|
SODIUM POLYSTYRENE SULFONATE 15 GRAM ORAL POWDER [7356]
|
Facility
|
IP
|
$0.21
|
|
|
Service Code
|
NDC 9994082106
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.04 |
| Max. Negotiated Rate |
$0.18 |
| Rate for Payer: Adventist Health Commercial |
$0.04
|
| Rate for Payer: Blue Shield of California Commercial |
$0.11
|
| Rate for Payer: Blue Shield of California Commercial |
$0.16
|
| Rate for Payer: Cash Price |
$0.09
|
| Rate for Payer: Cigna of CA HMO |
$0.15
|
| Rate for Payer: Cigna of CA PPO |
$0.15
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$0.15
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.08
|
| Rate for Payer: EPIC Health Plan Senior |
$0.08
|
| Rate for Payer: Galaxy Health WC |
$0.18
|
| Rate for Payer: Global Benefits Group Commercial |
$0.13
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$0.13
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$0.12
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.05
|
| Rate for Payer: Multiplan Commercial |
$0.17
|
| Rate for Payer: Networks By Design Commercial |
$0.14
|
| Rate for Payer: Prime Health Services Commercial |
$0.18
|
|
|
SODIUM POLYSTYRENE SULFONATE 15 GRAM ORAL POWDER [7356]
|
Facility
|
OP
|
$0.21
|
|
|
Service Code
|
NDC 9994082106
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.04 |
| Max. Negotiated Rate |
$0.18 |
| Rate for Payer: Adventist Health Commercial |
$0.04
|
| Rate for Payer: Aetna of CA HMO/PPO |
$0.14
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.18
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.12
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.16
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.13
|
| Rate for Payer: Cash Price |
$0.09
|
| Rate for Payer: Cigna of CA HMO |
$0.15
|
| Rate for Payer: Cigna of CA PPO |
$0.15
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.18
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.18
|
| Rate for Payer: Dignity Health Medicare Advantage |
$0.18
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$0.15
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.08
|
| Rate for Payer: EPIC Health Plan Senior |
$0.08
|
| Rate for Payer: Galaxy Health WC |
$0.18
|
| Rate for Payer: Global Benefits Group Commercial |
$0.13
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$0.13
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.08
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$0.12
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.05
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$0.15
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$0.15
|
| Rate for Payer: Multiplan Commercial |
$0.17
|
| Rate for Payer: Networks By Design Commercial |
$0.14
|
| Rate for Payer: Prime Health Services Commercial |
$0.18
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.13
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.13
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.11
|
| Rate for Payer: United Healthcare All Other HMO |
$0.11
|
| Rate for Payer: United Healthcare HMO Rider |
$0.11
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.11
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.18
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.18
|
| Rate for Payer: Vantage Medical Group Senior |
$0.18
|
|
|
SODIUM POLYSTYRENE SULFONATE 15 GRAM ORAL POWDER [7356]
|
Facility
|
IP
|
$0.21
|
|
|
Service Code
|
NDC 1153416644
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.04 |
| Max. Negotiated Rate |
$0.18 |
| Rate for Payer: Adventist Health Commercial |
$0.04
|
| Rate for Payer: Blue Shield of California Commercial |
$0.11
|
| Rate for Payer: Blue Shield of California Commercial |
$0.16
|
| Rate for Payer: Cash Price |
$0.09
|
| Rate for Payer: Cigna of CA HMO |
$0.15
|
| Rate for Payer: Cigna of CA PPO |
$0.15
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$0.15
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.08
|
| Rate for Payer: EPIC Health Plan Senior |
$0.08
|
| Rate for Payer: Galaxy Health WC |
$0.18
|
| Rate for Payer: Global Benefits Group Commercial |
$0.13
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$0.13
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$0.12
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.05
|
| Rate for Payer: Multiplan Commercial |
$0.17
|
| Rate for Payer: Networks By Design Commercial |
$0.14
|
| Rate for Payer: Prime Health Services Commercial |
$0.18
|
|
|
SODIUM POLYSTYRENE SULFONATE 15 GRAM ORAL POWDER [7356]
|
Facility
|
IP
|
$0.35
|
|
|
Service Code
|
NDC 4280601396
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.07 |
| Max. Negotiated Rate |
$0.30 |
| Rate for Payer: Adventist Health Commercial |
$0.07
|
| Rate for Payer: Blue Shield of California Commercial |
$0.18
|
| Rate for Payer: Blue Shield of California Commercial |
$0.27
|
| Rate for Payer: Cash Price |
$0.16
|
| Rate for Payer: Cigna of CA HMO |
$0.25
|
| Rate for Payer: Cigna of CA PPO |
$0.25
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$0.25
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.14
|
| Rate for Payer: EPIC Health Plan Senior |
$0.14
|
| Rate for Payer: Galaxy Health WC |
$0.30
|
| Rate for Payer: Global Benefits Group Commercial |
$0.21
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$0.22
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$0.21
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.08
|
| Rate for Payer: Multiplan Commercial |
$0.28
|
| Rate for Payer: Networks By Design Commercial |
$0.23
|
| Rate for Payer: Prime Health Services Commercial |
$0.30
|
|
|
SODIUM POLYSTYRENE SULFONATE 15 GRAM ORAL POWDER [7356]
|
Facility
|
IP
|
$0.21
|
|
|
Service Code
|
NDC 9999997356
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.04 |
| Max. Negotiated Rate |
$0.18 |
| Rate for Payer: Adventist Health Commercial |
$0.04
|
| Rate for Payer: Blue Shield of California Commercial |
$0.11
|
| Rate for Payer: Blue Shield of California Commercial |
$0.16
|
| Rate for Payer: Cash Price |
$0.09
|
| Rate for Payer: Cigna of CA HMO |
$0.15
|
| Rate for Payer: Cigna of CA PPO |
$0.15
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$0.15
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.08
|
| Rate for Payer: EPIC Health Plan Senior |
$0.08
|
| Rate for Payer: Galaxy Health WC |
$0.18
|
| Rate for Payer: Global Benefits Group Commercial |
$0.13
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$0.13
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$0.12
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.05
|
| Rate for Payer: Multiplan Commercial |
$0.17
|
| Rate for Payer: Networks By Design Commercial |
$0.14
|
| Rate for Payer: Prime Health Services Commercial |
$0.18
|
|
|
SODIUM POLYSTYRENE SULFONATE 15 GRAM ORAL POWDER [7356]
|
Facility
|
OP
|
$0.26
|
|
|
Service Code
|
NDC 5129383197
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.05 |
| Max. Negotiated Rate |
$0.22 |
| Rate for Payer: Adventist Health Commercial |
$0.05
|
| Rate for Payer: Aetna of CA HMO/PPO |
$0.17
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.22
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.14
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.20
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.17
|
| Rate for Payer: Cash Price |
$0.12
|
| Rate for Payer: Cigna of CA HMO |
$0.18
|
| Rate for Payer: Cigna of CA PPO |
$0.18
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.22
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.22
|
| Rate for Payer: Dignity Health Medicare Advantage |
$0.22
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$0.18
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.10
|
| Rate for Payer: EPIC Health Plan Senior |
$0.10
|
| Rate for Payer: Galaxy Health WC |
$0.22
|
| Rate for Payer: Global Benefits Group Commercial |
$0.16
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$0.17
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.09
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$0.15
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.06
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$0.18
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$0.18
|
| Rate for Payer: Multiplan Commercial |
$0.21
|
| Rate for Payer: Networks By Design Commercial |
$0.17
|
| Rate for Payer: Prime Health Services Commercial |
$0.22
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.16
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.16
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.13
|
| Rate for Payer: United Healthcare All Other HMO |
$0.13
|
| Rate for Payer: United Healthcare HMO Rider |
$0.13
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.13
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.22
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.22
|
| Rate for Payer: Vantage Medical Group Senior |
$0.22
|
|
|
SODIUM POLYSTYRENE SULFONATE 15 GRAM ORAL POWDER [7356]
|
Facility
|
OP
|
$0.35
|
|
|
Service Code
|
NDC 4280601396
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.07 |
| Max. Negotiated Rate |
$0.30 |
| Rate for Payer: Adventist Health Commercial |
$0.07
|
| Rate for Payer: Aetna of CA HMO/PPO |
$0.23
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.30
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.19
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.26
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.22
|
| Rate for Payer: Cash Price |
$0.16
|
| Rate for Payer: Cigna of CA HMO |
$0.25
|
| Rate for Payer: Cigna of CA PPO |
$0.25
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.30
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.30
|
| Rate for Payer: Dignity Health Medicare Advantage |
$0.30
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$0.25
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.14
|
| Rate for Payer: EPIC Health Plan Senior |
$0.14
|
| Rate for Payer: Galaxy Health WC |
$0.30
|
| Rate for Payer: Global Benefits Group Commercial |
$0.21
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$0.22
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.13
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$0.21
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.08
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$0.25
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$0.25
|
| Rate for Payer: Multiplan Commercial |
$0.28
|
| Rate for Payer: Networks By Design Commercial |
$0.23
|
| Rate for Payer: Prime Health Services Commercial |
$0.30
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.21
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.21
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.18
|
| Rate for Payer: United Healthcare All Other HMO |
$0.18
|
| Rate for Payer: United Healthcare HMO Rider |
$0.18
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.18
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.30
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.30
|
| Rate for Payer: Vantage Medical Group Senior |
$0.30
|
|
|
SODIUM POLYSTYRENE SULFONATE 15 GRAM ORAL POWDER [7356]
|
Facility
|
OP
|
$0.21
|
|
|
Service Code
|
NDC 1153416644
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.04 |
| Max. Negotiated Rate |
$0.18 |
| Rate for Payer: Adventist Health Commercial |
$0.04
|
| Rate for Payer: Aetna of CA HMO/PPO |
$0.14
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.18
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.12
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.16
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.13
|
| Rate for Payer: Cash Price |
$0.09
|
| Rate for Payer: Cigna of CA HMO |
$0.15
|
| Rate for Payer: Cigna of CA PPO |
$0.15
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.18
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.18
|
| Rate for Payer: Dignity Health Medicare Advantage |
$0.18
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$0.15
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.08
|
| Rate for Payer: EPIC Health Plan Senior |
$0.08
|
| Rate for Payer: Galaxy Health WC |
$0.18
|
| Rate for Payer: Global Benefits Group Commercial |
$0.13
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$0.13
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.08
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$0.12
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.05
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$0.15
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$0.15
|
| Rate for Payer: Multiplan Commercial |
$0.17
|
| Rate for Payer: Networks By Design Commercial |
$0.14
|
| Rate for Payer: Prime Health Services Commercial |
$0.18
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.13
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.13
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.11
|
| Rate for Payer: United Healthcare All Other HMO |
$0.11
|
| Rate for Payer: United Healthcare HMO Rider |
$0.11
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.11
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.18
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.18
|
| Rate for Payer: Vantage Medical Group Senior |
$0.18
|
|
|
SODIUM POLYSTYRENE SULFONATE 15 GRAM ORAL POWDER [7356]
|
Facility
|
IP
|
$0.26
|
|
|
Service Code
|
NDC 5129383197
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.05 |
| Max. Negotiated Rate |
$0.22 |
| Rate for Payer: Adventist Health Commercial |
$0.05
|
| Rate for Payer: Blue Shield of California Commercial |
$0.13
|
| Rate for Payer: Blue Shield of California Commercial |
$0.20
|
| Rate for Payer: Cash Price |
$0.12
|
| Rate for Payer: Cigna of CA HMO |
$0.18
|
| Rate for Payer: Cigna of CA PPO |
$0.18
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$0.18
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.10
|
| Rate for Payer: EPIC Health Plan Senior |
$0.10
|
| Rate for Payer: Galaxy Health WC |
$0.22
|
| Rate for Payer: Global Benefits Group Commercial |
$0.16
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$0.17
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$0.15
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.06
|
| Rate for Payer: Multiplan Commercial |
$0.21
|
| Rate for Payer: Networks By Design Commercial |
$0.17
|
| Rate for Payer: Prime Health Services Commercial |
$0.22
|
|
|
SODIUM TETRADECYL SULFATE 1 % (10 MG/ML) INTRAVENOUS SOLUTION [41787]
|
Facility
|
OP
|
$46.88
|
|
|
Service Code
|
HCPCS J3490
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$9.38 |
| Max. Negotiated Rate |
$39.85 |
| Rate for Payer: Adventist Health Commercial |
$9.38
|
| Rate for Payer: Aetna of CA HMO/PPO |
$30.75
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$39.85
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$25.78
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$35.16
|
| Rate for Payer: Cash Price |
$21.10
|
| Rate for Payer: Cigna of CA HMO |
$32.82
|
| Rate for Payer: Cigna of CA PPO |
$32.82
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$39.85
|
| Rate for Payer: Dignity Health Medi-Cal |
$39.85
|
| Rate for Payer: Dignity Health Medicare Advantage |
$39.85
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$32.82
|
| Rate for Payer: EPIC Health Plan Commercial |
$18.75
|
| Rate for Payer: EPIC Health Plan Senior |
$18.75
|
| Rate for Payer: Galaxy Health WC |
$39.85
|
| Rate for Payer: Global Benefits Group Commercial |
$28.13
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$29.77
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$27.66
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$11.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$32.82
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$32.82
|
| Rate for Payer: Multiplan Commercial |
$37.50
|
| Rate for Payer: Networks By Design Commercial |
$23.44
|
| Rate for Payer: Prime Health Services Commercial |
$39.85
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$28.13
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$28.13
|
| Rate for Payer: United Healthcare All Other Commercial |
$17.59
|
| Rate for Payer: United Healthcare All Other HMO |
$17.13
|
| Rate for Payer: United Healthcare HMO Rider |
$16.75
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$15.35
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$39.85
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$39.85
|
| Rate for Payer: Vantage Medical Group Senior |
$39.85
|
|
|
SODIUM TETRADECYL SULFATE 1 % (10 MG/ML) INTRAVENOUS SOLUTION [41787]
|
Facility
|
IP
|
$46.88
|
|
|
Service Code
|
HCPCS J3490
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$9.38 |
| Max. Negotiated Rate |
$39.85 |
| Rate for Payer: Adventist Health Commercial |
$9.38
|
| Rate for Payer: Blue Shield of California Commercial |
$23.77
|
| Rate for Payer: Blue Shield of California Commercial |
$36.05
|
| Rate for Payer: Cash Price |
$21.10
|
| Rate for Payer: Cigna of CA HMO |
$32.82
|
| Rate for Payer: Cigna of CA PPO |
$32.82
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$32.82
|
| Rate for Payer: EPIC Health Plan Commercial |
$18.75
|
| Rate for Payer: EPIC Health Plan Senior |
$18.75
|
| Rate for Payer: Galaxy Health WC |
$39.85
|
| Rate for Payer: Global Benefits Group Commercial |
$28.13
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$29.77
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$27.66
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$11.25
|
| Rate for Payer: Multiplan Commercial |
$37.50
|
| Rate for Payer: Networks By Design Commercial |
$23.44
|
| Rate for Payer: Prime Health Services Commercial |
$39.85
|
| Rate for Payer: United Healthcare All Other Commercial |
$17.59
|
| Rate for Payer: United Healthcare All Other HMO |
$17.13
|
| Rate for Payer: United Healthcare HMO Rider |
$16.75
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$15.35
|
|
|
SODIUM TETRADECYL SULFATE 3 % (30 MG/ML) INTRAVENOUS SOLUTION [41793]
|
Facility
|
IP
|
$46.88
|
|
|
Service Code
|
HCPCS J3490
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$9.38 |
| Max. Negotiated Rate |
$39.85 |
| Rate for Payer: Adventist Health Commercial |
$9.38
|
| Rate for Payer: Adventist Health Commercial |
$9.24
|
| Rate for Payer: Blue Shield of California Commercial |
$35.53
|
| Rate for Payer: Blue Shield of California Commercial |
$23.77
|
| Rate for Payer: Blue Shield of California Commercial |
$36.05
|
| Rate for Payer: Blue Shield of California Commercial |
$23.42
|
| Rate for Payer: Cash Price |
$20.79
|
| Rate for Payer: Cash Price |
$21.10
|
| Rate for Payer: Cigna of CA HMO |
$32.82
|
| Rate for Payer: Cigna of CA HMO |
$32.34
|
| Rate for Payer: Cigna of CA PPO |
$32.34
|
| Rate for Payer: Cigna of CA PPO |
$32.82
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$32.34
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$32.82
|
| Rate for Payer: EPIC Health Plan Commercial |
$18.48
|
| Rate for Payer: EPIC Health Plan Commercial |
$18.75
|
| Rate for Payer: EPIC Health Plan Senior |
$18.48
|
| Rate for Payer: EPIC Health Plan Senior |
$18.75
|
| Rate for Payer: Galaxy Health WC |
$39.27
|
| Rate for Payer: Galaxy Health WC |
$39.85
|
| Rate for Payer: Global Benefits Group Commercial |
$28.13
|
| Rate for Payer: Global Benefits Group Commercial |
$27.72
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$29.34
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$29.77
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$27.26
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$27.66
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$11.09
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$11.25
|
| Rate for Payer: Multiplan Commercial |
$36.96
|
| Rate for Payer: Multiplan Commercial |
$37.50
|
| Rate for Payer: Networks By Design Commercial |
$23.44
|
| Rate for Payer: Networks By Design Commercial |
$23.10
|
| Rate for Payer: Prime Health Services Commercial |
$39.85
|
| Rate for Payer: Prime Health Services Commercial |
$39.27
|
| Rate for Payer: United Healthcare All Other Commercial |
$17.34
|
| Rate for Payer: United Healthcare All Other Commercial |
$17.59
|
| Rate for Payer: United Healthcare All Other HMO |
$17.13
|
| Rate for Payer: United Healthcare All Other HMO |
$16.88
|
| Rate for Payer: United Healthcare HMO Rider |
$16.51
|
| Rate for Payer: United Healthcare HMO Rider |
$16.75
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$15.13
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$15.35
|
|
|
SODIUM TETRADECYL SULFATE 3 % (30 MG/ML) INTRAVENOUS SOLUTION [41793]
|
Facility
|
OP
|
$46.88
|
|
|
Service Code
|
HCPCS J3490
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$9.38 |
| Max. Negotiated Rate |
$39.85 |
| Rate for Payer: Adventist Health Commercial |
$9.38
|
| Rate for Payer: Adventist Health Commercial |
$9.24
|
| Rate for Payer: Aetna of CA HMO/PPO |
$30.30
|
| Rate for Payer: Aetna of CA HMO/PPO |
$30.75
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$39.27
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$39.85
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$25.78
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$25.41
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$34.65
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$35.16
|
| Rate for Payer: Cash Price |
$21.10
|
| Rate for Payer: Cash Price |
$20.79
|
| Rate for Payer: Cigna of CA HMO |
$32.34
|
| Rate for Payer: Cigna of CA HMO |
$32.82
|
| Rate for Payer: Cigna of CA PPO |
$32.34
|
| Rate for Payer: Cigna of CA PPO |
$32.82
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$39.85
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$39.27
|
| Rate for Payer: Dignity Health Medi-Cal |
$39.85
|
| Rate for Payer: Dignity Health Medi-Cal |
$39.27
|
| Rate for Payer: Dignity Health Medicare Advantage |
$39.27
|
| Rate for Payer: Dignity Health Medicare Advantage |
$39.85
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$32.82
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$32.34
|
| Rate for Payer: EPIC Health Plan Commercial |
$18.75
|
| Rate for Payer: EPIC Health Plan Commercial |
$18.48
|
| Rate for Payer: EPIC Health Plan Senior |
$18.48
|
| Rate for Payer: EPIC Health Plan Senior |
$18.75
|
| Rate for Payer: Galaxy Health WC |
$39.85
|
| Rate for Payer: Galaxy Health WC |
$39.27
|
| Rate for Payer: Global Benefits Group Commercial |
$28.13
|
| Rate for Payer: Global Benefits Group Commercial |
$27.72
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$29.77
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$29.34
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$27.66
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$27.26
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$11.09
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$11.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$32.34
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$32.82
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$32.82
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$32.34
|
| Rate for Payer: Multiplan Commercial |
$36.96
|
| Rate for Payer: Multiplan Commercial |
$37.50
|
| Rate for Payer: Networks By Design Commercial |
$23.44
|
| Rate for Payer: Networks By Design Commercial |
$23.10
|
| Rate for Payer: Prime Health Services Commercial |
$39.85
|
| Rate for Payer: Prime Health Services Commercial |
$39.27
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$27.72
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$28.13
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$27.72
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$28.13
|
| Rate for Payer: United Healthcare All Other Commercial |
$17.34
|
| Rate for Payer: United Healthcare All Other Commercial |
$17.59
|
| Rate for Payer: United Healthcare All Other HMO |
$17.13
|
| Rate for Payer: United Healthcare All Other HMO |
$16.88
|
| Rate for Payer: United Healthcare HMO Rider |
$16.75
|
| Rate for Payer: United Healthcare HMO Rider |
$16.51
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$15.13
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$15.35
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$39.27
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$39.85
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$39.85
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$39.27
|
| Rate for Payer: Vantage Medical Group Senior |
$39.27
|
| Rate for Payer: Vantage Medical Group Senior |
$39.85
|
|
|
SODIUM THIOSULFATE 12.5 GRAM/50 ML (250 MG/ML) INTRAVENOUS SOLUTION [7364]
|
Facility
|
IP
|
$2.40
|
|
|
Service Code
|
HCPCS J0209
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.48 |
| Max. Negotiated Rate |
$2.04 |
| Rate for Payer: Adventist Health Commercial |
$0.48
|
| Rate for Payer: Blue Shield of California Commercial |
$1.22
|
| Rate for Payer: Blue Shield of California Commercial |
$1.85
|
| Rate for Payer: Cash Price |
$1.08
|
| Rate for Payer: Cigna of CA HMO |
$1.68
|
| Rate for Payer: Cigna of CA PPO |
$1.68
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1.68
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.96
|
| Rate for Payer: EPIC Health Plan Senior |
$0.96
|
| Rate for Payer: Galaxy Health WC |
$2.04
|
| Rate for Payer: Global Benefits Group Commercial |
$1.44
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1.52
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1.42
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.58
|
| Rate for Payer: Multiplan Commercial |
$1.92
|
| Rate for Payer: Networks By Design Commercial |
$1.20
|
| Rate for Payer: Prime Health Services Commercial |
$2.04
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.90
|
| Rate for Payer: United Healthcare All Other HMO |
$0.88
|
| Rate for Payer: United Healthcare HMO Rider |
$0.86
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.79
|
|
|
SODIUM THIOSULFATE 12.5 GRAM/50 ML (250 MG/ML) INTRAVENOUS SOLUTION [7364]
|
Facility
|
OP
|
$2.40
|
|
|
Service Code
|
HCPCS J0209
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.48 |
| Max. Negotiated Rate |
$4.98 |
| Rate for Payer: Adventist Health Commercial |
$0.48
|
| Rate for Payer: Aetna of CA HMO/PPO |
$4.98
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1.26
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.92
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.84
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1.99
|
| Rate for Payer: Blue Shield of California Commercial |
$0.93
|
| Rate for Payer: Cash Price |
$1.08
|
| Rate for Payer: Cash Price |
$1.08
|
| Rate for Payer: Cigna of CA HMO |
$1.68
|
| Rate for Payer: Cigna of CA PPO |
$1.68
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1.26
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.92
|
| Rate for Payer: Dignity Health Medicare Advantage |
$0.84
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1.68
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.39
|
| Rate for Payer: EPIC Health Plan Senior |
$0.92
|
| Rate for Payer: Galaxy Health WC |
$2.04
|
| Rate for Payer: Global Benefits Group Commercial |
$1.44
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$1.38
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$0.84
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1.52
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.87
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1.18
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.58
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1.06
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1.13
|
| Rate for Payer: Multiplan Commercial |
$1.92
|
| Rate for Payer: Networks By Design Commercial |
$1.20
|
| Rate for Payer: Prime Health Services Commercial |
$2.04
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1.44
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1.44
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.90
|
| Rate for Payer: United Healthcare All Other HMO |
$0.88
|
| Rate for Payer: United Healthcare HMO Rider |
$0.86
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.79
|
| Rate for Payer: Upland Medical Group Pediatric |
$0.84
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1.26
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.92
|
| Rate for Payer: Vantage Medical Group Senior |
$0.84
|
|
|
SODIUM ZIRCONIUM CYCLOSILICATE 10 GRAM ORAL POWDER PACKET [222467]
|
Facility
|
IP
|
$35.49
|
|
|
Service Code
|
NDC 0310111039
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$7.10 |
| Max. Negotiated Rate |
$30.17 |
| Rate for Payer: Adventist Health Commercial |
$7.10
|
| Rate for Payer: Blue Shield of California Commercial |
$17.99
|
| Rate for Payer: Blue Shield of California Commercial |
$27.29
|
| Rate for Payer: Cash Price |
$15.97
|
| Rate for Payer: Cigna of CA HMO |
$24.84
|
| Rate for Payer: Cigna of CA PPO |
$24.84
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$24.84
|
| Rate for Payer: EPIC Health Plan Commercial |
$14.20
|
| Rate for Payer: EPIC Health Plan Senior |
$14.20
|
| Rate for Payer: Galaxy Health WC |
$30.17
|
| Rate for Payer: Global Benefits Group Commercial |
$21.29
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$22.54
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$20.94
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$8.52
|
| Rate for Payer: Multiplan Commercial |
$28.39
|
| Rate for Payer: Networks By Design Commercial |
$23.07
|
| Rate for Payer: Prime Health Services Commercial |
$30.17
|
|
|
SODIUM ZIRCONIUM CYCLOSILICATE 10 GRAM ORAL POWDER PACKET [222467]
|
Facility
|
OP
|
$35.49
|
|
|
Service Code
|
NDC 0310111039
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$7.10 |
| Max. Negotiated Rate |
$30.17 |
| Rate for Payer: Adventist Health Commercial |
$7.10
|
| Rate for Payer: Aetna of CA HMO/PPO |
$23.28
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$30.17
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$19.52
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$26.62
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$22.77
|
| Rate for Payer: Cash Price |
$15.97
|
| Rate for Payer: Cigna of CA HMO |
$24.84
|
| Rate for Payer: Cigna of CA PPO |
$24.84
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$30.17
|
| Rate for Payer: Dignity Health Medi-Cal |
$30.17
|
| Rate for Payer: Dignity Health Medicare Advantage |
$30.17
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$24.84
|
| Rate for Payer: EPIC Health Plan Commercial |
$14.20
|
| Rate for Payer: EPIC Health Plan Senior |
$14.20
|
| Rate for Payer: Galaxy Health WC |
$30.17
|
| Rate for Payer: Global Benefits Group Commercial |
$21.29
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$22.54
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$12.88
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$20.94
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$8.52
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$24.84
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$24.84
|
| Rate for Payer: Multiplan Commercial |
$28.39
|
| Rate for Payer: Networks By Design Commercial |
$23.07
|
| Rate for Payer: Prime Health Services Commercial |
$30.17
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$21.29
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$21.29
|
| Rate for Payer: United Healthcare All Other Commercial |
$17.75
|
| Rate for Payer: United Healthcare All Other HMO |
$17.75
|
| Rate for Payer: United Healthcare HMO Rider |
$17.75
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$17.75
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$30.17
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$30.17
|
| Rate for Payer: Vantage Medical Group Senior |
$30.17
|
|
|
SODIUM ZIRCONIUM CYCLOSILICATE 10 GRAM ORAL POWDER PACKET [222467]
|
Facility
|
OP
|
$35.49
|
|
|
Service Code
|
NDC 0310111001
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$7.10 |
| Max. Negotiated Rate |
$30.17 |
| Rate for Payer: Adventist Health Commercial |
$7.10
|
| Rate for Payer: Aetna of CA HMO/PPO |
$23.28
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$30.17
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$19.52
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$26.62
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$22.77
|
| Rate for Payer: Cash Price |
$15.97
|
| Rate for Payer: Cigna of CA HMO |
$24.84
|
| Rate for Payer: Cigna of CA PPO |
$24.84
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$30.17
|
| Rate for Payer: Dignity Health Medi-Cal |
$30.17
|
| Rate for Payer: Dignity Health Medicare Advantage |
$30.17
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$24.84
|
| Rate for Payer: EPIC Health Plan Commercial |
$14.20
|
| Rate for Payer: EPIC Health Plan Senior |
$14.20
|
| Rate for Payer: Galaxy Health WC |
$30.17
|
| Rate for Payer: Global Benefits Group Commercial |
$21.29
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$22.54
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$12.88
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$20.94
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$8.52
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$24.84
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$24.84
|
| Rate for Payer: Multiplan Commercial |
$28.39
|
| Rate for Payer: Networks By Design Commercial |
$23.07
|
| Rate for Payer: Prime Health Services Commercial |
$30.17
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$21.29
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$21.29
|
| Rate for Payer: United Healthcare All Other Commercial |
$17.75
|
| Rate for Payer: United Healthcare All Other HMO |
$17.75
|
| Rate for Payer: United Healthcare HMO Rider |
$17.75
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$17.75
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$30.17
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$30.17
|
| Rate for Payer: Vantage Medical Group Senior |
$30.17
|
|
|
SODIUM ZIRCONIUM CYCLOSILICATE 10 GRAM ORAL POWDER PACKET [222467]
|
Facility
|
IP
|
$35.49
|
|
|
Service Code
|
NDC 0310111001
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$7.10 |
| Max. Negotiated Rate |
$30.17 |
| Rate for Payer: Adventist Health Commercial |
$7.10
|
| Rate for Payer: Blue Shield of California Commercial |
$17.99
|
| Rate for Payer: Blue Shield of California Commercial |
$27.29
|
| Rate for Payer: Cash Price |
$15.97
|
| Rate for Payer: Cigna of CA HMO |
$24.84
|
| Rate for Payer: Cigna of CA PPO |
$24.84
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$24.84
|
| Rate for Payer: EPIC Health Plan Commercial |
$14.20
|
| Rate for Payer: EPIC Health Plan Senior |
$14.20
|
| Rate for Payer: Galaxy Health WC |
$30.17
|
| Rate for Payer: Global Benefits Group Commercial |
$21.29
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$22.54
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$20.94
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$8.52
|
| Rate for Payer: Multiplan Commercial |
$28.39
|
| Rate for Payer: Networks By Design Commercial |
$23.07
|
| Rate for Payer: Prime Health Services Commercial |
$30.17
|
|
|
SODIUM ZIRCONIUM CYCLOSILICATE 5 GRAM ORAL POWDER PACKET [222466]
|
Facility
|
OP
|
$35.49
|
|
|
Service Code
|
NDC 0310110501
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$7.10 |
| Max. Negotiated Rate |
$30.17 |
| Rate for Payer: Adventist Health Commercial |
$7.10
|
| Rate for Payer: Aetna of CA HMO/PPO |
$23.28
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$30.17
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$19.52
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$26.62
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$22.77
|
| Rate for Payer: Cash Price |
$15.97
|
| Rate for Payer: Cigna of CA HMO |
$24.84
|
| Rate for Payer: Cigna of CA PPO |
$24.84
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$30.17
|
| Rate for Payer: Dignity Health Medi-Cal |
$30.17
|
| Rate for Payer: Dignity Health Medicare Advantage |
$30.17
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$24.84
|
| Rate for Payer: EPIC Health Plan Commercial |
$14.20
|
| Rate for Payer: EPIC Health Plan Senior |
$14.20
|
| Rate for Payer: Galaxy Health WC |
$30.17
|
| Rate for Payer: Global Benefits Group Commercial |
$21.29
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$22.54
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$12.88
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$20.94
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$8.52
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$24.84
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$24.84
|
| Rate for Payer: Multiplan Commercial |
$28.39
|
| Rate for Payer: Networks By Design Commercial |
$23.07
|
| Rate for Payer: Prime Health Services Commercial |
$30.17
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$21.29
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$21.29
|
| Rate for Payer: United Healthcare All Other Commercial |
$17.75
|
| Rate for Payer: United Healthcare All Other HMO |
$17.75
|
| Rate for Payer: United Healthcare HMO Rider |
$17.75
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$17.75
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$30.17
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$30.17
|
| Rate for Payer: Vantage Medical Group Senior |
$30.17
|
|
|
SODIUM ZIRCONIUM CYCLOSILICATE 5 GRAM ORAL POWDER PACKET [222466]
|
Facility
|
OP
|
$35.49
|
|
|
Service Code
|
NDC 0310110539
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$7.10 |
| Max. Negotiated Rate |
$30.17 |
| Rate for Payer: Adventist Health Commercial |
$7.10
|
| Rate for Payer: Aetna of CA HMO/PPO |
$23.28
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$30.17
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$19.52
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$26.62
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$22.77
|
| Rate for Payer: Cash Price |
$15.97
|
| Rate for Payer: Cigna of CA HMO |
$24.84
|
| Rate for Payer: Cigna of CA PPO |
$24.84
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$30.17
|
| Rate for Payer: Dignity Health Medi-Cal |
$30.17
|
| Rate for Payer: Dignity Health Medicare Advantage |
$30.17
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$24.84
|
| Rate for Payer: EPIC Health Plan Commercial |
$14.20
|
| Rate for Payer: EPIC Health Plan Senior |
$14.20
|
| Rate for Payer: Galaxy Health WC |
$30.17
|
| Rate for Payer: Global Benefits Group Commercial |
$21.29
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$22.54
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$12.88
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$20.94
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$8.52
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$24.84
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$24.84
|
| Rate for Payer: Multiplan Commercial |
$28.39
|
| Rate for Payer: Networks By Design Commercial |
$23.07
|
| Rate for Payer: Prime Health Services Commercial |
$30.17
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$21.29
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$21.29
|
| Rate for Payer: United Healthcare All Other Commercial |
$17.75
|
| Rate for Payer: United Healthcare All Other HMO |
$17.75
|
| Rate for Payer: United Healthcare HMO Rider |
$17.75
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$17.75
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$30.17
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$30.17
|
| Rate for Payer: Vantage Medical Group Senior |
$30.17
|
|
|
SODIUM ZIRCONIUM CYCLOSILICATE 5 GRAM ORAL POWDER PACKET [222466]
|
Facility
|
IP
|
$35.49
|
|
|
Service Code
|
NDC 0310110501
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$7.10 |
| Max. Negotiated Rate |
$30.17 |
| Rate for Payer: Adventist Health Commercial |
$7.10
|
| Rate for Payer: Blue Shield of California Commercial |
$17.99
|
| Rate for Payer: Blue Shield of California Commercial |
$27.29
|
| Rate for Payer: Cash Price |
$15.97
|
| Rate for Payer: Cigna of CA HMO |
$24.84
|
| Rate for Payer: Cigna of CA PPO |
$24.84
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$24.84
|
| Rate for Payer: EPIC Health Plan Commercial |
$14.20
|
| Rate for Payer: EPIC Health Plan Senior |
$14.20
|
| Rate for Payer: Galaxy Health WC |
$30.17
|
| Rate for Payer: Global Benefits Group Commercial |
$21.29
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$22.54
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$20.94
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$8.52
|
| Rate for Payer: Multiplan Commercial |
$28.39
|
| Rate for Payer: Networks By Design Commercial |
$23.07
|
| Rate for Payer: Prime Health Services Commercial |
$30.17
|
|
|
SODIUM ZIRCONIUM CYCLOSILICATE 5 GRAM ORAL POWDER PACKET [222466]
|
Facility
|
IP
|
$35.49
|
|
|
Service Code
|
NDC 0310110539
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$7.10 |
| Max. Negotiated Rate |
$30.17 |
| Rate for Payer: Adventist Health Commercial |
$7.10
|
| Rate for Payer: Blue Shield of California Commercial |
$17.99
|
| Rate for Payer: Blue Shield of California Commercial |
$27.29
|
| Rate for Payer: Cash Price |
$15.97
|
| Rate for Payer: Cigna of CA HMO |
$24.84
|
| Rate for Payer: Cigna of CA PPO |
$24.84
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$24.84
|
| Rate for Payer: EPIC Health Plan Commercial |
$14.20
|
| Rate for Payer: EPIC Health Plan Senior |
$14.20
|
| Rate for Payer: Galaxy Health WC |
$30.17
|
| Rate for Payer: Global Benefits Group Commercial |
$21.29
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$22.54
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$20.94
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$8.52
|
| Rate for Payer: Multiplan Commercial |
$28.39
|
| Rate for Payer: Networks By Design Commercial |
$23.07
|
| Rate for Payer: Prime Health Services Commercial |
$30.17
|
|
|
SODIUM ZIRCONIUM CYCLOSILICATE 5 GRAM ORAL POWDER PACKET [222466]
|
Facility
|
OP
|
$35.49
|
|
|
Service Code
|
NDC 0310110530
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$7.10 |
| Max. Negotiated Rate |
$30.17 |
| Rate for Payer: Adventist Health Commercial |
$7.10
|
| Rate for Payer: Aetna of CA HMO/PPO |
$23.28
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$30.17
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$19.52
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$26.62
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$22.77
|
| Rate for Payer: Cash Price |
$15.97
|
| Rate for Payer: Cigna of CA HMO |
$24.84
|
| Rate for Payer: Cigna of CA PPO |
$24.84
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$30.17
|
| Rate for Payer: Dignity Health Medi-Cal |
$30.17
|
| Rate for Payer: Dignity Health Medicare Advantage |
$30.17
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$24.84
|
| Rate for Payer: EPIC Health Plan Commercial |
$14.20
|
| Rate for Payer: EPIC Health Plan Senior |
$14.20
|
| Rate for Payer: Galaxy Health WC |
$30.17
|
| Rate for Payer: Global Benefits Group Commercial |
$21.29
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$22.54
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$12.88
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$20.94
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$8.52
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$24.84
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$24.84
|
| Rate for Payer: Multiplan Commercial |
$28.39
|
| Rate for Payer: Networks By Design Commercial |
$23.07
|
| Rate for Payer: Prime Health Services Commercial |
$30.17
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$21.29
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$21.29
|
| Rate for Payer: United Healthcare All Other Commercial |
$17.75
|
| Rate for Payer: United Healthcare All Other HMO |
$17.75
|
| Rate for Payer: United Healthcare HMO Rider |
$17.75
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$17.75
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$30.17
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$30.17
|
| Rate for Payer: Vantage Medical Group Senior |
$30.17
|
|
|
SODIUM ZIRCONIUM CYCLOSILICATE 5 GRAM ORAL POWDER PACKET [222466]
|
Facility
|
IP
|
$35.49
|
|
|
Service Code
|
NDC 0310110530
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$7.10 |
| Max. Negotiated Rate |
$30.17 |
| Rate for Payer: Adventist Health Commercial |
$7.10
|
| Rate for Payer: Blue Shield of California Commercial |
$17.99
|
| Rate for Payer: Blue Shield of California Commercial |
$27.29
|
| Rate for Payer: Cash Price |
$15.97
|
| Rate for Payer: Cigna of CA HMO |
$24.84
|
| Rate for Payer: Cigna of CA PPO |
$24.84
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$24.84
|
| Rate for Payer: EPIC Health Plan Commercial |
$14.20
|
| Rate for Payer: EPIC Health Plan Senior |
$14.20
|
| Rate for Payer: Galaxy Health WC |
$30.17
|
| Rate for Payer: Global Benefits Group Commercial |
$21.29
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$22.54
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$20.94
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$8.52
|
| Rate for Payer: Multiplan Commercial |
$28.39
|
| Rate for Payer: Networks By Design Commercial |
$23.07
|
| Rate for Payer: Prime Health Services Commercial |
$30.17
|
|
