|
SODIUM POLYSTERENE SULFONATE 15 GRAM/60 ML ORAL SUSP WRAP [40827999]
|
Facility
IP
|
$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: Blue Shield of California Commercial |
$0.36
|
| Rate for Payer: Blue Shield of California EPN |
$0.26
|
| 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: EPIC Health Plan Commercial |
$0.20
|
| Rate for Payer: Galaxy Health WC |
$0.43
|
| Rate for Payer: Global Benefits Group Commercial |
$0.30
|
| 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
|
|
|
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
|
|
|
SODIUM POLYSTYRENE SULFONATE ORAL POWDER [7356]
|
Facility
OP
|
$0.35
|
|
|
Service Code
|
NDC 42806-013-96
|
| Hospital Charge Code |
1713002
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.08 |
| Max. Negotiated Rate |
$0.30 |
| Rate for Payer: Aetna of CA HMO/PPO |
$0.23
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$0.30
|
| 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 |
$0.21
|
| Rate for Payer: BCBS Transplant Transplant |
$0.21
|
| Rate for Payer: Blue Shield of California Commercial |
$0.26
|
| Rate for Payer: Blue Shield of California EPN |
$0.20
|
| Rate for Payer: Cash Price |
$0.16
|
| Rate for Payer: Cigna of CA HMO |
$0.25
|
| Rate for Payer: Cigna of CA PPO |
$0.25
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.30
|
| Rate for Payer: Dignity Health Media |
$0.30
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.14
|
| Rate for Payer: EPIC Health Plan Transplant |
$0.14
|
| Rate for Payer: Galaxy Health WC |
$0.30
|
| Rate for Payer: Global Benefits Group Commercial |
$0.21
|
| 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 |
$0.28
|
| Rate for Payer: Networks By Design Commercial |
$0.23
|
| Rate for Payer: Prime Health Services Commercial |
$0.30
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$0.21
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.21
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.21
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.18
|
| Rate for Payer: United Healthcare All Other HMO |
$0.18
|
| Rate for Payer: United Healthcare HMO Rider |
$0.18
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.18
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.30
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.30
|
| Rate for Payer: Vantage Medical Group Senior |
$0.30
|
|
|
SODIUM POLYSTYRENE SULFONATE ORAL POWDER [7356]
|
Facility
OP
|
$0.18
|
|
|
Service Code
|
NDC 9999-9973-56
|
| Hospital Charge Code |
NDG7356
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.04 |
| Max. Negotiated Rate |
$0.15 |
| Rate for Payer: Aetna of CA HMO/PPO |
$0.12
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$0.15
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$0.10
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$0.10
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.11
|
| Rate for Payer: BCBS Transplant Transplant |
$0.11
|
| Rate for Payer: Blue Shield of California Commercial |
$0.13
|
| Rate for Payer: Blue Shield of California EPN |
$0.11
|
| Rate for Payer: Cash Price |
$0.08
|
| Rate for Payer: Cigna of CA HMO |
$0.13
|
| Rate for Payer: Cigna of CA PPO |
$0.13
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.15
|
| Rate for Payer: Dignity Health Media |
$0.15
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.15
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.07
|
| Rate for Payer: EPIC Health Plan Transplant |
$0.07
|
| Rate for Payer: Galaxy Health WC |
$0.15
|
| Rate for Payer: Global Benefits Group Commercial |
$0.11
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$0.14
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.12
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.07
|
| 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 |
$0.12
|
| Rate for Payer: Prime Health Services Commercial |
$0.15
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$0.11
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.11
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.11
|
| 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 |
$0.15
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.15
|
| Rate for Payer: Vantage Medical Group Senior |
$0.15
|
|
|
SODIUM POLYSTYRENE SULFONATE ORAL POWDER [7356]
|
Facility
IP
|
$0.18
|
|
|
Service Code
|
NDC 9999-9973-56
|
| Hospital Charge Code |
NDG7356
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.04 |
| Max. Negotiated Rate |
$0.15 |
| Rate for Payer: Blue Shield of California Commercial |
$0.13
|
| Rate for Payer: Blue Shield of California EPN |
$0.09
|
| Rate for Payer: Cash Price |
$0.08
|
| Rate for Payer: Cigna of CA HMO |
$0.13
|
| Rate for Payer: Cigna of CA PPO |
$0.13
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.07
|
| Rate for Payer: Galaxy Health WC |
$0.15
|
| Rate for Payer: Global Benefits Group Commercial |
$0.11
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.12
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.07
|
| 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 |
$0.12
|
| Rate for Payer: Prime Health Services Commercial |
$0.15
|
|
|
SODIUM POLYSTYRENE SULFONATE ORAL POWDER [7356]
|
Facility
OP
|
$0.18
|
|
|
Service Code
|
NDC 9994-0821-06
|
| Hospital Charge Code |
NDG7356
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.04 |
| Max. Negotiated Rate |
$0.15 |
| Rate for Payer: Aetna of CA HMO/PPO |
$0.12
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$0.15
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$0.10
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$0.10
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.11
|
| Rate for Payer: BCBS Transplant Transplant |
$0.11
|
| Rate for Payer: Blue Shield of California Commercial |
$0.13
|
| Rate for Payer: Blue Shield of California EPN |
$0.11
|
| Rate for Payer: Cash Price |
$0.08
|
| Rate for Payer: Cigna of CA HMO |
$0.13
|
| Rate for Payer: Cigna of CA PPO |
$0.13
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.15
|
| Rate for Payer: Dignity Health Media |
$0.15
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.15
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.07
|
| Rate for Payer: EPIC Health Plan Transplant |
$0.07
|
| Rate for Payer: Galaxy Health WC |
$0.15
|
| Rate for Payer: Global Benefits Group Commercial |
$0.11
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$0.14
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.12
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.07
|
| 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 |
$0.12
|
| Rate for Payer: Prime Health Services Commercial |
$0.15
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$0.11
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.11
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.11
|
| 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 |
$0.15
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.15
|
| Rate for Payer: Vantage Medical Group Senior |
$0.15
|
|
|
SODIUM POLYSTYRENE SULFONATE ORAL POWDER [7356]
|
Facility
OP
|
$0.27
|
|
|
Service Code
|
NDC 51293-831-97
|
| Hospital Charge Code |
NDG7356A
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.06 |
| Max. Negotiated Rate |
$0.23 |
| Rate for Payer: Aetna of CA HMO/PPO |
$0.18
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$0.23
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$0.15
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$0.15
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.16
|
| Rate for Payer: BCBS Transplant Transplant |
$0.16
|
| Rate for Payer: Blue Shield of California Commercial |
$0.20
|
| Rate for Payer: Blue Shield of California EPN |
$0.16
|
| Rate for Payer: Cash Price |
$0.12
|
| Rate for Payer: Cigna of CA HMO |
$0.19
|
| Rate for Payer: Cigna of CA PPO |
$0.19
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.23
|
| Rate for Payer: Dignity Health Media |
$0.23
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.23
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.11
|
| Rate for Payer: EPIC Health Plan Transplant |
$0.11
|
| Rate for Payer: Galaxy Health WC |
$0.23
|
| Rate for Payer: Global Benefits Group Commercial |
$0.16
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$0.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.18
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.10
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.06
|
| Rate for Payer: Multiplan Commercial |
$0.22
|
| Rate for Payer: Networks By Design Commercial |
$0.18
|
| Rate for Payer: Prime Health Services Commercial |
$0.23
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$0.16
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.16
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.16
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.14
|
| Rate for Payer: United Healthcare All Other HMO |
$0.14
|
| Rate for Payer: United Healthcare HMO Rider |
$0.14
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.14
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.23
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.23
|
| Rate for Payer: Vantage Medical Group Senior |
$0.23
|
|
|
SODIUM POLYSTYRENE SULFONATE ORAL POWDER [7356]
|
Facility
OP
|
$0.35
|
|
|
Service Code
|
NDC 11534-166-44
|
| Hospital Charge Code |
1713002
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.08 |
| Max. Negotiated Rate |
$0.30 |
| Rate for Payer: Aetna of CA HMO/PPO |
$0.23
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$0.30
|
| 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 |
$0.21
|
| Rate for Payer: BCBS Transplant Transplant |
$0.21
|
| Rate for Payer: Blue Shield of California Commercial |
$0.26
|
| Rate for Payer: Blue Shield of California EPN |
$0.20
|
| Rate for Payer: Cash Price |
$0.16
|
| Rate for Payer: Cigna of CA HMO |
$0.25
|
| Rate for Payer: Cigna of CA PPO |
$0.25
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.30
|
| Rate for Payer: Dignity Health Media |
$0.30
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.14
|
| Rate for Payer: EPIC Health Plan Transplant |
$0.14
|
| Rate for Payer: Galaxy Health WC |
$0.30
|
| Rate for Payer: Global Benefits Group Commercial |
$0.21
|
| 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 |
$0.28
|
| Rate for Payer: Networks By Design Commercial |
$0.23
|
| Rate for Payer: Prime Health Services Commercial |
$0.30
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$0.21
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.21
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.21
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.18
|
| Rate for Payer: United Healthcare All Other HMO |
$0.18
|
| Rate for Payer: United Healthcare HMO Rider |
$0.18
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.18
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.30
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.30
|
| Rate for Payer: Vantage Medical Group Senior |
$0.30
|
|
|
SODIUM POLYSTYRENE SULFONATE ORAL POWDER [7356]
|
Facility
IP
|
$0.35
|
|
|
Service Code
|
NDC 42806-013-96
|
| Hospital Charge Code |
1713002
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.08 |
| Max. Negotiated Rate |
$0.30 |
| Rate for Payer: EPIC Health Plan Commercial |
$0.14
|
| Rate for Payer: Galaxy Health WC |
$0.30
|
| Rate for Payer: Blue Shield of California Commercial |
$0.25
|
| Rate for Payer: Blue Shield of California EPN |
$0.18
|
| Rate for Payer: Cash Price |
$0.16
|
| Rate for Payer: Cigna of CA HMO |
$0.25
|
| Rate for Payer: Cigna of CA PPO |
$0.25
|
| Rate for Payer: Global Benefits Group Commercial |
$0.21
|
| 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 |
$0.28
|
| Rate for Payer: Networks By Design Commercial |
$0.23
|
| Rate for Payer: Prime Health Services Commercial |
$0.30
|
|
|
SODIUM POLYSTYRENE SULFONATE ORAL POWDER [7356]
|
Facility
IP
|
$0.18
|
|
|
Service Code
|
NDC 9994-0821-06
|
| Hospital Charge Code |
NDG7356
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.04 |
| Max. Negotiated Rate |
$0.15 |
| Rate for Payer: Blue Shield of California Commercial |
$0.13
|
| Rate for Payer: Blue Shield of California EPN |
$0.09
|
| Rate for Payer: Cash Price |
$0.08
|
| Rate for Payer: Cigna of CA HMO |
$0.13
|
| Rate for Payer: Cigna of CA PPO |
$0.13
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.07
|
| Rate for Payer: Galaxy Health WC |
$0.15
|
| Rate for Payer: Global Benefits Group Commercial |
$0.11
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.12
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.07
|
| 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 |
$0.12
|
| Rate for Payer: Prime Health Services Commercial |
$0.15
|
|
|
SODIUM POLYSTYRENE SULFONATE ORAL POWDER [7356]
|
Facility
IP
|
$0.35
|
|
|
Service Code
|
NDC 11534-166-44
|
| Hospital Charge Code |
1713002
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.08 |
| Max. Negotiated Rate |
$0.30 |
| Rate for Payer: Blue Shield of California Commercial |
$0.25
|
| Rate for Payer: Blue Shield of California EPN |
$0.18
|
| Rate for Payer: Cash Price |
$0.16
|
| Rate for Payer: Cigna of CA HMO |
$0.25
|
| Rate for Payer: Cigna of CA PPO |
$0.25
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.14
|
| Rate for Payer: Galaxy Health WC |
$0.30
|
| Rate for Payer: Global Benefits Group Commercial |
$0.21
|
| 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 |
$0.28
|
| Rate for Payer: Networks By Design Commercial |
$0.23
|
| Rate for Payer: Prime Health Services Commercial |
$0.30
|
|
|
SODIUM POLYSTYRENE SULFONATE ORAL POWDER [7356]
|
Facility
IP
|
$0.27
|
|
|
Service Code
|
NDC 51293-831-97
|
| Hospital Charge Code |
NDG7356A
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.06 |
| Max. Negotiated Rate |
$0.23 |
| Rate for Payer: Blue Shield of California Commercial |
$0.19
|
| Rate for Payer: Blue Shield of California EPN |
$0.14
|
| Rate for Payer: Cash Price |
$0.12
|
| Rate for Payer: Cigna of CA HMO |
$0.19
|
| Rate for Payer: Cigna of CA PPO |
$0.19
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.11
|
| Rate for Payer: Galaxy Health WC |
$0.23
|
| Rate for Payer: Global Benefits Group Commercial |
$0.16
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.18
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.10
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.06
|
| Rate for Payer: Multiplan Commercial |
$0.22
|
| Rate for Payer: Networks By Design Commercial |
$0.18
|
| Rate for Payer: Prime Health Services Commercial |
$0.23
|
|
|
SODIUM TETRADECYL SULFATE 1 % (10 MG/ML) INTRAVENOUS SOLUTION [41787]
|
Facility
IP
|
$46.88
|
|
|
Service Code
|
CPT J3490
|
| Hospital Charge Code |
1720348
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$11.25 |
| Max. Negotiated Rate |
$39.85 |
| Rate for Payer: Blue Shield of California Commercial |
$33.38
|
| Rate for Payer: Blue Shield of California EPN |
$24.00
|
| Rate for Payer: Cash Price |
$21.10
|
| Rate for Payer: Cigna of CA HMO |
$32.82
|
| Rate for Payer: Cigna of CA PPO |
$32.82
|
| Rate for Payer: EPIC Health Plan Commercial |
$18.75
|
| Rate for Payer: EPIC Health Plan Transplant |
$18.75
|
| Rate for Payer: Galaxy Health WC |
$39.85
|
| Rate for Payer: Global Benefits Group Commercial |
$28.13
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$31.27
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$17.86
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$11.25
|
| Rate for Payer: Multiplan Commercial |
$37.50
|
| Rate for Payer: Networks By Design Commercial |
$23.44
|
| Rate for Payer: Prime Health Services Commercial |
$39.85
|
|
|
SODIUM TETRADECYL SULFATE 1 % (10 MG/ML) INTRAVENOUS SOLUTION [41787]
|
Facility
OP
|
$46.88
|
|
|
Service Code
|
CPT J3490
|
| Hospital Charge Code |
1720348
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$11.25 |
| Max. Negotiated Rate |
$39.85 |
| Rate for Payer: Aetna of CA HMO/PPO |
$30.75
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$39.85
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$25.78
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$25.78
|
| Rate for Payer: BCBS Transplant Transplant |
$28.13
|
| Rate for Payer: Blue Shield of California Commercial |
$34.55
|
| Rate for Payer: Blue Shield of California EPN |
$27.38
|
| Rate for Payer: Cash Price |
$21.10
|
| Rate for Payer: Cash Price |
$21.10
|
| Rate for Payer: Cigna of CA HMO |
$32.82
|
| Rate for Payer: Cigna of CA PPO |
$32.82
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$39.85
|
| Rate for Payer: Dignity Health Media |
$39.85
|
| Rate for Payer: Dignity Health Medi-Cal |
$39.85
|
| Rate for Payer: EPIC Health Plan Commercial |
$18.75
|
| Rate for Payer: EPIC Health Plan Transplant |
$18.75
|
| Rate for Payer: Galaxy Health WC |
$39.85
|
| Rate for Payer: Global Benefits Group Commercial |
$28.13
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$35.16
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$31.27
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$11.25
|
| Rate for Payer: Multiplan Commercial |
$37.50
|
| Rate for Payer: Networks By Design Commercial |
$23.44
|
| Rate for Payer: Prime Health Services Commercial |
$39.85
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$28.13
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$28.13
|
| Rate for Payer: United Healthcare All Other Commercial |
$23.44
|
| Rate for Payer: United Healthcare All Other HMO |
$23.44
|
| Rate for Payer: United Healthcare HMO Rider |
$23.44
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$23.44
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$39.85
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$39.85
|
| Rate for Payer: Vantage Medical Group Senior |
$39.85
|
|
|
SODIUM TETRADECYL SULFATE 3 % (30 MG/ML) INTRAVENOUS SOLUTION [41793]
|
Facility
IP
|
$46.88
|
|
|
Service Code
|
NDC 67457-163-02
|
| Hospital Charge Code |
1720349
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$11.25 |
| Max. Negotiated Rate |
$39.85 |
| Rate for Payer: Blue Shield of California Commercial |
$33.38
|
| Rate for Payer: Blue Shield of California EPN |
$24.00
|
| Rate for Payer: Cash Price |
$21.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$18.75
|
| Rate for Payer: Galaxy Health WC |
$39.85
|
| Rate for Payer: Global Benefits Group Commercial |
$28.13
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$31.27
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$17.86
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$11.25
|
| Rate for Payer: Multiplan Commercial |
$37.50
|
| Rate for Payer: Networks By Design Commercial |
$30.47
|
| Rate for Payer: Prime Health Services Commercial |
$39.85
|
|
|
SODIUM TETRADECYL SULFATE 3 % (30 MG/ML) INTRAVENOUS SOLUTION [41793]
|
Facility
OP
|
$46.88
|
|
|
Service Code
|
NDC 67457-163-02
|
| Hospital Charge Code |
1720349
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$11.25 |
| Max. Negotiated Rate |
$39.85 |
| Rate for Payer: Aetna of CA HMO/PPO |
$30.75
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$39.85
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$25.78
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$25.78
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$27.93
|
| Rate for Payer: BCBS Transplant Transplant |
$28.13
|
| Rate for Payer: Blue Shield of California Commercial |
$34.55
|
| Rate for Payer: Blue Shield of California EPN |
$27.38
|
| Rate for Payer: Cash Price |
$21.10
|
| Rate for Payer: Cash Price |
$21.10
|
| Rate for Payer: Cigna of CA HMO |
$30.00
|
| Rate for Payer: Cigna of CA PPO |
$34.69
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$39.85
|
| Rate for Payer: Dignity Health Media |
$39.85
|
| Rate for Payer: Dignity Health Medi-Cal |
$39.85
|
| Rate for Payer: EPIC Health Plan Commercial |
$18.75
|
| Rate for Payer: EPIC Health Plan Transplant |
$18.75
|
| Rate for Payer: Galaxy Health WC |
$39.85
|
| Rate for Payer: Global Benefits Group Commercial |
$28.13
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$35.16
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$31.27
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$17.86
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$11.25
|
| Rate for Payer: Multiplan Commercial |
$37.50
|
| Rate for Payer: Networks By Design Commercial |
$30.47
|
| Rate for Payer: Prime Health Services Commercial |
$39.85
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$28.13
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$28.13
|
| Rate for Payer: United Healthcare All Other Commercial |
$23.44
|
| Rate for Payer: United Healthcare All Other HMO |
$23.44
|
| Rate for Payer: United Healthcare HMO Rider |
$23.44
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$23.44
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$39.85
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$39.85
|
| Rate for Payer: Vantage Medical Group Senior |
$39.85
|
|
|
SODIUM TETRADECYL SULFATE 3 % (30 MG/ML) INTRAVENOUS SOLUTION [41793]
|
Facility
IP
|
$46.20
|
|
|
Service Code
|
NDC 24201-201-05
|
| Hospital Charge Code |
1720349
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$11.09 |
| Max. Negotiated Rate |
$39.27 |
| Rate for Payer: Blue Shield of California Commercial |
$32.89
|
| Rate for Payer: Blue Shield of California EPN |
$23.65
|
| Rate for Payer: Cash Price |
$20.79
|
| Rate for Payer: EPIC Health Plan Commercial |
$18.48
|
| Rate for Payer: Galaxy Health WC |
$39.27
|
| Rate for Payer: Global Benefits Group Commercial |
$27.72
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$30.82
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$17.60
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$11.09
|
| Rate for Payer: Multiplan Commercial |
$36.96
|
| Rate for Payer: Networks By Design Commercial |
$30.03
|
| Rate for Payer: Prime Health Services Commercial |
$39.27
|
|
|
SODIUM TETRADECYL SULFATE 3 % (30 MG/ML) INTRAVENOUS SOLUTION [41793]
|
Facility
OP
|
$46.20
|
|
|
Service Code
|
NDC 24201-201-05
|
| Hospital Charge Code |
1720349
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$11.09 |
| Max. Negotiated Rate |
$39.27 |
| Rate for Payer: Networks By Design Commercial |
$30.03
|
| Rate for Payer: Aetna of CA HMO/PPO |
$30.30
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$39.27
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$25.41
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$25.41
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$27.53
|
| Rate for Payer: BCBS Transplant Transplant |
$27.72
|
| Rate for Payer: Blue Shield of California Commercial |
$34.05
|
| Rate for Payer: Blue Shield of California EPN |
$26.98
|
| Rate for Payer: Cash Price |
$20.79
|
| Rate for Payer: Cash Price |
$20.79
|
| Rate for Payer: Cigna of CA HMO |
$29.57
|
| Rate for Payer: Cigna of CA PPO |
$34.19
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$39.27
|
| Rate for Payer: Dignity Health Media |
$39.27
|
| Rate for Payer: Dignity Health Medi-Cal |
$39.27
|
| Rate for Payer: EPIC Health Plan Commercial |
$18.48
|
| Rate for Payer: EPIC Health Plan Transplant |
$18.48
|
| Rate for Payer: Galaxy Health WC |
$39.27
|
| Rate for Payer: Global Benefits Group Commercial |
$27.72
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$34.65
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$30.82
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$17.60
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$11.09
|
| Rate for Payer: Multiplan Commercial |
$36.96
|
| Rate for Payer: Prime Health Services Commercial |
$39.27
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$27.72
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$27.72
|
| Rate for Payer: United Healthcare All Other Commercial |
$23.10
|
| Rate for Payer: United Healthcare All Other HMO |
$23.10
|
| Rate for Payer: United Healthcare HMO Rider |
$23.10
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$23.10
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$39.27
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$39.27
|
| Rate for Payer: Vantage Medical Group Senior |
$39.27
|
|
|
SODIUM TETRADECYL SULFATE 3 % (30 MG/ML) INTRAVENOUS SOLUTION [41793]
|
Facility
OP
|
$46.20
|
|
|
Service Code
|
NDC 24201-201-01
|
| Hospital Charge Code |
1720349
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$11.09 |
| Max. Negotiated Rate |
$39.27 |
| Rate for Payer: Aetna of CA HMO/PPO |
$30.30
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$39.27
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$25.41
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$25.41
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$27.53
|
| Rate for Payer: BCBS Transplant Transplant |
$27.72
|
| Rate for Payer: Blue Shield of California Commercial |
$34.05
|
| Rate for Payer: Blue Shield of California EPN |
$26.98
|
| Rate for Payer: Cash Price |
$20.79
|
| Rate for Payer: Cash Price |
$20.79
|
| Rate for Payer: Cigna of CA HMO |
$29.57
|
| Rate for Payer: Cigna of CA PPO |
$34.19
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$39.27
|
| Rate for Payer: Dignity Health Media |
$39.27
|
| Rate for Payer: Dignity Health Medi-Cal |
$39.27
|
| Rate for Payer: EPIC Health Plan Commercial |
$18.48
|
| Rate for Payer: EPIC Health Plan Transplant |
$18.48
|
| Rate for Payer: Galaxy Health WC |
$39.27
|
| Rate for Payer: Global Benefits Group Commercial |
$27.72
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$34.65
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$30.82
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$17.60
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$11.09
|
| Rate for Payer: Multiplan Commercial |
$36.96
|
| Rate for Payer: Networks By Design Commercial |
$30.03
|
| Rate for Payer: Prime Health Services Commercial |
$39.27
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$27.72
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$27.72
|
| Rate for Payer: United Healthcare All Other Commercial |
$23.10
|
| Rate for Payer: United Healthcare All Other HMO |
$23.10
|
| Rate for Payer: United Healthcare HMO Rider |
$23.10
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$23.10
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$39.27
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$39.27
|
| Rate for Payer: Vantage Medical Group Senior |
$39.27
|
|
|
SODIUM TETRADECYL SULFATE 3 % (30 MG/ML) INTRAVENOUS SOLUTION [41793]
|
Facility
IP
|
$46.20
|
|
|
Service Code
|
NDC 24201-201-01
|
| Hospital Charge Code |
1720349
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$11.09 |
| Max. Negotiated Rate |
$39.27 |
| Rate for Payer: Cash Price |
$20.79
|
| Rate for Payer: EPIC Health Plan Commercial |
$18.48
|
| Rate for Payer: Galaxy Health WC |
$39.27
|
| Rate for Payer: Blue Shield of California Commercial |
$32.89
|
| Rate for Payer: Blue Shield of California EPN |
$23.65
|
| Rate for Payer: Global Benefits Group Commercial |
$27.72
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$30.82
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$17.60
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$11.09
|
| Rate for Payer: Multiplan Commercial |
$36.96
|
| Rate for Payer: Networks By Design Commercial |
$30.03
|
| Rate for Payer: Prime Health Services Commercial |
$39.27
|
|
|
SODIUM THIOSULFATE 12.5 GRAM/50 ML (250 MG/ML) INTRAVENOUS SOLUTION [7364]
|
Facility
IP
|
$2.14
|
|
|
Service Code
|
CPT J0208
|
| Hospital Charge Code |
NDG7364
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.51 |
| Max. Negotiated Rate |
$1.82 |
| Rate for Payer: Blue Shield of California Commercial |
$1.52
|
| Rate for Payer: Blue Shield of California EPN |
$1.10
|
| Rate for Payer: Cash Price |
$0.96
|
| Rate for Payer: Cigna of CA HMO |
$1.50
|
| Rate for Payer: Cigna of CA PPO |
$1.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.86
|
| Rate for Payer: EPIC Health Plan Transplant |
$0.86
|
| Rate for Payer: Galaxy Health WC |
$1.82
|
| Rate for Payer: Global Benefits Group Commercial |
$1.28
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1.43
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.82
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.51
|
| Rate for Payer: Multiplan Commercial |
$1.71
|
| Rate for Payer: Networks By Design Commercial |
$1.07
|
| Rate for Payer: Prime Health Services Commercial |
$1.82
|
|
|
SODIUM THIOSULFATE 12.5 GRAM/50 ML (250 MG/ML) INTRAVENOUS SOLUTION [7364]
|
Facility
OP
|
$2.14
|
|
|
Service Code
|
CPT J0208
|
| Hospital Charge Code |
NDG7364
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.51 |
| Max. Negotiated Rate |
$566.49 |
| Rate for Payer: Aetna of CA HMO/PPO |
$566.49
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$120.24
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$105.81
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$105.81
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1.28
|
| Rate for Payer: BCBS Transplant Transplant |
$1.28
|
| Rate for Payer: Blue Shield of California Commercial |
$1.58
|
| Rate for Payer: Blue Shield of California EPN |
$1.25
|
| Rate for Payer: Cash Price |
$0.96
|
| Rate for Payer: Cash Price |
$0.96
|
| Rate for Payer: Cigna of CA HMO |
$1.50
|
| Rate for Payer: Cigna of CA PPO |
$1.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$120.24
|
| Rate for Payer: Dignity Health Media |
$105.81
|
| Rate for Payer: Dignity Health Medi-Cal |
$105.81
|
| Rate for Payer: EPIC Health Plan Commercial |
$129.85
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$96.19
|
| Rate for Payer: EPIC Health Plan Transplant |
$96.19
|
| Rate for Payer: Galaxy Health WC |
$1.82
|
| Rate for Payer: Global Benefits Group Commercial |
$1.28
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$1.60
|
| Rate for Payer: Heritage Provider Network Commercial |
$157.75
|
| Rate for Payer: Heritage Provider Network Transplant |
$157.75
|
| Rate for Payer: IEHP Medi-Cal |
$155.82
|
| Rate for Payer: IEHP Medi-Cal Transplant |
$155.82
|
| Rate for Payer: IEHP Medicare Advantage |
$96.19
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1.43
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$182.02
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$96.19
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.51
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$121.20
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$128.89
|
| Rate for Payer: Multiplan Commercial |
$1.71
|
| Rate for Payer: Networks By Design Commercial |
$1.07
|
| Rate for Payer: Prime Health Services Commercial |
$1.82
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1.28
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1.28
|
| Rate for Payer: United Healthcare All Other Commercial |
$1.07
|
| Rate for Payer: United Healthcare All Other HMO |
$1.07
|
| Rate for Payer: United Healthcare HMO Rider |
$1.07
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1.07
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$120.24
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$105.81
|
| Rate for Payer: Vantage Medical Group Senior |
$105.81
|
|
|
SODIUM ZIRCONIUM CYCLOSILICATE 10 GRAM ORAL POWDER PACKET [222467]
|
Facility
IP
|
$31.26
|
|
|
Service Code
|
NDC 0310-1110-39
|
| Hospital Charge Code |
ERX222467
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$7.50 |
| Max. Negotiated Rate |
$26.57 |
| Rate for Payer: Blue Shield of California Commercial |
$22.26
|
| Rate for Payer: Blue Shield of California EPN |
$16.01
|
| Rate for Payer: Cash Price |
$14.07
|
| Rate for Payer: Cigna of CA HMO |
$21.88
|
| Rate for Payer: Cigna of CA PPO |
$21.88
|
| Rate for Payer: EPIC Health Plan Commercial |
$12.50
|
| Rate for Payer: Galaxy Health WC |
$26.57
|
| Rate for Payer: Global Benefits Group Commercial |
$18.76
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$20.85
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$11.91
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$7.50
|
| Rate for Payer: Multiplan Commercial |
$25.01
|
| Rate for Payer: Networks By Design Commercial |
$20.32
|
| Rate for Payer: Prime Health Services Commercial |
$26.57
|
|
|
SODIUM ZIRCONIUM CYCLOSILICATE 10 GRAM ORAL POWDER PACKET [222467]
|
Facility
IP
|
$31.26
|
|
|
Service Code
|
NDC 0310-1110-01
|
| Hospital Charge Code |
ERX222467
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$7.50 |
| Max. Negotiated Rate |
$26.57 |
| Rate for Payer: Blue Shield of California Commercial |
$22.26
|
| Rate for Payer: Blue Shield of California EPN |
$16.01
|
| Rate for Payer: Cash Price |
$14.07
|
| Rate for Payer: Cigna of CA HMO |
$21.88
|
| Rate for Payer: Cigna of CA PPO |
$21.88
|
| Rate for Payer: EPIC Health Plan Commercial |
$12.50
|
| Rate for Payer: Galaxy Health WC |
$26.57
|
| Rate for Payer: Global Benefits Group Commercial |
$18.76
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$20.85
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$11.91
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$7.50
|
| Rate for Payer: Multiplan Commercial |
$25.01
|
| Rate for Payer: Networks By Design Commercial |
$20.32
|
| Rate for Payer: Prime Health Services Commercial |
$26.57
|
|
|
SODIUM ZIRCONIUM CYCLOSILICATE 10 GRAM ORAL POWDER PACKET [222467]
|
Facility
OP
|
$31.26
|
|
|
Service Code
|
NDC 0310-1110-01
|
| Hospital Charge Code |
ERX222467
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$7.50 |
| Max. Negotiated Rate |
$26.57 |
| Rate for Payer: Aetna of CA HMO/PPO |
$20.50
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$26.57
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$17.19
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$17.19
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$18.62
|
| Rate for Payer: BCBS Transplant Transplant |
$18.76
|
| Rate for Payer: Blue Shield of California Commercial |
$23.04
|
| Rate for Payer: Blue Shield of California EPN |
$18.26
|
| Rate for Payer: Cash Price |
$14.07
|
| Rate for Payer: Cigna of CA HMO |
$21.88
|
| Rate for Payer: Cigna of CA PPO |
$21.88
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$26.57
|
| Rate for Payer: Dignity Health Media |
$26.57
|
| Rate for Payer: Dignity Health Medi-Cal |
$26.57
|
| Rate for Payer: EPIC Health Plan Commercial |
$12.50
|
| Rate for Payer: EPIC Health Plan Transplant |
$12.50
|
| Rate for Payer: Galaxy Health WC |
$26.57
|
| Rate for Payer: Global Benefits Group Commercial |
$18.76
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$23.44
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$20.85
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$11.91
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$7.50
|
| Rate for Payer: Multiplan Commercial |
$25.01
|
| Rate for Payer: Networks By Design Commercial |
$20.32
|
| Rate for Payer: Prime Health Services Commercial |
$26.57
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$18.76
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$18.76
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$18.76
|
| Rate for Payer: United Healthcare All Other Commercial |
$15.63
|
| Rate for Payer: United Healthcare All Other HMO |
$15.63
|
| Rate for Payer: United Healthcare HMO Rider |
$15.63
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$15.63
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$26.57
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$26.57
|
| Rate for Payer: Vantage Medical Group Senior |
$26.57
|
|
