|
PHENYTOIN SODIUM EXTENDED 100 MG CAPSULE [6257]
|
Facility
|
IP
|
$0.30
|
|
|
Service Code
|
NDC 5766480888
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.06 |
| Max. Negotiated Rate |
$0.26 |
| Rate for Payer: Adventist Health Commercial |
$0.06
|
| Rate for Payer: Blue Shield of California Commercial |
$0.15
|
| Rate for Payer: Blue Shield of California Commercial |
$0.23
|
| Rate for Payer: Cash Price |
$0.14
|
| Rate for Payer: Cigna of CA HMO |
$0.21
|
| Rate for Payer: Cigna of CA PPO |
$0.21
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$0.21
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.12
|
| Rate for Payer: EPIC Health Plan Senior |
$0.12
|
| Rate for Payer: Galaxy Health WC |
$0.26
|
| Rate for Payer: Global Benefits Group Commercial |
$0.18
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$0.19
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$0.18
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.07
|
| Rate for Payer: Multiplan Commercial |
$0.24
|
| Rate for Payer: Networks By Design Commercial |
$0.20
|
| Rate for Payer: Prime Health Services Commercial |
$0.26
|
|
|
PHENYTOIN SODIUM EXTENDED 30 MG CAPSULE [11019]
|
Facility
|
OP
|
$1.88
|
|
|
Service Code
|
NDC 0071374066
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.38 |
| Max. Negotiated Rate |
$1.60 |
| Rate for Payer: Adventist Health Commercial |
$0.38
|
| Rate for Payer: Aetna of CA HMO/PPO |
$1.23
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1.60
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1.03
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1.41
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1.21
|
| Rate for Payer: Cash Price |
$0.85
|
| Rate for Payer: Cigna of CA HMO |
$1.32
|
| Rate for Payer: Cigna of CA PPO |
$1.32
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1.60
|
| Rate for Payer: Dignity Health Medi-Cal |
$1.60
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1.60
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1.32
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.75
|
| Rate for Payer: EPIC Health Plan Senior |
$0.75
|
| Rate for Payer: Galaxy Health WC |
$1.60
|
| Rate for Payer: Global Benefits Group Commercial |
$1.13
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1.19
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.68
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1.11
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.45
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1.32
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1.32
|
| Rate for Payer: Multiplan Commercial |
$1.50
|
| Rate for Payer: Networks By Design Commercial |
$1.22
|
| Rate for Payer: Prime Health Services Commercial |
$1.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1.13
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1.13
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.94
|
| Rate for Payer: United Healthcare All Other HMO |
$0.94
|
| Rate for Payer: United Healthcare HMO Rider |
$0.94
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.94
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1.60
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1.60
|
| Rate for Payer: Vantage Medical Group Senior |
$1.60
|
|
|
PHENYTOIN SODIUM EXTENDED 30 MG CAPSULE [11019]
|
Facility
|
IP
|
$1.88
|
|
|
Service Code
|
NDC 0071374066
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.38 |
| Max. Negotiated Rate |
$1.60 |
| Rate for Payer: Adventist Health Commercial |
$0.38
|
| Rate for Payer: Blue Shield of California Commercial |
$0.95
|
| Rate for Payer: Blue Shield of California Commercial |
$1.45
|
| Rate for Payer: Cash Price |
$0.85
|
| Rate for Payer: Cigna of CA HMO |
$1.32
|
| Rate for Payer: Cigna of CA PPO |
$1.32
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1.32
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.75
|
| Rate for Payer: EPIC Health Plan Senior |
$0.75
|
| Rate for Payer: Galaxy Health WC |
$1.60
|
| Rate for Payer: Global Benefits Group Commercial |
$1.13
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1.19
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1.11
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.45
|
| Rate for Payer: Multiplan Commercial |
$1.50
|
| Rate for Payer: Networks By Design Commercial |
$1.22
|
| Rate for Payer: Prime Health Services Commercial |
$1.60
|
|
|
PHOS-NAK ORAL SOLN CMPND 25 MG/ML (0.8 MMOL/ML) [4080310]
|
Facility
|
OP
|
$0.04
|
|
|
Service Code
|
NDC 9994080310
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| 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 |
$0.03
|
| 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$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 Foundation Hospitals Commercial/Self Funded |
$0.03
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.01
|
| Rate for Payer: Kaiser Foundation Hospitals 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
|
|
|
PHOS-NAK ORAL SOLN CMPND 25 MG/ML (0.8 MMOL/ML) [4080310]
|
Facility
|
IP
|
$0.04
|
|
|
Service Code
|
NDC 9994080310
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| 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 |
$0.02
|
| Rate for Payer: Blue Shield of California Commercial |
$0.03
|
| 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$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 Foundation Hospitals Commercial/Self Funded |
$0.03
|
| Rate for Payer: Kaiser Foundation Hospitals 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
|
|
|
PHOSPHATE DIALYSIS SOLN WITHOUT DEXTR K 4 MEQ-CA 2.5 MEQ-PO4 1 MMOL/L [212681]
|
Facility
|
OP
|
$0.01
|
|
|
Service Code
|
NDC 2457111605
|
| Hospital Charge Code |
901700001
|
|
Hospital Revenue Code
|
250
|
| Max. Negotiated Rate |
$0.01 |
| Rate for Payer: Adventist Health Commercial |
$0.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$0.01
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.01
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.01
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.01
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.01
|
| Rate for Payer: Cigna of CA HMO |
$0.01
|
| Rate for Payer: Cigna of CA PPO |
$0.01
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.01
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.01
|
| Rate for Payer: Dignity Health Medicare Advantage |
$0.01
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$0.01
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.00
|
| Rate for Payer: EPIC Health Plan Senior |
$0.00
|
| Rate for Payer: Galaxy Health WC |
$0.01
|
| Rate for Payer: Global Benefits Group Commercial |
$0.01
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$0.01
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.00
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$0.01
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$0.01
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$0.01
|
| Rate for Payer: Multiplan Commercial |
$0.01
|
| Rate for Payer: Networks By Design Commercial |
$0.01
|
| Rate for Payer: Prime Health Services Commercial |
$0.01
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.01
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.01
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.01
|
| Rate for Payer: United Healthcare All Other HMO |
$0.01
|
| Rate for Payer: United Healthcare HMO Rider |
$0.01
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.01
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.01
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.01
|
| Rate for Payer: Vantage Medical Group Senior |
$0.01
|
|
|
PHOSPHATE DIALYSIS SOLN WITHOUT DEXTR K 4 MEQ-CA 2.5 MEQ-PO4 1 MMOL/L [212681]
|
Facility
|
IP
|
$0.01
|
|
|
Service Code
|
NDC 2457111606
|
| Hospital Charge Code |
901700001
|
|
Hospital Revenue Code
|
250
|
| Max. Negotiated Rate |
$0.01 |
| Rate for Payer: Adventist Health Commercial |
$0.00
|
| Rate for Payer: Blue Shield of California Commercial |
$0.01
|
| Rate for Payer: Blue Shield of California Commercial |
$0.01
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$0.01
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.00
|
| Rate for Payer: EPIC Health Plan Senior |
$0.00
|
| Rate for Payer: Galaxy Health WC |
$0.01
|
| Rate for Payer: Global Benefits Group Commercial |
$0.01
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$0.01
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$0.01
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.00
|
| Rate for Payer: Multiplan Commercial |
$0.01
|
| Rate for Payer: Networks By Design Commercial |
$0.01
|
| Rate for Payer: Prime Health Services Commercial |
$0.01
|
|
|
PHOSPHATE DIALYSIS SOLN WITHOUT DEXTR K 4 MEQ-CA 2.5 MEQ-PO4 1 MMOL/L [212681]
|
Facility
|
IP
|
$0.01
|
|
|
Service Code
|
NDC 2457111605
|
| Hospital Charge Code |
901700001
|
|
Hospital Revenue Code
|
250
|
| Max. Negotiated Rate |
$0.01 |
| Rate for Payer: Adventist Health Commercial |
$0.00
|
| Rate for Payer: Blue Shield of California Commercial |
$0.01
|
| Rate for Payer: Blue Shield of California Commercial |
$0.01
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$0.01
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.00
|
| Rate for Payer: EPIC Health Plan Senior |
$0.00
|
| Rate for Payer: Galaxy Health WC |
$0.01
|
| Rate for Payer: Global Benefits Group Commercial |
$0.01
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$0.01
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$0.01
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.00
|
| Rate for Payer: Multiplan Commercial |
$0.01
|
| Rate for Payer: Networks By Design Commercial |
$0.01
|
| Rate for Payer: Prime Health Services Commercial |
$0.01
|
|
|
PHOSPHATE DIALYSIS SOLN WITHOUT DEXTR K 4 MEQ-CA 2.5 MEQ-PO4 1 MMOL/L [212681]
|
Facility
|
OP
|
$0.01
|
|
|
Service Code
|
NDC 2457111606
|
| Hospital Charge Code |
901700001
|
|
Hospital Revenue Code
|
250
|
| Max. Negotiated Rate |
$0.01 |
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.01
|
| Rate for Payer: Vantage Medical Group Senior |
$0.01
|
| Rate for Payer: Adventist Health Commercial |
$0.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$0.01
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.01
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.01
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.01
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.01
|
| Rate for Payer: Cigna of CA HMO |
$0.01
|
| Rate for Payer: Cigna of CA PPO |
$0.01
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.01
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.01
|
| Rate for Payer: Dignity Health Medicare Advantage |
$0.01
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$0.01
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.00
|
| Rate for Payer: EPIC Health Plan Senior |
$0.00
|
| Rate for Payer: Galaxy Health WC |
$0.01
|
| Rate for Payer: Global Benefits Group Commercial |
$0.01
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$0.01
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.00
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$0.01
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$0.01
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$0.01
|
| Rate for Payer: Multiplan Commercial |
$0.01
|
| Rate for Payer: Networks By Design Commercial |
$0.01
|
| Rate for Payer: Prime Health Services Commercial |
$0.01
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.01
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.01
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.01
|
| Rate for Payer: United Healthcare All Other HMO |
$0.01
|
| Rate for Payer: United Healthcare HMO Rider |
$0.01
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.01
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.01
|
|
|
PHOSPHATE DIALY SOLN W-OUT CALCIUM,DEX K 4 MEQ-MG 1.5 MEQ-PO4 1 MMOL/L [212682]
|
Facility
|
IP
|
$0.01
|
|
|
Service Code
|
NDC 2457111705
|
| Hospital Charge Code |
901700001
|
|
Hospital Revenue Code
|
250
|
| Max. Negotiated Rate |
$0.01 |
| Rate for Payer: Adventist Health Commercial |
$0.00
|
| Rate for Payer: Blue Shield of California Commercial |
$0.01
|
| Rate for Payer: Blue Shield of California Commercial |
$0.01
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$0.01
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.00
|
| Rate for Payer: EPIC Health Plan Senior |
$0.00
|
| Rate for Payer: Galaxy Health WC |
$0.01
|
| Rate for Payer: Global Benefits Group Commercial |
$0.01
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$0.01
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$0.01
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.00
|
| Rate for Payer: Multiplan Commercial |
$0.01
|
| Rate for Payer: Networks By Design Commercial |
$0.01
|
| Rate for Payer: Prime Health Services Commercial |
$0.01
|
|
|
PHOSPHATE DIALY SOLN W-OUT CALCIUM,DEX K 4 MEQ-MG 1.5 MEQ-PO4 1 MMOL/L [212682]
|
Facility
|
OP
|
$0.01
|
|
|
Service Code
|
NDC 2457111705
|
| Hospital Charge Code |
901700001
|
|
Hospital Revenue Code
|
250
|
| Max. Negotiated Rate |
$0.01 |
| Rate for Payer: Adventist Health Commercial |
$0.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$0.01
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.01
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.01
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.01
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.01
|
| Rate for Payer: Cigna of CA HMO |
$0.01
|
| Rate for Payer: Cigna of CA PPO |
$0.01
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.01
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.01
|
| Rate for Payer: Dignity Health Medicare Advantage |
$0.01
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$0.01
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.00
|
| Rate for Payer: EPIC Health Plan Senior |
$0.00
|
| Rate for Payer: Galaxy Health WC |
$0.01
|
| Rate for Payer: Global Benefits Group Commercial |
$0.01
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$0.01
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.00
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$0.01
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$0.01
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$0.01
|
| Rate for Payer: Multiplan Commercial |
$0.01
|
| Rate for Payer: Networks By Design Commercial |
$0.01
|
| Rate for Payer: Prime Health Services Commercial |
$0.01
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.01
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.01
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.01
|
| Rate for Payer: United Healthcare All Other HMO |
$0.01
|
| Rate for Payer: United Healthcare HMO Rider |
$0.01
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.01
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.01
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.01
|
| Rate for Payer: Vantage Medical Group Senior |
$0.01
|
|
|
PHYTONADIONE (VITAMIN K1) 10 MG/ML INJECTION SOLUTION [11023]
|
Facility
|
OP
|
$51.32
|
|
|
Service Code
|
HCPCS J3430
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$3.25 |
| Max. Negotiated Rate |
$43.62 |
| Rate for Payer: Galaxy Health WC |
$49.95
|
| Rate for Payer: Galaxy Health WC |
$32.64
|
| Rate for Payer: Adventist Health Commercial |
$10.26
|
| Rate for Payer: Adventist Health Commercial |
$7.68
|
| Rate for Payer: Adventist Health Commercial |
$11.75
|
| Rate for Payer: Aetna of CA HMO/PPO |
$15.38
|
| Rate for Payer: Aetna of CA HMO/PPO |
$15.38
|
| Rate for Payer: Aetna of CA HMO/PPO |
$15.38
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$43.62
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$49.95
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$32.64
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$28.23
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$21.12
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$32.32
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$28.80
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$38.49
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$44.07
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$11.09
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$11.09
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$11.09
|
| Rate for Payer: Blue Shield of California Commercial |
$6.45
|
| Rate for Payer: Blue Shield of California Commercial |
$6.45
|
| Rate for Payer: Blue Shield of California Commercial |
$6.45
|
| Rate for Payer: Cash Price |
$26.44
|
| Rate for Payer: Cash Price |
$23.09
|
| Rate for Payer: Cash Price |
$17.28
|
| Rate for Payer: Cash Price |
$23.09
|
| Rate for Payer: Cash Price |
$26.44
|
| Rate for Payer: Cash Price |
$17.28
|
| Rate for Payer: Cigna of CA HMO |
$41.13
|
| Rate for Payer: Cigna of CA HMO |
$35.92
|
| Rate for Payer: Cigna of CA HMO |
$26.88
|
| Rate for Payer: Cigna of CA PPO |
$26.88
|
| Rate for Payer: Cigna of CA PPO |
$41.13
|
| Rate for Payer: Cigna of CA PPO |
$35.92
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$43.62
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$49.95
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$32.64
|
| Rate for Payer: Dignity Health Medi-Cal |
$32.64
|
| Rate for Payer: Dignity Health Medi-Cal |
$43.62
|
| Rate for Payer: Dignity Health Medi-Cal |
$49.95
|
| Rate for Payer: Dignity Health Medicare Advantage |
$32.64
|
| Rate for Payer: Dignity Health Medicare Advantage |
$43.62
|
| Rate for Payer: Dignity Health Medicare Advantage |
$49.95
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$26.88
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$41.13
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$35.92
|
| Rate for Payer: EPIC Health Plan Commercial |
$15.36
|
| Rate for Payer: EPIC Health Plan Commercial |
$20.53
|
| Rate for Payer: EPIC Health Plan Commercial |
$23.50
|
| Rate for Payer: EPIC Health Plan Senior |
$23.50
|
| Rate for Payer: EPIC Health Plan Senior |
$15.36
|
| Rate for Payer: EPIC Health Plan Senior |
$20.53
|
| Rate for Payer: Galaxy Health WC |
$43.62
|
| Rate for Payer: Global Benefits Group Commercial |
$30.79
|
| Rate for Payer: Global Benefits Group Commercial |
$23.04
|
| Rate for Payer: Global Benefits Group Commercial |
$35.26
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$3.25
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$3.25
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$3.25
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$24.38
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$37.31
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$32.59
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$13.81
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$13.81
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$13.81
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$22.66
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$34.67
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$30.28
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$14.10
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$12.32
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$9.22
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$35.92
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$26.88
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$41.13
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$41.13
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$26.88
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$35.92
|
| Rate for Payer: Multiplan Commercial |
$41.06
|
| Rate for Payer: Multiplan Commercial |
$47.01
|
| Rate for Payer: Multiplan Commercial |
$30.72
|
| Rate for Payer: Networks By Design Commercial |
$29.38
|
| Rate for Payer: Networks By Design Commercial |
$25.66
|
| Rate for Payer: Networks By Design Commercial |
$19.20
|
| Rate for Payer: Prime Health Services Commercial |
$49.95
|
| Rate for Payer: Prime Health Services Commercial |
$32.64
|
| Rate for Payer: Prime Health Services Commercial |
$43.62
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$30.79
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$35.26
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$23.04
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$23.04
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$35.26
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$30.79
|
| Rate for Payer: United Healthcare All Other Commercial |
$19.26
|
| Rate for Payer: United Healthcare All Other Commercial |
$22.05
|
| Rate for Payer: United Healthcare All Other Commercial |
$14.41
|
| Rate for Payer: United Healthcare All Other HMO |
$21.47
|
| Rate for Payer: United Healthcare All Other HMO |
$18.75
|
| Rate for Payer: United Healthcare All Other HMO |
$14.03
|
| Rate for Payer: United Healthcare HMO Rider |
$13.72
|
| Rate for Payer: United Healthcare HMO Rider |
$21.00
|
| Rate for Payer: United Healthcare HMO Rider |
$18.34
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$19.24
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$16.81
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$12.58
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$43.62
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$32.64
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$49.95
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$43.62
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$32.64
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$49.95
|
| Rate for Payer: Vantage Medical Group Senior |
$32.64
|
| Rate for Payer: Vantage Medical Group Senior |
$49.95
|
| Rate for Payer: Vantage Medical Group Senior |
$43.62
|
|
|
PHYTONADIONE (VITAMIN K1) 10 MG/ML INJECTION SOLUTION [11023]
|
Facility
|
IP
|
$38.40
|
|
|
Service Code
|
HCPCS J3430
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$7.68 |
| Max. Negotiated Rate |
$32.64 |
| Rate for Payer: Adventist Health Commercial |
$7.68
|
| Rate for Payer: Adventist Health Commercial |
$10.26
|
| Rate for Payer: Adventist Health Commercial |
$11.75
|
| Rate for Payer: Blue Shield of California Commercial |
$39.47
|
| Rate for Payer: Blue Shield of California Commercial |
$19.47
|
| Rate for Payer: Blue Shield of California Commercial |
$29.53
|
| Rate for Payer: Blue Shield of California Commercial |
$45.19
|
| Rate for Payer: Blue Shield of California Commercial |
$29.79
|
| Rate for Payer: Blue Shield of California Commercial |
$26.02
|
| Rate for Payer: Cash Price |
$26.44
|
| Rate for Payer: Cash Price |
$23.09
|
| Rate for Payer: Cash Price |
$17.28
|
| Rate for Payer: Cigna of CA HMO |
$41.13
|
| Rate for Payer: Cigna of CA HMO |
$35.92
|
| Rate for Payer: Cigna of CA HMO |
$26.88
|
| Rate for Payer: Cigna of CA PPO |
$26.88
|
| Rate for Payer: Cigna of CA PPO |
$41.13
|
| Rate for Payer: Cigna of CA PPO |
$35.92
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$41.13
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$35.92
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$26.88
|
| Rate for Payer: EPIC Health Plan Commercial |
$20.53
|
| Rate for Payer: EPIC Health Plan Commercial |
$23.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$15.36
|
| Rate for Payer: EPIC Health Plan Senior |
$20.53
|
| Rate for Payer: EPIC Health Plan Senior |
$15.36
|
| Rate for Payer: EPIC Health Plan Senior |
$23.50
|
| Rate for Payer: Galaxy Health WC |
$49.95
|
| Rate for Payer: Galaxy Health WC |
$32.64
|
| Rate for Payer: Galaxy Health WC |
$43.62
|
| Rate for Payer: Global Benefits Group Commercial |
$30.79
|
| Rate for Payer: Global Benefits Group Commercial |
$23.04
|
| Rate for Payer: Global Benefits Group Commercial |
$35.26
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$24.38
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$32.59
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$37.31
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$30.28
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$22.66
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$34.67
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$9.22
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$12.32
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$14.10
|
| Rate for Payer: Multiplan Commercial |
$30.72
|
| Rate for Payer: Multiplan Commercial |
$41.06
|
| Rate for Payer: Multiplan Commercial |
$47.01
|
| Rate for Payer: Networks By Design Commercial |
$25.66
|
| Rate for Payer: Networks By Design Commercial |
$29.38
|
| Rate for Payer: Networks By Design Commercial |
$19.20
|
| Rate for Payer: Prime Health Services Commercial |
$32.64
|
| Rate for Payer: Prime Health Services Commercial |
$43.62
|
| Rate for Payer: Prime Health Services Commercial |
$49.95
|
| Rate for Payer: United Healthcare All Other Commercial |
$19.26
|
| Rate for Payer: United Healthcare All Other Commercial |
$14.41
|
| Rate for Payer: United Healthcare All Other Commercial |
$22.05
|
| Rate for Payer: United Healthcare All Other HMO |
$21.47
|
| Rate for Payer: United Healthcare All Other HMO |
$14.03
|
| Rate for Payer: United Healthcare All Other HMO |
$18.75
|
| Rate for Payer: United Healthcare HMO Rider |
$18.34
|
| Rate for Payer: United Healthcare HMO Rider |
$21.00
|
| Rate for Payer: United Healthcare HMO Rider |
$13.72
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$19.24
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$12.58
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$16.81
|
|
|
PHYTONADIONE (VITAMIN K1) 1 MG/0.5 ML INJECTION SOLUTION [110478]
|
Facility
|
IP
|
$11.79
|
|
|
Service Code
|
HCPCS J3430
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$2.36 |
| Max. Negotiated Rate |
$10.02 |
| Rate for Payer: Adventist Health Commercial |
$2.36
|
| Rate for Payer: Blue Shield of California Commercial |
$5.98
|
| Rate for Payer: Blue Shield of California Commercial |
$9.07
|
| Rate for Payer: Cash Price |
$5.31
|
| Rate for Payer: Cigna of CA HMO |
$8.25
|
| Rate for Payer: Cigna of CA PPO |
$8.25
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$8.25
|
| Rate for Payer: EPIC Health Plan Commercial |
$4.72
|
| Rate for Payer: EPIC Health Plan Senior |
$4.72
|
| Rate for Payer: Galaxy Health WC |
$10.02
|
| Rate for Payer: Global Benefits Group Commercial |
$7.07
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$7.49
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$6.96
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.83
|
| Rate for Payer: Multiplan Commercial |
$9.43
|
| Rate for Payer: Networks By Design Commercial |
$5.89
|
| Rate for Payer: Prime Health Services Commercial |
$10.02
|
| Rate for Payer: United Healthcare All Other Commercial |
$4.42
|
| Rate for Payer: United Healthcare All Other HMO |
$4.31
|
| Rate for Payer: United Healthcare HMO Rider |
$4.21
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3.86
|
|
|
PHYTONADIONE (VITAMIN K1) 1 MG/0.5 ML INJECTION SOLUTION [110478]
|
Facility
|
OP
|
$11.79
|
|
|
Service Code
|
HCPCS J3430
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$2.36 |
| Max. Negotiated Rate |
$15.38 |
| Rate for Payer: Adventist Health Commercial |
$2.36
|
| Rate for Payer: Aetna of CA HMO/PPO |
$15.38
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$10.02
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$6.48
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$8.84
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$11.09
|
| Rate for Payer: Blue Shield of California Commercial |
$6.45
|
| Rate for Payer: Cash Price |
$5.31
|
| Rate for Payer: Cash Price |
$5.31
|
| Rate for Payer: Cigna of CA HMO |
$8.25
|
| Rate for Payer: Cigna of CA PPO |
$8.25
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$10.02
|
| Rate for Payer: Dignity Health Medi-Cal |
$10.02
|
| Rate for Payer: Dignity Health Medicare Advantage |
$10.02
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$8.25
|
| Rate for Payer: EPIC Health Plan Commercial |
$4.72
|
| Rate for Payer: EPIC Health Plan Senior |
$4.72
|
| Rate for Payer: Galaxy Health WC |
$10.02
|
| Rate for Payer: Global Benefits Group Commercial |
$7.07
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$3.25
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$7.49
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$13.81
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$6.96
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.83
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$8.25
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$8.25
|
| Rate for Payer: Multiplan Commercial |
$9.43
|
| Rate for Payer: Networks By Design Commercial |
$5.89
|
| Rate for Payer: Prime Health Services Commercial |
$10.02
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$7.07
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$7.07
|
| Rate for Payer: United Healthcare All Other Commercial |
$4.42
|
| Rate for Payer: United Healthcare All Other HMO |
$4.31
|
| Rate for Payer: United Healthcare HMO Rider |
$4.21
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3.86
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$10.02
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$10.02
|
| Rate for Payer: Vantage Medical Group Senior |
$10.02
|
|
|
PHYTONADIONE (VITAMIN K1) 1 MG/0.5 ML INJECTION SYRINGE [6271]
|
Facility
|
IP
|
$59.35
|
|
|
Service Code
|
HCPCS J3430
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$11.87 |
| Max. Negotiated Rate |
$50.45 |
| Rate for Payer: Adventist Health Commercial |
$11.87
|
| Rate for Payer: Blue Shield of California Commercial |
$30.09
|
| Rate for Payer: Blue Shield of California Commercial |
$45.64
|
| Rate for Payer: Cash Price |
$26.71
|
| Rate for Payer: Cigna of CA HMO |
$41.55
|
| Rate for Payer: Cigna of CA PPO |
$41.55
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$41.55
|
| Rate for Payer: EPIC Health Plan Commercial |
$23.74
|
| Rate for Payer: EPIC Health Plan Senior |
$23.74
|
| Rate for Payer: Galaxy Health WC |
$50.45
|
| Rate for Payer: Global Benefits Group Commercial |
$35.61
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$37.69
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$35.02
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$14.24
|
| Rate for Payer: Multiplan Commercial |
$47.48
|
| Rate for Payer: Networks By Design Commercial |
$29.68
|
| Rate for Payer: Prime Health Services Commercial |
$50.45
|
| Rate for Payer: United Healthcare All Other Commercial |
$22.27
|
| Rate for Payer: United Healthcare All Other HMO |
$21.68
|
| Rate for Payer: United Healthcare HMO Rider |
$21.21
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$19.44
|
|
|
PHYTONADIONE (VITAMIN K1) 1 MG/0.5 ML INJECTION SYRINGE [6271]
|
Facility
|
OP
|
$59.35
|
|
|
Service Code
|
HCPCS J3430
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$3.25 |
| Max. Negotiated Rate |
$50.45 |
| Rate for Payer: Adventist Health Commercial |
$11.87
|
| Rate for Payer: Aetna of CA HMO/PPO |
$15.38
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$50.45
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$32.64
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$44.51
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$11.09
|
| Rate for Payer: Blue Shield of California Commercial |
$6.45
|
| Rate for Payer: Cash Price |
$26.71
|
| Rate for Payer: Cash Price |
$26.71
|
| Rate for Payer: Cigna of CA HMO |
$41.55
|
| Rate for Payer: Cigna of CA PPO |
$41.55
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$50.45
|
| Rate for Payer: Dignity Health Medi-Cal |
$50.45
|
| Rate for Payer: Dignity Health Medicare Advantage |
$50.45
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$41.55
|
| Rate for Payer: EPIC Health Plan Commercial |
$23.74
|
| Rate for Payer: EPIC Health Plan Senior |
$23.74
|
| Rate for Payer: Galaxy Health WC |
$50.45
|
| Rate for Payer: Global Benefits Group Commercial |
$35.61
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$3.25
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$37.69
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$13.81
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$35.02
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$14.24
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$41.55
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$41.55
|
| Rate for Payer: Multiplan Commercial |
$47.48
|
| Rate for Payer: Networks By Design Commercial |
$29.68
|
| Rate for Payer: Prime Health Services Commercial |
$50.45
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$35.61
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$35.61
|
| Rate for Payer: United Healthcare All Other Commercial |
$22.27
|
| Rate for Payer: United Healthcare All Other HMO |
$21.68
|
| Rate for Payer: United Healthcare HMO Rider |
$21.21
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$19.44
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$50.45
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$50.45
|
| Rate for Payer: Vantage Medical Group Senior |
$50.45
|
|
|
PHYTONADIONE (VITAMIN K1) 1 MG/0.5 ML ORAL SYRINGE [4081654]
|
Facility
|
IP
|
$59.35
|
|
|
Service Code
|
HCPCS J3430
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$11.87 |
| Max. Negotiated Rate |
$50.45 |
| Rate for Payer: Adventist Health Commercial |
$11.87
|
| Rate for Payer: Blue Shield of California Commercial |
$30.09
|
| Rate for Payer: Blue Shield of California Commercial |
$45.64
|
| Rate for Payer: Cash Price |
$26.71
|
| Rate for Payer: Cigna of CA HMO |
$41.55
|
| Rate for Payer: Cigna of CA PPO |
$41.55
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$41.55
|
| Rate for Payer: EPIC Health Plan Commercial |
$23.74
|
| Rate for Payer: EPIC Health Plan Senior |
$23.74
|
| Rate for Payer: Galaxy Health WC |
$50.45
|
| Rate for Payer: Global Benefits Group Commercial |
$35.61
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$37.69
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$35.02
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$14.24
|
| Rate for Payer: Multiplan Commercial |
$47.48
|
| Rate for Payer: Networks By Design Commercial |
$29.68
|
| Rate for Payer: Prime Health Services Commercial |
$50.45
|
| Rate for Payer: United Healthcare All Other Commercial |
$22.27
|
| Rate for Payer: United Healthcare All Other HMO |
$21.68
|
| Rate for Payer: United Healthcare HMO Rider |
$21.21
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$19.44
|
|
|
PHYTONADIONE (VITAMIN K1) 1 MG/0.5 ML ORAL SYRINGE [4081654]
|
Facility
|
OP
|
$59.35
|
|
|
Service Code
|
HCPCS J3430
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$3.25 |
| Max. Negotiated Rate |
$50.45 |
| Rate for Payer: Adventist Health Commercial |
$11.87
|
| Rate for Payer: Aetna of CA HMO/PPO |
$15.38
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$50.45
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$32.64
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$44.51
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$11.09
|
| Rate for Payer: Blue Shield of California Commercial |
$6.45
|
| Rate for Payer: Cash Price |
$26.71
|
| Rate for Payer: Cash Price |
$26.71
|
| Rate for Payer: Cigna of CA HMO |
$41.55
|
| Rate for Payer: Cigna of CA PPO |
$41.55
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$50.45
|
| Rate for Payer: Dignity Health Medi-Cal |
$50.45
|
| Rate for Payer: Dignity Health Medicare Advantage |
$50.45
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$41.55
|
| Rate for Payer: EPIC Health Plan Commercial |
$23.74
|
| Rate for Payer: EPIC Health Plan Senior |
$23.74
|
| Rate for Payer: Galaxy Health WC |
$50.45
|
| Rate for Payer: Global Benefits Group Commercial |
$35.61
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$3.25
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$37.69
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$13.81
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$35.02
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$14.24
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$41.55
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$41.55
|
| Rate for Payer: Multiplan Commercial |
$47.48
|
| Rate for Payer: Networks By Design Commercial |
$29.68
|
| Rate for Payer: Prime Health Services Commercial |
$50.45
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$35.61
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$35.61
|
| Rate for Payer: United Healthcare All Other Commercial |
$22.27
|
| Rate for Payer: United Healthcare All Other HMO |
$21.68
|
| Rate for Payer: United Healthcare HMO Rider |
$21.21
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$19.44
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$50.45
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$50.45
|
| Rate for Payer: Vantage Medical Group Senior |
$50.45
|
|
|
PHYTONADIONE (VITAMIN K1) 5 MG TABLET [11024]
|
Facility
|
OP
|
$27.01
|
|
|
Service Code
|
NDC 6909799902
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$5.40 |
| Max. Negotiated Rate |
$22.96 |
| Rate for Payer: Adventist Health Commercial |
$5.40
|
| Rate for Payer: Aetna of CA HMO/PPO |
$17.72
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$22.96
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$14.86
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$20.26
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$17.33
|
| Rate for Payer: Cash Price |
$12.15
|
| Rate for Payer: Cigna of CA HMO |
$18.91
|
| Rate for Payer: Cigna of CA PPO |
$18.91
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$22.96
|
| Rate for Payer: Dignity Health Medi-Cal |
$22.96
|
| Rate for Payer: Dignity Health Medicare Advantage |
$22.96
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$18.91
|
| Rate for Payer: EPIC Health Plan Commercial |
$10.80
|
| Rate for Payer: EPIC Health Plan Senior |
$10.80
|
| Rate for Payer: Galaxy Health WC |
$22.96
|
| Rate for Payer: Global Benefits Group Commercial |
$16.21
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$17.15
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$9.80
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$15.94
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6.48
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$18.91
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$18.91
|
| Rate for Payer: Multiplan Commercial |
$21.61
|
| Rate for Payer: Networks By Design Commercial |
$17.56
|
| Rate for Payer: Prime Health Services Commercial |
$22.96
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$16.21
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$16.21
|
| Rate for Payer: United Healthcare All Other Commercial |
$13.51
|
| Rate for Payer: United Healthcare All Other HMO |
$13.51
|
| Rate for Payer: United Healthcare HMO Rider |
$13.51
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$13.51
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$22.96
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$22.96
|
| Rate for Payer: Vantage Medical Group Senior |
$22.96
|
|
|
PHYTONADIONE (VITAMIN K1) 5 MG TABLET [11024]
|
Facility
|
OP
|
$80.85
|
|
|
Service Code
|
NDC 6068738111
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$16.17 |
| Max. Negotiated Rate |
$68.72 |
| Rate for Payer: Adventist Health Commercial |
$16.17
|
| Rate for Payer: Aetna of CA HMO/PPO |
$53.03
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$68.72
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$44.47
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$60.64
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$51.88
|
| Rate for Payer: Cash Price |
$36.38
|
| Rate for Payer: Cigna of CA HMO |
$56.59
|
| Rate for Payer: Cigna of CA PPO |
$56.59
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$68.72
|
| Rate for Payer: Dignity Health Medi-Cal |
$68.72
|
| Rate for Payer: Dignity Health Medicare Advantage |
$68.72
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$56.59
|
| Rate for Payer: EPIC Health Plan Commercial |
$32.34
|
| Rate for Payer: EPIC Health Plan Senior |
$32.34
|
| Rate for Payer: Galaxy Health WC |
$68.72
|
| Rate for Payer: Global Benefits Group Commercial |
$48.51
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$51.34
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$29.35
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$47.70
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$19.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$56.59
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$56.59
|
| Rate for Payer: Multiplan Commercial |
$64.68
|
| Rate for Payer: Networks By Design Commercial |
$52.55
|
| Rate for Payer: Prime Health Services Commercial |
$68.72
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$48.51
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$48.51
|
| Rate for Payer: United Healthcare All Other Commercial |
$40.42
|
| Rate for Payer: United Healthcare All Other HMO |
$40.42
|
| Rate for Payer: United Healthcare HMO Rider |
$40.42
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$40.42
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$68.72
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$68.72
|
| Rate for Payer: Vantage Medical Group Senior |
$68.72
|
|
|
PHYTONADIONE (VITAMIN K1) 5 MG TABLET [11024]
|
Facility
|
OP
|
$80.85
|
|
|
Service Code
|
NDC 6068738194
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$16.17 |
| Max. Negotiated Rate |
$68.72 |
| Rate for Payer: Adventist Health Commercial |
$16.17
|
| Rate for Payer: Aetna of CA HMO/PPO |
$53.03
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$68.72
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$44.47
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$60.64
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$51.88
|
| Rate for Payer: Cash Price |
$36.38
|
| Rate for Payer: Cigna of CA HMO |
$56.59
|
| Rate for Payer: Cigna of CA PPO |
$56.59
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$68.72
|
| Rate for Payer: Dignity Health Medi-Cal |
$68.72
|
| Rate for Payer: Dignity Health Medicare Advantage |
$68.72
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$56.59
|
| Rate for Payer: EPIC Health Plan Commercial |
$32.34
|
| Rate for Payer: EPIC Health Plan Senior |
$32.34
|
| Rate for Payer: Galaxy Health WC |
$68.72
|
| Rate for Payer: Global Benefits Group Commercial |
$48.51
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$51.34
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$29.35
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$47.70
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$19.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$56.59
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$56.59
|
| Rate for Payer: Multiplan Commercial |
$64.68
|
| Rate for Payer: Networks By Design Commercial |
$52.55
|
| Rate for Payer: Prime Health Services Commercial |
$68.72
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$48.51
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$48.51
|
| Rate for Payer: United Healthcare All Other Commercial |
$40.42
|
| Rate for Payer: United Healthcare All Other HMO |
$40.42
|
| Rate for Payer: United Healthcare HMO Rider |
$40.42
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$40.42
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$68.72
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$68.72
|
| Rate for Payer: Vantage Medical Group Senior |
$68.72
|
|
|
PHYTONADIONE (VITAMIN K1) 5 MG TABLET [11024]
|
Facility
|
IP
|
$33.76
|
|
|
Service Code
|
NDC 7071010143
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$6.75 |
| Max. Negotiated Rate |
$28.70 |
| Rate for Payer: Adventist Health Commercial |
$6.75
|
| Rate for Payer: Blue Shield of California Commercial |
$17.12
|
| Rate for Payer: Blue Shield of California Commercial |
$25.96
|
| Rate for Payer: Cash Price |
$15.19
|
| Rate for Payer: Cigna of CA HMO |
$23.63
|
| Rate for Payer: Cigna of CA PPO |
$23.63
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$23.63
|
| Rate for Payer: EPIC Health Plan Commercial |
$13.50
|
| Rate for Payer: EPIC Health Plan Senior |
$13.50
|
| Rate for Payer: Galaxy Health WC |
$28.70
|
| Rate for Payer: Global Benefits Group Commercial |
$20.26
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$21.44
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$19.92
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$8.10
|
| Rate for Payer: Multiplan Commercial |
$27.01
|
| Rate for Payer: Networks By Design Commercial |
$21.94
|
| Rate for Payer: Prime Health Services Commercial |
$28.70
|
|
|
PHYTONADIONE (VITAMIN K1) 5 MG TABLET [11024]
|
Facility
|
IP
|
$80.85
|
|
|
Service Code
|
NDC 6068738111
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$16.17 |
| Max. Negotiated Rate |
$68.72 |
| Rate for Payer: Adventist Health Commercial |
$16.17
|
| Rate for Payer: Blue Shield of California Commercial |
$40.99
|
| Rate for Payer: Blue Shield of California Commercial |
$62.17
|
| Rate for Payer: Cash Price |
$36.38
|
| Rate for Payer: Cigna of CA HMO |
$56.59
|
| Rate for Payer: Cigna of CA PPO |
$56.59
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$56.59
|
| Rate for Payer: EPIC Health Plan Commercial |
$32.34
|
| Rate for Payer: EPIC Health Plan Senior |
$32.34
|
| Rate for Payer: Galaxy Health WC |
$68.72
|
| Rate for Payer: Global Benefits Group Commercial |
$48.51
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$51.34
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$47.70
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$19.40
|
| Rate for Payer: Multiplan Commercial |
$64.68
|
| Rate for Payer: Networks By Design Commercial |
$52.55
|
| Rate for Payer: Prime Health Services Commercial |
$68.72
|
|
|
PHYTONADIONE (VITAMIN K1) 5 MG TABLET [11024]
|
Facility
|
IP
|
$80.85
|
|
|
Service Code
|
NDC 6068738194
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$16.17 |
| Max. Negotiated Rate |
$68.72 |
| Rate for Payer: Adventist Health Commercial |
$16.17
|
| Rate for Payer: Blue Shield of California Commercial |
$40.99
|
| Rate for Payer: Blue Shield of California Commercial |
$62.17
|
| Rate for Payer: Cash Price |
$36.38
|
| Rate for Payer: Cigna of CA HMO |
$56.59
|
| Rate for Payer: Cigna of CA PPO |
$56.59
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$56.59
|
| Rate for Payer: EPIC Health Plan Commercial |
$32.34
|
| Rate for Payer: EPIC Health Plan Senior |
$32.34
|
| Rate for Payer: Galaxy Health WC |
$68.72
|
| Rate for Payer: Global Benefits Group Commercial |
$48.51
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$51.34
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$47.70
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$19.40
|
| Rate for Payer: Multiplan Commercial |
$64.68
|
| Rate for Payer: Networks By Design Commercial |
$52.55
|
| Rate for Payer: Prime Health Services Commercial |
$68.72
|
|
