Other Commercial |
$5.68
|
| Rate for Payer: United Healthcare All Other HMO |
$5.68
|
| Rate for Payer: United Healthcare HMO Rider |
$5.68
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$5.68
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$9.65
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$9.65
|
| Rate for Payer: Vantage Medical Group Senior |
$9.65
|
|
|
SEVELAMER CARBONATE 2.4 GRAM ORAL POWDER PACKET [99695]
|
Facility
IP
|
$11.35
|
|
|
Service Code
|
NDC 0955-1054-01
|
| Hospital Charge Code |
1712470
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$2.72 |
| Max. Negotiated Rate |
$9.65 |
| Rate for Payer: Blue Shield of California Commercial |
$8.08
|
| Rate for Payer: Blue Shield of California EPN |
$5.81
|
| Rate for Payer: Cash Price |
$5.11
|
| Rate for Payer: Cigna of CA HMO |
$7.94
|
| Rate for Payer: Cigna of CA PPO |
$7.94
|
| Rate for Payer: EPIC Health Plan Commercial |
$4.54
|
| Rate for Payer: Galaxy Health WC |
$9.65
|
| Rate for Payer: Global Benefits Group Commercial |
$6.81
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$7.57
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4.32
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.72
|
| Rate for Payer: Multiplan Commercial |
$9.08
|
| Rate for Payer: Networks By Design Commercial |
$7.38
|
| Rate for Payer: Prime Health Services Commercial |
$9.65
|
|
|
SEVELAMER CARBONATE 2.4 GRAM ORAL POWDER PACKET [99695]
|
Facility
IP
|
$2.27
|
|
|
Service Code
|
NDC 65862-931-08
|
| Hospital Charge Code |
1712470
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.54 |
| Max. Negotiated Rate |
$1.93 |
| Rate for Payer: Blue Shield of California Commercial |
$1.62
|
| Rate for Payer: Blue Shield of California EPN |
$1.16
|
| Rate for Payer: Cash Price |
$1.02
|
| Rate for Payer: Cigna of CA HMO |
$1.59
|
| Rate for Payer: Cigna of CA PPO |
$1.59
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.91
|
| Rate for Payer: Galaxy Health WC |
$1.93
|
| Rate for Payer: Global Benefits Group Commercial |
$1.36
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1.51
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.86
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.54
|
| Rate for Payer: Multiplan Commercial |
$1.82
|
| Rate for Payer: Networks By Design Commercial |
$1.48
|
| Rate for Payer: Prime Health Services Commercial |
$1.93
|
|
|
SEVELAMER CARBONATE 2.4 GRAM ORAL POWDER PACKET [99695]
|
Facility
OP
|
$21.42
|
|
|
Service Code
|
NDC 58468-0131-1
|
| Hospital Charge Code |
1712470
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$5.14 |
| Max. Negotiated Rate |
$18.21 |
| Rate for Payer: Aetna of CA HMO/PPO |
$14.05
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$18.21
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$11.78
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$11.78
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$12.76
|
| Rate for Payer: BCBS Transplant Transplant |
$12.85
|
| Rate for Payer: Blue Shield of California Commercial |
$15.79
|
| Rate for Payer: Blue Shield of California EPN |
$12.51
|
| Rate for Payer: Cash Price |
$9.64
|
| Rate for Payer: Cigna of CA HMO |
$14.99
|
| Rate for Payer: Cigna of CA PPO |
$14.99
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$18.21
|
| Rate for Payer: Dignity Health Media |
$18.21
|
| Rate for Payer: Dignity Health Medi-Cal |
$18.21
|
| Rate for Payer: EPIC Health Plan Commercial |
$8.57
|
| Rate for Payer: EPIC Health Plan Transplant |
$8.57
|
| Rate for Payer: Galaxy Health WC |
$18.21
|
| Rate for Payer: Global Benefits Group Commercial |
$12.85
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$16.06
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$14.29
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$8.16
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5.14
|
| Rate for Payer: Multiplan Commercial |
$17.14
|
| Rate for Payer: Networks By Design Commercial |
$13.92
|
| Rate for Payer: Prime Health Services Commercial |
$18.21
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$12.85
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$12.85
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$12.85
|
| Rate for Payer: United Healthcare All Other Commercial |
$10.71
|
| Rate for Payer: United Healthcare All Other HMO |
$10.71
|
| Rate for Payer: United Healthcare HMO Rider |
$10.71
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$10.71
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$18.21
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$18.21
|
| Rate for Payer: Vantage Medical Group Senior |
$18.21
|
|
|
SEVELAMER CARBONATE 2.4 GRAM ORAL POWDER PACKET [99695]
|
Facility
IP
|
$11.35
|
|
|
Service Code
|
NDC 43598-479-90
|
| Hospital Charge Code |
1712470
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$2.72 |
| Max. Negotiated Rate |
$9.65 |
| Rate for Payer: Blue Shield of California Commercial |
$8.08
|
| Rate for Payer: Blue Shield of California EPN |
$5.81
|
| Rate for Payer: Cash Price |
$5.11
|
| Rate for Payer: Cigna of CA HMO |
$7.94
|
| Rate for Payer: Cigna of CA PPO |
$7.94
|
| Rate for Payer: EPIC Health Plan Commercial |
$4.54
|
| Rate for Payer: Galaxy Health WC |
$9.65
|
| Rate for Payer: Global Benefits Group Commercial |
$6.81
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$7.57
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4.32
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.72
|
| Rate for Payer: Multiplan Commercial |
$9.08
|
| Rate for Payer: Networks By Design Commercial |
$7.38
|
| Rate for Payer: Prime Health Services Commercial |
$9.65
|
|
|
SEVELAMER CARBONATE 800 MG TABLET [89201]
|
Facility
OP
|
$8.73
|
|
|
Service Code
|
NDC 50268-720-15
|
| Hospital Charge Code |
1712469
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$2.10 |
| Max. Negotiated Rate |
$7.42 |
| Rate for Payer: Galaxy Health WC |
$7.42
|
| Rate for Payer: Aetna of CA HMO/PPO |
$5.73
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$7.42
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$4.80
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$4.80
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5.20
|
| Rate for Payer: BCBS Transplant Transplant |
$5.24
|
| Rate for Payer: Blue Shield of California Commercial |
$6.43
|
| Rate for Payer: Blue Shield of California EPN |
$5.10
|
| Rate for Payer: Cash Price |
$3.93
|
| Rate for Payer: Cigna of CA HMO |
$6.11
|
| Rate for Payer: Cigna of CA PPO |
$6.11
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$7.42
|
| Rate for Payer: Dignity Health Media |
$7.42
|
| Rate for Payer: Dignity Health Medi-Cal |
$7.42
|
| Rate for Payer: EPIC Health Plan Commercial |
$3.49
|
| Rate for Payer: EPIC Health Plan Transplant |
$3.49
|
| Rate for Payer: Global Benefits Group Commercial |
$5.24
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$6.55
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$5.82
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3.33
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.10
|
| Rate for Payer: Multiplan Commercial |
$6.98
|
| Rate for Payer: Networks By Design Commercial |
$5.67
|
| Rate for Payer: Prime Health Services Commercial |
$7.42
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$5.24
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$5.24
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$5.24
|
| Rate for Payer: United Healthcare All Other Commercial |
$4.36
|
| Rate for Payer: United Healthcare All Other HMO |
$4.36
|
| Rate for Payer: United Healthcare HMO Rider |
$4.36
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$4.36
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$7.42
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$7.42
|
| Rate for Payer: Vantage Medical Group Senior |
$7.42
|
|
|
SEVELAMER CARBONATE 800 MG TABLET [89201]
|
Facility
IP
|
$0.47
|
|
|
Service Code
|
NDC 24979-186-46
|
| Hospital Charge Code |
1712469
|
|
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
|
|
|
SEVELAMER CARBONATE 800 MG TABLET [89201]
|
Facility
OP
|
$8.73
|
|
|
Service Code
|
NDC 50268-720-11
|
| Hospital Charge Code |
1712469
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$2.10 |
| Max. Negotiated Rate |
$7.42 |
| Rate for Payer: Aetna of CA HMO/PPO |
$5.73
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$7.42
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$4.80
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$4.80
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5.20
|
| Rate for Payer: BCBS Transplant Transplant |
$5.24
|
| Rate for Payer: Blue Shield of California Commercial |
$6.43
|
| Rate for Payer: Blue Shield of California EPN |
$5.10
|
| Rate for Payer: Cash Price |
$3.93
|
| Rate for Payer: Cigna of CA HMO |
$6.11
|
| Rate for Payer: Cigna of CA PPO |
$6.11
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$7.42
|
| Rate for Payer: Dignity Health Media |
$7.42
|
| Rate for Payer: Dignity Health Medi-Cal |
$7.42
|
| Rate for Payer: EPIC Health Plan Commercial |
$3.49
|
| Rate for Payer: EPIC Health Plan Transplant |
$3.49
|
| Rate for Payer: Galaxy Health WC |
$7.42
|
| Rate for Payer: Global Benefits Group Commercial |
$5.24
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$6.55
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$5.82
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3.33
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.10
|
| Rate for Payer: Multiplan Commercial |
$6.98
|
| Rate for Payer: Networks By Design Commercial |
$5.67
|
| Rate for Payer: Prime Health Services Commercial |
$7.42
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$5.24
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$5.24
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$5.24
|
| Rate for Payer: United Healthcare All Other Commercial |
$4.36
|
| Rate for Payer: United Healthcare All Other HMO |
$4.36
|
| Rate for Payer: United Healthcare HMO Rider |
$4.36
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$4.36
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$7.42
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$7.42
|
| Rate for Payer: Vantage Medical Group Senior |
$7.42
|
|
|
SEVELAMER CARBONATE 800 MG TABLET [89201]
|
Facility
OP
|
$0.47
|
|
|
Service Code
|
NDC 24979-186-46
|
| Hospital Charge Code |
1712469
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.11 |
| Max. Negotiated Rate |
$0.40 |
| Rate for Payer: Vantage Medical Group Senior |
$0.40
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.40
|
| Rate for Payer: Aetna of CA HMO/PPO |
$0.31
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$0.40
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$0.26
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$0.26
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.28
|
| Rate for Payer: BCBS Transplant Transplant |
$0.28
|
| Rate for Payer: Blue Shield of California Commercial |
$0.35
|
| Rate for Payer: Blue Shield of California EPN |
$0.27
|
| 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: Dignity Health Commercial/Exchange |
$0.40
|
| Rate for Payer: Dignity Health Media |
$0.40
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.19
|
| Rate for Payer: EPIC Health Plan Transplant |
$0.19
|
| Rate for Payer: Galaxy Health WC |
$0.40
|
| Rate for Payer: Global Benefits Group Commercial |
$0.28
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$0.35
|
| 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
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$0.28
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.28
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.28
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.24
|
| Rate for Payer: United Healthcare All Other HMO |
$0.24
|
| Rate for Payer: United Healthcare HMO Rider |
$0.24
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.24
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.40
|
|
|
SEVELAMER CARBONATE 800 MG TABLET [89201]
|
Facility
IP
|
$8.73
|
|
|
Service Code
|
NDC 50268-720-15
|
| Hospital Charge Code |
1712469
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$2.10 |
| Max. Negotiated Rate |
$7.42 |
| Rate for Payer: Blue Shield of California Commercial |
$6.22
|
| Rate for Payer: Blue Shield of California EPN |
$4.47
|
| Rate for Payer: Cash Price |
$3.93
|
| Rate for Payer: Cigna of CA HMO |
$6.11
|
| Rate for Payer: Cigna of CA PPO |
$6.11
|
| Rate for Payer: EPIC Health Plan Commercial |
$3.49
|
| Rate for Payer: Galaxy Health WC |
$7.42
|
| Rate for Payer: Global Benefits Group Commercial |
$5.24
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$5.82
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3.33
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.10
|
| Rate for Payer: Multiplan Commercial |
$6.98
|
| Rate for Payer: Networks By Design Commercial |
$5.67
|
| Rate for Payer: Prime Health Services Commercial |
$7.42
|
|
|
SEVELAMER CARBONATE 800 MG TABLET [89201]
|
Facility
IP
|
$2.28
|
|
|
Service Code
|
NDC 68094-034-59
|
| Hospital Charge Code |
1712469
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.55 |
| Max. Negotiated Rate |
$1.94 |
| Rate for Payer: Blue Shield of California Commercial |
$1.62
|
| Rate for Payer: Blue Shield of California EPN |
$1.17
|
| Rate for Payer: Cash Price |
$1.03
|
| Rate for Payer: Cigna of CA HMO |
$1.60
|
| Rate for Payer: Cigna of CA PPO |
$1.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.91
|
| Rate for Payer: Galaxy Health WC |
$1.94
|
| Rate for Payer: Global Benefits Group Commercial |
$1.37
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1.52
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.87
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.55
|
| Rate for Payer: Multiplan Commercial |
$1.82
|
| Rate for Payer: Networks By Design Commercial |
$1.48
|
| Rate for Payer: Prime Health Services Commercial |
$1.94
|
|
|
SEVELAMER CARBONATE 800 MG TABLET [89201]
|
Facility
OP
|
$2.28
|
|
|
Service Code
|
NDC 68094-034-64
|
| Hospital Charge Code |
1712469
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.55 |
| Max. Negotiated Rate |
$1.94 |
| Rate for Payer: Aetna of CA HMO/PPO |
$1.50
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$1.94
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$1.25
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$1.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1.36
|
| Rate for Payer: BCBS Transplant Transplant |
$1.37
|
| Rate for Payer: Blue Shield of California Commercial |
$1.68
|
| Rate for Payer: Blue Shield of California EPN |
$1.33
|
| Rate for Payer: Cash Price |
$1.03
|
| Rate for Payer: Cigna of CA HMO |
$1.60
|
| Rate for Payer: Cigna of CA PPO |
$1.60
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1.94
|
| Rate for Payer: Dignity Health Media |
$1.94
|
| Rate for Payer: Dignity Health Medi-Cal |
$1.94
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.91
|
| Rate for Payer: EPIC Health Plan Transplant |
$0.91
|
| Rate for Payer: Galaxy Health WC |
$1.94
|
| Rate for Payer: Global Benefits Group Commercial |
$1.37
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$1.71
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1.52
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.87
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.55
|
| Rate for Payer: Multiplan Commercial |
$1.82
|
| Rate for Payer: Networks By Design Commercial |
$1.48
|
| Rate for Payer: Prime Health Services Commercial |
$1.94
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$1.37
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1.37
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1.37
|
| Rate for Payer: United Healthcare All Other Commercial |
$1.14
|
| Rate for Payer: United Healthcare All Other HMO |
$1.14
|
| Rate for Payer: United Healthcare HMO Rider |
$1.14
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1.14
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1.94
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1.94
|
| Rate for Payer: Vantage Medical Group Senior |
$1.94
|
|
|
SEVELAMER CARBONATE 800 MG TABLET [89201]
|
Facility
IP
|
$2.28
|
|
|
Service Code
|
NDC 68094-034-64
|
| Hospital Charge Code |
1712469
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.55 |
| Max. Negotiated Rate |
$1.94 |
| Rate for Payer: Blue Shield of California Commercial |
$1.62
|
| Rate for Payer: Blue Shield of California EPN |
$1.17
|
| Rate for Payer: Cash Price |
$1.03
|
| Rate for Payer: Cigna of CA HMO |
$1.60
|
| Rate for Payer: Cigna of CA PPO |
$1.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.91
|
| Rate for Payer: Galaxy Health WC |
$1.94
|
| Rate for Payer: Global Benefits Group Commercial |
$1.37
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1.52
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.87
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.55
|
| Rate for Payer: Multiplan Commercial |
$1.82
|
| Rate for Payer: Networks By Design Commercial |
$1.48
|
| Rate for Payer: Prime Health Services Commercial |
$1.94
|
|
|
SEVELAMER CARBONATE 800 MG TABLET [89201]
|
Facility
OP
|
$0.47
|
|
|
Service Code
|
NDC 65162-058-27
|
| Hospital Charge Code |
1712469
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.11 |
| Max. Negotiated Rate |
$0.40 |
| Rate for Payer: Aetna of CA HMO/PPO |
$0.31
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$0.40
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$0.26
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$0.26
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.28
|
| Rate for Payer: BCBS Transplant Transplant |
$0.28
|
| Rate for Payer: Blue Shield of California Commercial |
$0.35
|
| Rate for Payer: Blue Shield of California EPN |
$0.27
|
| 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: Dignity Health Commercial/Exchange |
$0.40
|
| Rate for Payer: Dignity Health Media |
$0.40
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.19
|
| Rate for Payer: EPIC Health Plan Transplant |
$0.19
|
| Rate for Payer: Galaxy Health WC |
$0.40
|
| Rate for Payer: Global Benefits Group Commercial |
$0.28
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$0.35
|
| 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
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$0.28
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.28
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.28
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.24
|
| Rate for Payer: United Healthcare All Other HMO |
$0.24
|
| Rate for Payer: United Healthcare HMO Rider |
$0.24
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.24
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.40
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.40
|
| Rate for Payer: Vantage Medical Group Senior |
$0.40
|
|
|
SEVELAMER CARBONATE 800 MG TABLET [89201]
|
Facility
IP
|
$8.73
|
|
|
Service Code
|
NDC 50268-720-11
|
| Hospital Charge Code |
1712469
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$2.10 |
| Max. Negotiated Rate |
$7.42 |
| Rate for Payer: Blue Shield of California Commercial |
$6.22
|
| Rate for Payer: Blue Shield of California EPN |
$4.47
|
| Rate for Payer: Cash Price |
$3.93
|
| Rate for Payer: Cigna of CA HMO |
$6.11
|
| Rate for Payer: Cigna of CA PPO |
$6.11
|
| Rate for Payer: EPIC Health Plan Commercial |
$3.49
|
| Rate for Payer: Galaxy Health WC |
$7.42
|
| Rate for Payer: Global Benefits Group Commercial |
$5.24
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$5.82
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3.33
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.10
|
| Rate for Payer: Multiplan Commercial |
$6.98
|
| Rate for Payer: Networks By Design Commercial |
$5.67
|
| Rate for Payer: Prime Health Services Commercial |
$7.42
|
|
|
SEVELAMER CARBONATE 800 MG TABLET [89201]
|
Facility
IP
|
$0.47
|
|
|
Service Code
|
NDC 65162-058-27
|
| Hospital Charge Code |
1712469
|
|
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
|
|
|
SEVELAMER CARBONATE 800 MG TABLET [89201]
|
Facility
OP
|
$2.28
|
|
|
Service Code
|
NDC 68094-034-59
|
| Hospital Charge Code |
1712469
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.55 |
| Max. Negotiated Rate |
$1.94 |
| Rate for Payer: Aetna of CA HMO/PPO |
$1.50
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$1.94
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$1.25
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$1.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1.36
|
| Rate for Payer: BCBS Transplant Transplant |
$1.37
|
| Rate for Payer: Blue Shield of California Commercial |
$1.68
|
| Rate for Payer: Blue Shield of California EPN |
$1.33
|
| Rate for Payer: Cash Price |
$1.03
|
| Rate for Payer: Cigna of CA HMO |
$1.60
|
| Rate for Payer: Cigna of CA PPO |
$1.60
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1.94
|
| Rate for Payer: Dignity Health Media |
$1.94
|
| Rate for Payer: Dignity Health Medi-Cal |
$1.94
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.91
|
| Rate for Payer: EPIC Health Plan Transplant |
$0.91
|
| Rate for Payer: Galaxy Health WC |
$1.94
|
| Rate for Payer: Global Benefits Group Commercial |
$1.37
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$1.71
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1.52
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.87
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.55
|
| Rate for Payer: Multiplan Commercial |
$1.82
|
| Rate for Payer: Networks By Design Commercial |
$1.48
|
| Rate for Payer: Prime Health Services Commercial |
$1.94
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$1.37
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1.37
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1.37
|
| Rate for Payer: United Healthcare All Other Commercial |
$1.14
|
| Rate for Payer: United Healthcare All Other HMO |
$1.14
|
| Rate for Payer: United Healthcare HMO Rider |
$1.14
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1.14
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1.94
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1.94
|
| Rate for Payer: Vantage Medical Group Senior |
$1.94
|
|
|
SEVELAMER CARBONATE 800 MG TABLET [89201]
|
Facility
OP
|
$0.47
|
|
|
Service Code
|
NDC 65862-921-27
|
| Hospital Charge Code |
1712469
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.11 |
| Max. Negotiated Rate |
$0.40 |
| Rate for Payer: Aetna of CA HMO/PPO |
$0.31
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$0.40
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$0.26
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$0.26
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.28
|
| Rate for Payer: BCBS Transplant Transplant |
$0.28
|
| Rate for Payer: Blue Shield of California Commercial |
$0.35
|
| Rate for Payer: Blue Shield of California EPN |
$0.27
|
| 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: Dignity Health Commercial/Exchange |
$0.40
|
| Rate for Payer: Dignity Health Media |
$0.40
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.19
|
| Rate for Payer: EPIC Health Plan Transplant |
$0.19
|
| Rate for Payer: Galaxy Health WC |
$0.40
|
| Rate for Payer: Global Benefits Group Commercial |
$0.28
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$0.35
|
| 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
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$0.28
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.28
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.28
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.24
|
| Rate for Payer: United Healthcare All Other HMO |
$0.24
|
| Rate for Payer: United Healthcare HMO Rider |
$0.24
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.24
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.40
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.40
|
| Rate for Payer: Vantage Medical Group Senior |
$0.40
|
|
|
SEVELAMER CARBONATE 800 MG TABLET [89201]
|
Facility
IP
|
$0.47
|
|
|
Service Code
|
NDC 65862-921-27
|
| Hospital Charge Code |
1712469
|
|
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
|
|
|
SEVELAMER HCL 800 MG TABLET [28715]
|
Facility
OP
|
$8.92
|
|
|
Service Code
|
NDC 58468-0021-1
|
| Hospital Charge Code |
1712253
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$2.14 |
| Max. Negotiated Rate |
$7.58 |
| Rate for Payer: Aetna of CA HMO/PPO |
$5.85
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$7.58
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$4.91
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$4.91
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5.31
|
| Rate for Payer: BCBS Transplant Transplant |
$5.35
|
| Rate for Payer: Blue Shield of California Commercial |
$6.57
|
| Rate for Payer: Blue Shield of California EPN |
$5.21
|
| Rate for Payer: Cash Price |
$4.01
|
| Rate for Payer: Cigna of CA HMO |
$6.24
|
| Rate for Payer: Cigna of CA PPO |
$6.24
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$7.58
|
| Rate for Payer: Dignity Health Media |
$7.58
|
| Rate for Payer: Dignity Health Medi-Cal |
$7.58
|
| Rate for Payer: EPIC Health Plan Commercial |
$3.57
|
| Rate for Payer: EPIC Health Plan Transplant |
$3.57
|
| Rate for Payer: Galaxy Health WC |
$7.58
|
| Rate for Payer: Global Benefits Group Commercial |
$5.35
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$6.69
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$5.95
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3.40
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.14
|
| Rate for Payer: Multiplan Commercial |
$7.14
|
| Rate for Payer: Networks By Design Commercial |
$5.80
|
| Rate for Payer: Prime Health Services Commercial |
$7.58
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$5.35
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$5.35
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$5.35
|
| Rate for Payer: United Healthcare All Other Commercial |
$4.46
|
| Rate for Payer: United Healthcare All Other HMO |
$4.46
|
| Rate for Payer: United Healthcare HMO Rider |
$4.46
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$4.46
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$7.58
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$7.58
|
| Rate for Payer: Vantage Medical Group Senior |
$7.58
|
|
|
SEVELAMER HCL 800 MG TABLET [28715]
|
Facility
IP
|
$4.33
|
|
|
Service Code
|
NDC 68462-447-18
|
| Hospital Charge Code |
1712253
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$1.04 |
| Max. Negotiated Rate |
$3.68 |
| Rate for Payer: Blue Shield of California Commercial |
$3.08
|
| Rate for Payer: Blue Shield of California EPN |
$2.22
|
| Rate for Payer: Cash Price |
$1.95
|
| Rate for Payer: Cigna of CA HMO |
$3.03
|
| Rate for Payer: Cigna of CA PPO |
$3.03
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.73
|
| Rate for Payer: Galaxy Health WC |
$3.68
|
| Rate for Payer: Global Benefits Group Commercial |
$2.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2.89
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1.65
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.04
|
| Rate for Payer: Multiplan Commercial |
$3.46
|
| Rate for Payer: Networks By Design Commercial |
$2.81
|
| Rate for Payer: Prime Health Services Commercial |
$3.68
|
|
|
SEVELAMER HCL 800 MG TABLET [28715]
|
Facility
IP
|
$8.92
|
|
|
Service Code
|
NDC 58468-0021-1
|
| Hospital Charge Code |
1712253
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$2.14 |
| Max. Negotiated Rate |
$7.58 |
| Rate for Payer: Blue Shield of California Commercial |
$6.35
|
| Rate for Payer: Blue Shield of California EPN |
$4.57
|
| Rate for Payer: Cash Price |
$4.01
|
| Rate for Payer: Cigna of CA HMO |
$6.24
|
| Rate for Payer: Cigna of CA PPO |
$6.24
|
| Rate for Payer: EPIC Health Plan Commercial |
$3.57
|
| Rate for Payer: Galaxy Health WC |
$7.58
|
| Rate for Payer: Global Benefits Group Commercial |
$5.35
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$5.95
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3.40
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.14
|
| Rate for Payer: Multiplan Commercial |
$7.14
|
| Rate for Payer: Networks By Design Commercial |
$5.80
|
| Rate for Payer: Prime Health Services Commercial |
$7.58
|
|
