|
DOCETAXEL 80 MG/8 ML (10 MG/ML) INTRAVENOUS SOLUTION [108907]
|
Facility
|
IP
|
$24.00
|
|
|
Service Code
|
CPT J9171
|
| Hospital Charge Code |
NDG108907
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$5.76 |
| Max. Negotiated Rate |
$20.40 |
| Rate for Payer: Blue Shield of California Commercial |
$17.09
|
| Rate for Payer: Blue Shield of California Commercial |
$30.68
|
| Rate for Payer: Blue Shield of California EPN |
$12.29
|
| Rate for Payer: Blue Shield of California EPN |
$22.06
|
| Rate for Payer: Cash Price |
$10.80
|
| Rate for Payer: Cash Price |
$19.39
|
| Rate for Payer: Cigna of CA HMO |
$16.80
|
| Rate for Payer: Cigna of CA HMO |
$30.16
|
| Rate for Payer: Cigna of CA PPO |
$30.16
|
| Rate for Payer: Cigna of CA PPO |
$16.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$17.24
|
| Rate for Payer: EPIC Health Plan Commercial |
$9.60
|
| Rate for Payer: EPIC Health Plan Transplant |
$9.60
|
| Rate for Payer: EPIC Health Plan Transplant |
$17.24
|
| Rate for Payer: Galaxy Health WC |
$20.40
|
| Rate for Payer: Galaxy Health WC |
$36.63
|
| Rate for Payer: Global Benefits Group Commercial |
$25.85
|
| Rate for Payer: Global Benefits Group Commercial |
$14.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$28.74
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$16.01
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$9.14
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$16.42
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5.76
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$10.34
|
| Rate for Payer: Multiplan Commercial |
$19.20
|
| Rate for Payer: Multiplan Commercial |
$34.47
|
| Rate for Payer: Networks By Design Commercial |
$12.00
|
| Rate for Payer: Networks By Design Commercial |
$21.54
|
| Rate for Payer: Prime Health Services Commercial |
$20.40
|
| Rate for Payer: Prime Health Services Commercial |
$36.63
|
| Rate for Payer: United Healthcare All Other Commercial |
$9.06
|
| Rate for Payer: United Healthcare All Other Commercial |
$16.27
|
| Rate for Payer: United Healthcare All Other HMO |
$8.85
|
| Rate for Payer: United Healthcare All Other HMO |
$15.89
|
| Rate for Payer: United Healthcare HMO Rider |
$8.66
|
| Rate for Payer: United Healthcare HMO Rider |
$15.55
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$7.92
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$14.22
|
|
|
DOCETAXEL 80 MG/8 ML (10 MG/ML) INTRAVENOUS SOLUTION [108907]
|
Facility
|
OP
|
$24.00
|
|
|
Service Code
|
CPT J9171
|
| Hospital Charge Code |
NDG108907
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$4.13 |
| Max. Negotiated Rate |
$41.31 |
| Rate for Payer: Aetna of CA HMO/PPO |
$6.23
|
| Rate for Payer: Aetna of CA HMO/PPO |
$6.23
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$36.63
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$20.40
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$13.20
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$23.70
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$23.70
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$13.20
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$41.31
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$41.31
|
| Rate for Payer: Blue Distinction Transplant |
$14.40
|
| Rate for Payer: Blue Distinction Transplant |
$25.85
|
| Rate for Payer: Blue Shield of California Commercial |
$17.69
|
| Rate for Payer: Blue Shield of California Commercial |
$31.76
|
| Rate for Payer: Blue Shield of California EPN |
$4.13
|
| Rate for Payer: Blue Shield of California EPN |
$4.13
|
| Rate for Payer: Cash Price |
$19.39
|
| Rate for Payer: Cash Price |
$19.39
|
| Rate for Payer: Cash Price |
$10.80
|
| Rate for Payer: Cash Price |
$10.80
|
| Rate for Payer: Cigna of CA HMO |
$16.80
|
| Rate for Payer: Cigna of CA HMO |
$30.16
|
| Rate for Payer: Cigna of CA PPO |
$16.80
|
| Rate for Payer: Cigna of CA PPO |
$30.16
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$36.63
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$20.40
|
| Rate for Payer: Dignity Health Media |
$36.63
|
| Rate for Payer: Dignity Health Media |
$20.40
|
| Rate for Payer: Dignity Health Medi-Cal |
$20.40
|
| Rate for Payer: Dignity Health Medi-Cal |
$36.63
|
| Rate for Payer: EPIC Health Plan Commercial |
$17.24
|
| Rate for Payer: EPIC Health Plan Commercial |
$9.60
|
| Rate for Payer: EPIC Health Plan Transplant |
$9.60
|
| Rate for Payer: EPIC Health Plan Transplant |
$17.24
|
| Rate for Payer: Galaxy Health WC |
$20.40
|
| Rate for Payer: Galaxy Health WC |
$36.63
|
| Rate for Payer: Global Benefits Group Commercial |
$25.85
|
| Rate for Payer: Global Benefits Group Commercial |
$14.40
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$32.32
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$18.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$28.74
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$16.01
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$10.37
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$10.37
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$10.34
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5.76
|
| Rate for Payer: Multiplan Commercial |
$34.47
|
| Rate for Payer: Multiplan Commercial |
$19.20
|
| Rate for Payer: Networks By Design Commercial |
$12.00
|
| Rate for Payer: Networks By Design Commercial |
$21.54
|
| Rate for Payer: Prime Health Services Commercial |
$36.63
|
| Rate for Payer: Prime Health Services Commercial |
$20.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$25.85
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$14.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$25.85
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$14.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$12.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$21.54
|
| Rate for Payer: United Healthcare All Other HMO |
$21.54
|
| Rate for Payer: United Healthcare All Other HMO |
$12.00
|
| Rate for Payer: United Healthcare HMO Rider |
$21.54
|
| Rate for Payer: United Healthcare HMO Rider |
$12.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$12.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$21.54
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$20.40
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$36.63
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$20.40
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$36.63
|
| Rate for Payer: Vantage Medical Group Senior |
$36.63
|
| Rate for Payer: Vantage Medical Group Senior |
$20.40
|
|
|
DOCOSANOL 10 % TOPICAL CREAM [29287]
|
Facility
|
IP
|
$8.39
|
|
|
Service Code
|
NDC 46122-624-07
|
| Hospital Charge Code |
1743703
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$2.01 |
| Max. Negotiated Rate |
$7.13 |
| Rate for Payer: Blue Shield of California Commercial |
$5.97
|
| Rate for Payer: Blue Shield of California EPN |
$4.30
|
| Rate for Payer: Cash Price |
$3.78
|
| Rate for Payer: Cigna of CA HMO |
$5.87
|
| Rate for Payer: Cigna of CA PPO |
$5.87
|
| Rate for Payer: EPIC Health Plan Commercial |
$3.36
|
| Rate for Payer: Galaxy Health WC |
$7.13
|
| Rate for Payer: Global Benefits Group Commercial |
$5.03
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$5.60
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3.20
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.01
|
| Rate for Payer: Multiplan Commercial |
$6.71
|
| Rate for Payer: Networks By Design Commercial |
$5.45
|
| Rate for Payer: Prime Health Services Commercial |
$7.13
|
|
|
DOCOSANOL 10 % TOPICAL CREAM [29287]
|
Facility
|
IP
|
$9.28
|
|
|
Service Code
|
NDC 0766-0801-00
|
| Hospital Charge Code |
1743703
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$2.23 |
| Max. Negotiated Rate |
$7.89 |
| Rate for Payer: Blue Shield of California Commercial |
$6.61
|
| Rate for Payer: Blue Shield of California EPN |
$4.75
|
| Rate for Payer: Cash Price |
$4.18
|
| Rate for Payer: Cigna of CA HMO |
$6.50
|
| Rate for Payer: Cigna of CA PPO |
$6.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$3.71
|
| Rate for Payer: Galaxy Health WC |
$7.89
|
| Rate for Payer: Global Benefits Group Commercial |
$5.57
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$6.19
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3.54
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.23
|
| Rate for Payer: Multiplan Commercial |
$7.42
|
| Rate for Payer: Networks By Design Commercial |
$6.03
|
| Rate for Payer: Prime Health Services Commercial |
$7.89
|
|
|
DOCOSANOL 10 % TOPICAL CREAM [29287]
|
Facility
|
IP
|
$9.28
|
|
|
Service Code
|
NDC 0135-0200-01
|
| Hospital Charge Code |
1743703
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$2.23 |
| Max. Negotiated Rate |
$7.89 |
| Rate for Payer: Blue Shield of California Commercial |
$6.61
|
| Rate for Payer: Blue Shield of California EPN |
$4.75
|
| Rate for Payer: Cash Price |
$4.18
|
| Rate for Payer: Cigna of CA HMO |
$6.50
|
| Rate for Payer: Cigna of CA PPO |
$6.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$3.71
|
| Rate for Payer: Galaxy Health WC |
$7.89
|
| Rate for Payer: Global Benefits Group Commercial |
$5.57
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$6.19
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3.54
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.23
|
| Rate for Payer: Multiplan Commercial |
$7.42
|
| Rate for Payer: Networks By Design Commercial |
$6.03
|
| Rate for Payer: Prime Health Services Commercial |
$7.89
|
|
|
DOCOSANOL 10 % TOPICAL CREAM [29287]
|
Facility
|
IP
|
$9.28
|
|
|
Service Code
|
NDC 766080155
|
| Hospital Charge Code |
1743703
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$2.23 |
| Max. Negotiated Rate |
$7.89 |
| Rate for Payer: Blue Shield of California Commercial |
$6.61
|
| Rate for Payer: Blue Shield of California EPN |
$4.75
|
| Rate for Payer: Cash Price |
$4.18
|
| Rate for Payer: Cigna of CA HMO |
$6.50
|
| Rate for Payer: Cigna of CA PPO |
$6.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$3.71
|
| Rate for Payer: Galaxy Health WC |
$7.89
|
| Rate for Payer: Global Benefits Group Commercial |
$5.57
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$6.19
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3.54
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.23
|
| Rate for Payer: Multiplan Commercial |
$7.42
|
| Rate for Payer: Networks By Design Commercial |
$6.03
|
| Rate for Payer: Prime Health Services Commercial |
$7.89
|
|
|
DOCOSANOL 10 % TOPICAL CREAM [29287]
|
Facility
|
OP
|
$9.28
|
|
|
Service Code
|
NDC 0766-0801-00
|
| Hospital Charge Code |
1743703
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$2.23 |
| Max. Negotiated Rate |
$7.89 |
| Rate for Payer: Aetna of CA HMO/PPO |
$6.09
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$7.89
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$5.10
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$5.10
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5.53
|
| Rate for Payer: Blue Distinction Transplant |
$5.57
|
| Rate for Payer: Blue Shield of California Commercial |
$6.84
|
| Rate for Payer: Blue Shield of California EPN |
$5.42
|
| Rate for Payer: Cash Price |
$4.18
|
| Rate for Payer: Cigna of CA HMO |
$6.50
|
| Rate for Payer: Cigna of CA PPO |
$6.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$7.89
|
| Rate for Payer: Dignity Health Media |
$7.89
|
| Rate for Payer: Dignity Health Medi-Cal |
$7.89
|
| Rate for Payer: EPIC Health Plan Commercial |
$3.71
|
| Rate for Payer: EPIC Health Plan Transplant |
$3.71
|
| Rate for Payer: Galaxy Health WC |
$7.89
|
| Rate for Payer: Global Benefits Group Commercial |
$5.57
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$6.96
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$6.19
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3.54
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.23
|
| Rate for Payer: Multiplan Commercial |
$7.42
|
| Rate for Payer: Networks By Design Commercial |
$6.03
|
| Rate for Payer: Prime Health Services Commercial |
$7.89
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$5.57
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$5.57
|
| Rate for Payer: United Healthcare All Other Commercial |
$4.64
|
| Rate for Payer: United Healthcare All Other HMO |
$4.64
|
| Rate for Payer: United Healthcare HMO Rider |
$4.64
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$4.64
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$7.89
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$7.89
|
| Rate for Payer: Vantage Medical Group Senior |
$7.89
|
|
|
DOCOSANOL 10 % TOPICAL CREAM [29287]
|
Facility
|
OP
|
$8.39
|
|
|
Service Code
|
NDC 46122-681-07
|
| Hospital Charge Code |
1743703
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$2.01 |
| Max. Negotiated Rate |
$7.13 |
| Rate for Payer: Aetna of CA HMO/PPO |
$5.50
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$7.13
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4.61
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4.61
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5.00
|
| Rate for Payer: Blue Distinction Transplant |
$5.03
|
| Rate for Payer: Blue Shield of California Commercial |
$6.18
|
| Rate for Payer: Blue Shield of California EPN |
$4.90
|
| Rate for Payer: Cash Price |
$3.78
|
| Rate for Payer: Cigna of CA HMO |
$5.87
|
| Rate for Payer: Cigna of CA PPO |
$5.87
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$7.13
|
| Rate for Payer: Dignity Health Media |
$7.13
|
| Rate for Payer: Dignity Health Medi-Cal |
$7.13
|
| Rate for Payer: EPIC Health Plan Commercial |
$3.36
|
| Rate for Payer: EPIC Health Plan Transplant |
$3.36
|
| Rate for Payer: Galaxy Health WC |
$7.13
|
| Rate for Payer: Global Benefits Group Commercial |
$5.03
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$6.29
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$5.60
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3.20
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.01
|
| Rate for Payer: Multiplan Commercial |
$6.71
|
| Rate for Payer: Networks By Design Commercial |
$5.45
|
| Rate for Payer: Prime Health Services Commercial |
$7.13
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$5.03
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$5.03
|
| Rate for Payer: United Healthcare All Other Commercial |
$4.20
|
| Rate for Payer: United Healthcare All Other HMO |
$4.20
|
| Rate for Payer: United Healthcare HMO Rider |
$4.20
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$4.20
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$7.13
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$7.13
|
| Rate for Payer: Vantage Medical Group Senior |
$7.13
|
|
|
DOCOSANOL 10 % TOPICAL CREAM [29287]
|
Facility
|
OP
|
$8.39
|
|
|
Service Code
|
NDC 46122-624-07
|
| Hospital Charge Code |
1743703
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$2.01 |
| Max. Negotiated Rate |
$7.13 |
| Rate for Payer: Aetna of CA HMO/PPO |
$5.50
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$7.13
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4.61
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4.61
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5.00
|
| Rate for Payer: Blue Distinction Transplant |
$5.03
|
| Rate for Payer: Blue Shield of California Commercial |
$6.18
|
| Rate for Payer: Blue Shield of California EPN |
$4.90
|
| Rate for Payer: Cash Price |
$3.78
|
| Rate for Payer: Cigna of CA HMO |
$5.87
|
| Rate for Payer: Cigna of CA PPO |
$5.87
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$7.13
|
| Rate for Payer: Dignity Health Media |
$7.13
|
| Rate for Payer: Dignity Health Medi-Cal |
$7.13
|
| Rate for Payer: EPIC Health Plan Commercial |
$3.36
|
| Rate for Payer: EPIC Health Plan Transplant |
$3.36
|
| Rate for Payer: Galaxy Health WC |
$7.13
|
| Rate for Payer: Global Benefits Group Commercial |
$5.03
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$6.29
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$5.60
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3.20
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.01
|
| Rate for Payer: Multiplan Commercial |
$6.71
|
| Rate for Payer: Networks By Design Commercial |
$5.45
|
| Rate for Payer: Prime Health Services Commercial |
$7.13
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$5.03
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$5.03
|
| Rate for Payer: United Healthcare All Other Commercial |
$4.20
|
| Rate for Payer: United Healthcare All Other HMO |
$4.20
|
| Rate for Payer: United Healthcare HMO Rider |
$4.20
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$4.20
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$7.13
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$7.13
|
| Rate for Payer: Vantage Medical Group Senior |
$7.13
|
|
|
DOCOSANOL 10 % TOPICAL CREAM [29287]
|
Facility
|
OP
|
$9.28
|
|
|
Service Code
|
NDC 0135-0200-01
|
| Hospital Charge Code |
1743703
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$2.23 |
| Max. Negotiated Rate |
$7.89 |
| Rate for Payer: Aetna of CA HMO/PPO |
$6.09
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$7.89
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$5.10
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$5.10
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5.53
|
| Rate for Payer: Blue Distinction Transplant |
$5.57
|
| Rate for Payer: Blue Shield of California Commercial |
$6.84
|
| Rate for Payer: Blue Shield of California EPN |
$5.42
|
| Rate for Payer: Cash Price |
$4.18
|
| Rate for Payer: Cigna of CA HMO |
$6.50
|
| Rate for Payer: Cigna of CA PPO |
$6.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$7.89
|
| Rate for Payer: Dignity Health Media |
$7.89
|
| Rate for Payer: Dignity Health Medi-Cal |
$7.89
|
| Rate for Payer: EPIC Health Plan Commercial |
$3.71
|
| Rate for Payer: EPIC Health Plan Transplant |
$3.71
|
| Rate for Payer: Galaxy Health WC |
$7.89
|
| Rate for Payer: Global Benefits Group Commercial |
$5.57
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$6.96
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$6.19
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3.54
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.23
|
| Rate for Payer: Multiplan Commercial |
$7.42
|
| Rate for Payer: Networks By Design Commercial |
$6.03
|
| Rate for Payer: Prime Health Services Commercial |
$7.89
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$5.57
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$5.57
|
| Rate for Payer: United Healthcare All Other Commercial |
$4.64
|
| Rate for Payer: United Healthcare All Other HMO |
$4.64
|
| Rate for Payer: United Healthcare HMO Rider |
$4.64
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$4.64
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$7.89
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$7.89
|
| Rate for Payer: Vantage Medical Group Senior |
$7.89
|
|
|
DOCOSANOL 10 % TOPICAL CREAM [29287]
|
Facility
|
OP
|
$9.28
|
|
|
Service Code
|
NDC 766080155
|
| Hospital Charge Code |
1743703
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$2.23 |
| Max. Negotiated Rate |
$7.89 |
| Rate for Payer: Aetna of CA HMO/PPO |
$6.09
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$7.89
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$5.10
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$5.10
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5.53
|
| Rate for Payer: Blue Distinction Transplant |
$5.57
|
| Rate for Payer: Blue Shield of California Commercial |
$6.84
|
| Rate for Payer: Blue Shield of California EPN |
$5.42
|
| Rate for Payer: Cash Price |
$4.18
|
| Rate for Payer: Cigna of CA HMO |
$6.50
|
| Rate for Payer: Cigna of CA PPO |
$6.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$7.89
|
| Rate for Payer: Dignity Health Media |
$7.89
|
| Rate for Payer: Dignity Health Medi-Cal |
$7.89
|
| Rate for Payer: EPIC Health Plan Commercial |
$3.71
|
| Rate for Payer: EPIC Health Plan Transplant |
$3.71
|
| Rate for Payer: Galaxy Health WC |
$7.89
|
| Rate for Payer: Global Benefits Group Commercial |
$5.57
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$6.96
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$6.19
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3.54
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.23
|
| Rate for Payer: Multiplan Commercial |
$7.42
|
| Rate for Payer: Networks By Design Commercial |
$6.03
|
| Rate for Payer: Prime Health Services Commercial |
$7.89
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$5.57
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$5.57
|
| Rate for Payer: United Healthcare All Other Commercial |
$4.64
|
| Rate for Payer: United Healthcare All Other HMO |
$4.64
|
| Rate for Payer: United Healthcare HMO Rider |
$4.64
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$4.64
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$7.89
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$7.89
|
| Rate for Payer: Vantage Medical Group Senior |
$7.89
|
|
|
DOCOSANOL 10 % TOPICAL CREAM [29287]
|
Facility
|
OP
|
$8.02
|
|
|
Service Code
|
NDC 61269-981-35
|
| Hospital Charge Code |
1743703
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$1.92 |
| Max. Negotiated Rate |
$6.82 |
| Rate for Payer: Aetna of CA HMO/PPO |
$5.26
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$6.82
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4.41
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4.41
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4.78
|
| Rate for Payer: Blue Distinction Transplant |
$4.81
|
| Rate for Payer: Blue Shield of California Commercial |
$5.91
|
| Rate for Payer: Blue Shield of California EPN |
$4.68
|
| Rate for Payer: Cash Price |
$3.61
|
| Rate for Payer: Cigna of CA HMO |
$5.61
|
| Rate for Payer: Cigna of CA PPO |
$5.61
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$6.82
|
| Rate for Payer: Dignity Health Media |
$6.82
|
| Rate for Payer: Dignity Health Medi-Cal |
$6.82
|
| Rate for Payer: EPIC Health Plan Commercial |
$3.21
|
| Rate for Payer: EPIC Health Plan Transplant |
$3.21
|
| Rate for Payer: Galaxy Health WC |
$6.82
|
| Rate for Payer: Global Benefits Group Commercial |
$4.81
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$6.02
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$5.35
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3.06
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.92
|
| Rate for Payer: Multiplan Commercial |
$6.42
|
| Rate for Payer: Networks By Design Commercial |
$5.21
|
| Rate for Payer: Prime Health Services Commercial |
$6.82
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$4.81
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$4.81
|
| Rate for Payer: United Healthcare All Other Commercial |
$4.01
|
| Rate for Payer: United Healthcare All Other HMO |
$4.01
|
| Rate for Payer: United Healthcare HMO Rider |
$4.01
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$4.01
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$6.82
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$6.82
|
| Rate for Payer: Vantage Medical Group Senior |
$6.82
|
|
|
DOCOSANOL 10 % TOPICAL CREAM [29287]
|
Facility
|
IP
|
$8.39
|
|
|
Service Code
|
NDC 46122-681-07
|
| Hospital Charge Code |
1743703
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$2.01 |
| Max. Negotiated Rate |
$7.13 |
| Rate for Payer: Blue Shield of California Commercial |
$5.97
|
| Rate for Payer: Blue Shield of California EPN |
$4.30
|
| Rate for Payer: Cash Price |
$3.78
|
| Rate for Payer: Cigna of CA HMO |
$5.87
|
| Rate for Payer: Cigna of CA PPO |
$5.87
|
| Rate for Payer: EPIC Health Plan Commercial |
$3.36
|
| Rate for Payer: Galaxy Health WC |
$7.13
|
| Rate for Payer: Global Benefits Group Commercial |
$5.03
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$5.60
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3.20
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.01
|
| Rate for Payer: Multiplan Commercial |
$6.71
|
| Rate for Payer: Networks By Design Commercial |
$5.45
|
| Rate for Payer: Prime Health Services Commercial |
$7.13
|
|
|
DOCOSANOL 10 % TOPICAL CREAM [29287]
|
Facility
|
IP
|
$8.02
|
|
|
Service Code
|
NDC 61269-981-35
|
| Hospital Charge Code |
1743703
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$1.92 |
| Max. Negotiated Rate |
$6.82 |
| Rate for Payer: Blue Shield of California Commercial |
$5.71
|
| Rate for Payer: Blue Shield of California EPN |
$4.11
|
| Rate for Payer: Cash Price |
$3.61
|
| Rate for Payer: Cigna of CA HMO |
$5.61
|
| Rate for Payer: Cigna of CA PPO |
$5.61
|
| Rate for Payer: EPIC Health Plan Commercial |
$3.21
|
| Rate for Payer: Galaxy Health WC |
$6.82
|
| Rate for Payer: Global Benefits Group Commercial |
$4.81
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$5.35
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3.06
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.92
|
| Rate for Payer: Multiplan Commercial |
$6.42
|
| Rate for Payer: Networks By Design Commercial |
$5.21
|
| Rate for Payer: Prime Health Services Commercial |
$6.82
|
|
|
DOCUSATE SODIUM 100 MG CAPSULE [2566]
|
Facility
|
IP
|
$0.02
|
|
|
Service Code
|
NDC 57896-401-10
|
| Hospital Charge Code |
1710247
|
|
Hospital Revenue Code
|
259
|
| Max. Negotiated Rate |
$0.02 |
| 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: 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: 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
|
|
|
DOCUSATE SODIUM 100 MG CAPSULE [2566]
|
Facility
|
OP
|
$0.22
|
|
|
Service Code
|
NDC 60687-129-11
|
| Hospital Charge Code |
1710247
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.05 |
| Max. Negotiated Rate |
$0.19 |
| Rate for Payer: Aetna of CA HMO/PPO |
$0.14
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.19
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.12
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.12
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.13
|
| Rate for Payer: Blue Distinction Transplant |
$0.13
|
| Rate for Payer: Blue Shield of California Commercial |
$0.16
|
| Rate for Payer: Blue Shield of California EPN |
$0.13
|
| Rate for Payer: Cash Price |
$0.10
|
| 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 |
$0.19
|
| Rate for Payer: Dignity Health Media |
$0.19
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.19
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.09
|
| Rate for Payer: EPIC Health Plan Transplant |
$0.09
|
| Rate for Payer: Galaxy Health WC |
$0.19
|
| Rate for Payer: Global Benefits Group Commercial |
$0.13
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$0.17
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.15
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.08
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.05
|
| Rate for Payer: Multiplan Commercial |
$0.18
|
| Rate for Payer: Networks By Design Commercial |
$0.14
|
| Rate for Payer: Prime Health Services Commercial |
$0.19
|
| 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 |
$0.19
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.19
|
| Rate for Payer: Vantage Medical Group Senior |
$0.19
|
|
|
DOCUSATE SODIUM 100 MG CAPSULE [2566]
|
Facility
|
OP
|
$0.04
|
|
|
Service Code
|
NDC 46122-692-85
|
| Hospital Charge Code |
1710247
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.01 |
| Max. Negotiated Rate |
$0.03 |
| 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 |
$0.02
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.02
|
| Rate for Payer: Blue Distinction Transplant |
$0.02
|
| 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: Dignity Health Commercial/Exchange |
$0.03
|
| Rate for Payer: Dignity Health Media |
$0.03
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.03
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.02
|
| Rate for Payer: EPIC Health Plan Transplant |
$0.02
|
| Rate for Payer: Galaxy Health WC |
$0.03
|
| Rate for Payer: Global Benefits Group Commercial |
$0.02
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$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: 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
|
| 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
|
|
|
DOCUSATE SODIUM 100 MG CAPSULE [2566]
|
Facility
|
IP
|
$0.04
|
|
|
Service Code
|
NDC 46122-692-85
|
| Hospital Charge Code |
1710247
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.01 |
| Max. Negotiated Rate |
$0.03 |
| 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: 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: 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
|
|
|
DOCUSATE SODIUM 100 MG CAPSULE [2566]
|
Facility
|
OP
|
$0.22
|
|
|
Service Code
|
NDC 60687-129-01
|
| Hospital Charge Code |
1710247
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.05 |
| Max. Negotiated Rate |
$0.19 |
| Rate for Payer: Aetna of CA HMO/PPO |
$0.14
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.19
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.12
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.12
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.13
|
| Rate for Payer: Blue Distinction Transplant |
$0.13
|
| Rate for Payer: Blue Shield of California Commercial |
$0.16
|
| Rate for Payer: Blue Shield of California EPN |
$0.13
|
| Rate for Payer: Cash Price |
$0.10
|
| 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 |
$0.19
|
| Rate for Payer: Dignity Health Media |
$0.19
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.19
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.09
|
| Rate for Payer: EPIC Health Plan Transplant |
$0.09
|
| Rate for Payer: Galaxy Health WC |
$0.19
|
| Rate for Payer: Global Benefits Group Commercial |
$0.13
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$0.17
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.15
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.08
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.05
|
| Rate for Payer: Multiplan Commercial |
$0.18
|
| Rate for Payer: Networks By Design Commercial |
$0.14
|
| Rate for Payer: Prime Health Services Commercial |
$0.19
|
| 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 |
$0.19
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.19
|
| Rate for Payer: Vantage Medical Group Senior |
$0.19
|
|
|
DOCUSATE SODIUM 100 MG CAPSULE [2566]
|
Facility
|
IP
|
$0.06
|
|
|
Service Code
|
NDC 0904-7183-61
|
| Hospital Charge Code |
1710247
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.01 |
| Max. Negotiated Rate |
$0.05 |
| 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: 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: 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
|
|
|
DOCUSATE SODIUM 100 MG CAPSULE [2566]
|
Facility
|
OP
|
$0.02
|
|
|
Service Code
|
NDC 57896-401-10
|
| Hospital Charge Code |
1710247
|
|
Hospital Revenue Code
|
259
|
| Max. Negotiated Rate |
$0.02 |
| 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 |
$0.01
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.01
|
| Rate for Payer: Blue Distinction Transplant |
$0.01
|
| 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: Dignity Health Commercial/Exchange |
$0.02
|
| Rate for Payer: Dignity Health Media |
$0.02
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.02
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.01
|
| Rate for Payer: EPIC Health Plan Transplant |
$0.01
|
| Rate for Payer: Galaxy Health WC |
$0.02
|
| Rate for Payer: Global Benefits Group Commercial |
$0.01
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$0.02
|
| 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: 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
|
| 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
|
|
|
DOCUSATE SODIUM 100 MG CAPSULE [2566]
|
Facility
|
OP
|
$0.07
|
|
|
Service Code
|
NDC 46122-692-78
|
| Hospital Charge Code |
1710247
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.02 |
| Max. Negotiated Rate |
$0.06 |
| Rate for Payer: Aetna of CA HMO/PPO |
$0.05
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.06
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.04
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.04
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.04
|
| Rate for Payer: Blue Distinction Transplant |
$0.04
|
| Rate for Payer: Blue Shield of California Commercial |
$0.05
|
| Rate for Payer: Blue Shield of California EPN |
$0.04
|
| Rate for Payer: Cash Price |
$0.03
|
| Rate for Payer: Cigna of CA HMO |
$0.05
|
| Rate for Payer: Cigna of CA PPO |
$0.05
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.06
|
| Rate for Payer: Dignity Health Media |
$0.06
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.06
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.03
|
| Rate for Payer: EPIC Health Plan Transplant |
$0.03
|
| Rate for Payer: Galaxy Health WC |
$0.06
|
| Rate for Payer: Global Benefits Group Commercial |
$0.04
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$0.05
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.05
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.03
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.02
|
| Rate for Payer: Multiplan Commercial |
$0.06
|
| Rate for Payer: Networks By Design Commercial |
$0.05
|
| Rate for Payer: Prime Health Services Commercial |
$0.06
|
| 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 |
$0.04
|
| Rate for Payer: United Healthcare All Other HMO |
$0.04
|
| Rate for Payer: United Healthcare HMO Rider |
$0.04
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.04
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.06
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.06
|
| Rate for Payer: Vantage Medical Group Senior |
$0.06
|
|
|
DOCUSATE SODIUM 100 MG CAPSULE [2566]
|
Facility
|
OP
|
$0.06
|
|
|
Service Code
|
NDC 0904-7183-61
|
| Hospital Charge Code |
1710247
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.01 |
| Max. Negotiated Rate |
$0.05 |
| 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 |
$0.03
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.04
|
| Rate for Payer: Blue Distinction Transplant |
$0.04
|
| Rate for Payer: Blue Shield of California Commercial |
$0.04
|
| Rate for Payer: Blue Shield of California EPN |
$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 Media |
$0.05
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.05
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.02
|
| Rate for Payer: EPIC Health Plan Transplant |
$0.02
|
| Rate for Payer: Galaxy Health WC |
$0.05
|
| Rate for Payer: Global Benefits Group Commercial |
$0.04
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$0.05
|
| 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: 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
|
| 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
|
|
|
DOCUSATE SODIUM 100 MG CAPSULE [2566]
|
Facility
|
IP
|
$0.07
|
|
|
Service Code
|
NDC 46122-692-78
|
| Hospital Charge Code |
1710247
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.02 |
| Max. Negotiated Rate |
$0.06 |
| Rate for Payer: Blue Shield of California Commercial |
$0.05
|
| Rate for Payer: Blue Shield of California EPN |
$0.04
|
| Rate for Payer: Cash Price |
$0.03
|
| Rate for Payer: Cigna of CA HMO |
$0.05
|
| Rate for Payer: Cigna of CA PPO |
$0.05
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.03
|
| Rate for Payer: Galaxy Health WC |
$0.06
|
| Rate for Payer: Global Benefits Group Commercial |
$0.04
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.05
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.03
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.02
|
| Rate for Payer: Multiplan Commercial |
$0.06
|
| Rate for Payer: Networks By Design Commercial |
$0.05
|
| Rate for Payer: Prime Health Services Commercial |
$0.06
|
|
|
DOCUSATE SODIUM 100 MG CAPSULE [2566]
|
Facility
|
IP
|
$0.02
|
|
|
Service Code
|
NDC 0904-6998-60
|
| Hospital Charge Code |
1710247
|
|
Hospital Revenue Code
|
259
|
| Max. Negotiated Rate |
$0.02 |
| 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: 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: 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
|
|
