|
ACETIC ACID 2 % EAR SOLUTION [17801]
|
Facility
|
OP
|
$2.24
|
|
|
Service Code
|
NDC 52817-816-15
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.45 |
| Max. Negotiated Rate |
$1.90 |
| Rate for Payer: Adventist Health Commercial |
$0.45
|
| Rate for Payer: Aetna of CA HMO/PPO |
$1.47
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1.90
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1.23
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1.68
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1.38
|
| Rate for Payer: Cash Price |
$1.23
|
| Rate for Payer: Cigna of CA HMO |
$1.57
|
| Rate for Payer: Cigna of CA PPO |
$1.57
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1.90
|
| Rate for Payer: Dignity Health Medi-Cal |
$1.90
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.90
|
| Rate for Payer: EPIC Health Plan Senior |
$0.90
|
| Rate for Payer: Galaxy Health WC |
$1.90
|
| Rate for Payer: Global Benefits Group Commercial |
$1.34
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1.49
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.85
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1.39
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.54
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1.57
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1.57
|
| Rate for Payer: Multiplan Commercial |
$1.79
|
| Rate for Payer: Networks By Design Commercial |
$1.46
|
| Rate for Payer: Prime Health Services Commercial |
$1.90
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1.34
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1.34
|
| Rate for Payer: United Healthcare All Other Commercial |
$1.12
|
| Rate for Payer: United Healthcare All Other HMO |
$1.12
|
| Rate for Payer: United Healthcare HMO Rider |
$1.12
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1.12
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1.90
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1.90
|
| Rate for Payer: Vantage Medical Group Senior |
$1.90
|
|
|
ACETIC ACID 2 % EAR SOLUTION [17801]
|
Facility
|
IP
|
$2.24
|
|
|
Service Code
|
NDC 52817-816-15
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.45 |
| Max. Negotiated Rate |
$1.90 |
| Rate for Payer: Adventist Health Commercial |
$0.45
|
| Rate for Payer: Blue Shield of California Commercial |
$1.65
|
| Rate for Payer: Blue Shield of California EPN |
$1.09
|
| Rate for Payer: Cash Price |
$1.23
|
| Rate for Payer: Cigna of CA HMO |
$1.57
|
| Rate for Payer: Cigna of CA PPO |
$1.57
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.90
|
| Rate for Payer: EPIC Health Plan Senior |
$0.90
|
| Rate for Payer: Galaxy Health WC |
$1.90
|
| Rate for Payer: Global Benefits Group Commercial |
$1.34
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1.49
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.85
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1.39
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.54
|
| Rate for Payer: Multiplan Commercial |
$1.79
|
| Rate for Payer: Networks By Design Commercial |
$1.46
|
| Rate for Payer: Prime Health Services Commercial |
$1.90
|
|
|
ACETIC ACID (BULK) 3 % LIQUID [15091]
|
Facility
|
IP
|
$0.04
|
|
|
Service Code
|
NDC 5155200516
|
| Hospital Charge Code |
901700004
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.01 |
| Max. Negotiated Rate |
$0.03 |
| Rate for Payer: Adventist Health Commercial |
$0.01
|
| Rate for Payer: Blue Shield of California Commercial |
$0.03
|
| Rate for Payer: Blue Shield of California EPN |
$0.02
|
| Rate for Payer: Cash Price |
$0.02
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.02
|
| Rate for Payer: EPIC Health Plan Senior |
$0.02
|
| Rate for Payer: Galaxy Health WC |
$0.03
|
| Rate for Payer: Global Benefits Group Commercial |
$0.02
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.03
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.02
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$0.02
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.01
|
| Rate for Payer: Multiplan Commercial |
$0.03
|
| Rate for Payer: Networks By Design Commercial |
$0.03
|
| Rate for Payer: Prime Health Services Commercial |
$0.03
|
|
|
ACETIC ACID (BULK) 3 % LIQUID [15091]
|
Facility
|
OP
|
$0.04
|
|
|
Service Code
|
NDC 5155200516
|
| Hospital Charge Code |
901700004
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.01 |
| Max. Negotiated Rate |
$0.03 |
| Rate for Payer: Adventist Health Commercial |
$0.01
|
| Rate for Payer: Aetna of CA HMO/PPO |
$0.03
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.03
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.02
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.03
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.02
|
| Rate for Payer: Cash Price |
$0.02
|
| Rate for Payer: Cigna of CA HMO |
$0.03
|
| Rate for Payer: Cigna of CA PPO |
$0.03
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.03
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.03
|
| Rate for Payer: Dignity Health Medicare Advantage |
$0.03
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.02
|
| Rate for Payer: EPIC Health Plan Senior |
$0.02
|
| Rate for Payer: Galaxy Health WC |
$0.03
|
| Rate for Payer: Global Benefits Group Commercial |
$0.02
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.03
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.02
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$0.02
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.01
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$0.03
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$0.03
|
| Rate for Payer: Multiplan Commercial |
$0.03
|
| Rate for Payer: Networks By Design Commercial |
$0.03
|
| Rate for Payer: Prime Health Services Commercial |
$0.03
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.02
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.02
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.02
|
| Rate for Payer: United Healthcare All Other HMO |
$0.02
|
| Rate for Payer: United Healthcare HMO Rider |
$0.02
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.02
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.03
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.03
|
| Rate for Payer: Vantage Medical Group Senior |
$0.03
|
|
|
ACETYLCHOLINE CHLORIDE (10 MG/ML) BASE FOR IC MIXTURE [4088832559]
|
Facility
|
IP
|
$156.68
|
|
|
Service Code
|
NDC 24208-539-20
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$31.34 |
| Max. Negotiated Rate |
$133.18 |
| Rate for Payer: Adventist Health Commercial |
$31.34
|
| Rate for Payer: Blue Shield of California Commercial |
$115.63
|
| Rate for Payer: Blue Shield of California EPN |
$76.15
|
| Rate for Payer: Cash Price |
$86.18
|
| Rate for Payer: Cigna of CA HMO |
$109.68
|
| Rate for Payer: Cigna of CA PPO |
$109.68
|
| Rate for Payer: EPIC Health Plan Commercial |
$62.67
|
| Rate for Payer: EPIC Health Plan Senior |
$62.67
|
| Rate for Payer: Galaxy Health WC |
$133.18
|
| Rate for Payer: Global Benefits Group Commercial |
$94.01
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$104.51
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$59.70
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$96.98
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$37.60
|
| Rate for Payer: Multiplan Commercial |
$125.34
|
| Rate for Payer: Networks By Design Commercial |
$101.84
|
| Rate for Payer: Prime Health Services Commercial |
$133.18
|
|
|
ACETYLCHOLINE CHLORIDE (10 MG/ML) BASE FOR IC MIXTURE [4088832559]
|
Facility
|
OP
|
$156.68
|
|
|
Service Code
|
NDC 24208-539-20
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$31.34 |
| Max. Negotiated Rate |
$133.18 |
| Rate for Payer: Adventist Health Commercial |
$31.34
|
| Rate for Payer: Aetna of CA HMO/PPO |
$102.77
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$133.18
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$86.17
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$117.51
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$96.22
|
| Rate for Payer: Cash Price |
$86.18
|
| Rate for Payer: Cigna of CA HMO |
$109.68
|
| Rate for Payer: Cigna of CA PPO |
$109.68
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$133.18
|
| Rate for Payer: Dignity Health Medi-Cal |
$133.18
|
| Rate for Payer: Dignity Health Medicare Advantage |
$133.18
|
| Rate for Payer: EPIC Health Plan Commercial |
$62.67
|
| Rate for Payer: EPIC Health Plan Senior |
$62.67
|
| Rate for Payer: Galaxy Health WC |
$133.18
|
| Rate for Payer: Global Benefits Group Commercial |
$94.01
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$104.51
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$59.70
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$96.98
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$37.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$109.68
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$109.68
|
| Rate for Payer: Multiplan Commercial |
$125.34
|
| Rate for Payer: Networks By Design Commercial |
$101.84
|
| Rate for Payer: Prime Health Services Commercial |
$133.18
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$94.01
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$94.01
|
| Rate for Payer: United Healthcare All Other Commercial |
$78.34
|
| Rate for Payer: United Healthcare All Other HMO |
$78.34
|
| Rate for Payer: United Healthcare HMO Rider |
$78.34
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$78.34
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$133.18
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$133.18
|
| Rate for Payer: Vantage Medical Group Senior |
$133.18
|
|
|
ACETYLCHOLINE CHLORIDE 1 % (10 MG/ML) INTRAOCULAR KIT [32559]
|
Facility
|
IP
|
$156.68
|
|
|
Service Code
|
NDC 24208-539-20
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$31.34 |
| Max. Negotiated Rate |
$133.18 |
| Rate for Payer: Adventist Health Commercial |
$31.34
|
| Rate for Payer: Blue Shield of California Commercial |
$115.63
|
| Rate for Payer: Blue Shield of California EPN |
$76.15
|
| Rate for Payer: Cash Price |
$86.18
|
| Rate for Payer: Cigna of CA HMO |
$109.68
|
| Rate for Payer: Cigna of CA PPO |
$109.68
|
| Rate for Payer: EPIC Health Plan Commercial |
$62.67
|
| Rate for Payer: EPIC Health Plan Senior |
$62.67
|
| Rate for Payer: Galaxy Health WC |
$133.18
|
| Rate for Payer: Global Benefits Group Commercial |
$94.01
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$104.51
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$59.70
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$96.98
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$37.60
|
| Rate for Payer: Multiplan Commercial |
$125.34
|
| Rate for Payer: Networks By Design Commercial |
$101.84
|
| Rate for Payer: Prime Health Services Commercial |
$133.18
|
|
|
ACETYLCHOLINE CHLORIDE 1 % (10 MG/ML) INTRAOCULAR KIT [32559]
|
Facility
|
OP
|
$156.68
|
|
|
Service Code
|
NDC 24208-539-20
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$31.34 |
| Max. Negotiated Rate |
$133.18 |
| Rate for Payer: Cigna of CA PPO |
$109.68
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$133.18
|
| Rate for Payer: Dignity Health Medi-Cal |
$133.18
|
| Rate for Payer: Dignity Health Medicare Advantage |
$133.18
|
| Rate for Payer: EPIC Health Plan Commercial |
$62.67
|
| Rate for Payer: EPIC Health Plan Senior |
$62.67
|
| Rate for Payer: Galaxy Health WC |
$133.18
|
| Rate for Payer: Global Benefits Group Commercial |
$94.01
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$104.51
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$59.70
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$96.98
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$37.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$109.68
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$109.68
|
| Rate for Payer: Multiplan Commercial |
$125.34
|
| Rate for Payer: Networks By Design Commercial |
$101.84
|
| Rate for Payer: Prime Health Services Commercial |
$133.18
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$94.01
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$94.01
|
| Rate for Payer: United Healthcare All Other Commercial |
$78.34
|
| Rate for Payer: United Healthcare All Other HMO |
$78.34
|
| Rate for Payer: United Healthcare HMO Rider |
$78.34
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$78.34
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$133.18
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$133.18
|
| Rate for Payer: Vantage Medical Group Senior |
$133.18
|
| Rate for Payer: Cigna of CA HMO |
$109.68
|
| Rate for Payer: Adventist Health Commercial |
$31.34
|
| Rate for Payer: Aetna of CA HMO/PPO |
$102.77
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$133.18
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$86.17
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$117.51
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$96.22
|
| Rate for Payer: Cash Price |
$86.18
|
|
|
ACETYLCYSTEINE 100 MG/ML (10 %) SOLUTION [122]
|
Facility
|
OP
|
$3.83
|
|
|
Service Code
|
NDC 63323-695-22
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.77 |
| Max. Negotiated Rate |
$3.26 |
| Rate for Payer: Adventist Health Commercial |
$0.77
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2.51
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3.26
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2.11
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2.87
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2.35
|
| Rate for Payer: Cash Price |
$2.11
|
| Rate for Payer: Cigna of CA HMO |
$2.68
|
| Rate for Payer: Cigna of CA PPO |
$2.68
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3.26
|
| Rate for Payer: Dignity Health Medi-Cal |
$3.26
|
| Rate for Payer: Dignity Health Medicare Advantage |
$3.26
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.53
|
| Rate for Payer: EPIC Health Plan Senior |
$1.53
|
| Rate for Payer: Galaxy Health WC |
$3.26
|
| Rate for Payer: Global Benefits Group Commercial |
$2.30
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2.55
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1.46
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2.37
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.92
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2.68
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2.68
|
| Rate for Payer: Multiplan Commercial |
$3.06
|
| Rate for Payer: Networks By Design Commercial |
$2.49
|
| Rate for Payer: Prime Health Services Commercial |
$3.26
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2.30
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2.30
|
| Rate for Payer: United Healthcare All Other Commercial |
$1.92
|
| Rate for Payer: United Healthcare All Other HMO |
$1.92
|
| Rate for Payer: United Healthcare HMO Rider |
$1.92
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1.92
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3.26
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$3.26
|
| Rate for Payer: Vantage Medical Group Senior |
$3.26
|
|
|
ACETYLCYSTEINE 100 MG/ML (10 %) SOLUTION [122]
|
Facility
|
IP
|
$3.83
|
|
|
Service Code
|
NDC 63323-695-22
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.77 |
| Max. Negotiated Rate |
$3.26 |
| Rate for Payer: Adventist Health Commercial |
$0.77
|
| Rate for Payer: Blue Shield of California Commercial |
$2.83
|
| Rate for Payer: Blue Shield of California EPN |
$1.86
|
| Rate for Payer: Cash Price |
$2.11
|
| Rate for Payer: Cigna of CA HMO |
$2.68
|
| Rate for Payer: Cigna of CA PPO |
$2.68
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.53
|
| Rate for Payer: EPIC Health Plan Senior |
$1.53
|
| Rate for Payer: Galaxy Health WC |
$3.26
|
| Rate for Payer: Global Benefits Group Commercial |
$2.30
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2.55
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1.46
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2.37
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.92
|
| Rate for Payer: Multiplan Commercial |
$3.06
|
| Rate for Payer: Networks By Design Commercial |
$2.49
|
| Rate for Payer: Prime Health Services Commercial |
$3.26
|
|
|
ACETYLCYSTEINE 100 MG/ML (10 %) SOLUTION [122]
|
Facility
|
IP
|
$4.37
|
|
|
Service Code
|
NDC 63323-695-04
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.87 |
| Max. Negotiated Rate |
$3.71 |
| Rate for Payer: Adventist Health Commercial |
$0.87
|
| Rate for Payer: Blue Shield of California Commercial |
$3.23
|
| Rate for Payer: Blue Shield of California EPN |
$2.12
|
| Rate for Payer: Cash Price |
$2.40
|
| Rate for Payer: Cigna of CA HMO |
$3.06
|
| Rate for Payer: Cigna of CA PPO |
$3.06
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.75
|
| Rate for Payer: EPIC Health Plan Senior |
$1.75
|
| Rate for Payer: Galaxy Health WC |
$3.71
|
| Rate for Payer: Global Benefits Group Commercial |
$2.62
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2.91
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1.66
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2.71
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.05
|
| Rate for Payer: Multiplan Commercial |
$3.50
|
| Rate for Payer: Networks By Design Commercial |
$2.84
|
| Rate for Payer: Prime Health Services Commercial |
$3.71
|
|
|
ACETYLCYSTEINE 100 MG/ML (10 %) SOLUTION [122]
|
Facility
|
IP
|
$3.40
|
|
|
Service Code
|
NDC 0517-7504-25
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.68 |
| Max. Negotiated Rate |
$2.89 |
| Rate for Payer: Adventist Health Commercial |
$0.68
|
| Rate for Payer: Blue Shield of California Commercial |
$2.51
|
| Rate for Payer: Blue Shield of California EPN |
$1.65
|
| Rate for Payer: Cash Price |
$1.87
|
| Rate for Payer: Cigna of CA HMO |
$2.38
|
| Rate for Payer: Cigna of CA PPO |
$2.38
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.36
|
| Rate for Payer: EPIC Health Plan Senior |
$1.36
|
| Rate for Payer: Galaxy Health WC |
$2.89
|
| Rate for Payer: Global Benefits Group Commercial |
$2.04
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2.27
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1.30
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2.10
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.82
|
| Rate for Payer: Multiplan Commercial |
$2.72
|
| Rate for Payer: Networks By Design Commercial |
$2.21
|
| Rate for Payer: Prime Health Services Commercial |
$2.89
|
|
|
ACETYLCYSTEINE 100 MG/ML (10 %) SOLUTION [122]
|
Facility
|
OP
|
$3.40
|
|
|
Service Code
|
NDC 0517-7504-25
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.68 |
| Max. Negotiated Rate |
$2.89 |
| Rate for Payer: Adventist Health Commercial |
$0.68
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2.23
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2.89
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1.87
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2.55
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2.09
|
| Rate for Payer: Cash Price |
$1.87
|
| Rate for Payer: Cigna of CA HMO |
$2.38
|
| Rate for Payer: Cigna of CA PPO |
$2.38
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2.89
|
| Rate for Payer: Dignity Health Medi-Cal |
$2.89
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2.89
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.36
|
| Rate for Payer: EPIC Health Plan Senior |
$1.36
|
| Rate for Payer: Galaxy Health WC |
$2.89
|
| Rate for Payer: Global Benefits Group Commercial |
$2.04
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2.27
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1.30
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2.10
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.82
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2.38
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2.38
|
| Rate for Payer: Multiplan Commercial |
$2.72
|
| Rate for Payer: Networks By Design Commercial |
$2.21
|
| Rate for Payer: Prime Health Services Commercial |
$2.89
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2.04
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2.04
|
| Rate for Payer: United Healthcare All Other Commercial |
$1.70
|
| Rate for Payer: United Healthcare All Other HMO |
$1.70
|
| Rate for Payer: United Healthcare HMO Rider |
$1.70
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1.70
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2.89
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2.89
|
| Rate for Payer: Vantage Medical Group Senior |
$2.89
|
|
|
ACETYLCYSTEINE 100 MG/ML (10 %) SOLUTION [122]
|
Facility
|
OP
|
$0.80
|
|
|
Service Code
|
NDC 0409-3307-03
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.16 |
| Max. Negotiated Rate |
$0.68 |
| Rate for Payer: Adventist Health Commercial |
$0.16
|
| Rate for Payer: Aetna of CA HMO/PPO |
$0.52
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.68
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.44
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.60
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.49
|
| Rate for Payer: Cash Price |
$0.44
|
| Rate for Payer: Cigna of CA HMO |
$0.56
|
| Rate for Payer: Cigna of CA PPO |
$0.56
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.68
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.68
|
| Rate for Payer: Dignity Health Medicare Advantage |
$0.68
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.32
|
| Rate for Payer: EPIC Health Plan Senior |
$0.32
|
| Rate for Payer: Galaxy Health WC |
$0.68
|
| Rate for Payer: Global Benefits Group Commercial |
$0.48
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.53
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.30
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$0.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.19
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$0.56
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$0.56
|
| Rate for Payer: Multiplan Commercial |
$0.64
|
| Rate for Payer: Networks By Design Commercial |
$0.52
|
| Rate for Payer: Prime Health Services Commercial |
$0.68
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.48
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.48
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.40
|
| Rate for Payer: United Healthcare All Other HMO |
$0.40
|
| Rate for Payer: United Healthcare HMO Rider |
$0.40
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.40
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.68
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.68
|
| Rate for Payer: Vantage Medical Group Senior |
$0.68
|
|
|
ACETYLCYSTEINE 100 MG/ML (10 %) SOLUTION [122]
|
Facility
|
OP
|
$3.40
|
|
|
Service Code
|
NDC 0517-7504-01
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.68 |
| Max. Negotiated Rate |
$2.89 |
| Rate for Payer: Adventist Health Commercial |
$0.68
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2.23
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2.89
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1.87
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2.55
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2.09
|
| Rate for Payer: Cash Price |
$1.87
|
| Rate for Payer: Cigna of CA HMO |
$2.38
|
| Rate for Payer: Cigna of CA PPO |
$2.38
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2.89
|
| Rate for Payer: Dignity Health Medi-Cal |
$2.89
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2.89
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.36
|
| Rate for Payer: EPIC Health Plan Senior |
$1.36
|
| Rate for Payer: Galaxy Health WC |
$2.89
|
| Rate for Payer: Global Benefits Group Commercial |
$2.04
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2.27
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1.30
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2.10
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.82
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2.38
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2.38
|
| Rate for Payer: Multiplan Commercial |
$2.72
|
| Rate for Payer: Networks By Design Commercial |
$2.21
|
| Rate for Payer: Prime Health Services Commercial |
$2.89
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2.04
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2.04
|
| Rate for Payer: United Healthcare All Other Commercial |
$1.70
|
| Rate for Payer: United Healthcare All Other HMO |
$1.70
|
| Rate for Payer: United Healthcare HMO Rider |
$1.70
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1.70
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2.89
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2.89
|
| Rate for Payer: Vantage Medical Group Senior |
$2.89
|
|
|
ACETYLCYSTEINE 100 MG/ML (10 %) SOLUTION [122]
|
Facility
|
OP
|
$4.37
|
|
|
Service Code
|
NDC 63323-695-04
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.87 |
| Max. Negotiated Rate |
$3.71 |
| Rate for Payer: Vantage Medical Group Medi-Cal |
$3.71
|
| Rate for Payer: Vantage Medical Group Senior |
$3.71
|
| Rate for Payer: Adventist Health Commercial |
$0.87
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2.87
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3.71
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2.40
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$3.28
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2.68
|
| Rate for Payer: Cash Price |
$2.40
|
| Rate for Payer: Cigna of CA HMO |
$3.06
|
| Rate for Payer: Cigna of CA PPO |
$3.06
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3.71
|
| Rate for Payer: Dignity Health Medi-Cal |
$3.71
|
| Rate for Payer: Dignity Health Medicare Advantage |
$3.71
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.75
|
| Rate for Payer: EPIC Health Plan Senior |
$1.75
|
| Rate for Payer: Galaxy Health WC |
$3.71
|
| Rate for Payer: Global Benefits Group Commercial |
$2.62
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2.91
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1.66
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2.71
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.05
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$3.06
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$3.06
|
| Rate for Payer: Multiplan Commercial |
$3.50
|
| Rate for Payer: Networks By Design Commercial |
$2.84
|
| Rate for Payer: Prime Health Services Commercial |
$3.71
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2.62
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2.62
|
| Rate for Payer: United Healthcare All Other Commercial |
$2.19
|
| Rate for Payer: United Healthcare All Other HMO |
$2.19
|
| Rate for Payer: United Healthcare HMO Rider |
$2.19
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2.19
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3.71
|
|
|
ACETYLCYSTEINE 100 MG/ML (10 %) SOLUTION [122]
|
Facility
|
IP
|
$3.40
|
|
|
Service Code
|
NDC 0517-7504-01
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.68 |
| Max. Negotiated Rate |
$2.89 |
| Rate for Payer: Adventist Health Commercial |
$0.68
|
| Rate for Payer: Blue Shield of California Commercial |
$2.51
|
| Rate for Payer: Blue Shield of California EPN |
$1.65
|
| Rate for Payer: Cash Price |
$1.87
|
| Rate for Payer: Cigna of CA HMO |
$2.38
|
| Rate for Payer: Cigna of CA PPO |
$2.38
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.36
|
| Rate for Payer: EPIC Health Plan Senior |
$1.36
|
| Rate for Payer: Galaxy Health WC |
$2.89
|
| Rate for Payer: Global Benefits Group Commercial |
$2.04
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2.27
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1.30
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2.10
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.82
|
| Rate for Payer: Multiplan Commercial |
$2.72
|
| Rate for Payer: Networks By Design Commercial |
$2.21
|
| Rate for Payer: Prime Health Services Commercial |
$2.89
|
|
|
ACETYLCYSTEINE 100 MG/ML (10 %) SOLUTION [122]
|
Facility
|
IP
|
$0.80
|
|
|
Service Code
|
NDC 0409-3307-03
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.16 |
| Max. Negotiated Rate |
$0.68 |
| Rate for Payer: Adventist Health Commercial |
$0.16
|
| Rate for Payer: Blue Shield of California Commercial |
$0.59
|
| Rate for Payer: Blue Shield of California EPN |
$0.39
|
| Rate for Payer: Cash Price |
$0.44
|
| Rate for Payer: Cigna of CA HMO |
$0.56
|
| Rate for Payer: Cigna of CA PPO |
$0.56
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.32
|
| Rate for Payer: EPIC Health Plan Senior |
$0.32
|
| Rate for Payer: Galaxy Health WC |
$0.68
|
| Rate for Payer: Global Benefits Group Commercial |
$0.48
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.53
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.30
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$0.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.19
|
| Rate for Payer: Multiplan Commercial |
$0.64
|
| Rate for Payer: Networks By Design Commercial |
$0.52
|
| Rate for Payer: Prime Health Services Commercial |
$0.68
|
|
|
ACETYLCYSTEINE 200 MG/ML (20 %) INTRAVENOUS SOLUTION [38303]
|
Facility
|
OP
|
$2.40
|
|
|
Service Code
|
HCPCS J0132
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.45 |
| Max. Negotiated Rate |
$2.04 |
| Rate for Payer: Adventist Health Commercial |
$0.48
|
| Rate for Payer: Adventist Health Commercial |
$0.43
|
| Rate for Payer: Adventist Health Commercial |
$0.88
|
| Rate for Payer: Adventist Health Commercial |
$0.30
|
| Rate for Payer: Aetna of CA HMO/PPO |
$1.57
|
| Rate for Payer: Aetna of CA HMO/PPO |
$0.97
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2.89
|
| Rate for Payer: Aetna of CA HMO/PPO |
$1.40
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3.74
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1.26
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1.81
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2.04
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.81
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1.32
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2.42
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1.17
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1.11
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1.60
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1.80
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$3.30
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1.13
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1.13
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1.13
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1.13
|
| Rate for Payer: Blue Shield of California Commercial |
$1.20
|
| Rate for Payer: Blue Shield of California Commercial |
$1.20
|
| Rate for Payer: Blue Shield of California Commercial |
$1.20
|
| Rate for Payer: Blue Shield of California Commercial |
$1.20
|
| Rate for Payer: Blue Shield of California EPN |
$1.20
|
| Rate for Payer: Blue Shield of California EPN |
$1.20
|
| Rate for Payer: Blue Shield of California EPN |
$1.20
|
| Rate for Payer: Blue Shield of California EPN |
$1.20
|
| Rate for Payer: Cash Price |
$1.32
|
| Rate for Payer: Cash Price |
$0.81
|
| Rate for Payer: Cash Price |
$1.17
|
| Rate for Payer: Cash Price |
$0.81
|
| Rate for Payer: Cash Price |
$1.17
|
| Rate for Payer: Cash Price |
$2.42
|
| Rate for Payer: Cash Price |
$2.42
|
| Rate for Payer: Cash Price |
$1.32
|
| Rate for Payer: Cigna of CA HMO |
$1.04
|
| Rate for Payer: Cigna of CA HMO |
$1.68
|
| Rate for Payer: Cigna of CA HMO |
$1.49
|
| Rate for Payer: Cigna of CA HMO |
$3.08
|
| Rate for Payer: Cigna of CA PPO |
$3.08
|
| Rate for Payer: Cigna of CA PPO |
$1.04
|
| Rate for Payer: Cigna of CA PPO |
$1.49
|
| Rate for Payer: Cigna of CA PPO |
$1.68
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1.81
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3.74
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2.04
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1.26
|
| Rate for Payer: Dignity Health Medi-Cal |
$3.74
|
| Rate for Payer: Dignity Health Medi-Cal |
$1.26
|
| Rate for Payer: Dignity Health Medi-Cal |
$1.81
|
| Rate for Payer: Dignity Health Medi-Cal |
$2.04
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1.81
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2.04
|
| Rate for Payer: Dignity Health Medicare Advantage |
$3.74
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1.26
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.96
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.59
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.85
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.76
|
| Rate for Payer: EPIC Health Plan Senior |
$0.59
|
| Rate for Payer: EPIC Health Plan Senior |
$1.76
|
| Rate for Payer: EPIC Health Plan Senior |
$0.96
|
| Rate for Payer: EPIC Health Plan Senior |
$0.85
|
| Rate for Payer: Galaxy Health WC |
$2.04
|
| Rate for Payer: Galaxy Health WC |
$1.81
|
| Rate for Payer: Galaxy Health WC |
$1.26
|
| Rate for Payer: Galaxy Health WC |
$3.74
|
| Rate for Payer: Global Benefits Group Commercial |
$1.28
|
| Rate for Payer: Global Benefits Group Commercial |
$2.64
|
| Rate for Payer: Global Benefits Group Commercial |
$0.89
|
| Rate for Payer: Global Benefits Group Commercial |
$1.44
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$0.45
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$0.45
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$0.45
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$0.45
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.99
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2.93
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1.42
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1.04
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1.04
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1.04
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1.04
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2.72
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1.32
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$0.92
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1.49
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.06
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.51
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.36
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.58
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1.04
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1.68
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$3.08
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1.49
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1.04
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1.68
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$3.08
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1.49
|
| Rate for Payer: Multiplan Commercial |
$1.70
|
| Rate for Payer: Multiplan Commercial |
$1.18
|
| Rate for Payer: Multiplan Commercial |
$1.92
|
| Rate for Payer: Multiplan Commercial |
$3.52
|
| Rate for Payer: Networks By Design Commercial |
$2.20
|
| Rate for Payer: Networks By Design Commercial |
$1.06
|
| Rate for Payer: Networks By Design Commercial |
$0.74
|
| Rate for Payer: Networks By Design Commercial |
$1.20
|
| Rate for Payer: Prime Health Services Commercial |
$1.81
|
| Rate for Payer: Prime Health Services Commercial |
$2.04
|
| Rate for Payer: Prime Health Services Commercial |
$1.26
|
| Rate for Payer: Prime Health Services Commercial |
$3.74
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1.44
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.89
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2.64
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1.28
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2.64
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1.44
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.89
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1.28
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.56
|
| Rate for Payer: United Healthcare All Other Commercial |
$1.65
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.90
|
| Rate for Payer: United Healthcare All Other HMO |
$0.88
|
| Rate for Payer: United Healthcare All Other HMO |
$1.61
|
| Rate for Payer: United Healthcare All Other HMO |
$0.54
|
| Rate for Payer: United Healthcare All Other HMO |
$0.78
|
| Rate for Payer: United Healthcare HMO Rider |
$0.76
|
| Rate for Payer: United Healthcare HMO Rider |
$0.86
|
| Rate for Payer: United Healthcare HMO Rider |
$0.53
|
| Rate for Payer: United Healthcare HMO Rider |
$1.57
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.79
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.70
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1.44
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.48
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1.26
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3.74
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1.81
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2.04
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$3.74
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2.04
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1.26
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1.81
|
| Rate for Payer: Vantage Medical Group Senior |
$3.74
|
| Rate for Payer: Vantage Medical Group Senior |
$1.81
|
| Rate for Payer: Vantage Medical Group Senior |
$2.04
|
| Rate for Payer: Vantage Medical Group Senior |
$1.26
|
|
|
ACETYLCYSTEINE 200 MG/ML (20 %) INTRAVENOUS SOLUTION [38303]
|
Facility
|
IP
|
$2.13
|
|
|
Service Code
|
HCPCS J0132
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.43 |
| Max. Negotiated Rate |
$1.81 |
| Rate for Payer: EPIC Health Plan Senior |
$0.59
|
| Rate for Payer: EPIC Health Plan Senior |
$0.96
|
| Rate for Payer: EPIC Health Plan Senior |
$0.85
|
| Rate for Payer: EPIC Health Plan Senior |
$1.76
|
| Rate for Payer: Galaxy Health WC |
$1.26
|
| Rate for Payer: Galaxy Health WC |
$1.81
|
| Rate for Payer: Galaxy Health WC |
$2.04
|
| Rate for Payer: Galaxy Health WC |
$3.74
|
| Rate for Payer: Global Benefits Group Commercial |
$2.64
|
| Rate for Payer: Global Benefits Group Commercial |
$0.89
|
| Rate for Payer: Global Benefits Group Commercial |
$1.44
|
| Rate for Payer: Global Benefits Group Commercial |
$1.28
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1.42
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2.93
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.99
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.91
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.81
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1.68
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.56
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$0.92
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1.32
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1.49
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2.72
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.51
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.36
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.58
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.06
|
| Rate for Payer: Multiplan Commercial |
$1.18
|
| Rate for Payer: Multiplan Commercial |
$1.92
|
| Rate for Payer: Multiplan Commercial |
$1.70
|
| Rate for Payer: Multiplan Commercial |
$3.52
|
| Rate for Payer: Networks By Design Commercial |
$1.06
|
| Rate for Payer: Networks By Design Commercial |
$1.20
|
| Rate for Payer: Networks By Design Commercial |
$2.20
|
| Rate for Payer: Networks By Design Commercial |
$0.74
|
| Rate for Payer: Prime Health Services Commercial |
$2.04
|
| Rate for Payer: Prime Health Services Commercial |
$1.26
|
| Rate for Payer: Prime Health Services Commercial |
$3.74
|
| Rate for Payer: Prime Health Services Commercial |
$1.81
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.90
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.56
|
| Rate for Payer: United Healthcare All Other Commercial |
$1.65
|
| Rate for Payer: United Healthcare All Other HMO |
$0.78
|
| Rate for Payer: United Healthcare All Other HMO |
$1.61
|
| Rate for Payer: United Healthcare All Other HMO |
$0.88
|
| Rate for Payer: United Healthcare All Other HMO |
$0.54
|
| Rate for Payer: United Healthcare HMO Rider |
$0.76
|
| Rate for Payer: United Healthcare HMO Rider |
$0.53
|
| Rate for Payer: United Healthcare HMO Rider |
$1.57
|
| Rate for Payer: United Healthcare HMO Rider |
$0.86
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.70
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.48
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1.44
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.79
|
| Rate for Payer: Adventist Health Commercial |
$0.43
|
| Rate for Payer: Adventist Health Commercial |
$0.88
|
| Rate for Payer: Adventist Health Commercial |
$0.30
|
| Rate for Payer: Adventist Health Commercial |
$0.48
|
| Rate for Payer: Blue Shield of California Commercial |
$1.09
|
| Rate for Payer: Blue Shield of California Commercial |
$3.25
|
| Rate for Payer: Blue Shield of California Commercial |
$1.77
|
| Rate for Payer: Blue Shield of California Commercial |
$1.57
|
| Rate for Payer: Blue Shield of California EPN |
$0.72
|
| Rate for Payer: Blue Shield of California EPN |
$1.04
|
| Rate for Payer: Blue Shield of California EPN |
$1.17
|
| Rate for Payer: Blue Shield of California EPN |
$2.14
|
| Rate for Payer: Cash Price |
$1.32
|
| Rate for Payer: Cash Price |
$0.81
|
| Rate for Payer: Cash Price |
$2.42
|
| Rate for Payer: Cash Price |
$1.17
|
| Rate for Payer: Cigna of CA HMO |
$1.04
|
| Rate for Payer: Cigna of CA HMO |
$1.68
|
| Rate for Payer: Cigna of CA HMO |
$1.49
|
| Rate for Payer: Cigna of CA HMO |
$3.08
|
| Rate for Payer: Cigna of CA PPO |
$3.08
|
| Rate for Payer: Cigna of CA PPO |
$1.68
|
| Rate for Payer: Cigna of CA PPO |
$1.04
|
| Rate for Payer: Cigna of CA PPO |
$1.49
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.85
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.96
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.59
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.76
|
|
|
ACETYLCYSTEINE 200 MG/ML (20 %) SOLUTION [123]
|
Facility
|
IP
|
$0.26
|
|
|
Service Code
|
NDC 63323-690-41
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.05 |
| Max. Negotiated Rate |
$0.22 |
| Rate for Payer: Adventist Health Commercial |
$0.05
|
| Rate for Payer: Blue Shield of California Commercial |
$0.19
|
| Rate for Payer: Blue Shield of California EPN |
$0.13
|
| Rate for Payer: Cash Price |
$0.14
|
| Rate for Payer: Cigna of CA HMO |
$0.18
|
| Rate for Payer: Cigna of CA PPO |
$0.18
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.10
|
| Rate for Payer: EPIC Health Plan Senior |
$0.10
|
| Rate for Payer: Galaxy Health WC |
$0.22
|
| Rate for Payer: Global Benefits Group Commercial |
$0.16
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.17
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.10
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$0.16
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.06
|
| Rate for Payer: Multiplan Commercial |
$0.21
|
| Rate for Payer: Networks By Design Commercial |
$0.17
|
| Rate for Payer: Prime Health Services Commercial |
$0.22
|
|
|
ACETYLCYSTEINE 200 MG/ML (20 %) SOLUTION [123]
|
Facility
|
IP
|
$4.79
|
|
|
Service Code
|
NDC 63323-694-04
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.96 |
| Max. Negotiated Rate |
$4.07 |
| Rate for Payer: Adventist Health Commercial |
$0.96
|
| Rate for Payer: Blue Shield of California Commercial |
$3.54
|
| Rate for Payer: Blue Shield of California EPN |
$2.33
|
| Rate for Payer: Cash Price |
$2.64
|
| Rate for Payer: Cigna of CA HMO |
$3.35
|
| Rate for Payer: Cigna of CA PPO |
$3.35
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.92
|
| Rate for Payer: EPIC Health Plan Senior |
$1.92
|
| Rate for Payer: Galaxy Health WC |
$4.07
|
| Rate for Payer: Global Benefits Group Commercial |
$2.87
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3.19
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1.82
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2.97
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.15
|
| Rate for Payer: Multiplan Commercial |
$3.83
|
| Rate for Payer: Networks By Design Commercial |
$3.11
|
| Rate for Payer: Prime Health Services Commercial |
$4.07
|
|
|
ACETYLCYSTEINE 200 MG/ML (20 %) SOLUTION [123]
|
Facility
|
OP
|
$4.79
|
|
|
Service Code
|
NDC 63323-694-04
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.96 |
| Max. Negotiated Rate |
$4.07 |
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4.07
|
| Rate for Payer: Vantage Medical Group Senior |
$4.07
|
| Rate for Payer: Adventist Health Commercial |
$0.96
|
| Rate for Payer: Aetna of CA HMO/PPO |
$3.14
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$4.07
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2.63
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$3.59
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2.94
|
| Rate for Payer: Cash Price |
$2.64
|
| Rate for Payer: Cigna of CA HMO |
$3.35
|
| Rate for Payer: Cigna of CA PPO |
$3.35
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$4.07
|
| Rate for Payer: Dignity Health Medi-Cal |
$4.07
|
| Rate for Payer: Dignity Health Medicare Advantage |
$4.07
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.92
|
| Rate for Payer: EPIC Health Plan Senior |
$1.92
|
| Rate for Payer: Galaxy Health WC |
$4.07
|
| Rate for Payer: Global Benefits Group Commercial |
$2.87
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3.19
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1.82
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2.97
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.15
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$3.35
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$3.35
|
| Rate for Payer: Multiplan Commercial |
$3.83
|
| Rate for Payer: Networks By Design Commercial |
$3.11
|
| Rate for Payer: Prime Health Services Commercial |
$4.07
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2.87
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2.87
|
| Rate for Payer: United Healthcare All Other Commercial |
$2.40
|
| Rate for Payer: United Healthcare All Other HMO |
$2.40
|
| Rate for Payer: United Healthcare HMO Rider |
$2.40
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2.40
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$4.07
|
|
|
ACETYLCYSTEINE 200 MG/ML (20 %) SOLUTION [123]
|
Facility
|
IP
|
$4.52
|
|
|
Service Code
|
NDC 0517-7604-25
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.90 |
| Max. Negotiated Rate |
$3.84 |
| Rate for Payer: Adventist Health Commercial |
$0.90
|
| Rate for Payer: Blue Shield of California Commercial |
$3.34
|
| Rate for Payer: Blue Shield of California EPN |
$2.20
|
| Rate for Payer: Cash Price |
$2.49
|
| Rate for Payer: Cigna of CA HMO |
$3.16
|
| Rate for Payer: Cigna of CA PPO |
$3.16
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.81
|
| Rate for Payer: EPIC Health Plan Senior |
$1.81
|
| Rate for Payer: Galaxy Health WC |
$3.84
|
| Rate for Payer: Global Benefits Group Commercial |
$2.71
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3.01
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1.72
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2.80
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.08
|
| Rate for Payer: Multiplan Commercial |
$3.62
|
| Rate for Payer: Networks By Design Commercial |
$2.94
|
| Rate for Payer: Prime Health Services Commercial |
$3.84
|
|
|
ACETYLCYSTEINE 200 MG/ML (20 %) SOLUTION [123]
|
Facility
|
OP
|
$1.19
|
|
|
Service Code
|
NDC 63323-690-30
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.24 |
| Max. Negotiated Rate |
$1.01 |
| Rate for Payer: Adventist Health Commercial |
$0.24
|
| Rate for Payer: Aetna of CA HMO/PPO |
$0.78
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1.01
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.65
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.89
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.73
|
| Rate for Payer: Cash Price |
$0.65
|
| Rate for Payer: Cigna of CA HMO |
$0.83
|
| Rate for Payer: Cigna of CA PPO |
$0.83
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1.01
|
| Rate for Payer: Dignity Health Medi-Cal |
$1.01
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1.01
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.48
|
| Rate for Payer: EPIC Health Plan Senior |
$0.48
|
| Rate for Payer: Galaxy Health WC |
$1.01
|
| Rate for Payer: Global Benefits Group Commercial |
$0.71
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.79
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.45
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$0.74
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.29
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$0.83
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$0.83
|
| Rate for Payer: Multiplan Commercial |
$0.95
|
| Rate for Payer: Networks By Design Commercial |
$0.77
|
| Rate for Payer: Prime Health Services Commercial |
$1.01
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.71
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.71
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.60
|
| Rate for Payer: United Healthcare All Other HMO |
$0.60
|
| Rate for Payer: United Healthcare HMO Rider |
$0.60
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.60
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1.01
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1.01
|
| Rate for Payer: Vantage Medical Group Senior |
$1.01
|
|
