|
SODIUM IODIDE 100 MCG/ML INTRAVENOUS SOLUTION [7344]
|
Facility
OP
|
$1.20
|
|
|
Service Code
|
NDC 63323-019-10
|
| Hospital Charge Code |
NDG7344
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.29 |
| Max. Negotiated Rate |
$1.02 |
| Rate for Payer: Aetna of CA HMO/PPO |
$0.79
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$1.02
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$0.66
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$0.66
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.71
|
| Rate for Payer: BCBS Transplant Transplant |
$0.72
|
| Rate for Payer: Blue Shield of California Commercial |
$0.88
|
| Rate for Payer: Blue Shield of California EPN |
$0.70
|
| Rate for Payer: Cash Price |
$0.54
|
| Rate for Payer: Cash Price |
$0.54
|
| Rate for Payer: Cigna of CA HMO |
$0.77
|
| Rate for Payer: Cigna of CA PPO |
$0.89
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1.02
|
| Rate for Payer: Dignity Health Media |
$1.02
|
| Rate for Payer: Dignity Health Medi-Cal |
$1.02
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.48
|
| Rate for Payer: EPIC Health Plan Transplant |
$0.48
|
| Rate for Payer: Galaxy Health WC |
$1.02
|
| Rate for Payer: Global Benefits Group Commercial |
$0.72
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$0.90
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.80
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.46
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.29
|
| Rate for Payer: Multiplan Commercial |
$0.96
|
| Rate for Payer: Networks By Design Commercial |
$0.78
|
| Rate for Payer: Prime Health Services Commercial |
$1.02
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.72
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.72
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.60
|
| Rate for Payer: United Healthcare All Other HMO |
$0.60
|
| Rate for Payer: United Healthcare HMO Rider |
$0.60
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.60
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1.02
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1.02
|
| Rate for Payer: Vantage Medical Group Senior |
$1.02
|
|
|
SODIUM IODIDE-123 3.7 MBQ (100 MICROCI) CAPSULE [153922]
|
Facility
OP
|
$442.90
|
|
|
Service Code
|
CPT A9516
|
| Hospital Charge Code |
ERX153922
|
|
Hospital Revenue Code
|
343
|
| Min. Negotiated Rate |
$106.30 |
| Max. Negotiated Rate |
$376.46 |
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$376.46
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$243.60
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$243.60
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$121.59
|
| Rate for Payer: BCBS Transplant Transplant |
$265.74
|
| Rate for Payer: Blue Shield of California Commercial |
$261.75
|
| Rate for Payer: Blue Shield of California EPN |
$207.72
|
| Rate for Payer: Cash Price |
$199.31
|
| Rate for Payer: Cash Price |
$199.31
|
| Rate for Payer: Cigna of CA HMO |
$283.46
|
| Rate for Payer: Cigna of CA PPO |
$327.75
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$376.46
|
| Rate for Payer: Dignity Health Media |
$376.46
|
| Rate for Payer: Dignity Health Medi-Cal |
$376.46
|
| Rate for Payer: EPIC Health Plan Commercial |
$177.16
|
| Rate for Payer: EPIC Health Plan Transplant |
$177.16
|
| Rate for Payer: Galaxy Health WC |
$376.46
|
| Rate for Payer: Global Benefits Group Commercial |
$265.74
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$332.18
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$295.41
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$169.73
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$106.30
|
| Rate for Payer: Multiplan Commercial |
$354.32
|
| Rate for Payer: Networks By Design Commercial |
$287.88
|
| Rate for Payer: Prime Health Services Commercial |
$376.46
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$265.74
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$265.74
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$265.74
|
| Rate for Payer: United Healthcare All Other Commercial |
$221.45
|
| Rate for Payer: United Healthcare All Other HMO |
$221.45
|
| Rate for Payer: United Healthcare HMO Rider |
$221.45
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$221.45
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$376.46
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$376.46
|
| Rate for Payer: Vantage Medical Group Senior |
$376.46
|
|
|
SODIUM IODIDE-123 3.7 MBQ (100 MICROCI) CAPSULE [153922]
|
Facility
IP
|
$442.90
|
|
|
Service Code
|
CPT A9516
|
| Hospital Charge Code |
ERX153922
|
|
Hospital Revenue Code
|
343
|
| Min. Negotiated Rate |
$106.30 |
| Max. Negotiated Rate |
$376.46 |
| Rate for Payer: Blue Shield of California Commercial |
$315.34
|
| Rate for Payer: Blue Shield of California EPN |
$226.76
|
| Rate for Payer: Cash Price |
$199.31
|
| Rate for Payer: EPIC Health Plan Commercial |
$177.16
|
| Rate for Payer: Galaxy Health WC |
$376.46
|
| Rate for Payer: Global Benefits Group Commercial |
$265.74
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$295.41
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$168.74
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$106.30
|
| Rate for Payer: Multiplan Commercial |
$354.32
|
| Rate for Payer: Networks By Design Commercial |
$287.88
|
| Rate for Payer: Prime Health Services Commercial |
$376.46
|
|
|
SODIUM NITROPRUSSIDE 25 MG/ML INTRAVENOUS SOLUTION [18908]
|
Facility
OP
|
$78.00
|
|
|
Service Code
|
NDC 67457-839-02
|
| Hospital Charge Code |
1757922
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$18.72 |
| Max. Negotiated Rate |
$66.30 |
| Rate for Payer: Aetna of CA HMO/PPO |
$51.16
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$66.30
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$42.90
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$42.90
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$46.47
|
| Rate for Payer: BCBS Transplant Transplant |
$46.80
|
| Rate for Payer: Blue Shield of California Commercial |
$57.49
|
| Rate for Payer: Blue Shield of California EPN |
$45.55
|
| Rate for Payer: Cash Price |
$35.10
|
| Rate for Payer: Cash Price |
$35.10
|
| Rate for Payer: Cigna of CA HMO |
$49.92
|
| Rate for Payer: Cigna of CA PPO |
$57.72
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$66.30
|
| Rate for Payer: Dignity Health Media |
$66.30
|
| Rate for Payer: Dignity Health Medi-Cal |
$66.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$31.20
|
| Rate for Payer: EPIC Health Plan Transplant |
$31.20
|
| Rate for Payer: Galaxy Health WC |
$66.30
|
| Rate for Payer: Global Benefits Group Commercial |
$46.80
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$58.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$52.03
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$29.72
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$18.72
|
| Rate for Payer: Multiplan Commercial |
$62.40
|
| Rate for Payer: Networks By Design Commercial |
$50.70
|
| Rate for Payer: Prime Health Services Commercial |
$66.30
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$46.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$46.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$39.00
|
| Rate for Payer: United Healthcare All Other HMO |
$39.00
|
| Rate for Payer: United Healthcare HMO Rider |
$39.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$39.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$66.30
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$66.30
|
| Rate for Payer: Vantage Medical Group Senior |
$66.30
|
|
|
SODIUM NITROPRUSSIDE 25 MG/ML INTRAVENOUS SOLUTION [18908]
|
Facility
IP
|
$78.00
|
|
|
Service Code
|
NDC 67457-839-02
|
| Hospital Charge Code |
1757922
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$18.72 |
| Max. Negotiated Rate |
$66.30 |
| Rate for Payer: Blue Shield of California Commercial |
$55.54
|
| Rate for Payer: Blue Shield of California EPN |
$39.94
|
| Rate for Payer: Cash Price |
$35.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$31.20
|
| Rate for Payer: Galaxy Health WC |
$66.30
|
| Rate for Payer: Global Benefits Group Commercial |
$46.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$52.03
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$29.72
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$18.72
|
| Rate for Payer: Multiplan Commercial |
$62.40
|
| Rate for Payer: Networks By Design Commercial |
$50.70
|
| Rate for Payer: Prime Health Services Commercial |
$66.30
|
|
|
SODIUM NITROPRUSSIDE 25 MG/ML INTRAVENOUS SOLUTION [18908]
|
Facility
OP
|
$12.00
|
|
|
Service Code
|
NDC 70069-261-01
|
| Hospital Charge Code |
1757922
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$2.88 |
| Max. Negotiated Rate |
$10.20 |
| Rate for Payer: Aetna of CA HMO/PPO |
$7.87
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$10.20
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$6.60
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$6.60
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$7.15
|
| Rate for Payer: BCBS Transplant Transplant |
$7.20
|
| Rate for Payer: Blue Shield of California Commercial |
$8.84
|
| Rate for Payer: Blue Shield of California EPN |
$7.01
|
| Rate for Payer: Cash Price |
$5.40
|
| Rate for Payer: Cash Price |
$5.40
|
| Rate for Payer: Cigna of CA HMO |
$7.68
|
| Rate for Payer: Cigna of CA PPO |
$8.88
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$10.20
|
| Rate for Payer: Dignity Health Media |
$10.20
|
| Rate for Payer: Dignity Health Medi-Cal |
$10.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$4.80
|
| Rate for Payer: EPIC Health Plan Transplant |
$4.80
|
| Rate for Payer: Galaxy Health WC |
$10.20
|
| Rate for Payer: Global Benefits Group Commercial |
$7.20
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$9.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$8.00
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4.57
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.88
|
| Rate for Payer: Multiplan Commercial |
$9.60
|
| Rate for Payer: Networks By Design Commercial |
$7.80
|
| Rate for Payer: Prime Health Services Commercial |
$10.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$7.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$7.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$6.00
|
| Rate for Payer: United Healthcare All Other HMO |
$6.00
|
| Rate for Payer: United Healthcare HMO Rider |
$6.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$6.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$10.20
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$10.20
|
| Rate for Payer: Vantage Medical Group Senior |
$10.20
|
|
|
SODIUM NITROPRUSSIDE 25 MG/ML INTRAVENOUS SOLUTION [18908]
|
Facility
IP
|
$12.00
|
|
|
Service Code
|
NDC 70069-261-01
|
| Hospital Charge Code |
1757922
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$2.88 |
| Max. Negotiated Rate |
$10.20 |
| Rate for Payer: Blue Shield of California Commercial |
$8.54
|
| Rate for Payer: Blue Shield of California EPN |
$6.14
|
| Rate for Payer: Cash Price |
$5.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$4.80
|
| Rate for Payer: Galaxy Health WC |
$10.20
|
| Rate for Payer: Global Benefits Group Commercial |
$7.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$8.00
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4.57
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.88
|
| Rate for Payer: Multiplan Commercial |
$9.60
|
| Rate for Payer: Networks By Design Commercial |
$7.80
|
| Rate for Payer: Prime Health Services Commercial |
$10.20
|
|
|
SODIUM PHENYLBUTYRATE 0.94 GRAM/GRAM ORAL POWDER [17601]
|
Facility
OP
|
$20.30
|
|
|
Service Code
|
NDC 42794-086-14
|
| Hospital Charge Code |
ERX17601A
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$4.87 |
| Max. Negotiated Rate |
$17.26 |
| Rate for Payer: Aetna of CA HMO/PPO |
$13.31
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$17.26
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$11.16
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$11.16
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$12.09
|
| Rate for Payer: BCBS Transplant Transplant |
$12.18
|
| Rate for Payer: Blue Shield of California Commercial |
$14.96
|
| Rate for Payer: Blue Shield of California EPN |
$11.86
|
| Rate for Payer: Cash Price |
$9.14
|
| Rate for Payer: Cigna of CA HMO |
$14.21
|
| Rate for Payer: Cigna of CA PPO |
$14.21
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$17.26
|
| Rate for Payer: Dignity Health Media |
$17.26
|
| Rate for Payer: Dignity Health Medi-Cal |
$17.26
|
| Rate for Payer: EPIC Health Plan Commercial |
$8.12
|
| Rate for Payer: EPIC Health Plan Transplant |
$8.12
|
| Rate for Payer: Galaxy Health WC |
$17.26
|
| Rate for Payer: Global Benefits Group Commercial |
$12.18
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$15.22
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$13.54
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$7.73
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.87
|
| Rate for Payer: Multiplan Commercial |
$16.24
|
| Rate for Payer: Networks By Design Commercial |
$13.20
|
| Rate for Payer: Prime Health Services Commercial |
$17.26
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$12.18
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$12.18
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$12.18
|
| Rate for Payer: United Healthcare All Other Commercial |
$10.15
|
| Rate for Payer: United Healthcare All Other HMO |
$10.15
|
| Rate for Payer: United Healthcare HMO Rider |
$10.15
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$10.15
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$17.26
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$17.26
|
| Rate for Payer: Vantage Medical Group Senior |
$17.26
|
|
|
SODIUM PHENYLBUTYRATE 0.94 GRAM/GRAM ORAL POWDER [17601]
|
Facility
OP
|
$61.48
|
|
|
Service Code
|
NDC 75987-070-09
|
| Hospital Charge Code |
ERX17601A
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$14.76 |
| Max. Negotiated Rate |
$52.26 |
| Rate for Payer: Aetna of CA HMO/PPO |
$40.32
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$52.26
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$33.81
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$33.81
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$36.63
|
| Rate for Payer: BCBS Transplant Transplant |
$36.89
|
| Rate for Payer: Blue Shield of California Commercial |
$45.31
|
| Rate for Payer: Blue Shield of California EPN |
$35.90
|
| Rate for Payer: Cash Price |
$27.67
|
| Rate for Payer: Cigna of CA HMO |
$43.04
|
| Rate for Payer: Cigna of CA PPO |
$43.04
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$52.26
|
| Rate for Payer: Dignity Health Media |
$52.26
|
| Rate for Payer: Dignity Health Medi-Cal |
$52.26
|
| Rate for Payer: EPIC Health Plan Commercial |
$24.59
|
| Rate for Payer: EPIC Health Plan Transplant |
$24.59
|
| Rate for Payer: Galaxy Health WC |
$52.26
|
| Rate for Payer: Global Benefits Group Commercial |
$36.89
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$46.11
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$41.01
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$23.42
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$14.76
|
| Rate for Payer: Multiplan Commercial |
$49.18
|
| Rate for Payer: Networks By Design Commercial |
$39.96
|
| Rate for Payer: Prime Health Services Commercial |
$52.26
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$36.89
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$36.89
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$36.89
|
| Rate for Payer: United Healthcare All Other Commercial |
$30.74
|
| Rate for Payer: United Healthcare All Other HMO |
$30.74
|
| Rate for Payer: United Healthcare HMO Rider |
$30.74
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$30.74
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$52.26
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$52.26
|
| Rate for Payer: Vantage Medical Group Senior |
$52.26
|
|
|
SODIUM PHENYLBUTYRATE 0.94 GRAM/GRAM ORAL POWDER [17601]
|
Facility
IP
|
$61.48
|
|
|
Service Code
|
NDC 75987-070-09
|
| Hospital Charge Code |
ERX17601A
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$14.76 |
| Max. Negotiated Rate |
$52.26 |
| Rate for Payer: Blue Shield of California Commercial |
$43.77
|
| Rate for Payer: Blue Shield of California EPN |
$31.48
|
| Rate for Payer: Cash Price |
$27.67
|
| Rate for Payer: Cigna of CA HMO |
$43.04
|
| Rate for Payer: Cigna of CA PPO |
$43.04
|
| Rate for Payer: EPIC Health Plan Commercial |
$24.59
|
| Rate for Payer: Galaxy Health WC |
$52.26
|
| Rate for Payer: Global Benefits Group Commercial |
$36.89
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$41.01
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$23.42
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$14.76
|
| Rate for Payer: Multiplan Commercial |
$49.18
|
| Rate for Payer: Networks By Design Commercial |
$39.96
|
| Rate for Payer: Prime Health Services Commercial |
$52.26
|
|
|
SODIUM PHENYLBUTYRATE 0.94 GRAM/GRAM ORAL POWDER [17601]
|
Facility
IP
|
$20.30
|
|
|
Service Code
|
NDC 42794-086-14
|
| Hospital Charge Code |
ERX17601A
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$4.87 |
| Max. Negotiated Rate |
$17.26 |
| Rate for Payer: Blue Shield of California Commercial |
$14.45
|
| Rate for Payer: Blue Shield of California EPN |
$10.39
|
| Rate for Payer: Cash Price |
$9.14
|
| Rate for Payer: Cigna of CA HMO |
$14.21
|
| Rate for Payer: Cigna of CA PPO |
$14.21
|
| Rate for Payer: EPIC Health Plan Commercial |
$8.12
|
| Rate for Payer: Galaxy Health WC |
$17.26
|
| Rate for Payer: Global Benefits Group Commercial |
$12.18
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$13.54
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$7.73
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.87
|
| Rate for Payer: Multiplan Commercial |
$16.24
|
| Rate for Payer: Networks By Design Commercial |
$13.20
|
| Rate for Payer: Prime Health Services Commercial |
$17.26
|
|
|
SODIUM PHENYLBUTYRATE (BULK) 100 % POWDER [77481]
|
Facility
IP
|
$56.63
|
|
|
Service Code
|
NDC 38779-3207-8
|
| Hospital Charge Code |
NDG77481A
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$13.59 |
| Max. Negotiated Rate |
$48.14 |
| Rate for Payer: Blue Shield of California Commercial |
$40.32
|
| Rate for Payer: Blue Shield of California EPN |
$28.99
|
| Rate for Payer: Cash Price |
$25.48
|
| Rate for Payer: Cigna of CA HMO |
$39.64
|
| Rate for Payer: Cigna of CA PPO |
$39.64
|
| Rate for Payer: EPIC Health Plan Commercial |
$22.65
|
| Rate for Payer: Galaxy Health WC |
$48.14
|
| Rate for Payer: Global Benefits Group Commercial |
$33.98
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$37.77
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$21.58
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$13.59
|
| Rate for Payer: Multiplan Commercial |
$45.30
|
| Rate for Payer: Networks By Design Commercial |
$36.81
|
| Rate for Payer: Prime Health Services Commercial |
$48.14
|
|
|
SODIUM PHENYLBUTYRATE (BULK) 100 % POWDER [77481]
|
Facility
OP
|
$56.63
|
|
|
Service Code
|
NDC 38779-3207-8
|
| Hospital Charge Code |
NDG77481A
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$13.59 |
| Max. Negotiated Rate |
$48.14 |
| Rate for Payer: Aetna of CA HMO/PPO |
$37.14
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$48.14
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$31.15
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$31.15
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$33.74
|
| Rate for Payer: BCBS Transplant Transplant |
$33.98
|
| Rate for Payer: Blue Shield of California Commercial |
$41.74
|
| Rate for Payer: Blue Shield of California EPN |
$33.07
|
| Rate for Payer: Cash Price |
$25.48
|
| Rate for Payer: Cigna of CA HMO |
$39.64
|
| Rate for Payer: Cigna of CA PPO |
$39.64
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$48.14
|
| Rate for Payer: Dignity Health Media |
$48.14
|
| Rate for Payer: Dignity Health Medi-Cal |
$48.14
|
| Rate for Payer: EPIC Health Plan Commercial |
$22.65
|
| Rate for Payer: EPIC Health Plan Transplant |
$22.65
|
| Rate for Payer: Galaxy Health WC |
$48.14
|
| Rate for Payer: Global Benefits Group Commercial |
$33.98
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$42.47
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$37.77
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$21.58
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$13.59
|
| Rate for Payer: Multiplan Commercial |
$45.30
|
| Rate for Payer: Networks By Design Commercial |
$36.81
|
| Rate for Payer: Prime Health Services Commercial |
$48.14
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$33.98
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$33.98
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$33.98
|
| Rate for Payer: United Healthcare All Other Commercial |
$28.32
|
| Rate for Payer: United Healthcare All Other HMO |
$28.32
|
| Rate for Payer: United Healthcare HMO Rider |
$28.32
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$28.32
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$48.14
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$48.14
|
| Rate for Payer: Vantage Medical Group Senior |
$48.14
|
|
|
SODIUM PHENYLBUTYRATE ORAL SUSPENSION COMPOUND 200 MG/ML [4080337]
|
Facility
IP
|
$0.04
|
|
|
Service Code
|
NDC 9994-0803-37
|
| Hospital Charge Code |
NDG4080337
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.01 |
| Max. Negotiated Rate |
$0.03 |
| Rate for Payer: Blue Shield of California Commercial |
$0.03
|
| Rate for Payer: Blue Shield of California EPN |
$0.02
|
| Rate for Payer: Cash Price |
$0.02
|
| Rate for Payer: Cigna of CA HMO |
$0.03
|
| Rate for Payer: Cigna of CA PPO |
$0.03
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.02
|
| Rate for Payer: Galaxy Health WC |
$0.03
|
| Rate for Payer: Global Benefits Group Commercial |
$0.02
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.03
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.02
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.01
|
| Rate for Payer: Multiplan Commercial |
$0.03
|
| Rate for Payer: Networks By Design Commercial |
$0.03
|
| Rate for Payer: Prime Health Services Commercial |
$0.03
|
|
|
SODIUM PHENYLBUTYRATE ORAL SUSPENSION COMPOUND 200 MG/ML [4080337]
|
Facility
OP
|
$0.04
|
|
|
Service Code
|
NDC 9994-0803-37
|
| Hospital Charge Code |
NDG4080337
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.01 |
| Max. Negotiated Rate |
$0.03 |
| Rate for Payer: Aetna of CA HMO/PPO |
$0.03
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$0.03
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$0.02
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$0.02
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.02
|
| Rate for Payer: BCBS Transplant Transplant |
$0.02
|
| Rate for Payer: Blue Shield of California Commercial |
$0.03
|
| Rate for Payer: Blue Shield of California EPN |
$0.02
|
| Rate for Payer: Cash Price |
$0.02
|
| Rate for Payer: Cigna of CA HMO |
$0.03
|
| Rate for Payer: Cigna of CA PPO |
$0.03
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.03
|
| Rate for Payer: Dignity Health Media |
$0.03
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.03
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.02
|
| Rate for Payer: EPIC Health Plan Transplant |
$0.02
|
| Rate for Payer: Galaxy Health WC |
$0.03
|
| Rate for Payer: Global Benefits Group Commercial |
$0.02
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$0.03
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.03
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.02
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.01
|
| Rate for Payer: Multiplan Commercial |
$0.03
|
| Rate for Payer: Networks By Design Commercial |
$0.03
|
| Rate for Payer: Prime Health Services Commercial |
$0.03
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$0.02
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.02
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.02
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.02
|
| Rate for Payer: United Healthcare All Other HMO |
$0.02
|
| Rate for Payer: United Healthcare HMO Rider |
$0.02
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.02
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.03
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.03
|
| Rate for Payer: Vantage Medical Group Senior |
$0.03
|
|
|
SODIUM PHOSPHATE ORAL SOLUTION (IV FORM) 3 MMOL/ML [4080445]
|
Facility
IP
|
$0.07
|
|
|
Service Code
|
NDC 9994-0804-45
|
| Hospital Charge Code |
1715308
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.02 |
| Max. Negotiated Rate |
$0.06 |
| Rate for Payer: Blue Shield of California Commercial |
$0.05
|
| Rate for Payer: Blue Shield of California EPN |
$0.04
|
| Rate for Payer: Cash Price |
$0.03
|
| Rate for Payer: Cigna of CA HMO |
$0.05
|
| Rate for Payer: Cigna of CA PPO |
$0.05
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.03
|
| Rate for Payer: Galaxy Health WC |
$0.06
|
| Rate for Payer: Global Benefits Group Commercial |
$0.04
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.05
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.03
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.02
|
| Rate for Payer: Multiplan Commercial |
$0.06
|
| Rate for Payer: Networks By Design Commercial |
$0.05
|
| Rate for Payer: Prime Health Services Commercial |
$0.06
|
|
|
SODIUM PHOSPHATE ORAL SOLUTION (IV FORM) 3 MMOL/ML [4080445]
|
Facility
OP
|
$0.07
|
|
|
Service Code
|
NDC 9994-0804-45
|
| Hospital Charge Code |
1715308
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.02 |
| Max. Negotiated Rate |
$0.06 |
| Rate for Payer: Aetna of CA HMO/PPO |
$0.05
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$0.06
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$0.04
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$0.04
|
| 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 |
$0.05
|
| Rate for Payer: Blue Shield of California EPN |
$0.04
|
| Rate for Payer: Cash Price |
$0.03
|
| Rate for Payer: Cigna of CA HMO |
$0.05
|
| Rate for Payer: Cigna of CA PPO |
$0.05
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.06
|
| Rate for Payer: Dignity Health Media |
$0.06
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.06
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.03
|
| Rate for Payer: EPIC Health Plan Transplant |
$0.03
|
| Rate for Payer: Galaxy Health WC |
$0.06
|
| 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 |
$0.05
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.03
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.02
|
| Rate for Payer: Multiplan Commercial |
$0.06
|
| Rate for Payer: Networks By Design Commercial |
$0.05
|
| Rate for Payer: Prime Health Services Commercial |
$0.06
|
| 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 |
$0.04
|
| Rate for Payer: United Healthcare All Other HMO |
$0.04
|
| Rate for Payer: United Healthcare HMO Rider |
$0.04
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.04
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.06
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.06
|
| Rate for Payer: Vantage Medical Group Senior |
$0.06
|
|
|
SODIUM PHOSPHATES 19 GRAM-7 GRAM/118 ML ENEMA [11395]
|
Facility
OP
|
$0.01
|
|
|
Service Code
|
NDC 0536-7415-51
|
| Hospital Charge Code |
1748014
|
|
Hospital Revenue Code
|
259
|
| Max. Negotiated Rate |
$0.01 |
| Rate for Payer: Aetna of CA HMO/PPO |
$0.01
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$0.01
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$0.01
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$0.01
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.01
|
| Rate for Payer: BCBS Transplant Transplant |
$0.01
|
| Rate for Payer: Blue Shield of California Commercial |
$0.01
|
| Rate for Payer: Blue Shield of California EPN |
$0.01
|
| Rate for Payer: Cigna of CA HMO |
$0.01
|
| Rate for Payer: Cigna of CA PPO |
$0.01
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.01
|
| Rate for Payer: Dignity Health Media |
$0.01
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.01
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.00
|
| Rate for Payer: EPIC Health Plan Transplant |
$0.00
|
| Rate for Payer: Galaxy Health WC |
$0.01
|
| Rate for Payer: Global Benefits Group Commercial |
$0.01
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$0.01
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.01
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.00
|
| Rate for Payer: Multiplan Commercial |
$0.01
|
| Rate for Payer: Networks By Design Commercial |
$0.01
|
| Rate for Payer: Prime Health Services Commercial |
$0.01
|
| Rate for Payer: 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 |
$0.01
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.01
|
| Rate for Payer: Vantage Medical Group Senior |
$0.01
|
|
|
SODIUM PHOSPHATES 19 GRAM-7 GRAM/118 ML ENEMA [11395]
|
Facility
OP
|
$0.01
|
|
|
Service Code
|
NDC 0132-0201-40
|
| Hospital Charge Code |
1748014
|
|
Hospital Revenue Code
|
259
|
| Max. Negotiated Rate |
$0.01 |
| Rate for Payer: Aetna of CA HMO/PPO |
$0.01
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$0.01
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$0.01
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$0.01
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.01
|
| Rate for Payer: BCBS Transplant Transplant |
$0.01
|
| Rate for Payer: Blue Shield of California Commercial |
$0.01
|
| Rate for Payer: Blue Shield of California EPN |
$0.01
|
| Rate for Payer: Cigna of CA HMO |
$0.01
|
| Rate for Payer: Cigna of CA PPO |
$0.01
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.01
|
| Rate for Payer: Dignity Health Media |
$0.01
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.01
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.00
|
| Rate for Payer: EPIC Health Plan Transplant |
$0.00
|
| Rate for Payer: Galaxy Health WC |
$0.01
|
| Rate for Payer: Global Benefits Group Commercial |
$0.01
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$0.01
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.01
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.00
|
| Rate for Payer: Multiplan Commercial |
$0.01
|
| Rate for Payer: Networks By Design Commercial |
$0.01
|
| Rate for Payer: Prime Health Services Commercial |
$0.01
|
| Rate for Payer: 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 |
$0.01
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.01
|
| Rate for Payer: Vantage Medical Group Senior |
$0.01
|
|
|
SODIUM PHOSPHATES 19 GRAM-7 GRAM/118 ML ENEMA [11395]
|
Facility
IP
|
$0.01
|
|
|
Service Code
|
NDC 0536-7415-51
|
| Hospital Charge Code |
1748014
|
|
Hospital Revenue Code
|
259
|
| Max. Negotiated Rate |
$0.01 |
| Rate for Payer: Blue Shield of California Commercial |
$0.01
|
| Rate for Payer: Blue Shield of California EPN |
$0.01
|
| Rate for Payer: Cigna of CA HMO |
$0.01
|
| Rate for Payer: Cigna of CA PPO |
$0.01
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.00
|
| Rate for Payer: Galaxy Health WC |
$0.01
|
| Rate for Payer: Global Benefits Group Commercial |
$0.01
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.01
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.00
|
| Rate for Payer: Multiplan Commercial |
$0.01
|
| Rate for Payer: Networks By Design Commercial |
$0.01
|
| Rate for Payer: Prime Health Services Commercial |
$0.01
|
|
|
SODIUM PHOSPHATES 19 GRAM-7 GRAM/118 ML ENEMA [11395]
|
Facility
IP
|
$0.01
|
|
|
Service Code
|
NDC 0132-0201-40
|
| Hospital Charge Code |
1748014
|
|
Hospital Revenue Code
|
259
|
| Max. Negotiated Rate |
$0.01 |
| Rate for Payer: Galaxy Health WC |
$0.01
|
| Rate for Payer: Blue Shield of California Commercial |
$0.01
|
| Rate for Payer: Blue Shield of California EPN |
$0.01
|
| Rate for Payer: Cigna of CA HMO |
$0.01
|
| Rate for Payer: Cigna of CA PPO |
$0.01
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.00
|
| Rate for Payer: Global Benefits Group Commercial |
$0.01
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.01
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.00
|
| Rate for Payer: Multiplan Commercial |
$0.01
|
| Rate for Payer: Networks By Design Commercial |
$0.01
|
| Rate for Payer: Prime Health Services Commercial |
$0.01
|
|
|
SODIUM PHOSPHATES 9.5 GRAM-3.5 GRAM/59 ML ENEMA [118601]
|
Facility
OP
|
$0.02
|
|
|
Service Code
|
NDC 0132-0202-20
|
| Hospital Charge Code |
1748004
|
|
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
|
|
|
SODIUM PHOSPHATES 9.5 GRAM-3.5 GRAM/59 ML ENEMA [118601]
|
Facility
IP
|
$0.02
|
|
|
Service Code
|
NDC 0132-0202-20
|
| Hospital Charge Code |
1748004
|
|
Hospital Revenue Code
|
259
|
| Max. Negotiated Rate |
$0.02 |
| Rate for Payer: Multiplan Commercial |
$0.02
|
| Rate for Payer: Networks By Design Commercial |
$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: 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: Prime Health Services Commercial |
$0.02
|
|
|
SODIUM POLYSTERENE SULFONATE 15 GRAM/60 ML ORAL SUSP WRAP [40827999]
|
Facility
OP
|
$0.50
|
|
|
Service Code
|
NDC 46287-006-01
|
| Hospital Charge Code |
1715036
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.12 |
| Max. Negotiated Rate |
$0.43 |
| Rate for Payer: Aetna of CA HMO/PPO |
$0.33
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$0.43
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$0.28
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$0.28
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.30
|
| Rate for Payer: BCBS Transplant Transplant |
$0.30
|
| Rate for Payer: Blue Shield of California Commercial |
$0.37
|
| Rate for Payer: Blue Shield of California EPN |
$0.29
|
| Rate for Payer: Cash Price |
$0.23
|
| Rate for Payer: Cigna of CA HMO |
$0.35
|
| Rate for Payer: Cigna of CA PPO |
$0.35
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.43
|
| Rate for Payer: Dignity Health Media |
$0.43
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.43
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.20
|
| Rate for Payer: EPIC Health Plan Transplant |
$0.20
|
| Rate for Payer: Galaxy Health WC |
$0.43
|
| Rate for Payer: Global Benefits Group Commercial |
$0.30
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$0.38
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.33
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.19
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.12
|
| Rate for Payer: Multiplan Commercial |
$0.40
|
| Rate for Payer: Networks By Design Commercial |
$0.33
|
| Rate for Payer: Prime Health Services Commercial |
$0.43
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$0.30
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.30
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.30
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.25
|
| Rate for Payer: United Healthcare All Other HMO |
$0.25
|
| Rate for Payer: United Healthcare HMO Rider |
$0.25
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.25
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.43
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.43
|
| Rate for Payer: Vantage Medical Group Senior |
$0.43
|
|
|
SODIUM POLYSTERENE SULFONATE 15 GRAM/60 ML ORAL SUSP WRAP [40827999]
|
Facility
IP
|
$0.49
|
|
|
Service Code
|
NDC 46287-006-60
|
| Hospital Charge Code |
1719164
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.12 |
| Max. Negotiated Rate |
$0.42 |
| Rate for Payer: Blue Shield of California Commercial |
$0.35
|
| Rate for Payer: Blue Shield of California EPN |
$0.25
|
| Rate for Payer: Cash Price |
$0.22
|
| Rate for Payer: Cigna of CA HMO |
$0.34
|
| Rate for Payer: Cigna of CA PPO |
$0.34
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.20
|
| Rate for Payer: Galaxy Health WC |
$0.42
|
| Rate for Payer: Global Benefits Group Commercial |
$0.29
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.33
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.19
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.12
|
| Rate for Payer: Multiplan Commercial |
$0.39
|
| Rate for Payer: Networks By Design Commercial |
$0.32
|
| Rate for Payer: Prime Health Services Commercial |
$0.42
|
|
