|
SODIUM IODIDE 100 MCG/ML INTRAVENOUS SOLUTION [7344]
|
Facility
|
IP
|
$1.20
|
|
|
Service Code
|
NDC 63323-019-10
|
| Hospital Charge Code |
901700004
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.24 |
| Max. Negotiated Rate |
$1.02 |
| Rate for Payer: Adventist Health Commercial |
$0.24
|
| Rate for Payer: Blue Shield of California Commercial |
$0.89
|
| Rate for Payer: Blue Shield of California EPN |
$0.58
|
| Rate for Payer: Cash Price |
$0.66
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.48
|
| Rate for Payer: EPIC Health Plan Senior |
$0.48
|
| Rate for Payer: Galaxy Health WC |
$1.02
|
| Rate for Payer: Global Benefits Group Commercial |
$0.72
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.80
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.46
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$0.74
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.29
|
| Rate for Payer: Multiplan Commercial |
$0.96
|
| Rate for Payer: Networks By Design Commercial |
$0.78
|
| Rate for Payer: Prime Health Services Commercial |
$1.02
|
|
|
SODIUM IODIDE-123 3.7 MBQ (100 MICROCI) CAPSULE [153922]
|
Facility
|
OP
|
$442.90
|
|
|
Service Code
|
HCPCS A9516
|
| Hospital Charge Code |
901700057
|
|
Hospital Revenue Code
|
343
|
| Min. Negotiated Rate |
$88.58 |
| Max. Negotiated Rate |
$376.46 |
| Rate for Payer: Adventist Health Commercial |
$88.58
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$376.46
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$243.59
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$332.18
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$271.98
|
| Rate for Payer: Blue Shield of California Commercial |
$271.05
|
| Rate for Payer: Blue Shield of California EPN |
$178.93
|
| Rate for Payer: Cash Price |
$243.60
|
| Rate for Payer: Cash Price |
$243.60
|
| Rate for Payer: Cigna of CA HMO |
$283.46
|
| Rate for Payer: Cigna of CA PPO |
$327.75
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$376.46
|
| Rate for Payer: Dignity Health Medi-Cal |
$376.46
|
| Rate for Payer: Dignity Health Medicare Advantage |
$376.46
|
| Rate for Payer: EPIC Health Plan Commercial |
$177.16
|
| Rate for Payer: EPIC Health Plan Senior |
$177.16
|
| Rate for Payer: Galaxy Health WC |
$376.46
|
| Rate for Payer: Global Benefits Group Commercial |
$265.74
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$150.07
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$295.41
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$169.73
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$274.16
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$106.30
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$310.03
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$310.03
|
| Rate for Payer: Multiplan Commercial |
$354.32
|
| Rate for Payer: Networks By Design Commercial |
$287.88
|
| Rate for Payer: Prime Health Services Commercial |
$376.46
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$265.74
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$265.74
|
| Rate for Payer: United Healthcare All Other Commercial |
$166.22
|
| Rate for Payer: United Healthcare All Other HMO |
$161.79
|
| Rate for Payer: United Healthcare HMO Rider |
$158.29
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$145.05
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$376.46
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$376.46
|
| Rate for Payer: Vantage Medical Group Senior |
$376.46
|
|
|
SODIUM IODIDE-123 3.7 MBQ (100 MICROCI) CAPSULE [153922]
|
Facility
|
IP
|
$442.90
|
|
|
Service Code
|
HCPCS A9516
|
| Hospital Charge Code |
901700057
|
|
Hospital Revenue Code
|
343
|
| Min. Negotiated Rate |
$88.58 |
| Max. Negotiated Rate |
$376.46 |
| Rate for Payer: Adventist Health Commercial |
$88.58
|
| Rate for Payer: Blue Shield of California Commercial |
$326.86
|
| Rate for Payer: Blue Shield of California EPN |
$215.25
|
| Rate for Payer: Cash Price |
$243.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$177.16
|
| Rate for Payer: EPIC Health Plan Senior |
$177.16
|
| Rate for Payer: Galaxy Health WC |
$376.46
|
| Rate for Payer: Global Benefits Group Commercial |
$265.74
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$295.41
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$168.74
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$274.16
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$106.30
|
| Rate for Payer: Multiplan Commercial |
$354.32
|
| Rate for Payer: Networks By Design Commercial |
$287.88
|
| Rate for Payer: Prime Health Services Commercial |
$376.46
|
| Rate for Payer: United Healthcare All Other Commercial |
$166.22
|
| Rate for Payer: United Healthcare All Other HMO |
$161.79
|
| Rate for Payer: United Healthcare HMO Rider |
$158.29
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$145.05
|
|
|
SODIUM IODIDE-131 (I-131) 500 MCI/0.5 ML ORAL KIT [211669]
|
Facility
|
IP
|
$15.53
|
|
|
Service Code
|
HCPCS A9530
|
| Hospital Charge Code |
901700056
|
|
Hospital Revenue Code
|
344
|
| Min. Negotiated Rate |
$3.11 |
| Max. Negotiated Rate |
$13.20 |
| Rate for Payer: Adventist Health Commercial |
$3.11
|
| Rate for Payer: Blue Shield of California Commercial |
$11.46
|
| Rate for Payer: Blue Shield of California EPN |
$7.55
|
| Rate for Payer: Cash Price |
$8.54
|
| Rate for Payer: EPIC Health Plan Commercial |
$6.21
|
| Rate for Payer: EPIC Health Plan Senior |
$6.21
|
| Rate for Payer: Galaxy Health WC |
$13.20
|
| Rate for Payer: Global Benefits Group Commercial |
$9.32
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$10.36
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$5.92
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$9.61
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.73
|
| Rate for Payer: Multiplan Commercial |
$12.42
|
| Rate for Payer: Networks By Design Commercial |
$10.09
|
| Rate for Payer: Prime Health Services Commercial |
$13.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$5.83
|
| Rate for Payer: United Healthcare All Other HMO |
$5.67
|
| Rate for Payer: United Healthcare HMO Rider |
$5.55
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$5.09
|
|
|
SODIUM IODIDE-131 (I-131) 500 MCI/0.5 ML ORAL KIT [211669]
|
Facility
|
OP
|
$15.53
|
|
|
Service Code
|
HCPCS A9530
|
| Hospital Charge Code |
901700056
|
|
Hospital Revenue Code
|
344
|
| Min. Negotiated Rate |
$3.11 |
| Max. Negotiated Rate |
$34.24 |
| Rate for Payer: Adventist Health Commercial |
$3.11
|
| Rate for Payer: Aetna of CA HMO/PPO |
$10.19
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$26.10
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$22.97
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$22.97
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$9.54
|
| Rate for Payer: Blue Shield of California Commercial |
$9.50
|
| Rate for Payer: Blue Shield of California EPN |
$6.27
|
| Rate for Payer: Cash Price |
$8.54
|
| Rate for Payer: Cash Price |
$8.54
|
| Rate for Payer: Cigna of CA HMO |
$9.94
|
| Rate for Payer: Cigna of CA PPO |
$11.49
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$26.10
|
| Rate for Payer: Dignity Health Medi-Cal |
$22.97
|
| Rate for Payer: Dignity Health Medicare Advantage |
$22.97
|
| Rate for Payer: EPIC Health Plan Commercial |
$28.19
|
| Rate for Payer: EPIC Health Plan Senior |
$20.88
|
| Rate for Payer: Galaxy Health WC |
$13.20
|
| Rate for Payer: Global Benefits Group Commercial |
$9.32
|
| Rate for Payer: Heritage Provider Network Commercial |
$34.24
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$20.88
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$10.36
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$20.88
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.73
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$26.31
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$27.98
|
| Rate for Payer: Multiplan Commercial |
$12.42
|
| Rate for Payer: Networks By Design Commercial |
$10.09
|
| Rate for Payer: Prime Health Services Commercial |
$13.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$9.32
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$9.32
|
| Rate for Payer: United Healthcare All Other Commercial |
$5.83
|
| Rate for Payer: United Healthcare All Other HMO |
$5.67
|
| Rate for Payer: United Healthcare HMO Rider |
$5.55
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$5.09
|
| Rate for Payer: Upland Medical Group Pediatric |
$20.88
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$26.10
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$22.97
|
| Rate for Payer: Vantage Medical Group Senior |
$22.97
|
|
|
SODIUM NITRITE-SODIUM THIOSULFATE 300 MG/10 ML-12.5 GRAM/50 ML IV SOLN [109784]
|
Facility
|
IP
|
$3.92
|
|
|
Service Code
|
NDC 60267-812-00
|
| Min. Negotiated Rate |
$0.78 |
| Max. Negotiated Rate |
$3.33 |
| Rate for Payer: Adventist Health Commercial |
$0.78
|
| Rate for Payer: Cash Price |
$2.15
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.57
|
| Rate for Payer: EPIC Health Plan Senior |
$1.57
|
| Rate for Payer: Galaxy Health WC |
$3.33
|
| Rate for Payer: Global Benefits Group Commercial |
$2.35
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2.61
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1.49
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2.43
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.94
|
| Rate for Payer: Multiplan Commercial |
$3.14
|
| Rate for Payer: Networks By Design Commercial |
$2.55
|
| Rate for Payer: Prime Health Services Commercial |
$3.33
|
|
|
SODIUM NITRITE-SODIUM THIOSULFATE 300 MG/10 ML-12.5 GRAM/50 ML IV SOLN [109784]
|
Facility
|
OP
|
$3.92
|
|
|
Service Code
|
NDC 60267-812-00
|
| Min. Negotiated Rate |
$0.78 |
| Max. Negotiated Rate |
$3.33 |
| Rate for Payer: Adventist Health Commercial |
$0.78
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2.57
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3.33
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2.16
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2.94
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2.41
|
| Rate for Payer: Cash Price |
$2.15
|
| Rate for Payer: Cigna of CA HMO |
$2.51
|
| Rate for Payer: Cigna of CA PPO |
$2.90
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3.33
|
| Rate for Payer: Dignity Health Medi-Cal |
$3.33
|
| Rate for Payer: Dignity Health Medicare Advantage |
$3.33
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.57
|
| Rate for Payer: EPIC Health Plan Senior |
$1.57
|
| Rate for Payer: Galaxy Health WC |
$3.33
|
| Rate for Payer: Global Benefits Group Commercial |
$2.35
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2.61
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1.49
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2.43
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.94
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2.74
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2.74
|
| Rate for Payer: Multiplan Commercial |
$3.14
|
| Rate for Payer: Networks By Design Commercial |
$2.55
|
| Rate for Payer: Prime Health Services Commercial |
$3.33
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2.35
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2.35
|
| Rate for Payer: United Healthcare All Other Commercial |
$1.96
|
| Rate for Payer: United Healthcare All Other HMO |
$1.96
|
| Rate for Payer: United Healthcare HMO Rider |
$1.96
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1.96
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3.33
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$3.33
|
| Rate for Payer: Vantage Medical Group Senior |
$3.33
|
|
|
SODIUM NITROPRUSSIDE 25 MG/ML INTRAVENOUS SOLUTION [18908]
|
Facility
|
OP
|
$78.00
|
|
|
Service Code
|
NDC 67457-839-02
|
| Hospital Charge Code |
901700004
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$15.60 |
| Max. Negotiated Rate |
$66.30 |
| Rate for Payer: Adventist Health Commercial |
$15.60
|
| Rate for Payer: Aetna of CA HMO/PPO |
$51.16
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$66.30
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$42.90
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$58.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$47.90
|
| Rate for Payer: Cash Price |
$42.90
|
| Rate for Payer: Cigna of CA HMO |
$49.92
|
| Rate for Payer: Cigna of CA PPO |
$57.72
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$66.30
|
| Rate for Payer: Dignity Health Medi-Cal |
$66.30
|
| Rate for Payer: Dignity Health Medicare Advantage |
$66.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$31.20
|
| Rate for Payer: EPIC Health Plan Senior |
$31.20
|
| Rate for Payer: Galaxy Health WC |
$66.30
|
| Rate for Payer: Global Benefits Group Commercial |
$46.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$52.03
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$29.72
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$48.28
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$18.72
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$54.60
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$54.60
|
| Rate for Payer: Multiplan Commercial |
$62.40
|
| Rate for Payer: Networks By Design Commercial |
$50.70
|
| Rate for Payer: Prime Health Services Commercial |
$66.30
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$46.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$46.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$39.00
|
| Rate for Payer: United Healthcare All Other HMO |
$39.00
|
| Rate for Payer: United Healthcare HMO Rider |
$39.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$39.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$66.30
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$66.30
|
| Rate for Payer: Vantage Medical Group Senior |
$66.30
|
|
|
SODIUM NITROPRUSSIDE 25 MG/ML INTRAVENOUS SOLUTION [18908]
|
Facility
|
IP
|
$12.00
|
|
|
Service Code
|
NDC 70069-261-01
|
| Hospital Charge Code |
901700004
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$2.40 |
| Max. Negotiated Rate |
$10.20 |
| Rate for Payer: Adventist Health Commercial |
$2.40
|
| Rate for Payer: Blue Shield of California Commercial |
$8.86
|
| Rate for Payer: Blue Shield of California EPN |
$5.83
|
| Rate for Payer: Cash Price |
$6.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$4.80
|
| Rate for Payer: EPIC Health Plan Senior |
$4.80
|
| Rate for Payer: Galaxy Health WC |
$10.20
|
| Rate for Payer: Global Benefits Group Commercial |
$7.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$8.00
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4.57
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$7.43
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.88
|
| Rate for Payer: Multiplan Commercial |
$9.60
|
| Rate for Payer: Networks By Design Commercial |
$7.80
|
| Rate for Payer: Prime Health Services Commercial |
$10.20
|
|
|
SODIUM NITROPRUSSIDE 25 MG/ML INTRAVENOUS SOLUTION [18908]
|
Facility
|
IP
|
$78.00
|
|
|
Service Code
|
NDC 67457-839-02
|
| Hospital Charge Code |
901700004
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$15.60 |
| Max. Negotiated Rate |
$66.30 |
| Rate for Payer: Adventist Health Commercial |
$15.60
|
| Rate for Payer: Blue Shield of California Commercial |
$57.56
|
| Rate for Payer: Blue Shield of California EPN |
$37.91
|
| Rate for Payer: Cash Price |
$42.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$31.20
|
| Rate for Payer: EPIC Health Plan Senior |
$31.20
|
| Rate for Payer: Galaxy Health WC |
$66.30
|
| Rate for Payer: Global Benefits Group Commercial |
$46.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$52.03
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$29.72
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$48.28
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$18.72
|
| Rate for Payer: Multiplan Commercial |
$62.40
|
| Rate for Payer: Networks By Design Commercial |
$50.70
|
| Rate for Payer: Prime Health Services Commercial |
$66.30
|
|
|
SODIUM NITROPRUSSIDE 25 MG/ML INTRAVENOUS SOLUTION [18908]
|
Facility
|
OP
|
$12.00
|
|
|
Service Code
|
NDC 70069-261-01
|
| Hospital Charge Code |
901700004
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$2.40 |
| Max. Negotiated Rate |
$10.20 |
| Rate for Payer: Adventist Health Commercial |
$2.40
|
| Rate for Payer: Aetna of CA HMO/PPO |
$7.87
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$10.20
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$6.60
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$9.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$7.37
|
| Rate for Payer: Cash Price |
$6.60
|
| Rate for Payer: Cigna of CA HMO |
$7.68
|
| Rate for Payer: Cigna of CA PPO |
$8.88
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$10.20
|
| Rate for Payer: Dignity Health Medi-Cal |
$10.20
|
| Rate for Payer: Dignity Health Medicare Advantage |
$10.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$4.80
|
| Rate for Payer: EPIC Health Plan Senior |
$4.80
|
| Rate for Payer: Galaxy Health WC |
$10.20
|
| Rate for Payer: Global Benefits Group Commercial |
$7.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$8.00
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4.57
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$7.43
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.88
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$8.40
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$8.40
|
| Rate for Payer: Multiplan Commercial |
$9.60
|
| Rate for Payer: Networks By Design Commercial |
$7.80
|
| Rate for Payer: Prime Health Services Commercial |
$10.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$7.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$7.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$6.00
|
| Rate for Payer: United Healthcare All Other HMO |
$6.00
|
| Rate for Payer: United Healthcare HMO Rider |
$6.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$6.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$10.20
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$10.20
|
| Rate for Payer: Vantage Medical Group Senior |
$10.20
|
|
|
SODIUM PHENYLBUTYRATE 0.94 GRAM/GRAM ORAL POWDER [17601]
|
Facility
|
OP
|
$20.30
|
|
|
Service Code
|
NDC 42794-086-14
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$4.06 |
| Max. Negotiated Rate |
$17.25 |
| Rate for Payer: Adventist Health Commercial |
$4.06
|
| Rate for Payer: Aetna of CA HMO/PPO |
$13.31
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$17.25
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$11.16
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$15.22
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$12.47
|
| Rate for Payer: Cash Price |
$11.16
|
| Rate for Payer: Cigna of CA HMO |
$14.21
|
| Rate for Payer: Cigna of CA PPO |
$14.21
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$17.25
|
| Rate for Payer: Dignity Health Medi-Cal |
$17.25
|
| Rate for Payer: Dignity Health Medicare Advantage |
$17.25
|
| Rate for Payer: EPIC Health Plan Commercial |
$8.12
|
| Rate for Payer: EPIC Health Plan Senior |
$8.12
|
| Rate for Payer: Galaxy Health WC |
$17.25
|
| Rate for Payer: Global Benefits Group Commercial |
$12.18
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$13.54
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$7.73
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$12.57
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.87
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$14.21
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$14.21
|
| Rate for Payer: Multiplan Commercial |
$16.24
|
| Rate for Payer: Networks By Design Commercial |
$13.20
|
| Rate for Payer: Prime Health Services Commercial |
$17.25
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$12.18
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$12.18
|
| Rate for Payer: United Healthcare All Other Commercial |
$10.15
|
| Rate for Payer: United Healthcare All Other HMO |
$10.15
|
| Rate for Payer: United Healthcare HMO Rider |
$10.15
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$10.15
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$17.25
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$17.25
|
| Rate for Payer: Vantage Medical Group Senior |
$17.25
|
|
|
SODIUM PHENYLBUTYRATE 0.94 GRAM/GRAM ORAL POWDER [17601]
|
Facility
|
IP
|
$20.30
|
|
|
Service Code
|
NDC 42794-086-14
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$4.06 |
| Max. Negotiated Rate |
$17.25 |
| Rate for Payer: Adventist Health Commercial |
$4.06
|
| Rate for Payer: Blue Shield of California Commercial |
$14.98
|
| Rate for Payer: Blue Shield of California EPN |
$9.87
|
| Rate for Payer: Cash Price |
$11.16
|
| Rate for Payer: Cigna of CA HMO |
$14.21
|
| Rate for Payer: Cigna of CA PPO |
$14.21
|
| Rate for Payer: EPIC Health Plan Commercial |
$8.12
|
| Rate for Payer: EPIC Health Plan Senior |
$8.12
|
| Rate for Payer: Galaxy Health WC |
$17.25
|
| Rate for Payer: Global Benefits Group Commercial |
$12.18
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$13.54
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$7.73
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$12.57
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.87
|
| Rate for Payer: Multiplan Commercial |
$16.24
|
| Rate for Payer: Networks By Design Commercial |
$13.20
|
| Rate for Payer: Prime Health Services Commercial |
$17.25
|
|
|
SODIUM PHENYLBUTYRATE 0.94 GRAM/GRAM ORAL POWDER [17601]
|
Facility
|
IP
|
$61.48
|
|
|
Service Code
|
NDC 75987-070-09
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$12.30 |
| Max. Negotiated Rate |
$52.26 |
| Rate for Payer: Adventist Health Commercial |
$12.30
|
| Rate for Payer: Blue Shield of California Commercial |
$45.37
|
| Rate for Payer: Blue Shield of California EPN |
$29.88
|
| Rate for Payer: Cash Price |
$33.81
|
| Rate for Payer: Cigna of CA HMO |
$43.04
|
| Rate for Payer: Cigna of CA PPO |
$43.04
|
| Rate for Payer: EPIC Health Plan Commercial |
$24.59
|
| Rate for Payer: EPIC Health Plan Senior |
$24.59
|
| Rate for Payer: Galaxy Health WC |
$52.26
|
| Rate for Payer: Global Benefits Group Commercial |
$36.89
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$41.01
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$23.42
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$38.06
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$14.76
|
| Rate for Payer: Multiplan Commercial |
$49.18
|
| Rate for Payer: Networks By Design Commercial |
$39.96
|
| Rate for Payer: Prime Health Services Commercial |
$52.26
|
|
|
SODIUM PHENYLBUTYRATE 0.94 GRAM/GRAM ORAL POWDER [17601]
|
Facility
|
OP
|
$61.48
|
|
|
Service Code
|
NDC 75987-070-09
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$12.30 |
| Max. Negotiated Rate |
$52.26 |
| Rate for Payer: Adventist Health Commercial |
$12.30
|
| Rate for Payer: Aetna of CA HMO/PPO |
$40.32
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$52.26
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$33.81
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$46.11
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$37.75
|
| Rate for Payer: Cash Price |
$33.81
|
| Rate for Payer: Cigna of CA HMO |
$43.04
|
| Rate for Payer: Cigna of CA PPO |
$43.04
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$52.26
|
| Rate for Payer: Dignity Health Medi-Cal |
$52.26
|
| Rate for Payer: Dignity Health Medicare Advantage |
$52.26
|
| Rate for Payer: EPIC Health Plan Commercial |
$24.59
|
| Rate for Payer: EPIC Health Plan Senior |
$24.59
|
| Rate for Payer: Galaxy Health WC |
$52.26
|
| Rate for Payer: Global Benefits Group Commercial |
$36.89
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$41.01
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$23.42
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$38.06
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$14.76
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$43.04
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$43.04
|
| Rate for Payer: Multiplan Commercial |
$49.18
|
| Rate for Payer: Networks By Design Commercial |
$39.96
|
| Rate for Payer: Prime Health Services Commercial |
$52.26
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$36.89
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$36.89
|
| Rate for Payer: United Healthcare All Other Commercial |
$30.74
|
| Rate for Payer: United Healthcare All Other HMO |
$30.74
|
| Rate for Payer: United Healthcare HMO Rider |
$30.74
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$30.74
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$52.26
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$52.26
|
| Rate for Payer: Vantage Medical Group Senior |
$52.26
|
|
|
SODIUM PHENYLBUTYRATE (BULK) 100 % POWDER [77481]
|
Facility
|
IP
|
$56.63
|
|
|
Service Code
|
NDC 38779-3207-8
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$11.33 |
| Max. Negotiated Rate |
$48.14 |
| Rate for Payer: Adventist Health Commercial |
$11.33
|
| Rate for Payer: Blue Shield of California Commercial |
$41.79
|
| Rate for Payer: Blue Shield of California EPN |
$27.52
|
| Rate for Payer: Cash Price |
$31.15
|
| Rate for Payer: Cigna of CA HMO |
$39.64
|
| Rate for Payer: Cigna of CA PPO |
$39.64
|
| Rate for Payer: EPIC Health Plan Commercial |
$22.65
|
| Rate for Payer: EPIC Health Plan Senior |
$22.65
|
| Rate for Payer: Galaxy Health WC |
$48.14
|
| Rate for Payer: Global Benefits Group Commercial |
$33.98
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$37.77
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$21.58
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$35.05
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$13.59
|
| Rate for Payer: Multiplan Commercial |
$45.30
|
| Rate for Payer: Networks By Design Commercial |
$36.81
|
| Rate for Payer: Prime Health Services Commercial |
$48.14
|
|
|
SODIUM PHENYLBUTYRATE (BULK) 100 % POWDER [77481]
|
Facility
|
OP
|
$56.63
|
|
|
Service Code
|
NDC 38779-3207-8
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$11.33 |
| Max. Negotiated Rate |
$48.14 |
| Rate for Payer: Adventist Health Commercial |
$11.33
|
| Rate for Payer: Aetna of CA HMO/PPO |
$37.14
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$48.14
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$31.15
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$42.47
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$34.78
|
| Rate for Payer: Cash Price |
$31.15
|
| Rate for Payer: Cigna of CA HMO |
$39.64
|
| Rate for Payer: Cigna of CA PPO |
$39.64
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$48.14
|
| Rate for Payer: Dignity Health Medi-Cal |
$48.14
|
| Rate for Payer: Dignity Health Medicare Advantage |
$48.14
|
| Rate for Payer: EPIC Health Plan Commercial |
$22.65
|
| Rate for Payer: EPIC Health Plan Senior |
$22.65
|
| Rate for Payer: Galaxy Health WC |
$48.14
|
| Rate for Payer: Global Benefits Group Commercial |
$33.98
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$37.77
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$21.58
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$35.05
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$13.59
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$39.64
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$39.64
|
| Rate for Payer: Multiplan Commercial |
$45.30
|
| Rate for Payer: Networks By Design Commercial |
$36.81
|
| Rate for Payer: Prime Health Services Commercial |
$48.14
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$33.98
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$33.98
|
| Rate for Payer: United Healthcare All Other Commercial |
$28.32
|
| Rate for Payer: United Healthcare All Other HMO |
$28.32
|
| Rate for Payer: United Healthcare HMO Rider |
$28.32
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$28.32
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$48.14
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$48.14
|
| Rate for Payer: Vantage Medical Group Senior |
$48.14
|
|
|
SODIUM PHENYLBUTYRATE ORAL SUSPENSION COMPOUND 200 MG/ML [4080337]
|
Facility
|
OP
|
$0.04
|
|
|
Service Code
|
NDC 9994-0803-37
|
| 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 |
$0.02
|
| Rate for Payer: Cash Price |
$0.02
|
| Rate for Payer: Cigna of CA HMO |
$0.03
|
| Rate for Payer: Cigna of CA PPO |
$0.03
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.03
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.03
|
| Rate for Payer: Dignity Health Medicare Advantage |
$0.03
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.02
|
| Rate for Payer: EPIC Health Plan Senior |
$0.02
|
| Rate for Payer: Galaxy Health WC |
$0.03
|
| Rate for Payer: Global Benefits Group Commercial |
$0.02
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.03
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.02
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$0.02
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.01
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$0.03
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$0.03
|
| Rate for Payer: Multiplan Commercial |
$0.03
|
| Rate for Payer: Networks By Design Commercial |
$0.03
|
| Rate for Payer: Prime Health Services Commercial |
$0.03
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.02
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.02
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.02
|
| Rate for Payer: United Healthcare All Other HMO |
$0.02
|
| Rate for Payer: United Healthcare HMO Rider |
$0.02
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.02
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.03
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.03
|
| Rate for Payer: Vantage Medical Group Senior |
$0.03
|
|
|
SODIUM PHENYLBUTYRATE ORAL SUSPENSION COMPOUND 200 MG/ML [4080337]
|
Facility
|
IP
|
$0.04
|
|
|
Service Code
|
NDC 9994-0803-37
|
| 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 |
$0.03
|
| Rate for Payer: Blue Shield of California EPN |
$0.02
|
| Rate for Payer: Cash Price |
$0.02
|
| Rate for Payer: Cigna of CA HMO |
$0.03
|
| Rate for Payer: Cigna of CA PPO |
$0.03
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.02
|
| Rate for Payer: EPIC Health Plan Senior |
$0.02
|
| Rate for Payer: Galaxy Health WC |
$0.03
|
| Rate for Payer: Global Benefits Group Commercial |
$0.02
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.03
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.02
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$0.02
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.01
|
| Rate for Payer: Multiplan Commercial |
$0.03
|
| Rate for Payer: Networks By Design Commercial |
$0.03
|
| Rate for Payer: Prime Health Services Commercial |
$0.03
|
|
|
SODIUM PHOSPHATE 3 MMOL/ML INTRAVENOUS SOLUTION [7351]
|
Facility
|
IP
|
$3.30
|
|
|
Service Code
|
NDC 0517-7315-25
|
| Hospital Charge Code |
901700004
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.66 |
| Max. Negotiated Rate |
$2.81 |
| Rate for Payer: Adventist Health Commercial |
$0.66
|
| Rate for Payer: Blue Shield of California Commercial |
$2.44
|
| Rate for Payer: Blue Shield of California EPN |
$1.60
|
| Rate for Payer: Cash Price |
$1.81
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.32
|
| Rate for Payer: EPIC Health Plan Senior |
$1.32
|
| Rate for Payer: Galaxy Health WC |
$2.81
|
| Rate for Payer: Global Benefits Group Commercial |
$1.98
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2.20
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1.26
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2.04
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.79
|
| Rate for Payer: Multiplan Commercial |
$2.64
|
| Rate for Payer: Networks By Design Commercial |
$2.15
|
| Rate for Payer: Prime Health Services Commercial |
$2.81
|
|
|
SODIUM PHOSPHATE 3 MMOL/ML INTRAVENOUS SOLUTION [7351]
|
Facility
|
IP
|
$3.22
|
|
|
Service Code
|
NDC 0409-7391-72
|
| Hospital Charge Code |
901700004
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.64 |
| Max. Negotiated Rate |
$2.74 |
| Rate for Payer: Adventist Health Commercial |
$0.64
|
| Rate for Payer: Blue Shield of California Commercial |
$2.38
|
| Rate for Payer: Blue Shield of California EPN |
$1.56
|
| Rate for Payer: Cash Price |
$1.77
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.29
|
| Rate for Payer: EPIC Health Plan Senior |
$1.29
|
| Rate for Payer: Galaxy Health WC |
$2.74
|
| Rate for Payer: Global Benefits Group Commercial |
$1.93
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2.15
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1.23
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1.99
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.77
|
| Rate for Payer: Multiplan Commercial |
$2.58
|
| Rate for Payer: Networks By Design Commercial |
$2.09
|
| Rate for Payer: Prime Health Services Commercial |
$2.74
|
|
|
SODIUM PHOSPHATE 3 MMOL/ML INTRAVENOUS SOLUTION [7351]
|
Facility
|
IP
|
$3.22
|
|
|
Service Code
|
NDC 0409-7391-82
|
| Hospital Charge Code |
901700004
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.64 |
| Max. Negotiated Rate |
$2.74 |
| Rate for Payer: Adventist Health Commercial |
$0.64
|
| Rate for Payer: Blue Shield of California Commercial |
$2.38
|
| Rate for Payer: Blue Shield of California EPN |
$1.56
|
| Rate for Payer: Cash Price |
$1.77
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.29
|
| Rate for Payer: EPIC Health Plan Senior |
$1.29
|
| Rate for Payer: Galaxy Health WC |
$2.74
|
| Rate for Payer: Global Benefits Group Commercial |
$1.93
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2.15
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1.23
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1.99
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.77
|
| Rate for Payer: Multiplan Commercial |
$2.58
|
| Rate for Payer: Networks By Design Commercial |
$2.09
|
| Rate for Payer: Prime Health Services Commercial |
$2.74
|
|
|
SODIUM PHOSPHATE 3 MMOL/ML INTRAVENOUS SOLUTION [7351]
|
Facility
|
OP
|
$3.22
|
|
|
Service Code
|
NDC 0409-7391-82
|
| Hospital Charge Code |
901700004
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.64 |
| Max. Negotiated Rate |
$2.74 |
| Rate for Payer: Adventist Health Commercial |
$0.64
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2.11
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2.74
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1.77
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2.42
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1.98
|
| Rate for Payer: Cash Price |
$1.77
|
| Rate for Payer: Cigna of CA HMO |
$2.06
|
| Rate for Payer: Cigna of CA PPO |
$2.38
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2.74
|
| Rate for Payer: Dignity Health Medi-Cal |
$2.74
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2.74
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.29
|
| Rate for Payer: EPIC Health Plan Senior |
$1.29
|
| Rate for Payer: Galaxy Health WC |
$2.74
|
| Rate for Payer: Global Benefits Group Commercial |
$1.93
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2.15
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1.23
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1.99
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.77
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2.25
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2.25
|
| Rate for Payer: Multiplan Commercial |
$2.58
|
| Rate for Payer: Networks By Design Commercial |
$2.09
|
| Rate for Payer: Prime Health Services Commercial |
$2.74
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1.93
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1.93
|
| Rate for Payer: United Healthcare All Other Commercial |
$1.61
|
| Rate for Payer: United Healthcare All Other HMO |
$1.61
|
| Rate for Payer: United Healthcare HMO Rider |
$1.61
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1.61
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2.74
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2.74
|
| Rate for Payer: Vantage Medical Group Senior |
$2.74
|
|
|
SODIUM PHOSPHATE 3 MMOL/ML INTRAVENOUS SOLUTION [7351]
|
Facility
|
IP
|
$3.30
|
|
|
Service Code
|
NDC 0517-7315-01
|
| Hospital Charge Code |
901700004
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.66 |
| Max. Negotiated Rate |
$2.81 |
| Rate for Payer: Adventist Health Commercial |
$0.66
|
| Rate for Payer: Blue Shield of California Commercial |
$2.44
|
| Rate for Payer: Blue Shield of California EPN |
$1.60
|
| Rate for Payer: Cash Price |
$1.81
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.32
|
| Rate for Payer: EPIC Health Plan Senior |
$1.32
|
| Rate for Payer: Galaxy Health WC |
$2.81
|
| Rate for Payer: Global Benefits Group Commercial |
$1.98
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2.20
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1.26
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2.04
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.79
|
| Rate for Payer: Multiplan Commercial |
$2.64
|
| Rate for Payer: Networks By Design Commercial |
$2.15
|
| Rate for Payer: Prime Health Services Commercial |
$2.81
|
|
|
SODIUM PHOSPHATE 3 MMOL/ML INTRAVENOUS SOLUTION [7351]
|
Facility
|
OP
|
$3.30
|
|
|
Service Code
|
NDC 0517-7315-25
|
| Hospital Charge Code |
901700004
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.66 |
| Max. Negotiated Rate |
$2.81 |
| Rate for Payer: Adventist Health Commercial |
$0.66
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2.16
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2.81
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1.81
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2.48
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2.03
|
| Rate for Payer: Cash Price |
$1.81
|
| Rate for Payer: Cigna of CA HMO |
$2.11
|
| Rate for Payer: Cigna of CA PPO |
$2.44
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2.81
|
| Rate for Payer: Dignity Health Medi-Cal |
$2.81
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2.81
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.32
|
| Rate for Payer: EPIC Health Plan Senior |
$1.32
|
| Rate for Payer: Galaxy Health WC |
$2.81
|
| Rate for Payer: Global Benefits Group Commercial |
$1.98
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2.20
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1.26
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2.04
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.79
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2.31
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2.31
|
| Rate for Payer: Multiplan Commercial |
$2.64
|
| Rate for Payer: Networks By Design Commercial |
$2.15
|
| Rate for Payer: Prime Health Services Commercial |
$2.81
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1.98
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1.98
|
| Rate for Payer: United Healthcare All Other Commercial |
$1.65
|
| Rate for Payer: United Healthcare All Other HMO |
$1.65
|
| Rate for Payer: United Healthcare HMO Rider |
$1.65
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1.65
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2.81
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2.81
|
| Rate for Payer: Vantage Medical Group Senior |
$2.81
|
|
