SULFACETAMIDE SODIUM 10 % EYE DROPS [7359]
|
Facility
OP
|
$3.90
|
|
Service Code
|
NDC 24208-670-04
|
Hospital Charge Code |
1740173
|
Hospital Revenue Code
|
259
|
Min. Negotiated Rate |
$0.94 |
Max. Negotiated Rate |
$3.32 |
Rate for Payer: Aetna of CA HMO/PPO |
$2.56
|
Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$3.32
|
Rate for Payer: AlphaCare Medical Group Medi-Cal |
$2.14
|
Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$2.14
|
Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2.32
|
Rate for Payer: BCBS Transplant Transplant |
$2.34
|
Rate for Payer: Blue Shield of California Commercial |
$2.87
|
Rate for Payer: Blue Shield of California EPN |
$2.28
|
Rate for Payer: Cash Price |
$1.76
|
Rate for Payer: Cigna of CA HMO |
$2.73
|
Rate for Payer: Cigna of CA PPO |
$2.73
|
Rate for Payer: Dignity Health Commercial/Exchange |
$3.32
|
Rate for Payer: Dignity Health Media |
$3.32
|
Rate for Payer: Dignity Health Medi-Cal |
$3.32
|
Rate for Payer: EPIC Health Plan Commercial |
$1.56
|
Rate for Payer: EPIC Health Plan Transplant |
$1.56
|
Rate for Payer: Galaxy Health WC |
$3.32
|
Rate for Payer: Global Benefits Group Commercial |
$2.34
|
Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$2.92
|
Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2.60
|
Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1.49
|
Rate for Payer: LLUH Dept of Risk Management WC |
$0.94
|
Rate for Payer: Multiplan Commercial |
$3.12
|
Rate for Payer: Networks By Design Commercial |
$2.54
|
Rate for Payer: Prime Health Services Commercial |
$3.32
|
Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$2.34
|
Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2.34
|
Rate for Payer: TriValley Medical Group Commercial/Senior |
$2.34
|
Rate for Payer: United Healthcare All Other Commercial |
$1.95
|
Rate for Payer: United Healthcare All Other HMO |
$1.95
|
Rate for Payer: United Healthcare HMO Rider |
$1.95
|
Rate for Payer: United Healthcare Select/Navigate/Core |
$1.95
|
Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3.32
|
Rate for Payer: Vantage Medical Group Medi-Cal |
$3.32
|
Rate for Payer: Vantage Medical Group Senior |
$3.32
|
|
SULFACETAMIDE SODIUM 10 % EYE DROPS [7359]
|
Facility
IP
|
$3.90
|
|
Service Code
|
NDC 24208-670-04
|
Hospital Charge Code |
1740173
|
Hospital Revenue Code
|
259
|
Min. Negotiated Rate |
$0.94 |
Max. Negotiated Rate |
$3.32 |
Rate for Payer: Blue Shield of California Commercial |
$2.78
|
Rate for Payer: Blue Shield of California EPN |
$2.00
|
Rate for Payer: Cash Price |
$1.76
|
Rate for Payer: Cigna of CA HMO |
$2.73
|
Rate for Payer: Cigna of CA PPO |
$2.73
|
Rate for Payer: EPIC Health Plan Commercial |
$1.56
|
Rate for Payer: Galaxy Health WC |
$3.32
|
Rate for Payer: Global Benefits Group Commercial |
$2.34
|
Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2.60
|
Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1.49
|
Rate for Payer: LLUH Dept of Risk Management WC |
$0.94
|
Rate for Payer: Multiplan Commercial |
$3.12
|
Rate for Payer: Networks By Design Commercial |
$2.54
|
Rate for Payer: Prime Health Services Commercial |
$3.32
|
|
SULFADIAZINE 500 MG TABLET [7554]
|
Facility
OP
|
$4.85
|
|
Service Code
|
NDC 0185-0757-01
|
Hospital Charge Code |
1710652
|
Hospital Revenue Code
|
259
|
Min. Negotiated Rate |
$1.16 |
Max. Negotiated Rate |
$4.12 |
Rate for Payer: Aetna of CA HMO/PPO |
$3.18
|
Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$4.12
|
Rate for Payer: AlphaCare Medical Group Medi-Cal |
$2.67
|
Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$2.67
|
Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2.89
|
Rate for Payer: BCBS Transplant Transplant |
$2.91
|
Rate for Payer: Blue Shield of California Commercial |
$3.57
|
Rate for Payer: Blue Shield of California EPN |
$2.83
|
Rate for Payer: Cash Price |
$2.18
|
Rate for Payer: Cigna of CA HMO |
$3.40
|
Rate for Payer: Cigna of CA PPO |
$3.40
|
Rate for Payer: Dignity Health Commercial/Exchange |
$4.12
|
Rate for Payer: Dignity Health Media |
$4.12
|
Rate for Payer: Dignity Health Medi-Cal |
$4.12
|
Rate for Payer: EPIC Health Plan Commercial |
$1.94
|
Rate for Payer: EPIC Health Plan Transplant |
$1.94
|
Rate for Payer: Galaxy Health WC |
$4.12
|
Rate for Payer: Global Benefits Group Commercial |
$2.91
|
Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$3.64
|
Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3.23
|
Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1.85
|
Rate for Payer: LLUH Dept of Risk Management WC |
$1.16
|
Rate for Payer: Multiplan Commercial |
$3.88
|
Rate for Payer: Networks By Design Commercial |
$3.15
|
Rate for Payer: Prime Health Services Commercial |
$4.12
|
Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$2.91
|
Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2.91
|
Rate for Payer: TriValley Medical Group Commercial/Senior |
$2.91
|
Rate for Payer: United Healthcare All Other Commercial |
$2.42
|
Rate for Payer: United Healthcare All Other HMO |
$2.42
|
Rate for Payer: United Healthcare HMO Rider |
$2.42
|
Rate for Payer: United Healthcare Select/Navigate/Core |
$2.42
|
Rate for Payer: Vantage Medical Group Commercial/Exchange |
$4.12
|
Rate for Payer: Vantage Medical Group Medi-Cal |
$4.12
|
Rate for Payer: Vantage Medical Group Senior |
$4.12
|
|
SULFADIAZINE 500 MG TABLET [7554]
|
Facility
IP
|
$4.85
|
|
Service Code
|
NDC 0185-0757-01
|
Hospital Charge Code |
1710652
|
Hospital Revenue Code
|
259
|
Min. Negotiated Rate |
$1.16 |
Max. Negotiated Rate |
$4.12 |
Rate for Payer: Blue Shield of California Commercial |
$3.45
|
Rate for Payer: Blue Shield of California EPN |
$2.48
|
Rate for Payer: Cash Price |
$2.18
|
Rate for Payer: Cigna of CA HMO |
$3.40
|
Rate for Payer: Cigna of CA PPO |
$3.40
|
Rate for Payer: EPIC Health Plan Commercial |
$1.94
|
Rate for Payer: Galaxy Health WC |
$4.12
|
Rate for Payer: Global Benefits Group Commercial |
$2.91
|
Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3.23
|
Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1.85
|
Rate for Payer: LLUH Dept of Risk Management WC |
$1.16
|
Rate for Payer: Multiplan Commercial |
$3.88
|
Rate for Payer: Networks By Design Commercial |
$3.15
|
Rate for Payer: Prime Health Services Commercial |
$4.12
|
|
SULFADIAZINE ORAL SUSPENSION COMPOUND 100 MG/ML [4080341]
|
Facility
IP
|
$0.72
|
|
Service Code
|
NDC 9994-0803-41
|
Hospital Charge Code |
1715994
|
Hospital Revenue Code
|
259
|
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 EPN |
$0.37
|
Rate for Payer: Cash Price |
$0.32
|
Rate for Payer: Cigna of CA HMO |
$0.50
|
Rate for Payer: Cigna of CA PPO |
$0.50
|
Rate for Payer: EPIC Health Plan Commercial |
$0.29
|
Rate for Payer: Galaxy Health WC |
$0.61
|
Rate for Payer: Global Benefits Group Commercial |
$0.43
|
Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.48
|
Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.27
|
Rate for Payer: LLUH Dept of Risk Management WC |
$0.17
|
Rate for Payer: Multiplan Commercial |
$0.58
|
Rate for Payer: Networks By Design Commercial |
$0.47
|
Rate for Payer: Prime Health Services Commercial |
$0.61
|
|
SULFADIAZINE ORAL SUSPENSION COMPOUND 100 MG/ML [4080341]
|
Facility
OP
|
$0.72
|
|
Service Code
|
NDC 9994-0803-41
|
Hospital Charge Code |
1715994
|
Hospital Revenue Code
|
259
|
Min. Negotiated Rate |
$0.17 |
Max. Negotiated Rate |
$0.61 |
Rate for Payer: Aetna of CA HMO/PPO |
$0.47
|
Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$0.61
|
Rate for Payer: AlphaCare Medical Group Medi-Cal |
$0.40
|
Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$0.40
|
Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.43
|
Rate for Payer: BCBS Transplant Transplant |
$0.43
|
Rate for Payer: Blue Shield of California Commercial |
$0.53
|
Rate for Payer: Blue Shield of California EPN |
$0.42
|
Rate for Payer: Cash Price |
$0.32
|
Rate for Payer: Cigna of CA HMO |
$0.50
|
Rate for Payer: Cigna of CA PPO |
$0.50
|
Rate for Payer: Dignity Health Commercial/Exchange |
$0.61
|
Rate for Payer: Dignity Health Media |
$0.61
|
Rate for Payer: Dignity Health Medi-Cal |
$0.61
|
Rate for Payer: EPIC Health Plan Commercial |
$0.29
|
Rate for Payer: EPIC Health Plan Transplant |
$0.29
|
Rate for Payer: Galaxy Health WC |
$0.61
|
Rate for Payer: Global Benefits Group Commercial |
$0.43
|
Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$0.54
|
Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.48
|
Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.27
|
Rate for Payer: LLUH Dept of Risk Management WC |
$0.17
|
Rate for Payer: Multiplan Commercial |
$0.58
|
Rate for Payer: Networks By Design Commercial |
$0.47
|
Rate for Payer: Prime Health Services Commercial |
$0.61
|
Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$0.43
|
Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.43
|
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 HMO |
$0.36
|
Rate for Payer: United Healthcare HMO Rider |
$0.36
|
Rate for Payer: United Healthcare Select/Navigate/Core |
$0.36
|
Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.61
|
Rate for Payer: Vantage Medical Group Medi-Cal |
$0.61
|
Rate for Payer: Vantage Medical Group Senior |
$0.61
|
|
SULFAMETHOXAZOLE 200 MG-TRIMETHOPRIM 40 MG/5 ML ORAL SUSPENSION [22560]
|
Facility
OP
|
$0.11
|
|
Service Code
|
NDC 65862-496-47
|
Hospital Charge Code |
NDG22560
|
Hospital Revenue Code
|
259
|
Min. Negotiated Rate |
$0.03 |
Max. Negotiated Rate |
$0.09 |
Rate for Payer: Aetna of CA HMO/PPO |
$0.07
|
Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$0.09
|
Rate for Payer: AlphaCare Medical Group Medi-Cal |
$0.06
|
Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$0.06
|
Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.07
|
Rate for Payer: BCBS Transplant Transplant |
$0.07
|
Rate for Payer: Blue Shield of California Commercial |
$0.08
|
Rate for Payer: Blue Shield of California EPN |
$0.06
|
Rate for Payer: Cash Price |
$0.05
|
Rate for Payer: Cigna of CA HMO |
$0.08
|
Rate for Payer: Cigna of CA PPO |
$0.08
|
Rate for Payer: Dignity Health Commercial/Exchange |
$0.09
|
Rate for Payer: Dignity Health Media |
$0.09
|
Rate for Payer: Dignity Health Medi-Cal |
$0.09
|
Rate for Payer: EPIC Health Plan Commercial |
$0.04
|
Rate for Payer: EPIC Health Plan Transplant |
$0.04
|
Rate for Payer: Galaxy Health WC |
$0.09
|
Rate for Payer: Global Benefits Group Commercial |
$0.07
|
Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$0.08
|
Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.07
|
Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.04
|
Rate for Payer: LLUH Dept of Risk Management WC |
$0.03
|
Rate for Payer: Multiplan Commercial |
$0.09
|
Rate for Payer: Networks By Design Commercial |
$0.07
|
Rate for Payer: Prime Health Services Commercial |
$0.09
|
Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$0.07
|
Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.07
|
Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.07
|
Rate for Payer: United Healthcare All Other Commercial |
$0.06
|
Rate for Payer: United Healthcare All Other HMO |
$0.06
|
Rate for Payer: United Healthcare HMO Rider |
$0.06
|
Rate for Payer: United Healthcare Select/Navigate/Core |
$0.06
|
Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.09
|
Rate for Payer: Vantage Medical Group Medi-Cal |
$0.09
|
Rate for Payer: Vantage Medical Group Senior |
$0.09
|
|
SULFAMETHOXAZOLE 200 MG-TRIMETHOPRIM 40 MG/5 ML ORAL SUSPENSION [22560]
|
Facility
IP
|
$0.10
|
|
Service Code
|
NDC 0121-0854-16
|
Hospital Charge Code |
NDG22560
|
Hospital Revenue Code
|
259
|
Min. Negotiated Rate |
$0.02 |
Max. Negotiated Rate |
$0.09 |
Rate for Payer: Blue Shield of California Commercial |
$0.07
|
Rate for Payer: Blue Shield of California EPN |
$0.05
|
Rate for Payer: Cash Price |
$0.05
|
Rate for Payer: Cigna of CA HMO |
$0.07
|
Rate for Payer: Cigna of CA PPO |
$0.07
|
Rate for Payer: EPIC Health Plan Commercial |
$0.04
|
Rate for Payer: Galaxy Health WC |
$0.09
|
Rate for Payer: Global Benefits Group Commercial |
$0.06
|
Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.07
|
Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.04
|
Rate for Payer: LLUH Dept of Risk Management WC |
$0.02
|
Rate for Payer: Multiplan Commercial |
$0.08
|
Rate for Payer: Networks By Design Commercial |
$0.07
|
Rate for Payer: Prime Health Services Commercial |
$0.09
|
|
SULFAMETHOXAZOLE 200 MG-TRIMETHOPRIM 40 MG/5 ML ORAL SUSPENSION [22560]
|
Facility
OP
|
$0.23
|
|
Service Code
|
NDC 50383-823-16
|
Hospital Charge Code |
NDG22560
|
Hospital Revenue Code
|
259
|
Min. Negotiated Rate |
$0.06 |
Max. Negotiated Rate |
$0.20 |
Rate for Payer: Aetna of CA HMO/PPO |
$0.15
|
Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$0.20
|
Rate for Payer: AlphaCare Medical Group Medi-Cal |
$0.13
|
Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$0.13
|
Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.14
|
Rate for Payer: BCBS Transplant Transplant |
$0.14
|
Rate for Payer: Blue Shield of California Commercial |
$0.17
|
Rate for Payer: Blue Shield of California EPN |
$0.13
|
Rate for Payer: Cash Price |
$0.10
|
Rate for Payer: Cigna of CA HMO |
$0.16
|
Rate for Payer: Cigna of CA PPO |
$0.16
|
Rate for Payer: Dignity Health Commercial/Exchange |
$0.20
|
Rate for Payer: Dignity Health Media |
$0.20
|
Rate for Payer: Dignity Health Medi-Cal |
$0.20
|
Rate for Payer: EPIC Health Plan Commercial |
$0.09
|
Rate for Payer: EPIC Health Plan Transplant |
$0.09
|
Rate for Payer: Galaxy Health WC |
$0.20
|
Rate for Payer: Global Benefits Group Commercial |
$0.14
|
Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$0.17
|
Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.15
|
Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.09
|
Rate for Payer: LLUH Dept of Risk Management WC |
$0.06
|
Rate for Payer: Multiplan Commercial |
$0.18
|
Rate for Payer: Networks By Design Commercial |
$0.15
|
Rate for Payer: Prime Health Services Commercial |
$0.20
|
Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$0.14
|
Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.14
|
Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.14
|
Rate for Payer: United Healthcare All Other Commercial |
$0.12
|
Rate for Payer: United Healthcare All Other HMO |
$0.12
|
Rate for Payer: United Healthcare HMO Rider |
$0.12
|
Rate for Payer: United Healthcare Select/Navigate/Core |
$0.12
|
Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.20
|
Rate for Payer: Vantage Medical Group Medi-Cal |
$0.20
|
Rate for Payer: Vantage Medical Group Senior |
$0.20
|
|
SULFAMETHOXAZOLE 200 MG-TRIMETHOPRIM 40 MG/5 ML ORAL SUSPENSION [22560]
|
Facility
OP
|
$0.10
|
|
Service Code
|
NDC 0121-0854-16
|
Hospital Charge Code |
NDG22560
|
Hospital Revenue Code
|
259
|
Min. Negotiated Rate |
$0.02 |
Max. Negotiated Rate |
$0.09 |
Rate for Payer: Aetna of CA HMO/PPO |
$0.07
|
Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$0.09
|
Rate for Payer: AlphaCare Medical Group Medi-Cal |
$0.06
|
Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$0.06
|
Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.06
|
Rate for Payer: BCBS Transplant Transplant |
$0.06
|
Rate for Payer: Blue Shield of California Commercial |
$0.07
|
Rate for Payer: Blue Shield of California EPN |
$0.06
|
Rate for Payer: Cash Price |
$0.05
|
Rate for Payer: Cigna of CA HMO |
$0.07
|
Rate for Payer: Cigna of CA PPO |
$0.07
|
Rate for Payer: Dignity Health Commercial/Exchange |
$0.09
|
Rate for Payer: Dignity Health Media |
$0.09
|
Rate for Payer: Dignity Health Medi-Cal |
$0.09
|
Rate for Payer: EPIC Health Plan Commercial |
$0.04
|
Rate for Payer: EPIC Health Plan Transplant |
$0.04
|
Rate for Payer: Galaxy Health WC |
$0.09
|
Rate for Payer: Global Benefits Group Commercial |
$0.06
|
Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$0.08
|
Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.07
|
Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.04
|
Rate for Payer: LLUH Dept of Risk Management WC |
$0.02
|
Rate for Payer: Multiplan Commercial |
$0.08
|
Rate for Payer: Networks By Design Commercial |
$0.07
|
Rate for Payer: Prime Health Services Commercial |
$0.09
|
Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$0.06
|
Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.06
|
Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.06
|
Rate for Payer: United Healthcare All Other Commercial |
$0.05
|
Rate for Payer: United Healthcare All Other HMO |
$0.05
|
Rate for Payer: United Healthcare HMO Rider |
$0.05
|
Rate for Payer: United Healthcare Select/Navigate/Core |
$0.05
|
Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.09
|
Rate for Payer: Vantage Medical Group Medi-Cal |
$0.09
|
Rate for Payer: Vantage Medical Group Senior |
$0.09
|
|
SULFAMETHOXAZOLE 200 MG-TRIMETHOPRIM 40 MG/5 ML ORAL SUSPENSION [22560]
|
Facility
IP
|
$0.23
|
|
Service Code
|
NDC 50383-823-16
|
Hospital Charge Code |
NDG22560
|
Hospital Revenue Code
|
259
|
Min. Negotiated Rate |
$0.06 |
Max. Negotiated Rate |
$0.20 |
Rate for Payer: Blue Shield of California Commercial |
$0.16
|
Rate for Payer: Blue Shield of California EPN |
$0.12
|
Rate for Payer: Cash Price |
$0.10
|
Rate for Payer: Cigna of CA HMO |
$0.16
|
Rate for Payer: Cigna of CA PPO |
$0.16
|
Rate for Payer: EPIC Health Plan Commercial |
$0.09
|
Rate for Payer: Galaxy Health WC |
$0.20
|
Rate for Payer: Global Benefits Group Commercial |
$0.14
|
Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.15
|
Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.09
|
Rate for Payer: LLUH Dept of Risk Management WC |
$0.06
|
Rate for Payer: Multiplan Commercial |
$0.18
|
Rate for Payer: Networks By Design Commercial |
$0.15
|
Rate for Payer: Prime Health Services Commercial |
$0.20
|
|
SULFAMETHOXAZOLE 200 MG-TRIMETHOPRIM 40 MG/5 ML ORAL SUSPENSION [22560]
|
Facility
IP
|
$0.11
|
|
Service Code
|
NDC 65862-496-47
|
Hospital Charge Code |
NDG22560
|
Hospital Revenue Code
|
259
|
Min. Negotiated Rate |
$0.03 |
Max. Negotiated Rate |
$0.09 |
Rate for Payer: Blue Shield of California Commercial |
$0.08
|
Rate for Payer: Blue Shield of California EPN |
$0.06
|
Rate for Payer: Cash Price |
$0.05
|
Rate for Payer: Cigna of CA HMO |
$0.08
|
Rate for Payer: Cigna of CA PPO |
$0.08
|
Rate for Payer: EPIC Health Plan Commercial |
$0.04
|
Rate for Payer: Galaxy Health WC |
$0.09
|
Rate for Payer: Global Benefits Group Commercial |
$0.07
|
Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.07
|
Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.04
|
Rate for Payer: LLUH Dept of Risk Management WC |
$0.03
|
Rate for Payer: Multiplan Commercial |
$0.09
|
Rate for Payer: Networks By Design Commercial |
$0.07
|
Rate for Payer: Prime Health Services Commercial |
$0.09
|
|
SULFAMETHOXAZOLE 400 MG-TRIMETHOPRIM 80 MG/5 ML INTRAVENOUS SOLUTION [7556]
|
Facility
IP
|
$1.46
|
|
Service Code
|
NDC 70069-362-01
|
Hospital Charge Code |
NDG7556
|
Hospital Revenue Code
|
250
|
Min. Negotiated Rate |
$0.35 |
Max. Negotiated Rate |
$1.24 |
Rate for Payer: Blue Shield of California Commercial |
$1.04
|
Rate for Payer: Blue Shield of California EPN |
$0.75
|
Rate for Payer: Cash Price |
$0.66
|
Rate for Payer: EPIC Health Plan Commercial |
$0.58
|
Rate for Payer: Galaxy Health WC |
$1.24
|
Rate for Payer: Global Benefits Group Commercial |
$0.88
|
Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.97
|
Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.56
|
Rate for Payer: LLUH Dept of Risk Management WC |
$0.35
|
Rate for Payer: Multiplan Commercial |
$1.17
|
Rate for Payer: Networks By Design Commercial |
$0.95
|
Rate for Payer: Prime Health Services Commercial |
$1.24
|
|
SULFAMETHOXAZOLE 400 MG-TRIMETHOPRIM 80 MG/5 ML INTRAVENOUS SOLUTION [7556]
|
Facility
OP
|
$1.46
|
|
Service Code
|
NDC 70069-362-10
|
Hospital Charge Code |
NDG7556
|
Hospital Revenue Code
|
250
|
Min. Negotiated Rate |
$0.35 |
Max. Negotiated Rate |
$1.24 |
Rate for Payer: Aetna of CA HMO/PPO |
$0.96
|
Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$1.24
|
Rate for Payer: AlphaCare Medical Group Medi-Cal |
$0.80
|
Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$0.80
|
Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.87
|
Rate for Payer: BCBS Transplant Transplant |
$0.88
|
Rate for Payer: Blue Shield of California Commercial |
$1.08
|
Rate for Payer: Blue Shield of California EPN |
$0.85
|
Rate for Payer: Cash Price |
$0.66
|
Rate for Payer: Cash Price |
$0.66
|
Rate for Payer: Cigna of CA HMO |
$0.93
|
Rate for Payer: Cigna of CA PPO |
$1.08
|
Rate for Payer: Dignity Health Commercial/Exchange |
$1.24
|
Rate for Payer: Dignity Health Media |
$1.24
|
Rate for Payer: Dignity Health Medi-Cal |
$1.24
|
Rate for Payer: EPIC Health Plan Commercial |
$0.58
|
Rate for Payer: EPIC Health Plan Transplant |
$0.58
|
Rate for Payer: Galaxy Health WC |
$1.24
|
Rate for Payer: Global Benefits Group Commercial |
$0.88
|
Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$1.10
|
Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.97
|
Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.56
|
Rate for Payer: LLUH Dept of Risk Management WC |
$0.35
|
Rate for Payer: Multiplan Commercial |
$1.17
|
Rate for Payer: Networks By Design Commercial |
$0.95
|
Rate for Payer: Prime Health Services Commercial |
$1.24
|
Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.88
|
Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.88
|
Rate for Payer: United Healthcare All Other Commercial |
$0.73
|
Rate for Payer: United Healthcare All Other HMO |
$0.73
|
Rate for Payer: United Healthcare HMO Rider |
$0.73
|
Rate for Payer: United Healthcare Select/Navigate/Core |
$0.73
|
Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1.24
|
Rate for Payer: Vantage Medical Group Medi-Cal |
$1.24
|
Rate for Payer: Vantage Medical Group Senior |
$1.24
|
|
SULFAMETHOXAZOLE 400 MG-TRIMETHOPRIM 80 MG/5 ML INTRAVENOUS SOLUTION [7556]
|
Facility
IP
|
$1.46
|
|
Service Code
|
NDC 70069-362-10
|
Hospital Charge Code |
NDG7556
|
Hospital Revenue Code
|
250
|
Min. Negotiated Rate |
$0.35 |
Max. Negotiated Rate |
$1.24 |
Rate for Payer: Blue Shield of California Commercial |
$1.04
|
Rate for Payer: Blue Shield of California EPN |
$0.75
|
Rate for Payer: Cash Price |
$0.66
|
Rate for Payer: EPIC Health Plan Commercial |
$0.58
|
Rate for Payer: Galaxy Health WC |
$1.24
|
Rate for Payer: Global Benefits Group Commercial |
$0.88
|
Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.97
|
Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.56
|
Rate for Payer: LLUH Dept of Risk Management WC |
$0.35
|
Rate for Payer: Multiplan Commercial |
$1.17
|
Rate for Payer: Networks By Design Commercial |
$0.95
|
Rate for Payer: Prime Health Services Commercial |
$1.24
|
|
SULFAMETHOXAZOLE 400 MG-TRIMETHOPRIM 80 MG/5 ML INTRAVENOUS SOLUTION [7556]
|
Facility
OP
|
$1.46
|
|
Service Code
|
NDC 70069-362-01
|
Hospital Charge Code |
NDG7556
|
Hospital Revenue Code
|
250
|
Min. Negotiated Rate |
$0.35 |
Max. Negotiated Rate |
$1.24 |
Rate for Payer: Aetna of CA HMO/PPO |
$0.96
|
Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$1.24
|
Rate for Payer: AlphaCare Medical Group Medi-Cal |
$0.80
|
Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$0.80
|
Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.87
|
Rate for Payer: BCBS Transplant Transplant |
$0.88
|
Rate for Payer: Blue Shield of California Commercial |
$1.08
|
Rate for Payer: Blue Shield of California EPN |
$0.85
|
Rate for Payer: Cash Price |
$0.66
|
Rate for Payer: Cash Price |
$0.66
|
Rate for Payer: Cigna of CA HMO |
$0.93
|
Rate for Payer: Cigna of CA PPO |
$1.08
|
Rate for Payer: Dignity Health Commercial/Exchange |
$1.24
|
Rate for Payer: Dignity Health Media |
$1.24
|
Rate for Payer: Dignity Health Medi-Cal |
$1.24
|
Rate for Payer: EPIC Health Plan Commercial |
$0.58
|
Rate for Payer: EPIC Health Plan Transplant |
$0.58
|
Rate for Payer: Galaxy Health WC |
$1.24
|
Rate for Payer: Global Benefits Group Commercial |
$0.88
|
Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$1.10
|
Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.97
|
Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.56
|
Rate for Payer: LLUH Dept of Risk Management WC |
$0.35
|
Rate for Payer: Multiplan Commercial |
$1.17
|
Rate for Payer: Networks By Design Commercial |
$0.95
|
Rate for Payer: Prime Health Services Commercial |
$1.24
|
Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.88
|
Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.88
|
Rate for Payer: United Healthcare All Other Commercial |
$0.73
|
Rate for Payer: United Healthcare All Other HMO |
$0.73
|
Rate for Payer: United Healthcare HMO Rider |
$0.73
|
Rate for Payer: United Healthcare Select/Navigate/Core |
$0.73
|
Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1.24
|
Rate for Payer: Vantage Medical Group Medi-Cal |
$1.24
|
Rate for Payer: Vantage Medical Group Senior |
$1.24
|
|
SULFAMETHOXAZOLE 400 MG-TRIMETHOPRIM 80 MG TABLET [7557]
|
Facility
OP
|
$0.36
|
|
Service Code
|
NDC 50268-728-11
|
Hospital Charge Code |
1710651
|
Hospital Revenue Code
|
259
|
Min. Negotiated Rate |
$0.09 |
Max. Negotiated Rate |
$0.31 |
Rate for Payer: Aetna of CA HMO/PPO |
$0.24
|
Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$0.31
|
Rate for Payer: AlphaCare Medical Group Medi-Cal |
$0.20
|
Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$0.20
|
Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.21
|
Rate for Payer: BCBS Transplant Transplant |
$0.22
|
Rate for Payer: Blue Shield of California Commercial |
$0.27
|
Rate for Payer: Blue Shield of California EPN |
$0.21
|
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 |
$0.31
|
Rate for Payer: Dignity Health Media |
$0.31
|
Rate for Payer: Dignity Health Medi-Cal |
$0.31
|
Rate for Payer: EPIC Health Plan Commercial |
$0.14
|
Rate for Payer: EPIC Health Plan Transplant |
$0.14
|
Rate for Payer: Galaxy Health WC |
$0.31
|
Rate for Payer: Global Benefits Group Commercial |
$0.22
|
Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$0.27
|
Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.24
|
Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.14
|
Rate for Payer: LLUH Dept of Risk Management WC |
$0.09
|
Rate for Payer: Multiplan Commercial |
$0.29
|
Rate for Payer: Networks By Design Commercial |
$0.23
|
Rate for Payer: Prime Health Services Commercial |
$0.31
|
Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$0.22
|
Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.22
|
Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.22
|
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 |
$0.31
|
Rate for Payer: Vantage Medical Group Medi-Cal |
$0.31
|
Rate for Payer: Vantage Medical Group Senior |
$0.31
|
|
SULFAMETHOXAZOLE 400 MG-TRIMETHOPRIM 80 MG TABLET [7557]
|
Facility
IP
|
$0.37
|
|
Service Code
|
NDC 60687-603-65
|
Hospital Charge Code |
1710651
|
Hospital Revenue Code
|
259
|
Min. Negotiated Rate |
$0.09 |
Max. Negotiated Rate |
$0.31 |
Rate for Payer: Blue Shield of California Commercial |
$0.26
|
Rate for Payer: Blue Shield of California EPN |
$0.19
|
Rate for Payer: Cash Price |
$0.17
|
Rate for Payer: Cigna of CA HMO |
$0.26
|
Rate for Payer: Cigna of CA PPO |
$0.26
|
Rate for Payer: EPIC Health Plan Commercial |
$0.15
|
Rate for Payer: Galaxy Health WC |
$0.31
|
Rate for Payer: Global Benefits Group Commercial |
$0.22
|
Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.25
|
Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.14
|
Rate for Payer: LLUH Dept of Risk Management WC |
$0.09
|
Rate for Payer: Multiplan Commercial |
$0.30
|
Rate for Payer: Networks By Design Commercial |
$0.24
|
Rate for Payer: Prime Health Services Commercial |
$0.31
|
|
SULFAMETHOXAZOLE 400 MG-TRIMETHOPRIM 80 MG TABLET [7557]
|
Facility
IP
|
$0.37
|
|
Service Code
|
NDC 60687-603-11
|
Hospital Charge Code |
1710651
|
Hospital Revenue Code
|
259
|
Min. Negotiated Rate |
$0.09 |
Max. Negotiated Rate |
$0.31 |
Rate for Payer: Blue Shield of California Commercial |
$0.26
|
Rate for Payer: Blue Shield of California EPN |
$0.19
|
Rate for Payer: Cash Price |
$0.17
|
Rate for Payer: Cigna of CA HMO |
$0.26
|
Rate for Payer: Cigna of CA PPO |
$0.26
|
Rate for Payer: EPIC Health Plan Commercial |
$0.15
|
Rate for Payer: Galaxy Health WC |
$0.31
|
Rate for Payer: Global Benefits Group Commercial |
$0.22
|
Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.25
|
Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.14
|
Rate for Payer: LLUH Dept of Risk Management WC |
$0.09
|
Rate for Payer: Multiplan Commercial |
$0.30
|
Rate for Payer: Networks By Design Commercial |
$0.24
|
Rate for Payer: Prime Health Services Commercial |
$0.31
|
|
SULFAMETHOXAZOLE 400 MG-TRIMETHOPRIM 80 MG TABLET [7557]
|
Facility
IP
|
$0.36
|
|
Service Code
|
NDC 50268-728-11
|
Hospital Charge Code |
1710651
|
Hospital Revenue Code
|
259
|
Min. Negotiated Rate |
$0.09 |
Max. Negotiated Rate |
$0.31 |
Rate for Payer: Blue Shield of California Commercial |
$0.26
|
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 |
$0.31
|
Rate for Payer: Global Benefits Group Commercial |
$0.22
|
Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.24
|
Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.14
|
Rate for Payer: LLUH Dept of Risk Management WC |
$0.09
|
Rate for Payer: Multiplan Commercial |
$0.29
|
Rate for Payer: Networks By Design Commercial |
$0.23
|
Rate for Payer: Prime Health Services Commercial |
$0.31
|
|
SULFAMETHOXAZOLE 400 MG-TRIMETHOPRIM 80 MG TABLET [7557]
|
Facility
OP
|
$0.37
|
|
Service Code
|
NDC 60687-603-65
|
Hospital Charge Code |
1710651
|
Hospital Revenue Code
|
259
|
Min. Negotiated Rate |
$0.09 |
Max. Negotiated Rate |
$0.31 |
Rate for Payer: Aetna of CA HMO/PPO |
$0.24
|
Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$0.31
|
Rate for Payer: AlphaCare Medical Group Medi-Cal |
$0.20
|
Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$0.20
|
Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.22
|
Rate for Payer: BCBS Transplant Transplant |
$0.22
|
Rate for Payer: Blue Shield of California Commercial |
$0.27
|
Rate for Payer: Blue Shield of California EPN |
$0.22
|
Rate for Payer: Cash Price |
$0.17
|
Rate for Payer: Cigna of CA HMO |
$0.26
|
Rate for Payer: Cigna of CA PPO |
$0.26
|
Rate for Payer: Dignity Health Commercial/Exchange |
$0.31
|
Rate for Payer: Dignity Health Media |
$0.31
|
Rate for Payer: Dignity Health Medi-Cal |
$0.31
|
Rate for Payer: EPIC Health Plan Commercial |
$0.15
|
Rate for Payer: EPIC Health Plan Transplant |
$0.15
|
Rate for Payer: Galaxy Health WC |
$0.31
|
Rate for Payer: Global Benefits Group Commercial |
$0.22
|
Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$0.28
|
Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.25
|
Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.14
|
Rate for Payer: LLUH Dept of Risk Management WC |
$0.09
|
Rate for Payer: Multiplan Commercial |
$0.30
|
Rate for Payer: Networks By Design Commercial |
$0.24
|
Rate for Payer: Prime Health Services Commercial |
$0.31
|
Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$0.22
|
Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.22
|
Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.22
|
Rate for Payer: United Healthcare All Other Commercial |
$0.19
|
Rate for Payer: United Healthcare All Other HMO |
$0.19
|
Rate for Payer: United Healthcare HMO Rider |
$0.19
|
Rate for Payer: United Healthcare Select/Navigate/Core |
$0.19
|
Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.31
|
Rate for Payer: Vantage Medical Group Medi-Cal |
$0.31
|
Rate for Payer: Vantage Medical Group Senior |
$0.31
|
|
SULFAMETHOXAZOLE 400 MG-TRIMETHOPRIM 80 MG TABLET [7557]
|
Facility
IP
|
$0.36
|
|
Service Code
|
NDC 50268-728-15
|
Hospital Charge Code |
1710651
|
Hospital Revenue Code
|
259
|
Min. Negotiated Rate |
$0.09 |
Max. Negotiated Rate |
$0.31 |
Rate for Payer: Blue Shield of California Commercial |
$0.26
|
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 |
$0.31
|
Rate for Payer: Global Benefits Group Commercial |
$0.22
|
Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.24
|
Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.14
|
Rate for Payer: LLUH Dept of Risk Management WC |
$0.09
|
Rate for Payer: Multiplan Commercial |
$0.29
|
Rate for Payer: Networks By Design Commercial |
$0.23
|
Rate for Payer: Prime Health Services Commercial |
$0.31
|
|
SULFAMETHOXAZOLE 400 MG-TRIMETHOPRIM 80 MG TABLET [7557]
|
Facility
IP
|
$0.07
|
|
Service Code
|
NDC 65862-419-01
|
Hospital Charge Code |
1710651
|
Hospital Revenue Code
|
259
|
Min. Negotiated Rate |
$0.02 |
Max. Negotiated Rate |
$0.06 |
Rate for Payer: Blue Shield of California Commercial |
$0.05
|
Rate for Payer: Blue Shield of California EPN |
$0.04
|
Rate for Payer: Cash Price |
$0.03
|
Rate for Payer: Cigna of CA HMO |
$0.05
|
Rate for Payer: Cigna of CA PPO |
$0.05
|
Rate for Payer: EPIC Health Plan Commercial |
$0.03
|
Rate for Payer: Galaxy Health WC |
$0.06
|
Rate for Payer: Global Benefits Group Commercial |
$0.04
|
Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.05
|
Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.03
|
Rate for Payer: LLUH Dept of Risk Management WC |
$0.02
|
Rate for Payer: Multiplan Commercial |
$0.06
|
Rate for Payer: Networks By Design Commercial |
$0.05
|
Rate for Payer: Prime Health Services Commercial |
$0.06
|
|
SULFAMETHOXAZOLE 400 MG-TRIMETHOPRIM 80 MG TABLET [7557]
|
Facility
OP
|
$0.36
|
|
Service Code
|
NDC 50268-728-15
|
Hospital Charge Code |
1710651
|
Hospital Revenue Code
|
259
|
Min. Negotiated Rate |
$0.09 |
Max. Negotiated Rate |
$0.31 |
Rate for Payer: Aetna of CA HMO/PPO |
$0.24
|
Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$0.31
|
Rate for Payer: AlphaCare Medical Group Medi-Cal |
$0.20
|
Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$0.20
|
Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.21
|
Rate for Payer: BCBS Transplant Transplant |
$0.22
|
Rate for Payer: Blue Shield of California Commercial |
$0.27
|
Rate for Payer: Blue Shield of California EPN |
$0.21
|
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 |
$0.31
|
Rate for Payer: Dignity Health Media |
$0.31
|
Rate for Payer: Dignity Health Medi-Cal |
$0.31
|
Rate for Payer: EPIC Health Plan Commercial |
$0.14
|
Rate for Payer: EPIC Health Plan Transplant |
$0.14
|
Rate for Payer: Galaxy Health WC |
$0.31
|
Rate for Payer: Global Benefits Group Commercial |
$0.22
|
Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$0.27
|
Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.24
|
Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.14
|
Rate for Payer: LLUH Dept of Risk Management WC |
$0.09
|
Rate for Payer: Multiplan Commercial |
$0.29
|
Rate for Payer: Networks By Design Commercial |
$0.23
|
Rate for Payer: Prime Health Services Commercial |
$0.31
|
Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$0.22
|
Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.22
|
Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.22
|
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 |
$0.31
|
Rate for Payer: Vantage Medical Group Medi-Cal |
$0.31
|
Rate for Payer: Vantage Medical Group Senior |
$0.31
|
|
SULFAMETHOXAZOLE 400 MG-TRIMETHOPRIM 80 MG TABLET [7557]
|
Facility
OP
|
$0.37
|
|
Service Code
|
NDC 60687-603-11
|
Hospital Charge Code |
1710651
|
Hospital Revenue Code
|
259
|
Min. Negotiated Rate |
$0.09 |
Max. Negotiated Rate |
$0.31 |
Rate for Payer: Vantage Medical Group Medi-Cal |
$0.31
|
Rate for Payer: Vantage Medical Group Senior |
$0.31
|
Rate for Payer: Aetna of CA HMO/PPO |
$0.24
|
Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$0.31
|
Rate for Payer: AlphaCare Medical Group Medi-Cal |
$0.20
|
Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$0.20
|
Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.22
|
Rate for Payer: BCBS Transplant Transplant |
$0.22
|
Rate for Payer: Blue Shield of California Commercial |
$0.27
|
Rate for Payer: Blue Shield of California EPN |
$0.22
|
Rate for Payer: Cash Price |
$0.17
|
Rate for Payer: Cigna of CA HMO |
$0.26
|
Rate for Payer: Cigna of CA PPO |
$0.26
|
Rate for Payer: Dignity Health Commercial/Exchange |
$0.31
|
Rate for Payer: Dignity Health Media |
$0.31
|
Rate for Payer: Dignity Health Medi-Cal |
$0.31
|
Rate for Payer: EPIC Health Plan Commercial |
$0.15
|
Rate for Payer: EPIC Health Plan Transplant |
$0.15
|
Rate for Payer: Galaxy Health WC |
$0.31
|
Rate for Payer: Global Benefits Group Commercial |
$0.22
|
Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$0.28
|
Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.25
|
Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.14
|
Rate for Payer: LLUH Dept of Risk Management WC |
$0.09
|
Rate for Payer: Multiplan Commercial |
$0.30
|
Rate for Payer: Networks By Design Commercial |
$0.24
|
Rate for Payer: Prime Health Services Commercial |
$0.31
|
Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$0.22
|
Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.22
|
Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.22
|
Rate for Payer: United Healthcare All Other Commercial |
$0.19
|
Rate for Payer: United Healthcare All Other HMO |
$0.19
|
Rate for Payer: United Healthcare HMO Rider |
$0.19
|
Rate for Payer: United Healthcare Select/Navigate/Core |
$0.19
|
Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.31
|
|