|
STREPTOMYCIN 1 GRAM INTRAMUSCULAR SOLUTION [7508]
|
Facility
IP
|
$90.00
|
|
|
Service Code
|
CPT J3000
|
| Hospital Charge Code |
1720358
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$21.60 |
| Max. Negotiated Rate |
$76.50 |
| Rate for Payer: Blue Shield of California Commercial |
$64.08
|
| Rate for Payer: Blue Shield of California EPN |
$46.08
|
| Rate for Payer: Cash Price |
$40.50
|
| Rate for Payer: Cigna of CA HMO |
$63.00
|
| Rate for Payer: Cigna of CA PPO |
$63.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$36.00
|
| Rate for Payer: EPIC Health Plan Transplant |
$36.00
|
| Rate for Payer: Galaxy Health WC |
$76.50
|
| Rate for Payer: Global Benefits Group Commercial |
$54.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$60.03
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$34.29
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$21.60
|
| Rate for Payer: Multiplan Commercial |
$72.00
|
| Rate for Payer: Networks By Design Commercial |
$45.00
|
| Rate for Payer: Prime Health Services Commercial |
$76.50
|
|
|
Submucous resection inferior turbinate, partial or complete, any method
|
Facility
OP
|
$7,385.00
|
|
|
Service Code
|
CPT 30140
|
| Min. Negotiated Rate |
$453.42 |
| Max. Negotiated Rate |
$7,385.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$7,385.00
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$6,034.04
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$4,424.96
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$4,022.69
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,938.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$6,034.04
|
| Rate for Payer: Dignity Health Media |
$4,022.69
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,424.96
|
| Rate for Payer: EPIC Health Plan Commercial |
$5,430.63
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$4,022.69
|
| Rate for Payer: EPIC Health Plan Transplant |
$4,022.69
|
| Rate for Payer: Heritage Provider Network Commercial |
$6,597.21
|
| Rate for Payer: Heritage Provider Network Transplant |
$6,597.21
|
| Rate for Payer: IEHP Medi-Cal |
$6,516.76
|
| Rate for Payer: IEHP Medi-Cal Transplant |
$6,516.76
|
| Rate for Payer: IEHP Medicare Advantage |
$4,022.69
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$453.42
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4,022.69
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$5,068.59
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$5,390.40
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$6,034.04
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,424.96
|
| Rate for Payer: Vantage Medical Group Senior |
$4,022.69
|
|
|
SUCCIMER 100 MG CAPSULE [11438]
|
Facility
OP
|
$28.85
|
|
|
Service Code
|
NDC 55292-201-11
|
| Hospital Charge Code |
ERX11438
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$6.92 |
| Max. Negotiated Rate |
$24.52 |
| Rate for Payer: Aetna of CA HMO/PPO |
$18.92
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$24.52
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$15.87
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$15.87
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$17.19
|
| Rate for Payer: BCBS Transplant Transplant |
$17.31
|
| Rate for Payer: Blue Shield of California Commercial |
$21.26
|
| Rate for Payer: Blue Shield of California EPN |
$16.85
|
| Rate for Payer: Cash Price |
$12.98
|
| Rate for Payer: Cash Price |
$12.98
|
| Rate for Payer: Cigna of CA HMO |
$18.46
|
| Rate for Payer: Cigna of CA PPO |
$21.35
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$24.52
|
| Rate for Payer: Dignity Health Media |
$24.52
|
| Rate for Payer: Dignity Health Medi-Cal |
$24.52
|
| Rate for Payer: EPIC Health Plan Commercial |
$11.54
|
| Rate for Payer: EPIC Health Plan Transplant |
$11.54
|
| Rate for Payer: Galaxy Health WC |
$24.52
|
| Rate for Payer: Global Benefits Group Commercial |
$17.31
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$21.64
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$19.24
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$10.99
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6.92
|
| Rate for Payer: Multiplan Commercial |
$23.08
|
| Rate for Payer: Networks By Design Commercial |
$18.75
|
| Rate for Payer: Prime Health Services Commercial |
$24.52
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$17.31
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$17.31
|
| Rate for Payer: United Healthcare All Other Commercial |
$14.42
|
| Rate for Payer: United Healthcare All Other HMO |
$14.42
|
| Rate for Payer: United Healthcare HMO Rider |
$14.42
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$14.42
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$24.52
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$24.52
|
| Rate for Payer: Vantage Medical Group Senior |
$24.52
|
|
|
SUCCIMER 100 MG CAPSULE [11438]
|
Facility
IP
|
$28.85
|
|
|
Service Code
|
NDC 55292-201-11
|
| Hospital Charge Code |
ERX11438
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$6.92 |
| Max. Negotiated Rate |
$24.52 |
| Rate for Payer: Blue Shield of California Commercial |
$20.54
|
| Rate for Payer: Blue Shield of California EPN |
$14.77
|
| Rate for Payer: Cash Price |
$12.98
|
| Rate for Payer: EPIC Health Plan Commercial |
$11.54
|
| Rate for Payer: Galaxy Health WC |
$24.52
|
| Rate for Payer: Global Benefits Group Commercial |
$17.31
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$19.24
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$10.99
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6.92
|
| Rate for Payer: Multiplan Commercial |
$23.08
|
| Rate for Payer: Networks By Design Commercial |
$18.75
|
| Rate for Payer: Prime Health Services Commercial |
$24.52
|
|
|
SUCCINYLCHOLINE CHLORIDE 100 MG/5 ML (20 MG/ML) INTRAVENOUS SYRINGE [121307]
|
Facility
IP
|
$5.15
|
|
|
Service Code
|
CPT J0330
|
| Hospital Charge Code |
ERX121307
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.24 |
| Max. Negotiated Rate |
$4.38 |
| Rate for Payer: Blue Shield of California Commercial |
$3.67
|
| Rate for Payer: Blue Shield of California EPN |
$2.64
|
| Rate for Payer: Cash Price |
$2.32
|
| Rate for Payer: Cigna of CA HMO |
$3.60
|
| Rate for Payer: Cigna of CA PPO |
$3.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.06
|
| Rate for Payer: EPIC Health Plan Transplant |
$2.06
|
| Rate for Payer: Galaxy Health WC |
$4.38
|
| Rate for Payer: Global Benefits Group Commercial |
$3.09
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3.44
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1.96
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.24
|
| Rate for Payer: Multiplan Commercial |
$4.12
|
| Rate for Payer: Networks By Design Commercial |
$2.58
|
| Rate for Payer: Prime Health Services Commercial |
$4.38
|
|
|
SUCCINYLCHOLINE CHLORIDE 100 MG/5 ML (20 MG/ML) INTRAVENOUS SYRINGE [121307]
|
Facility
OP
|
$5.15
|
|
|
Service Code
|
CPT J0330
|
| Hospital Charge Code |
ERX121307
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.24 |
| Max. Negotiated Rate |
$10.98 |
| Rate for Payer: Aetna of CA HMO/PPO |
$5.04
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$4.38
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$2.83
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$2.83
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$6.49
|
| Rate for Payer: BCBS Transplant Transplant |
$3.09
|
| Rate for Payer: Blue Shield of California Commercial |
$3.80
|
| Rate for Payer: Blue Shield of California EPN |
$1.54
|
| Rate for Payer: Cash Price |
$2.32
|
| Rate for Payer: Cash Price |
$2.32
|
| Rate for Payer: Cigna of CA HMO |
$3.60
|
| Rate for Payer: Cigna of CA PPO |
$3.60
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$4.38
|
| Rate for Payer: Dignity Health Media |
$4.38
|
| Rate for Payer: Dignity Health Medi-Cal |
$4.38
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.06
|
| Rate for Payer: EPIC Health Plan Transplant |
$2.06
|
| Rate for Payer: Galaxy Health WC |
$4.38
|
| Rate for Payer: Global Benefits Group Commercial |
$3.09
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$3.86
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3.44
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$10.98
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.24
|
| Rate for Payer: Multiplan Commercial |
$4.12
|
| Rate for Payer: Networks By Design Commercial |
$2.58
|
| Rate for Payer: Prime Health Services Commercial |
$4.38
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3.09
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$3.09
|
| Rate for Payer: United Healthcare All Other Commercial |
$2.58
|
| Rate for Payer: United Healthcare All Other HMO |
$2.58
|
| Rate for Payer: United Healthcare HMO Rider |
$2.58
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2.58
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$4.38
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4.38
|
| Rate for Payer: Vantage Medical Group Senior |
$4.38
|
|
|
SUCCINYLCHOLINE CHLORIDE 200 MG/10 ML INJECTION VIAL - CODE [4087536]
|
Facility
OP
|
$2.33
|
|
|
Service Code
|
CPT J0330
|
| Hospital Charge Code |
1720071
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.56 |
| Max. Negotiated Rate |
$10.98 |
| Rate for Payer: Cash Price |
$1.05
|
| Rate for Payer: Cash Price |
$1.05
|
| Rate for Payer: Cigna of CA HMO |
$1.63
|
| Rate for Payer: Cigna of CA PPO |
$1.63
|
| Rate for Payer: Aetna of CA HMO/PPO |
$5.04
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$1.98
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$1.28
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$1.28
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$6.49
|
| Rate for Payer: BCBS Transplant Transplant |
$1.40
|
| Rate for Payer: Blue Shield of California Commercial |
$1.72
|
| Rate for Payer: Blue Shield of California EPN |
$1.54
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1.98
|
| Rate for Payer: Dignity Health Media |
$1.98
|
| Rate for Payer: Dignity Health Medi-Cal |
$1.98
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.93
|
| Rate for Payer: EPIC Health Plan Transplant |
$0.93
|
| Rate for Payer: Galaxy Health WC |
$1.98
|
| Rate for Payer: Global Benefits Group Commercial |
$1.40
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$1.75
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1.55
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$10.98
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.56
|
| Rate for Payer: Multiplan Commercial |
$1.86
|
| Rate for Payer: Networks By Design Commercial |
$1.16
|
| Rate for Payer: Prime Health Services Commercial |
$1.98
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$1.16
|
| Rate for Payer: United Healthcare All Other HMO |
$1.16
|
| Rate for Payer: United Healthcare HMO Rider |
$1.16
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1.16
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1.98
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1.98
|
| Rate for Payer: Vantage Medical Group Senior |
$1.98
|
|
|
SUCCINYLCHOLINE CHLORIDE 200 MG/10 ML INJECTION VIAL - CODE [4087536]
|
Facility
IP
|
$2.33
|
|
|
Service Code
|
CPT J0330
|
| Hospital Charge Code |
1720071
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.56 |
| Max. Negotiated Rate |
$1.98 |
| Rate for Payer: Blue Shield of California Commercial |
$1.66
|
| Rate for Payer: Blue Shield of California EPN |
$1.19
|
| Rate for Payer: Cash Price |
$1.05
|
| Rate for Payer: Cigna of CA HMO |
$1.63
|
| Rate for Payer: Cigna of CA PPO |
$1.63
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.93
|
| Rate for Payer: EPIC Health Plan Transplant |
$0.93
|
| Rate for Payer: Galaxy Health WC |
$1.98
|
| Rate for Payer: Global Benefits Group Commercial |
$1.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1.55
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.89
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.56
|
| Rate for Payer: Multiplan Commercial |
$1.86
|
| Rate for Payer: Networks By Design Commercial |
$1.16
|
| Rate for Payer: Prime Health Services Commercial |
$1.98
|
|
|
SUCCINYLCHOLINE CHLORIDE 20 MG/ML INJECTION SOLUTION [7536]
|
Facility
OP
|
$2.30
|
|
|
Service Code
|
CPT J0330
|
| Hospital Charge Code |
1720071
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.55 |
| Max. Negotiated Rate |
$10.98 |
| Rate for Payer: Aetna of CA HMO/PPO |
$5.04
|
| Rate for Payer: Aetna of CA HMO/PPO |
$5.04
|
| Rate for Payer: Aetna of CA HMO/PPO |
$5.04
|
| Rate for Payer: Aetna of CA HMO/PPO |
$5.04
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$0.61
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$1.06
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$0.87
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$1.96
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$0.56
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$0.40
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$0.69
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$1.26
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$0.56
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$1.26
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$0.69
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$0.40
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$6.49
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$6.49
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$6.49
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$6.49
|
| Rate for Payer: BCBS Transplant Transplant |
$1.38
|
| Rate for Payer: BCBS Transplant Transplant |
$0.75
|
| Rate for Payer: BCBS Transplant Transplant |
$0.43
|
| Rate for Payer: BCBS Transplant Transplant |
$0.61
|
| Rate for Payer: Blue Shield of California Commercial |
$1.70
|
| Rate for Payer: Blue Shield of California Commercial |
$0.53
|
| Rate for Payer: Blue Shield of California Commercial |
$0.92
|
| Rate for Payer: Blue Shield of California Commercial |
$0.75
|
| Rate for Payer: Blue Shield of California EPN |
$1.54
|
| Rate for Payer: Blue Shield of California EPN |
$1.54
|
| Rate for Payer: Blue Shield of California EPN |
$1.54
|
| Rate for Payer: Blue Shield of California EPN |
$1.54
|
| Rate for Payer: Cash Price |
$0.46
|
| Rate for Payer: Cash Price |
$0.56
|
| Rate for Payer: Cash Price |
$0.32
|
| Rate for Payer: Cash Price |
$0.32
|
| Rate for Payer: Cash Price |
$1.04
|
| Rate for Payer: Cash Price |
$1.04
|
| Rate for Payer: Cash Price |
$0.46
|
| Rate for Payer: Cash Price |
$0.56
|
| Rate for Payer: Cigna of CA HMO |
$0.71
|
| Rate for Payer: Cigna of CA HMO |
$1.61
|
| Rate for Payer: Cigna of CA HMO |
$0.50
|
| Rate for Payer: Cigna of CA HMO |
$0.88
|
| Rate for Payer: Cigna of CA PPO |
$1.61
|
| Rate for Payer: Cigna of CA PPO |
$0.71
|
| Rate for Payer: Cigna of CA PPO |
$0.88
|
| Rate for Payer: Cigna of CA PPO |
$0.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.61
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1.06
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1.96
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.87
|
| Rate for Payer: Dignity Health Media |
$1.96
|
| Rate for Payer: Dignity Health Media |
$1.06
|
| Rate for Payer: Dignity Health Media |
$0.61
|
| Rate for Payer: Dignity Health Media |
$0.87
|
| Rate for Payer: Dignity Health Medi-Cal |
$1.06
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.87
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.61
|
| Rate for Payer: Dignity Health Medi-Cal |
$1.96
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.41
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.92
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.29
|
| Rate for Payer: EPIC Health Plan Transplant |
$0.92
|
| Rate for Payer: EPIC Health Plan Transplant |
$0.50
|
| Rate for Payer: EPIC Health Plan Transplant |
$0.29
|
| Rate for Payer: EPIC Health Plan Transplant |
$0.41
|
| Rate for Payer: Galaxy Health WC |
$1.96
|
| Rate for Payer: Galaxy Health WC |
$0.61
|
| Rate for Payer: Galaxy Health WC |
$0.87
|
| Rate for Payer: Galaxy Health WC |
$1.06
|
| Rate for Payer: Global Benefits Group Commercial |
$1.38
|
| Rate for Payer: Global Benefits Group Commercial |
$0.43
|
| Rate for Payer: Global Benefits Group Commercial |
$0.75
|
| Rate for Payer: Global Benefits Group Commercial |
$0.61
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$0.54
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$1.72
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$0.77
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$0.94
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1.53
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.68
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.83
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.48
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$10.98
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$10.98
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$10.98
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$10.98
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.24
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.17
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.30
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.55
|
| Rate for Payer: Multiplan Commercial |
$1.84
|
| Rate for Payer: Multiplan Commercial |
$1.00
|
| Rate for Payer: Multiplan Commercial |
$0.58
|
| Rate for Payer: Multiplan Commercial |
$0.82
|
| Rate for Payer: Networks By Design Commercial |
$0.51
|
| Rate for Payer: Networks By Design Commercial |
$0.36
|
| Rate for Payer: Networks By Design Commercial |
$0.63
|
| Rate for Payer: Networks By Design Commercial |
$1.15
|
| Rate for Payer: Prime Health Services Commercial |
$0.61
|
| Rate for Payer: Prime Health Services Commercial |
$1.96
|
| Rate for Payer: Prime Health Services Commercial |
$0.87
|
| Rate for Payer: Prime Health Services Commercial |
$1.06
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.75
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1.38
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.61
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.43
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.61
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.75
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1.38
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.43
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.36
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.51
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.63
|
| Rate for Payer: United Healthcare All Other Commercial |
$1.15
|
| Rate for Payer: United Healthcare All Other HMO |
$0.63
|
| Rate for Payer: United Healthcare All Other HMO |
$1.15
|
| Rate for Payer: United Healthcare All Other HMO |
$0.36
|
| Rate for Payer: United Healthcare All Other HMO |
$0.51
|
| Rate for Payer: United Healthcare HMO Rider |
$1.15
|
| Rate for Payer: United Healthcare HMO Rider |
$0.36
|
| Rate for Payer: United Healthcare HMO Rider |
$0.63
|
| Rate for Payer: United Healthcare HMO Rider |
$0.51
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.51
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.63
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1.15
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.36
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1.06
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1.96
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.61
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.87
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.87
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1.96
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1.06
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.61
|
| Rate for Payer: Vantage Medical Group Senior |
$1.96
|
| Rate for Payer: Vantage Medical Group Senior |
$0.61
|
| Rate for Payer: Vantage Medical Group Senior |
$1.06
|
| Rate for Payer: Vantage Medical Group Senior |
$0.87
|
|
|
SUCCINYLCHOLINE CHLORIDE 20 MG/ML INJECTION SOLUTION [7536]
|
Facility
IP
|
$0.72
|
|
|
Service Code
|
CPT J0330
|
| Hospital Charge Code |
1720071
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.17 |
| Max. Negotiated Rate |
$0.61 |
| Rate for Payer: Blue Shield of California Commercial |
$0.51
|
| Rate for Payer: Blue Shield of California Commercial |
$0.89
|
| Rate for Payer: Blue Shield of California Commercial |
$0.73
|
| Rate for Payer: Blue Shield of California Commercial |
$1.64
|
| Rate for Payer: Blue Shield of California EPN |
$0.52
|
| Rate for Payer: Blue Shield of California EPN |
$0.37
|
| Rate for Payer: Blue Shield of California EPN |
$0.64
|
| Rate for Payer: Blue Shield of California EPN |
$1.18
|
| Rate for Payer: Cash Price |
$1.04
|
| Rate for Payer: Cash Price |
$0.56
|
| Rate for Payer: Cash Price |
$0.46
|
| Rate for Payer: Cash Price |
$0.32
|
| Rate for Payer: Cigna of CA HMO |
$0.50
|
| Rate for Payer: Cigna of CA HMO |
$0.71
|
| Rate for Payer: Cigna of CA HMO |
$1.61
|
| Rate for Payer: Cigna of CA HMO |
$0.88
|
| Rate for Payer: Cigna of CA PPO |
$0.88
|
| Rate for Payer: Cigna of CA PPO |
$0.50
|
| Rate for Payer: Cigna of CA PPO |
$0.71
|
| Rate for Payer: Cigna of CA PPO |
$1.61
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.41
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.29
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.92
|
| Rate for Payer: EPIC Health Plan Transplant |
$0.29
|
| Rate for Payer: EPIC Health Plan Transplant |
$0.50
|
| Rate for Payer: EPIC Health Plan Transplant |
$0.41
|
| Rate for Payer: EPIC Health Plan Transplant |
$0.92
|
| Rate for Payer: Galaxy Health WC |
$0.61
|
| Rate for Payer: Galaxy Health WC |
$0.87
|
| Rate for Payer: Galaxy Health WC |
$1.96
|
| Rate for Payer: Galaxy Health WC |
$1.06
|
| Rate for Payer: Global Benefits Group Commercial |
$1.38
|
| Rate for Payer: Global Benefits Group Commercial |
$0.43
|
| Rate for Payer: Global Benefits Group Commercial |
$0.61
|
| Rate for Payer: Global Benefits Group Commercial |
$0.75
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.48
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.68
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.83
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1.53
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.39
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.88
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.27
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.48
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.24
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.55
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.30
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.17
|
| Rate for Payer: Multiplan Commercial |
$0.58
|
| Rate for Payer: Multiplan Commercial |
$1.84
|
| Rate for Payer: Multiplan Commercial |
$0.82
|
| Rate for Payer: Multiplan Commercial |
$1.00
|
| Rate for Payer: Networks By Design Commercial |
$0.51
|
| Rate for Payer: Networks By Design Commercial |
$0.63
|
| Rate for Payer: Networks By Design Commercial |
$0.36
|
| Rate for Payer: Networks By Design Commercial |
$1.15
|
| Rate for Payer: Prime Health Services Commercial |
$0.87
|
| Rate for Payer: Prime Health Services Commercial |
$1.06
|
| Rate for Payer: Prime Health Services Commercial |
$1.96
|
| Rate for Payer: Prime Health Services Commercial |
$0.61
|
|
|
SUCCINYLCHOLINE(PF)100 MG/5 ML (20 MG/ML)-NACL,ISO INTRAVENOUS INJECTION. [408216150]
|
Facility
OP
|
$1.20
|
|
|
Service Code
|
CPT J0330
|
| Hospital Charge Code |
NDG216150A
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.29 |
| Max. Negotiated Rate |
$10.98 |
| Rate for Payer: Aetna of CA HMO/PPO |
$5.04
|
| Rate for Payer: Aetna of CA HMO/PPO |
$5.04
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$1.68
|
| 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 Medi-Cal |
$1.09
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$1.09
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$0.66
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$6.49
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$6.49
|
| Rate for Payer: BCBS Transplant Transplant |
$1.19
|
| 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 Commercial |
$1.46
|
| Rate for Payer: Blue Shield of California EPN |
$1.54
|
| Rate for Payer: Blue Shield of California EPN |
$1.54
|
| Rate for Payer: Cash Price |
$0.89
|
| Rate for Payer: Cash Price |
$0.54
|
| Rate for Payer: Cash Price |
$0.89
|
| Rate for Payer: Cash Price |
$0.54
|
| Rate for Payer: Cigna of CA HMO |
$1.39
|
| Rate for Payer: Cigna of CA HMO |
$0.84
|
| Rate for Payer: Cigna of CA PPO |
$1.39
|
| Rate for Payer: Cigna of CA PPO |
$0.84
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1.02
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1.68
|
| Rate for Payer: Dignity Health Media |
$1.68
|
| Rate for Payer: Dignity Health Media |
$1.02
|
| Rate for Payer: Dignity Health Medi-Cal |
$1.02
|
| Rate for Payer: Dignity Health Medi-Cal |
$1.68
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.79
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.48
|
| Rate for Payer: EPIC Health Plan Transplant |
$0.48
|
| Rate for Payer: EPIC Health Plan Transplant |
$0.79
|
| Rate for Payer: Galaxy Health WC |
$1.68
|
| Rate for Payer: Galaxy Health WC |
$1.02
|
| Rate for Payer: Global Benefits Group Commercial |
$1.19
|
| Rate for Payer: Global Benefits Group Commercial |
$0.72
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$0.90
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$1.48
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1.32
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.80
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$10.98
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$10.98
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.48
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.29
|
| Rate for Payer: Multiplan Commercial |
$1.58
|
| Rate for Payer: Multiplan Commercial |
$0.96
|
| Rate for Payer: Networks By Design Commercial |
$0.99
|
| Rate for Payer: Networks By Design Commercial |
$0.60
|
| Rate for Payer: Prime Health Services Commercial |
$1.02
|
| Rate for Payer: Prime Health Services Commercial |
$1.68
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1.19
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.72
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1.19
|
| 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 Commercial |
$0.99
|
| Rate for Payer: United Healthcare All Other HMO |
$0.99
|
| Rate for Payer: United Healthcare All Other HMO |
$0.60
|
| Rate for Payer: United Healthcare HMO Rider |
$0.60
|
| Rate for Payer: United Healthcare HMO Rider |
$0.99
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.60
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.99
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1.02
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1.68
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1.68
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1.02
|
| Rate for Payer: Vantage Medical Group Senior |
$1.02
|
| Rate for Payer: Vantage Medical Group Senior |
$1.68
|
|
|
SUCCINYLCHOLINE(PF)100 MG/5 ML (20 MG/ML)-NACL,ISO INTRAVENOUS INJECTION. [408216150]
|
Facility
IP
|
$1.20
|
|
|
Service Code
|
CPT J0330
|
| Hospital Charge Code |
NDG216150A
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.29 |
| Max. Negotiated Rate |
$1.02 |
| Rate for Payer: Blue Shield of California Commercial |
$0.85
|
| Rate for Payer: Blue Shield of California Commercial |
$1.41
|
| Rate for Payer: Blue Shield of California EPN |
$0.61
|
| Rate for Payer: Blue Shield of California EPN |
$1.01
|
| Rate for Payer: Cash Price |
$0.54
|
| Rate for Payer: Cash Price |
$0.89
|
| Rate for Payer: Cigna of CA HMO |
$0.84
|
| Rate for Payer: Cigna of CA HMO |
$1.39
|
| Rate for Payer: Cigna of CA PPO |
$0.84
|
| Rate for Payer: Cigna of CA PPO |
$1.39
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.79
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.48
|
| Rate for Payer: EPIC Health Plan Transplant |
$0.48
|
| Rate for Payer: EPIC Health Plan Transplant |
$0.79
|
| Rate for Payer: Galaxy Health WC |
$1.68
|
| Rate for Payer: Galaxy Health WC |
$1.02
|
| Rate for Payer: Global Benefits Group Commercial |
$1.19
|
| Rate for Payer: Global Benefits Group Commercial |
$0.72
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1.32
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.80
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.75
|
| 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: LLUH Dept of Risk Management WC |
$0.48
|
| Rate for Payer: Multiplan Commercial |
$0.96
|
| Rate for Payer: Multiplan Commercial |
$1.58
|
| Rate for Payer: Networks By Design Commercial |
$0.60
|
| Rate for Payer: Networks By Design Commercial |
$0.99
|
| Rate for Payer: Prime Health Services Commercial |
$1.02
|
| Rate for Payer: Prime Health Services Commercial |
$1.68
|
|
|
SUCCINYLCHOLINE(PF)100 MG/5 ML (20 MG/ML)-NACL,ISO INTRAVENOUS SYRINGE [216150]
|
Facility
OP
|
$4.55
|
|
|
Service Code
|
CPT J0330
|
| Hospital Charge Code |
NDG216150A
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.09 |
| Max. Negotiated Rate |
$10.98 |
| Rate for Payer: Aetna of CA HMO/PPO |
$5.04
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$3.87
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$2.50
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$2.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$6.49
|
| Rate for Payer: BCBS Transplant Transplant |
$2.73
|
| Rate for Payer: Blue Shield of California Commercial |
$3.35
|
| Rate for Payer: Blue Shield of California EPN |
$1.54
|
| Rate for Payer: Cash Price |
$2.05
|
| Rate for Payer: Cash Price |
$2.05
|
| Rate for Payer: Cigna of CA HMO |
$3.18
|
| Rate for Payer: Cigna of CA PPO |
$3.18
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3.87
|
| Rate for Payer: Dignity Health Media |
$3.87
|
| Rate for Payer: Dignity Health Medi-Cal |
$3.87
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.82
|
| Rate for Payer: EPIC Health Plan Transplant |
$1.82
|
| Rate for Payer: Galaxy Health WC |
$3.87
|
| Rate for Payer: Global Benefits Group Commercial |
$2.73
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$3.41
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3.03
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$10.98
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.09
|
| Rate for Payer: Multiplan Commercial |
$3.64
|
| Rate for Payer: Networks By Design Commercial |
$2.28
|
| Rate for Payer: Prime Health Services Commercial |
$3.87
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2.73
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2.73
|
| Rate for Payer: United Healthcare All Other Commercial |
$2.28
|
| Rate for Payer: United Healthcare All Other HMO |
$2.28
|
| Rate for Payer: United Healthcare HMO Rider |
$2.28
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2.28
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3.87
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$3.87
|
| Rate for Payer: Vantage Medical Group Senior |
$3.87
|
|
|
SUCCINYLCHOLINE(PF)100 MG/5 ML (20 MG/ML)-NACL,ISO INTRAVENOUS SYRINGE [216150]
|
Facility
IP
|
$4.55
|
|
|
Service Code
|
CPT J0330
|
| Hospital Charge Code |
NDG216150A
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.09 |
| Max. Negotiated Rate |
$3.87 |
| Rate for Payer: Blue Shield of California Commercial |
$3.24
|
| Rate for Payer: Blue Shield of California EPN |
$2.33
|
| Rate for Payer: Cash Price |
$2.05
|
| Rate for Payer: Cigna of CA HMO |
$3.18
|
| Rate for Payer: Cigna of CA PPO |
$3.18
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.82
|
| Rate for Payer: EPIC Health Plan Transplant |
$1.82
|
| Rate for Payer: Galaxy Health WC |
$3.87
|
| Rate for Payer: Global Benefits Group Commercial |
$2.73
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3.03
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1.73
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.09
|
| Rate for Payer: Multiplan Commercial |
$3.64
|
| Rate for Payer: Networks By Design Commercial |
$2.28
|
| Rate for Payer: Prime Health Services Commercial |
$3.87
|
|
|
SUCRALFATE 100 MG/ML ORAL SUSPENSION [11441]
|
Facility
IP
|
$1.08
|
|
|
Service Code
|
NDC 68094-043-59
|
| Hospital Charge Code |
1716079
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.26 |
| Max. Negotiated Rate |
$0.92 |
| Rate for Payer: Blue Shield of California Commercial |
$0.77
|
| Rate for Payer: Blue Shield of California EPN |
$0.55
|
| Rate for Payer: Cash Price |
$0.49
|
| Rate for Payer: Cigna of CA HMO |
$0.76
|
| Rate for Payer: Cigna of CA PPO |
$0.76
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.43
|
| Rate for Payer: Galaxy Health WC |
$0.92
|
| Rate for Payer: Global Benefits Group Commercial |
$0.65
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.72
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.41
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.26
|
| Rate for Payer: Multiplan Commercial |
$0.86
|
| Rate for Payer: Networks By Design Commercial |
$0.70
|
| Rate for Payer: Prime Health Services Commercial |
$0.92
|
|
|
SUCRALFATE 100 MG/ML ORAL SUSPENSION [11441]
|
Facility
OP
|
$1.09
|
|
|
Service Code
|
NDC 0121-0974-94
|
| Hospital Charge Code |
1716079
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.26 |
| Max. Negotiated Rate |
$0.93 |
| Rate for Payer: Aetna of CA HMO/PPO |
$0.71
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$0.93
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$0.60
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$0.60
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.65
|
| Rate for Payer: BCBS Transplant Transplant |
$0.65
|
| Rate for Payer: Blue Shield of California Commercial |
$0.80
|
| Rate for Payer: Blue Shield of California EPN |
$0.64
|
| Rate for Payer: Cash Price |
$0.49
|
| Rate for Payer: Cigna of CA HMO |
$0.76
|
| Rate for Payer: Cigna of CA PPO |
$0.76
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.93
|
| Rate for Payer: Dignity Health Media |
$0.93
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.93
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.44
|
| Rate for Payer: EPIC Health Plan Transplant |
$0.44
|
| Rate for Payer: Galaxy Health WC |
$0.93
|
| Rate for Payer: Global Benefits Group Commercial |
$0.65
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$0.82
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.73
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.42
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.26
|
| Rate for Payer: Multiplan Commercial |
$0.87
|
| Rate for Payer: Networks By Design Commercial |
$0.71
|
| Rate for Payer: Prime Health Services Commercial |
$0.93
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$0.65
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.65
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.65
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.55
|
| Rate for Payer: United Healthcare All Other HMO |
$0.55
|
| Rate for Payer: United Healthcare HMO Rider |
$0.55
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.55
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.93
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.93
|
| Rate for Payer: Vantage Medical Group Senior |
$0.93
|
|
|
SUCRALFATE 100 MG/ML ORAL SUSPENSION [11441]
|
Facility
IP
|
$1.08
|
|
|
Service Code
|
NDC 0121-0974-10
|
| Hospital Charge Code |
1716079
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.26 |
| Max. Negotiated Rate |
$0.92 |
| Rate for Payer: Blue Shield of California Commercial |
$0.77
|
| Rate for Payer: Blue Shield of California EPN |
$0.55
|
| Rate for Payer: Cash Price |
$0.49
|
| Rate for Payer: Cigna of CA HMO |
$0.76
|
| Rate for Payer: Cigna of CA PPO |
$0.76
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.43
|
| Rate for Payer: Galaxy Health WC |
$0.92
|
| Rate for Payer: Global Benefits Group Commercial |
$0.65
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.72
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.41
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.26
|
| Rate for Payer: Multiplan Commercial |
$0.86
|
| Rate for Payer: Networks By Design Commercial |
$0.70
|
| Rate for Payer: Prime Health Services Commercial |
$0.92
|
|
|
SUCRALFATE 100 MG/ML ORAL SUSPENSION [11441]
|
Facility
IP
|
$1.09
|
|
|
Service Code
|
NDC 0121-0974-94
|
| Hospital Charge Code |
1716079
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.26 |
| Max. Negotiated Rate |
$0.93 |
| Rate for Payer: Blue Shield of California Commercial |
$0.78
|
| Rate for Payer: Blue Shield of California EPN |
$0.56
|
| Rate for Payer: Cash Price |
$0.49
|
| Rate for Payer: Cigna of CA HMO |
$0.76
|
| Rate for Payer: Cigna of CA PPO |
$0.76
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.44
|
| Rate for Payer: Galaxy Health WC |
$0.93
|
| Rate for Payer: Global Benefits Group Commercial |
$0.65
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.73
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.42
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.26
|
| Rate for Payer: Multiplan Commercial |
$0.87
|
| Rate for Payer: Networks By Design Commercial |
$0.71
|
| Rate for Payer: Prime Health Services Commercial |
$0.93
|
|
|
SUCRALFATE 100 MG/ML ORAL SUSPENSION [11441]
|
Facility
IP
|
$1.09
|
|
|
Service Code
|
NDC 68094-043-62
|
| Hospital Charge Code |
1716079
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.26 |
| Max. Negotiated Rate |
$0.93 |
| Rate for Payer: Blue Shield of California Commercial |
$0.78
|
| Rate for Payer: Blue Shield of California EPN |
$0.56
|
| Rate for Payer: Cash Price |
$0.49
|
| Rate for Payer: Cigna of CA HMO |
$0.76
|
| Rate for Payer: Cigna of CA PPO |
$0.76
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.44
|
| Rate for Payer: Galaxy Health WC |
$0.93
|
| Rate for Payer: Global Benefits Group Commercial |
$0.65
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.73
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.42
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.26
|
| Rate for Payer: Multiplan Commercial |
$0.87
|
| Rate for Payer: Networks By Design Commercial |
$0.71
|
| Rate for Payer: Prime Health Services Commercial |
$0.93
|
|
|
SUCRALFATE 100 MG/ML ORAL SUSPENSION [11441]
|
Facility
OP
|
$1.08
|
|
|
Service Code
|
NDC 0121-0974-10
|
| Hospital Charge Code |
1716079
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.26 |
| Max. Negotiated Rate |
$0.92 |
| Rate for Payer: Aetna of CA HMO/PPO |
$0.71
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$0.92
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$0.59
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$0.59
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.64
|
| Rate for Payer: BCBS Transplant Transplant |
$0.65
|
| Rate for Payer: Blue Shield of California Commercial |
$0.80
|
| Rate for Payer: Blue Shield of California EPN |
$0.63
|
| Rate for Payer: Cash Price |
$0.49
|
| Rate for Payer: Cigna of CA HMO |
$0.76
|
| Rate for Payer: Cigna of CA PPO |
$0.76
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.92
|
| Rate for Payer: Dignity Health Media |
$0.92
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.92
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.43
|
| Rate for Payer: EPIC Health Plan Transplant |
$0.43
|
| Rate for Payer: Galaxy Health WC |
$0.92
|
| Rate for Payer: Global Benefits Group Commercial |
$0.65
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$0.81
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.72
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.41
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.26
|
| Rate for Payer: Multiplan Commercial |
$0.86
|
| Rate for Payer: Networks By Design Commercial |
$0.70
|
| Rate for Payer: Prime Health Services Commercial |
$0.92
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$0.65
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.65
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.65
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.54
|
| Rate for Payer: United Healthcare All Other HMO |
$0.54
|
| Rate for Payer: United Healthcare HMO Rider |
$0.54
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.54
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.92
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.92
|
| Rate for Payer: Vantage Medical Group Senior |
$0.92
|
|
|
SUCRALFATE 100 MG/ML ORAL SUSPENSION [11441]
|
Facility
OP
|
$1.08
|
|
|
Service Code
|
NDC 68094-043-59
|
| Hospital Charge Code |
1716079
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.26 |
| Max. Negotiated Rate |
$0.92 |
| Rate for Payer: Galaxy Health WC |
$0.92
|
| Rate for Payer: Aetna of CA HMO/PPO |
$0.71
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$0.92
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$0.59
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$0.59
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.64
|
| Rate for Payer: BCBS Transplant Transplant |
$0.65
|
| Rate for Payer: Blue Shield of California Commercial |
$0.80
|
| Rate for Payer: Blue Shield of California EPN |
$0.63
|
| Rate for Payer: Cash Price |
$0.49
|
| Rate for Payer: Cigna of CA HMO |
$0.76
|
| Rate for Payer: Cigna of CA PPO |
$0.76
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.92
|
| Rate for Payer: Dignity Health Media |
$0.92
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.92
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.43
|
| Rate for Payer: EPIC Health Plan Transplant |
$0.43
|
| Rate for Payer: Global Benefits Group Commercial |
$0.65
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$0.81
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.72
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.41
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.26
|
| Rate for Payer: Multiplan Commercial |
$0.86
|
| Rate for Payer: Networks By Design Commercial |
$0.70
|
| Rate for Payer: Prime Health Services Commercial |
$0.92
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$0.65
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.65
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.65
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.54
|
| Rate for Payer: United Healthcare All Other HMO |
$0.54
|
| Rate for Payer: United Healthcare HMO Rider |
$0.54
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.54
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.92
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.92
|
| Rate for Payer: Vantage Medical Group Senior |
$0.92
|
|
|
SUCRALFATE 100 MG/ML ORAL SUSPENSION [11441]
|
Facility
OP
|
$1.09
|
|
|
Service Code
|
NDC 68094-043-62
|
| Hospital Charge Code |
1716079
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.26 |
| Max. Negotiated Rate |
$0.93 |
| Rate for Payer: Aetna of CA HMO/PPO |
$0.71
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$0.93
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$0.60
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$0.60
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.65
|
| Rate for Payer: BCBS Transplant Transplant |
$0.65
|
| Rate for Payer: Blue Shield of California Commercial |
$0.80
|
| Rate for Payer: Blue Shield of California EPN |
$0.64
|
| Rate for Payer: Cash Price |
$0.49
|
| Rate for Payer: Cigna of CA HMO |
$0.76
|
| Rate for Payer: Cigna of CA PPO |
$0.76
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.93
|
| Rate for Payer: Dignity Health Media |
$0.93
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.93
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.44
|
| Rate for Payer: EPIC Health Plan Transplant |
$0.44
|
| Rate for Payer: Galaxy Health WC |
$0.93
|
| Rate for Payer: Global Benefits Group Commercial |
$0.65
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$0.82
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.73
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.42
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.26
|
| Rate for Payer: Multiplan Commercial |
$0.87
|
| Rate for Payer: Networks By Design Commercial |
$0.71
|
| Rate for Payer: Prime Health Services Commercial |
$0.93
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$0.65
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.65
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.65
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.55
|
| Rate for Payer: United Healthcare All Other HMO |
$0.55
|
| Rate for Payer: United Healthcare HMO Rider |
$0.55
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.55
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.93
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.93
|
| Rate for Payer: Vantage Medical Group Senior |
$0.93
|
|
|
SUCRALFATE 1 GRAM TABLET [11442]
|
Facility
IP
|
$0.32
|
|
|
Service Code
|
NDC 0093-2210-01
|
| Hospital Charge Code |
1712027
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.08 |
| Max. Negotiated Rate |
$0.27 |
| Rate for Payer: Blue Shield of California Commercial |
$0.23
|
| Rate for Payer: Blue Shield of California EPN |
$0.16
|
| Rate for Payer: Cash Price |
$0.14
|
| Rate for Payer: Cigna of CA HMO |
$0.22
|
| Rate for Payer: Cigna of CA PPO |
$0.22
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.13
|
| Rate for Payer: Galaxy Health WC |
$0.27
|
| Rate for Payer: Global Benefits Group Commercial |
$0.19
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.21
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.12
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.08
|
| Rate for Payer: Multiplan Commercial |
$0.26
|
| Rate for Payer: Networks By Design Commercial |
$0.21
|
| Rate for Payer: Prime Health Services Commercial |
$0.27
|
|
|
SUCRALFATE 1 GRAM TABLET [11442]
|
Facility
IP
|
$0.18
|
|
|
Service Code
|
NDC 59762-0401-5
|
| Hospital Charge Code |
1712027
|
|
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
|
|
|
SUCRALFATE 1 GRAM TABLET [11442]
|
Facility
IP
|
$0.19
|
|
|
Service Code
|
NDC 59762-0401-1
|
| Hospital Charge Code |
1712027
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.05 |
| Max. Negotiated Rate |
$0.16 |
| Rate for Payer: Blue Shield of California Commercial |
$0.14
|
| Rate for Payer: Blue Shield of California EPN |
$0.10
|
| Rate for Payer: Cash Price |
$0.09
|
| 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 |
$0.08
|
| Rate for Payer: Galaxy Health WC |
$0.16
|
| Rate for Payer: Global Benefits Group Commercial |
$0.11
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.13
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.07
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.05
|
| Rate for Payer: Multiplan Commercial |
$0.15
|
| Rate for Payer: Networks By Design Commercial |
$0.12
|
| Rate for Payer: Prime Health Services Commercial |
$0.16
|
|
