|
SELENIUM 200 MCG TABLET [7139]
|
Facility
|
OP
|
$0.06
|
|
|
Service Code
|
NDC 4009310196
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.01 |
| Max. Negotiated Rate |
$0.05 |
| Rate for Payer: Adventist Health Commercial |
$0.01
|
| Rate for Payer: Aetna of CA HMO/PPO |
$0.04
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.05
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.03
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.05
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.04
|
| Rate for Payer: Cash Price |
$0.03
|
| Rate for Payer: Cigna of CA HMO |
$0.04
|
| Rate for Payer: Cigna of CA PPO |
$0.04
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.05
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.05
|
| Rate for Payer: Dignity Health Medicare Advantage |
$0.05
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.02
|
| Rate for Payer: EPIC Health Plan Senior |
$0.02
|
| Rate for Payer: Galaxy Health WC |
$0.05
|
| Rate for Payer: Global Benefits Group Commercial |
$0.04
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.04
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.02
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$0.04
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.01
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$0.04
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$0.04
|
| Rate for Payer: Multiplan Commercial |
$0.05
|
| Rate for Payer: Networks By Design Commercial |
$0.04
|
| Rate for Payer: Prime Health Services Commercial |
$0.05
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.04
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.04
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.03
|
| Rate for Payer: United Healthcare All Other HMO |
$0.03
|
| Rate for Payer: United Healthcare HMO Rider |
$0.03
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.03
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.05
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.05
|
| Rate for Payer: Vantage Medical Group Senior |
$0.05
|
|
|
SELENIUM 50 MCG TABLET [7140]
|
Facility
|
OP
|
$0.05
|
|
|
Service Code
|
NDC 26899-721-74
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.01 |
| Max. Negotiated Rate |
$0.04 |
| 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 |
$0.04
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.03
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.04
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.03
|
| Rate for Payer: Cash Price |
$0.03
|
| Rate for Payer: Cigna of CA HMO |
$0.04
|
| Rate for Payer: Cigna of CA PPO |
$0.04
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.04
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.04
|
| Rate for Payer: Dignity Health Medicare Advantage |
$0.04
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.02
|
| Rate for Payer: EPIC Health Plan Senior |
$0.02
|
| Rate for Payer: Galaxy Health WC |
$0.04
|
| Rate for Payer: Global Benefits Group Commercial |
$0.03
|
| 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 |
$0.03
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.01
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$0.04
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$0.04
|
| Rate for Payer: Multiplan Commercial |
$0.04
|
| Rate for Payer: Networks By Design Commercial |
$0.03
|
| Rate for Payer: Prime Health Services Commercial |
$0.04
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.03
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.03
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.03
|
| Rate for Payer: United Healthcare All Other HMO |
$0.03
|
| Rate for Payer: United Healthcare HMO Rider |
$0.03
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.03
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.04
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.04
|
| Rate for Payer: Vantage Medical Group Senior |
$0.04
|
|
|
SELENIUM 50 MCG TABLET [7140]
|
Facility
|
IP
|
$0.05
|
|
|
Service Code
|
NDC 26899-721-74
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.01 |
| Max. Negotiated Rate |
$0.04 |
| Rate for Payer: Adventist Health Commercial |
$0.01
|
| Rate for Payer: Blue Shield of California Commercial |
$0.04
|
| Rate for Payer: Blue Shield of California EPN |
$0.02
|
| Rate for Payer: Cash Price |
$0.03
|
| Rate for Payer: Cigna of CA HMO |
$0.04
|
| Rate for Payer: Cigna of CA PPO |
$0.04
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.02
|
| Rate for Payer: EPIC Health Plan Senior |
$0.02
|
| Rate for Payer: Galaxy Health WC |
$0.04
|
| Rate for Payer: Global Benefits Group Commercial |
$0.03
|
| 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 |
$0.03
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.01
|
| Rate for Payer: Multiplan Commercial |
$0.04
|
| Rate for Payer: Networks By Design Commercial |
$0.03
|
| Rate for Payer: Prime Health Services Commercial |
$0.04
|
|
|
SELENIUM 60 MCG/ML INTRAVENOUS SOLUTION [225026]
|
Facility
|
OP
|
$41.16
|
|
|
Service Code
|
NDC 0517-6560-25
|
| Hospital Charge Code |
901700004
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$8.23 |
| Max. Negotiated Rate |
$34.99 |
| Rate for Payer: Adventist Health Commercial |
$8.23
|
| Rate for Payer: Aetna of CA HMO/PPO |
$27.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$34.99
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$22.64
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$30.87
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$25.28
|
| Rate for Payer: Cash Price |
$22.64
|
| Rate for Payer: Cigna of CA HMO |
$26.34
|
| Rate for Payer: Cigna of CA PPO |
$30.46
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$34.99
|
| Rate for Payer: Dignity Health Medi-Cal |
$34.99
|
| Rate for Payer: Dignity Health Medicare Advantage |
$34.99
|
| Rate for Payer: EPIC Health Plan Commercial |
$16.46
|
| Rate for Payer: EPIC Health Plan Senior |
$16.46
|
| Rate for Payer: Galaxy Health WC |
$34.99
|
| Rate for Payer: Global Benefits Group Commercial |
$24.70
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$27.45
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$15.68
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$25.48
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$9.88
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$28.81
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$28.81
|
| Rate for Payer: Multiplan Commercial |
$32.93
|
| Rate for Payer: Networks By Design Commercial |
$26.75
|
| Rate for Payer: Prime Health Services Commercial |
$34.99
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$24.70
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$24.70
|
| Rate for Payer: United Healthcare All Other Commercial |
$20.58
|
| Rate for Payer: United Healthcare All Other HMO |
$20.58
|
| Rate for Payer: United Healthcare HMO Rider |
$20.58
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$20.58
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$34.99
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$34.99
|
| Rate for Payer: Vantage Medical Group Senior |
$34.99
|
|
|
SELENIUM 60 MCG/ML INTRAVENOUS SOLUTION [225026]
|
Facility
|
IP
|
$41.16
|
|
|
Service Code
|
NDC 0517-6560-25
|
| Hospital Charge Code |
901700004
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$8.23 |
| Max. Negotiated Rate |
$34.99 |
| Rate for Payer: Adventist Health Commercial |
$8.23
|
| Rate for Payer: Blue Shield of California Commercial |
$30.38
|
| Rate for Payer: Blue Shield of California EPN |
$20.00
|
| Rate for Payer: Cash Price |
$22.64
|
| Rate for Payer: EPIC Health Plan Commercial |
$16.46
|
| Rate for Payer: EPIC Health Plan Senior |
$16.46
|
| Rate for Payer: Galaxy Health WC |
$34.99
|
| Rate for Payer: Global Benefits Group Commercial |
$24.70
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$27.45
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$15.68
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$25.48
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$9.88
|
| Rate for Payer: Multiplan Commercial |
$32.93
|
| Rate for Payer: Networks By Design Commercial |
$26.75
|
| Rate for Payer: Prime Health Services Commercial |
$34.99
|
|
|
SELENIUM SULFIDE 1 % SHAMPOO [38961]
|
Facility
|
IP
|
$0.02
|
|
|
Service Code
|
NDC 0536-1995-53
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Max. Negotiated Rate |
$0.02 |
| 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 EPN |
$0.01
|
| Rate for Payer: Cash Price |
$0.01
|
| Rate for Payer: Cigna of CA HMO |
$0.01
|
| Rate for Payer: Cigna of CA PPO |
$0.01
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.01
|
| Rate for Payer: EPIC Health Plan Senior |
$0.01
|
| Rate for Payer: Galaxy Health WC |
$0.02
|
| Rate for Payer: Global Benefits Group Commercial |
$0.01
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.01
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.01
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$0.01
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.00
|
| Rate for Payer: Multiplan Commercial |
$0.02
|
| Rate for Payer: Networks By Design Commercial |
$0.01
|
| Rate for Payer: Prime Health Services Commercial |
$0.02
|
|
|
SELENIUM SULFIDE 1 % SHAMPOO [38961]
|
Facility
|
OP
|
$0.02
|
|
|
Service Code
|
NDC 0536-1995-53
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Max. Negotiated Rate |
$0.02 |
| 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 |
$0.02
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.01
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.02
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.01
|
| Rate for Payer: Cash Price |
$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 |
$0.02
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.02
|
| Rate for Payer: Dignity Health Medicare Advantage |
$0.02
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.01
|
| Rate for Payer: EPIC Health Plan Senior |
$0.01
|
| Rate for Payer: Galaxy Health WC |
$0.02
|
| Rate for Payer: Global Benefits Group Commercial |
$0.01
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.01
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.01
|
| Rate for Payer: Kaiser Permanente of CA 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 |
$0.02
|
| Rate for Payer: Networks By Design Commercial |
$0.01
|
| Rate for Payer: Prime Health Services Commercial |
$0.02
|
| 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 |
$0.02
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.02
|
| Rate for Payer: Vantage Medical Group Senior |
$0.02
|
|
|
SELENIUM SULFIDE 2.25 % SHAMPOO [40158]
|
Facility
|
IP
|
$0.75
|
|
|
Service Code
|
NDC 42192-152-06
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.15 |
| Max. Negotiated Rate |
$0.64 |
| Rate for Payer: Adventist Health Commercial |
$0.15
|
| Rate for Payer: Blue Shield of California Commercial |
$0.55
|
| Rate for Payer: Blue Shield of California EPN |
$0.36
|
| Rate for Payer: Cash Price |
$0.41
|
| Rate for Payer: Cigna of CA HMO |
$0.53
|
| Rate for Payer: Cigna of CA PPO |
$0.53
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.30
|
| Rate for Payer: EPIC Health Plan Senior |
$0.30
|
| Rate for Payer: Galaxy Health WC |
$0.64
|
| Rate for Payer: Global Benefits Group Commercial |
$0.45
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.50
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.29
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$0.46
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.18
|
| Rate for Payer: Multiplan Commercial |
$0.60
|
| Rate for Payer: Networks By Design Commercial |
$0.49
|
| Rate for Payer: Prime Health Services Commercial |
$0.64
|
|
|
SELENIUM SULFIDE 2.25 % SHAMPOO [40158]
|
Facility
|
OP
|
$0.75
|
|
|
Service Code
|
NDC 42192-152-06
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.15 |
| Max. Negotiated Rate |
$0.64 |
| Rate for Payer: Adventist Health Commercial |
$0.15
|
| Rate for Payer: Aetna of CA HMO/PPO |
$0.49
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.64
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.41
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.56
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.46
|
| Rate for Payer: Cash Price |
$0.41
|
| Rate for Payer: Cigna of CA HMO |
$0.53
|
| Rate for Payer: Cigna of CA PPO |
$0.53
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.64
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.64
|
| Rate for Payer: Dignity Health Medicare Advantage |
$0.64
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.30
|
| Rate for Payer: EPIC Health Plan Senior |
$0.30
|
| Rate for Payer: Galaxy Health WC |
$0.64
|
| Rate for Payer: Global Benefits Group Commercial |
$0.45
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.50
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.29
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$0.46
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.18
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$0.53
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$0.53
|
| Rate for Payer: Multiplan Commercial |
$0.60
|
| Rate for Payer: Networks By Design Commercial |
$0.49
|
| Rate for Payer: Prime Health Services Commercial |
$0.64
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.45
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.45
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.38
|
| Rate for Payer: United Healthcare All Other HMO |
$0.38
|
| Rate for Payer: United Healthcare HMO Rider |
$0.38
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.38
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.64
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.64
|
| Rate for Payer: Vantage Medical Group Senior |
$0.64
|
|
|
SELEXIPAG 200 MCG TABLET [212415]
|
Facility
|
IP
|
$306.97
|
|
|
Service Code
|
HCPCS C9399
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$61.39 |
| Max. Negotiated Rate |
$260.92 |
| Rate for Payer: Adventist Health Commercial |
$61.39
|
| Rate for Payer: Blue Shield of California Commercial |
$226.54
|
| Rate for Payer: Blue Shield of California EPN |
$149.19
|
| Rate for Payer: Cash Price |
$168.83
|
| Rate for Payer: Cigna of CA HMO |
$214.88
|
| Rate for Payer: Cigna of CA PPO |
$214.88
|
| Rate for Payer: EPIC Health Plan Commercial |
$122.79
|
| Rate for Payer: EPIC Health Plan Senior |
$122.79
|
| Rate for Payer: Galaxy Health WC |
$260.92
|
| Rate for Payer: Global Benefits Group Commercial |
$184.18
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$204.75
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$116.96
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$190.01
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$73.67
|
| Rate for Payer: Multiplan Commercial |
$245.58
|
| Rate for Payer: Networks By Design Commercial |
$153.49
|
| Rate for Payer: Prime Health Services Commercial |
$260.92
|
| Rate for Payer: United Healthcare All Other Commercial |
$115.21
|
| Rate for Payer: United Healthcare All Other HMO |
$112.14
|
| Rate for Payer: United Healthcare HMO Rider |
$109.71
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$100.53
|
|
|
SELEXIPAG 200 MCG TABLET [212415]
|
Facility
|
OP
|
$306.97
|
|
|
Service Code
|
HCPCS C9399
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$61.39 |
| Max. Negotiated Rate |
$260.92 |
| Rate for Payer: Adventist Health Commercial |
$61.39
|
| Rate for Payer: Aetna of CA HMO/PPO |
$201.34
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$260.92
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$168.83
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$230.23
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$188.51
|
| Rate for Payer: Cash Price |
$168.83
|
| Rate for Payer: Cigna of CA HMO |
$214.88
|
| Rate for Payer: Cigna of CA PPO |
$214.88
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$260.92
|
| Rate for Payer: Dignity Health Medi-Cal |
$260.92
|
| Rate for Payer: Dignity Health Medicare Advantage |
$260.92
|
| Rate for Payer: EPIC Health Plan Commercial |
$122.79
|
| Rate for Payer: EPIC Health Plan Senior |
$122.79
|
| Rate for Payer: Galaxy Health WC |
$260.92
|
| Rate for Payer: Global Benefits Group Commercial |
$184.18
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$204.75
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$116.96
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$190.01
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$73.67
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$214.88
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$214.88
|
| Rate for Payer: Multiplan Commercial |
$245.58
|
| Rate for Payer: Networks By Design Commercial |
$153.49
|
| Rate for Payer: Prime Health Services Commercial |
$260.92
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$184.18
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$184.18
|
| Rate for Payer: United Healthcare All Other Commercial |
$115.21
|
| Rate for Payer: United Healthcare All Other HMO |
$112.14
|
| Rate for Payer: United Healthcare HMO Rider |
$109.71
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$100.53
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$260.92
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$260.92
|
| Rate for Payer: Vantage Medical Group Senior |
$260.92
|
|
|
SELEXIPAG 400 MCG TABLET [212416]
|
Facility
|
IP
|
$477.38
|
|
|
Service Code
|
HCPCS C9399
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$95.48 |
| Max. Negotiated Rate |
$405.77 |
| Rate for Payer: Adventist Health Commercial |
$95.48
|
| Rate for Payer: Blue Shield of California Commercial |
$352.31
|
| Rate for Payer: Blue Shield of California EPN |
$232.01
|
| Rate for Payer: Cash Price |
$262.56
|
| Rate for Payer: Cigna of CA HMO |
$334.17
|
| Rate for Payer: Cigna of CA PPO |
$334.17
|
| Rate for Payer: EPIC Health Plan Commercial |
$190.95
|
| Rate for Payer: EPIC Health Plan Senior |
$190.95
|
| Rate for Payer: Galaxy Health WC |
$405.77
|
| Rate for Payer: Global Benefits Group Commercial |
$286.43
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$318.41
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$181.88
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$295.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$114.57
|
| Rate for Payer: Multiplan Commercial |
$381.90
|
| Rate for Payer: Networks By Design Commercial |
$238.69
|
| Rate for Payer: Prime Health Services Commercial |
$405.77
|
| Rate for Payer: United Healthcare All Other Commercial |
$179.16
|
| Rate for Payer: United Healthcare All Other HMO |
$174.39
|
| Rate for Payer: United Healthcare HMO Rider |
$170.62
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$156.34
|
|
|
SELEXIPAG 400 MCG TABLET [212416]
|
Facility
|
OP
|
$477.38
|
|
|
Service Code
|
HCPCS C9399
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$95.48 |
| Max. Negotiated Rate |
$405.77 |
| Rate for Payer: Adventist Health Commercial |
$95.48
|
| Rate for Payer: Aetna of CA HMO/PPO |
$313.11
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$405.77
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$262.56
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$358.04
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$293.16
|
| Rate for Payer: Cash Price |
$262.56
|
| Rate for Payer: Cigna of CA HMO |
$334.17
|
| Rate for Payer: Cigna of CA PPO |
$334.17
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$405.77
|
| Rate for Payer: Dignity Health Medi-Cal |
$405.77
|
| Rate for Payer: Dignity Health Medicare Advantage |
$405.77
|
| Rate for Payer: EPIC Health Plan Commercial |
$190.95
|
| Rate for Payer: EPIC Health Plan Senior |
$190.95
|
| Rate for Payer: Galaxy Health WC |
$405.77
|
| Rate for Payer: Global Benefits Group Commercial |
$286.43
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$318.41
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$181.88
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$295.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$114.57
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$334.17
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$334.17
|
| Rate for Payer: Multiplan Commercial |
$381.90
|
| Rate for Payer: Networks By Design Commercial |
$238.69
|
| Rate for Payer: Prime Health Services Commercial |
$405.77
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$286.43
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$286.43
|
| Rate for Payer: United Healthcare All Other Commercial |
$179.16
|
| Rate for Payer: United Healthcare All Other HMO |
$174.39
|
| Rate for Payer: United Healthcare HMO Rider |
$170.62
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$156.34
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$405.77
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$405.77
|
| Rate for Payer: Vantage Medical Group Senior |
$405.77
|
|
|
SELEXIPAG 800 MCG TABLET [212418]
|
Facility
|
OP
|
$477.38
|
|
|
Service Code
|
HCPCS C9399
|
| Hospital Charge Code |
901700030
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$95.48 |
| Max. Negotiated Rate |
$405.77 |
| Rate for Payer: Adventist Health Commercial |
$95.48
|
| Rate for Payer: Aetna of CA HMO/PPO |
$313.11
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$405.77
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$262.56
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$358.04
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$293.16
|
| Rate for Payer: Cash Price |
$262.56
|
| Rate for Payer: Cigna of CA HMO |
$334.17
|
| Rate for Payer: Cigna of CA PPO |
$334.17
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$405.77
|
| Rate for Payer: Dignity Health Medi-Cal |
$405.77
|
| Rate for Payer: Dignity Health Medicare Advantage |
$405.77
|
| Rate for Payer: EPIC Health Plan Commercial |
$190.95
|
| Rate for Payer: EPIC Health Plan Senior |
$190.95
|
| Rate for Payer: Galaxy Health WC |
$405.77
|
| Rate for Payer: Global Benefits Group Commercial |
$286.43
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$318.41
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$181.88
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$295.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$114.57
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$334.17
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$334.17
|
| Rate for Payer: Multiplan Commercial |
$381.90
|
| Rate for Payer: Networks By Design Commercial |
$310.30
|
| Rate for Payer: Prime Health Services Commercial |
$405.77
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$286.43
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$286.43
|
| Rate for Payer: United Healthcare All Other Commercial |
$238.69
|
| Rate for Payer: United Healthcare All Other HMO |
$238.69
|
| Rate for Payer: United Healthcare HMO Rider |
$238.69
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$238.69
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$405.77
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$405.77
|
| Rate for Payer: Vantage Medical Group Senior |
$405.77
|
|
|
SELEXIPAG 800 MCG TABLET [212418]
|
Facility
|
IP
|
$477.38
|
|
|
Service Code
|
HCPCS C9399
|
| Hospital Charge Code |
901700030
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$95.48 |
| Max. Negotiated Rate |
$405.77 |
| Rate for Payer: Adventist Health Commercial |
$95.48
|
| Rate for Payer: Blue Shield of California Commercial |
$352.31
|
| Rate for Payer: Blue Shield of California EPN |
$232.01
|
| Rate for Payer: Cash Price |
$262.56
|
| Rate for Payer: Cigna of CA HMO |
$334.17
|
| Rate for Payer: Cigna of CA PPO |
$334.17
|
| Rate for Payer: EPIC Health Plan Commercial |
$190.95
|
| Rate for Payer: EPIC Health Plan Senior |
$190.95
|
| Rate for Payer: Galaxy Health WC |
$405.77
|
| Rate for Payer: Global Benefits Group Commercial |
$286.43
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$318.41
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$181.88
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$295.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$114.57
|
| Rate for Payer: Multiplan Commercial |
$381.90
|
| Rate for Payer: Networks By Design Commercial |
$310.30
|
| Rate for Payer: Prime Health Services Commercial |
$405.77
|
|
|
SENNA LEAF EXTRACT 176 MG/5 ML ORAL SYRUP [117388]
|
Facility
|
IP
|
$0.06
|
|
|
Service Code
|
NDC 0121072208
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.01 |
| Max. Negotiated Rate |
$0.05 |
| Rate for Payer: Adventist Health Commercial |
$0.01
|
| Rate for Payer: Blue Shield of California Commercial |
$0.04
|
| Rate for Payer: Blue Shield of California EPN |
$0.03
|
| Rate for Payer: Cash Price |
$0.03
|
| Rate for Payer: Cigna of CA HMO |
$0.04
|
| Rate for Payer: Cigna of CA PPO |
$0.04
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.02
|
| Rate for Payer: EPIC Health Plan Senior |
$0.02
|
| Rate for Payer: Galaxy Health WC |
$0.05
|
| Rate for Payer: Global Benefits Group Commercial |
$0.04
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.04
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.02
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$0.04
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.01
|
| Rate for Payer: Multiplan Commercial |
$0.05
|
| Rate for Payer: Networks By Design Commercial |
$0.04
|
| Rate for Payer: Prime Health Services Commercial |
$0.05
|
|
|
SENNA LEAF EXTRACT 176 MG/5 ML ORAL SYRUP [117388]
|
Facility
|
OP
|
$0.06
|
|
|
Service Code
|
NDC 0121072208
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.01 |
| Max. Negotiated Rate |
$0.05 |
| Rate for Payer: Adventist Health Commercial |
$0.01
|
| Rate for Payer: Aetna of CA HMO/PPO |
$0.04
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.05
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.03
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.05
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.04
|
| Rate for Payer: Cash Price |
$0.03
|
| Rate for Payer: Cigna of CA HMO |
$0.04
|
| Rate for Payer: Cigna of CA PPO |
$0.04
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.05
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.05
|
| Rate for Payer: Dignity Health Medicare Advantage |
$0.05
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.02
|
| Rate for Payer: EPIC Health Plan Senior |
$0.02
|
| Rate for Payer: Galaxy Health WC |
$0.05
|
| Rate for Payer: Global Benefits Group Commercial |
$0.04
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.04
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.02
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$0.04
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.01
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$0.04
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$0.04
|
| Rate for Payer: Multiplan Commercial |
$0.05
|
| Rate for Payer: Networks By Design Commercial |
$0.04
|
| Rate for Payer: Prime Health Services Commercial |
$0.05
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.04
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.04
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.03
|
| Rate for Payer: United Healthcare All Other HMO |
$0.03
|
| Rate for Payer: United Healthcare HMO Rider |
$0.03
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.03
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.05
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.05
|
| Rate for Payer: Vantage Medical Group Senior |
$0.05
|
|
|
SENNOSIDES 8.6 MG-DOCUSATE SODIUM 50 MG TABLET [24216]
|
Facility
|
OP
|
$0.02
|
|
|
Service Code
|
NDC 69618-065-01
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Max. Negotiated Rate |
$0.02 |
| 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 |
$0.02
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.01
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.02
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.01
|
| Rate for Payer: Cash Price |
$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 |
$0.02
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.02
|
| Rate for Payer: Dignity Health Medicare Advantage |
$0.02
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.01
|
| Rate for Payer: EPIC Health Plan Senior |
$0.01
|
| Rate for Payer: Galaxy Health WC |
$0.02
|
| Rate for Payer: Global Benefits Group Commercial |
$0.01
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.01
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.01
|
| Rate for Payer: Kaiser Permanente of CA 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 |
$0.02
|
| Rate for Payer: Networks By Design Commercial |
$0.01
|
| Rate for Payer: Prime Health Services Commercial |
$0.02
|
| 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 |
$0.02
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.02
|
| Rate for Payer: Vantage Medical Group Senior |
$0.02
|
|
|
SENNOSIDES 8.6 MG-DOCUSATE SODIUM 50 MG TABLET [24216]
|
Facility
|
OP
|
$0.03
|
|
|
Service Code
|
NDC 0536-1248-01
|
| 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 |
$0.02
|
| 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 |
$0.02
|
| 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 |
$0.02
|
| Rate for Payer: Cigna of CA PPO |
$0.02
|
| 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 |
$0.01
|
| Rate for Payer: EPIC Health Plan Senior |
$0.01
|
| 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 |
$0.02
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.01
|
| 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 |
$0.02
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$0.02
|
| Rate for Payer: Multiplan Commercial |
$0.02
|
| Rate for Payer: Networks By Design Commercial |
$0.02
|
| 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
|
|
|
SENNOSIDES 8.6 MG-DOCUSATE SODIUM 50 MG TABLET [24216]
|
Facility
|
IP
|
$0.19
|
|
|
Service Code
|
NDC 0904-7440-61
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.04 |
| Max. Negotiated Rate |
$0.16 |
| Rate for Payer: Adventist Health Commercial |
$0.04
|
| Rate for Payer: Blue Shield of California Commercial |
$0.14
|
| Rate for Payer: Blue Shield of California EPN |
$0.09
|
| Rate for Payer: Cash Price |
$0.11
|
| Rate for Payer: Cigna of CA HMO |
$0.13
|
| Rate for Payer: Cigna of CA PPO |
$0.13
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.08
|
| Rate for Payer: EPIC Health Plan Senior |
$0.08
|
| Rate for Payer: Galaxy Health WC |
$0.16
|
| Rate for Payer: Global Benefits Group Commercial |
$0.11
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.13
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.07
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$0.12
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.05
|
| Rate for Payer: Multiplan Commercial |
$0.15
|
| Rate for Payer: Networks By Design Commercial |
$0.12
|
| Rate for Payer: Prime Health Services Commercial |
$0.16
|
|
|
SENNOSIDES 8.6 MG-DOCUSATE SODIUM 50 MG TABLET [24216]
|
Facility
|
IP
|
$0.03
|
|
|
Service Code
|
NDC 0536-1248-01
|
| 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 EPN |
$0.01
|
| Rate for Payer: Cash Price |
$0.02
|
| Rate for Payer: Cigna of CA HMO |
$0.02
|
| Rate for Payer: Cigna of CA PPO |
$0.02
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.01
|
| Rate for Payer: EPIC Health Plan Senior |
$0.01
|
| 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 |
$0.02
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.01
|
| 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 |
$0.02
|
| Rate for Payer: Networks By Design Commercial |
$0.02
|
| Rate for Payer: Prime Health Services Commercial |
$0.03
|
|
|
SENNOSIDES 8.6 MG-DOCUSATE SODIUM 50 MG TABLET [24216]
|
Facility
|
OP
|
$0.19
|
|
|
Service Code
|
NDC 0904-7440-61
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.04 |
| Max. Negotiated Rate |
$0.16 |
| Rate for Payer: Adventist Health Commercial |
$0.04
|
| Rate for Payer: Aetna of CA HMO/PPO |
$0.12
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.16
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.10
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.14
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.12
|
| Rate for Payer: Cash Price |
$0.11
|
| Rate for Payer: Cigna of CA HMO |
$0.13
|
| Rate for Payer: Cigna of CA PPO |
$0.13
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.16
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.16
|
| Rate for Payer: Dignity Health Medicare Advantage |
$0.16
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.08
|
| Rate for Payer: EPIC Health Plan Senior |
$0.08
|
| Rate for Payer: Galaxy Health WC |
$0.16
|
| Rate for Payer: Global Benefits Group Commercial |
$0.11
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.13
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.07
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$0.12
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.05
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$0.13
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$0.13
|
| Rate for Payer: Multiplan Commercial |
$0.15
|
| Rate for Payer: Networks By Design Commercial |
$0.12
|
| Rate for Payer: Prime Health Services Commercial |
$0.16
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.11
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.11
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.10
|
| Rate for Payer: United Healthcare All Other HMO |
$0.10
|
| Rate for Payer: United Healthcare HMO Rider |
$0.10
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.10
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.16
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.16
|
| Rate for Payer: Vantage Medical Group Senior |
$0.16
|
|
|
SENNOSIDES 8.6 MG-DOCUSATE SODIUM 50 MG TABLET [24216]
|
Facility
|
OP
|
$0.19
|
|
|
Service Code
|
NDC 60687-622-11
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.04 |
| Max. Negotiated Rate |
$0.16 |
| Rate for Payer: Adventist Health Commercial |
$0.04
|
| Rate for Payer: Aetna of CA HMO/PPO |
$0.12
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.16
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.10
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.14
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.12
|
| Rate for Payer: Cash Price |
$0.11
|
| Rate for Payer: Cigna of CA HMO |
$0.13
|
| Rate for Payer: Cigna of CA PPO |
$0.13
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.16
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.16
|
| Rate for Payer: Dignity Health Medicare Advantage |
$0.16
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.08
|
| Rate for Payer: EPIC Health Plan Senior |
$0.08
|
| Rate for Payer: Galaxy Health WC |
$0.16
|
| Rate for Payer: Global Benefits Group Commercial |
$0.11
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.13
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.07
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$0.12
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.05
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$0.13
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$0.13
|
| Rate for Payer: Multiplan Commercial |
$0.15
|
| Rate for Payer: Networks By Design Commercial |
$0.12
|
| Rate for Payer: Prime Health Services Commercial |
$0.16
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.11
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.11
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.10
|
| Rate for Payer: United Healthcare All Other HMO |
$0.10
|
| Rate for Payer: United Healthcare HMO Rider |
$0.10
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.10
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.16
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.16
|
| Rate for Payer: Vantage Medical Group Senior |
$0.16
|
|
|
SENNOSIDES 8.6 MG-DOCUSATE SODIUM 50 MG TABLET [24216]
|
Facility
|
IP
|
$0.34
|
|
|
Service Code
|
NDC 67618-110-60
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.07 |
| Max. Negotiated Rate |
$0.29 |
| Rate for Payer: Adventist Health Commercial |
$0.07
|
| Rate for Payer: Blue Shield of California Commercial |
$0.25
|
| Rate for Payer: Blue Shield of California EPN |
$0.17
|
| Rate for Payer: Cash Price |
$0.19
|
| Rate for Payer: Cigna of CA HMO |
$0.24
|
| Rate for Payer: Cigna of CA PPO |
$0.24
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.14
|
| Rate for Payer: EPIC Health Plan Senior |
$0.14
|
| Rate for Payer: Galaxy Health WC |
$0.29
|
| Rate for Payer: Global Benefits Group Commercial |
$0.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.23
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.13
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$0.21
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.08
|
| Rate for Payer: Multiplan Commercial |
$0.27
|
| Rate for Payer: Networks By Design Commercial |
$0.22
|
| Rate for Payer: Prime Health Services Commercial |
$0.29
|
|
|
SENNOSIDES 8.6 MG-DOCUSATE SODIUM 50 MG TABLET [24216]
|
Facility
|
IP
|
$0.02
|
|
|
Service Code
|
NDC 69618-065-01
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Max. Negotiated Rate |
$0.02 |
| 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 EPN |
$0.01
|
| Rate for Payer: Cash Price |
$0.01
|
| Rate for Payer: Cigna of CA HMO |
$0.01
|
| Rate for Payer: Cigna of CA PPO |
$0.01
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.01
|
| Rate for Payer: EPIC Health Plan Senior |
$0.01
|
| Rate for Payer: Galaxy Health WC |
$0.02
|
| Rate for Payer: Global Benefits Group Commercial |
$0.01
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.01
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.01
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$0.01
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.00
|
| Rate for Payer: Multiplan Commercial |
$0.02
|
| Rate for Payer: Networks By Design Commercial |
$0.01
|
| Rate for Payer: Prime Health Services Commercial |
$0.02
|
|
