BIPOLAR DISORDERS
|
Facility
IP
|
$6,247.90
|
|
Service Code
|
APR-DRG 7531
|
Min. Negotiated Rate |
$4,792.80 |
Max. Negotiated Rate |
$6,247.90 |
Rate for Payer: IEHP Medi-Cal |
$4,792.80
|
Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$6,247.90
|
|
BIPOLAR DISORDERS
|
Facility
IP
|
$8,439.90
|
|
Service Code
|
APR-DRG 7532
|
Min. Negotiated Rate |
$6,474.29 |
Max. Negotiated Rate |
$8,439.90 |
Rate for Payer: IEHP Medi-Cal |
$6,474.29
|
Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$8,439.90
|
|
BIPOLAR DISORDERS
|
Facility
IP
|
$14,948.50
|
|
Service Code
|
APR-DRG 7533
|
Min. Negotiated Rate |
$11,467.07 |
Max. Negotiated Rate |
$14,948.50 |
Rate for Payer: IEHP Medi-Cal |
$11,467.07
|
Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$14,948.50
|
|
BISACODYL 10 MG RECTAL SUPPOSITORY [1080]
|
Facility
IP
|
$0.28
|
|
Service Code
|
NDC 58980-415-12
|
Hospital Charge Code |
1748045
|
Hospital Revenue Code
|
259
|
Min. Negotiated Rate |
$0.07 |
Max. Negotiated Rate |
$0.24 |
Rate for Payer: Blue Shield of California Commercial |
$0.20
|
Rate for Payer: Blue Shield of California EPN |
$0.14
|
Rate for Payer: Cash Price |
$0.13
|
Rate for Payer: Cigna of CA HMO |
$0.20
|
Rate for Payer: Cigna of CA PPO |
$0.20
|
Rate for Payer: EPIC Health Plan Commercial |
$0.11
|
Rate for Payer: Galaxy Health WC |
$0.24
|
Rate for Payer: Global Benefits Group Commercial |
$0.17
|
Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.19
|
Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.11
|
Rate for Payer: LLUH Dept of Risk Management WC |
$0.07
|
Rate for Payer: Multiplan Commercial |
$0.22
|
Rate for Payer: Networks By Design Commercial |
$0.18
|
Rate for Payer: Prime Health Services Commercial |
$0.24
|
|
BISACODYL 10 MG RECTAL SUPPOSITORY [1080]
|
Facility
IP
|
$0.28
|
|
Service Code
|
NDC 58980-415-01
|
Hospital Charge Code |
1748045
|
Hospital Revenue Code
|
259
|
Min. Negotiated Rate |
$0.07 |
Max. Negotiated Rate |
$0.24 |
Rate for Payer: Blue Shield of California Commercial |
$0.20
|
Rate for Payer: Blue Shield of California EPN |
$0.14
|
Rate for Payer: Cash Price |
$0.13
|
Rate for Payer: Cigna of CA HMO |
$0.20
|
Rate for Payer: Cigna of CA PPO |
$0.20
|
Rate for Payer: EPIC Health Plan Commercial |
$0.11
|
Rate for Payer: Galaxy Health WC |
$0.24
|
Rate for Payer: Global Benefits Group Commercial |
$0.17
|
Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.19
|
Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.11
|
Rate for Payer: LLUH Dept of Risk Management WC |
$0.07
|
Rate for Payer: Multiplan Commercial |
$0.22
|
Rate for Payer: Networks By Design Commercial |
$0.18
|
Rate for Payer: Prime Health Services Commercial |
$0.24
|
|
BISACODYL 10 MG RECTAL SUPPOSITORY [1080]
|
Facility
OP
|
$0.28
|
|
Service Code
|
NDC 68784-102-12
|
Hospital Charge Code |
1748045
|
Hospital Revenue Code
|
259
|
Min. Negotiated Rate |
$0.07 |
Max. Negotiated Rate |
$0.24 |
Rate for Payer: Galaxy Health WC |
$0.24
|
Rate for Payer: Aetna of CA HMO/PPO |
$0.18
|
Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$0.24
|
Rate for Payer: AlphaCare Medical Group Medi-Cal |
$0.15
|
Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$0.15
|
Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.17
|
Rate for Payer: BCBS Transplant Transplant |
$0.17
|
Rate for Payer: Blue Shield of California Commercial |
$0.21
|
Rate for Payer: Blue Shield of California EPN |
$0.16
|
Rate for Payer: Cash Price |
$0.13
|
Rate for Payer: Cigna of CA HMO |
$0.20
|
Rate for Payer: Cigna of CA PPO |
$0.20
|
Rate for Payer: Dignity Health Commercial/Exchange |
$0.24
|
Rate for Payer: Dignity Health Media |
$0.24
|
Rate for Payer: Dignity Health Medi-Cal |
$0.24
|
Rate for Payer: EPIC Health Plan Commercial |
$0.11
|
Rate for Payer: EPIC Health Plan Transplant |
$0.11
|
Rate for Payer: Global Benefits Group Commercial |
$0.17
|
Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$0.21
|
Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.19
|
Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.11
|
Rate for Payer: LLUH Dept of Risk Management WC |
$0.07
|
Rate for Payer: Multiplan Commercial |
$0.22
|
Rate for Payer: Networks By Design Commercial |
$0.18
|
Rate for Payer: Prime Health Services Commercial |
$0.24
|
Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$0.17
|
Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.17
|
Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.17
|
Rate for Payer: United Healthcare All Other Commercial |
$0.14
|
Rate for Payer: United Healthcare All Other HMO |
$0.14
|
Rate for Payer: United Healthcare HMO Rider |
$0.14
|
Rate for Payer: United Healthcare Select/Navigate/Core |
$0.14
|
Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.24
|
Rate for Payer: Vantage Medical Group Medi-Cal |
$0.24
|
Rate for Payer: Vantage Medical Group Senior |
$0.24
|
|
BISACODYL 10 MG RECTAL SUPPOSITORY [1080]
|
Facility
IP
|
$0.32
|
|
Service Code
|
NDC 0574-7050-50
|
Hospital Charge Code |
1748045
|
Hospital Revenue Code
|
259
|
Min. Negotiated Rate |
$0.08 |
Max. Negotiated Rate |
$0.27 |
Rate for Payer: Blue Shield of California Commercial |
$0.23
|
Rate for Payer: Blue Shield of California EPN |
$0.16
|
Rate for Payer: Cash Price |
$0.14
|
Rate for Payer: Cigna of CA HMO |
$0.22
|
Rate for Payer: Cigna of CA PPO |
$0.22
|
Rate for Payer: EPIC Health Plan Commercial |
$0.13
|
Rate for Payer: Galaxy Health WC |
$0.27
|
Rate for Payer: Global Benefits Group Commercial |
$0.19
|
Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.21
|
Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.12
|
Rate for Payer: LLUH Dept of Risk Management WC |
$0.08
|
Rate for Payer: Multiplan Commercial |
$0.26
|
Rate for Payer: Networks By Design Commercial |
$0.21
|
Rate for Payer: Prime Health Services Commercial |
$0.27
|
|
BISACODYL 10 MG RECTAL SUPPOSITORY [1080]
|
Facility
OP
|
$1.15
|
|
Service Code
|
NDC 8142102102
|
Hospital Charge Code |
1748045
|
Hospital Revenue Code
|
259
|
Min. Negotiated Rate |
$0.28 |
Max. Negotiated Rate |
$0.98 |
Rate for Payer: Aetna of CA HMO/PPO |
$0.75
|
Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$0.98
|
Rate for Payer: AlphaCare Medical Group Medi-Cal |
$0.63
|
Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$0.63
|
Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.69
|
Rate for Payer: BCBS Transplant Transplant |
$0.69
|
Rate for Payer: Blue Shield of California Commercial |
$0.85
|
Rate for Payer: Blue Shield of California EPN |
$0.67
|
Rate for Payer: Cash Price |
$0.52
|
Rate for Payer: Cigna of CA HMO |
$0.81
|
Rate for Payer: Cigna of CA PPO |
$0.81
|
Rate for Payer: Dignity Health Commercial/Exchange |
$0.98
|
Rate for Payer: Dignity Health Media |
$0.98
|
Rate for Payer: Dignity Health Medi-Cal |
$0.98
|
Rate for Payer: EPIC Health Plan Commercial |
$0.46
|
Rate for Payer: EPIC Health Plan Transplant |
$0.46
|
Rate for Payer: Galaxy Health WC |
$0.98
|
Rate for Payer: Global Benefits Group Commercial |
$0.69
|
Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$0.86
|
Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.77
|
Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.44
|
Rate for Payer: LLUH Dept of Risk Management WC |
$0.28
|
Rate for Payer: Multiplan Commercial |
$0.92
|
Rate for Payer: Networks By Design Commercial |
$0.75
|
Rate for Payer: Prime Health Services Commercial |
$0.98
|
Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$0.69
|
Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.69
|
Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.69
|
Rate for Payer: United Healthcare All Other Commercial |
$0.58
|
Rate for Payer: United Healthcare All Other HMO |
$0.58
|
Rate for Payer: United Healthcare HMO Rider |
$0.58
|
Rate for Payer: United Healthcare Select/Navigate/Core |
$0.58
|
Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.98
|
Rate for Payer: Vantage Medical Group Medi-Cal |
$0.98
|
Rate for Payer: Vantage Medical Group Senior |
$0.98
|
|
BISACODYL 10 MG RECTAL SUPPOSITORY [1080]
|
Facility
OP
|
$0.31
|
|
Service Code
|
NDC 71399-8460-5
|
Hospital Charge Code |
1748045
|
Hospital Revenue Code
|
259
|
Min. Negotiated Rate |
$0.07 |
Max. Negotiated Rate |
$0.26 |
Rate for Payer: Aetna of CA HMO/PPO |
$0.20
|
Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$0.26
|
Rate for Payer: AlphaCare Medical Group Medi-Cal |
$0.17
|
Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$0.17
|
Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.18
|
Rate for Payer: BCBS Transplant Transplant |
$0.19
|
Rate for Payer: Blue Shield of California Commercial |
$0.23
|
Rate for Payer: Blue Shield of California EPN |
$0.18
|
Rate for Payer: Cash Price |
$0.14
|
Rate for Payer: Cigna of CA HMO |
$0.22
|
Rate for Payer: Cigna of CA PPO |
$0.22
|
Rate for Payer: Dignity Health Commercial/Exchange |
$0.26
|
Rate for Payer: Dignity Health Media |
$0.26
|
Rate for Payer: Dignity Health Medi-Cal |
$0.26
|
Rate for Payer: EPIC Health Plan Commercial |
$0.12
|
Rate for Payer: EPIC Health Plan Transplant |
$0.12
|
Rate for Payer: Galaxy Health WC |
$0.26
|
Rate for Payer: Global Benefits Group Commercial |
$0.19
|
Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$0.23
|
Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.21
|
Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.12
|
Rate for Payer: LLUH Dept of Risk Management WC |
$0.07
|
Rate for Payer: Multiplan Commercial |
$0.25
|
Rate for Payer: Networks By Design Commercial |
$0.20
|
Rate for Payer: Prime Health Services Commercial |
$0.26
|
Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$0.19
|
Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.19
|
Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.19
|
Rate for Payer: United Healthcare All Other Commercial |
$0.16
|
Rate for Payer: United Healthcare All Other HMO |
$0.16
|
Rate for Payer: United Healthcare HMO Rider |
$0.16
|
Rate for Payer: United Healthcare Select/Navigate/Core |
$0.16
|
Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.26
|
Rate for Payer: Vantage Medical Group Medi-Cal |
$0.26
|
Rate for Payer: Vantage Medical Group Senior |
$0.26
|
|
BISACODYL 10 MG RECTAL SUPPOSITORY [1080]
|
Facility
IP
|
$1.33
|
|
Service Code
|
NDC 8142102101
|
Hospital Charge Code |
1748045
|
Hospital Revenue Code
|
259
|
Min. Negotiated Rate |
$0.32 |
Max. Negotiated Rate |
$1.13 |
Rate for Payer: Blue Shield of California Commercial |
$0.95
|
Rate for Payer: Blue Shield of California EPN |
$0.68
|
Rate for Payer: Cash Price |
$0.60
|
Rate for Payer: Cigna of CA HMO |
$0.93
|
Rate for Payer: Cigna of CA PPO |
$0.93
|
Rate for Payer: EPIC Health Plan Commercial |
$0.53
|
Rate for Payer: Galaxy Health WC |
$1.13
|
Rate for Payer: Global Benefits Group Commercial |
$0.80
|
Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.89
|
Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.51
|
Rate for Payer: LLUH Dept of Risk Management WC |
$0.32
|
Rate for Payer: Multiplan Commercial |
$1.06
|
Rate for Payer: Networks By Design Commercial |
$0.86
|
Rate for Payer: Prime Health Services Commercial |
$1.13
|
|
BISACODYL 10 MG RECTAL SUPPOSITORY [1080]
|
Facility
IP
|
$0.28
|
|
Service Code
|
NDC 68784-102-12
|
Hospital Charge Code |
1748045
|
Hospital Revenue Code
|
259
|
Min. Negotiated Rate |
$0.07 |
Max. Negotiated Rate |
$0.24 |
Rate for Payer: Blue Shield of California Commercial |
$0.20
|
Rate for Payer: Blue Shield of California EPN |
$0.14
|
Rate for Payer: Cash Price |
$0.13
|
Rate for Payer: Cigna of CA HMO |
$0.20
|
Rate for Payer: Cigna of CA PPO |
$0.20
|
Rate for Payer: EPIC Health Plan Commercial |
$0.11
|
Rate for Payer: Galaxy Health WC |
$0.24
|
Rate for Payer: Global Benefits Group Commercial |
$0.17
|
Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.19
|
Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.11
|
Rate for Payer: LLUH Dept of Risk Management WC |
$0.07
|
Rate for Payer: Multiplan Commercial |
$0.22
|
Rate for Payer: Networks By Design Commercial |
$0.18
|
Rate for Payer: Prime Health Services Commercial |
$0.24
|
|
BISACODYL 10 MG RECTAL SUPPOSITORY [1080]
|
Facility
IP
|
$1.15
|
|
Service Code
|
NDC 8142102102
|
Hospital Charge Code |
1748045
|
Hospital Revenue Code
|
259
|
Min. Negotiated Rate |
$0.28 |
Max. Negotiated Rate |
$0.98 |
Rate for Payer: Blue Shield of California Commercial |
$0.82
|
Rate for Payer: Blue Shield of California EPN |
$0.59
|
Rate for Payer: Cash Price |
$0.52
|
Rate for Payer: Cigna of CA HMO |
$0.81
|
Rate for Payer: Cigna of CA PPO |
$0.81
|
Rate for Payer: EPIC Health Plan Commercial |
$0.46
|
Rate for Payer: Galaxy Health WC |
$0.98
|
Rate for Payer: Global Benefits Group Commercial |
$0.69
|
Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.77
|
Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.44
|
Rate for Payer: LLUH Dept of Risk Management WC |
$0.28
|
Rate for Payer: Multiplan Commercial |
$0.92
|
Rate for Payer: Networks By Design Commercial |
$0.75
|
Rate for Payer: Prime Health Services Commercial |
$0.98
|
|
BISACODYL 10 MG RECTAL SUPPOSITORY [1080]
|
Facility
OP
|
$0.28
|
|
Service Code
|
NDC 58980-415-12
|
Hospital Charge Code |
1748045
|
Hospital Revenue Code
|
259
|
Min. Negotiated Rate |
$0.07 |
Max. Negotiated Rate |
$0.24 |
Rate for Payer: Aetna of CA HMO/PPO |
$0.18
|
Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$0.24
|
Rate for Payer: AlphaCare Medical Group Medi-Cal |
$0.15
|
Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$0.15
|
Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.17
|
Rate for Payer: BCBS Transplant Transplant |
$0.17
|
Rate for Payer: Blue Shield of California Commercial |
$0.21
|
Rate for Payer: Blue Shield of California EPN |
$0.16
|
Rate for Payer: Cash Price |
$0.13
|
Rate for Payer: Cigna of CA HMO |
$0.20
|
Rate for Payer: Cigna of CA PPO |
$0.20
|
Rate for Payer: Dignity Health Commercial/Exchange |
$0.24
|
Rate for Payer: Dignity Health Media |
$0.24
|
Rate for Payer: Dignity Health Medi-Cal |
$0.24
|
Rate for Payer: EPIC Health Plan Commercial |
$0.11
|
Rate for Payer: EPIC Health Plan Transplant |
$0.11
|
Rate for Payer: Galaxy Health WC |
$0.24
|
Rate for Payer: Global Benefits Group Commercial |
$0.17
|
Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$0.21
|
Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.19
|
Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.11
|
Rate for Payer: LLUH Dept of Risk Management WC |
$0.07
|
Rate for Payer: Multiplan Commercial |
$0.22
|
Rate for Payer: Networks By Design Commercial |
$0.18
|
Rate for Payer: Prime Health Services Commercial |
$0.24
|
Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$0.17
|
Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.17
|
Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.17
|
Rate for Payer: United Healthcare All Other Commercial |
$0.14
|
Rate for Payer: United Healthcare All Other HMO |
$0.14
|
Rate for Payer: United Healthcare HMO Rider |
$0.14
|
Rate for Payer: United Healthcare Select/Navigate/Core |
$0.14
|
Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.24
|
Rate for Payer: Vantage Medical Group Medi-Cal |
$0.24
|
Rate for Payer: Vantage Medical Group Senior |
$0.24
|
|
BISACODYL 10 MG RECTAL SUPPOSITORY [1080]
|
Facility
OP
|
$0.42
|
|
Service Code
|
NDC 0574-7050-12
|
Hospital Charge Code |
1748045
|
Hospital Revenue Code
|
259
|
Min. Negotiated Rate |
$0.10 |
Max. Negotiated Rate |
$0.36 |
Rate for Payer: Aetna of CA HMO/PPO |
$0.28
|
Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$0.36
|
Rate for Payer: AlphaCare Medical Group Medi-Cal |
$0.23
|
Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$0.23
|
Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.25
|
Rate for Payer: BCBS Transplant Transplant |
$0.25
|
Rate for Payer: Blue Shield of California Commercial |
$0.31
|
Rate for Payer: Blue Shield of California EPN |
$0.25
|
Rate for Payer: Cash Price |
$0.19
|
Rate for Payer: Cigna of CA HMO |
$0.29
|
Rate for Payer: Cigna of CA PPO |
$0.29
|
Rate for Payer: Dignity Health Commercial/Exchange |
$0.36
|
Rate for Payer: Dignity Health Media |
$0.36
|
Rate for Payer: Dignity Health Medi-Cal |
$0.36
|
Rate for Payer: EPIC Health Plan Commercial |
$0.17
|
Rate for Payer: EPIC Health Plan Transplant |
$0.17
|
Rate for Payer: Galaxy Health WC |
$0.36
|
Rate for Payer: Global Benefits Group Commercial |
$0.25
|
Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$0.32
|
Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.28
|
Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.16
|
Rate for Payer: LLUH Dept of Risk Management WC |
$0.10
|
Rate for Payer: Multiplan Commercial |
$0.34
|
Rate for Payer: Networks By Design Commercial |
$0.27
|
Rate for Payer: Prime Health Services Commercial |
$0.36
|
Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$0.25
|
Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.25
|
Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.25
|
Rate for Payer: United Healthcare All Other Commercial |
$0.21
|
Rate for Payer: United Healthcare All Other HMO |
$0.21
|
Rate for Payer: United Healthcare HMO Rider |
$0.21
|
Rate for Payer: United Healthcare Select/Navigate/Core |
$0.21
|
Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.36
|
Rate for Payer: Vantage Medical Group Medi-Cal |
$0.36
|
Rate for Payer: Vantage Medical Group Senior |
$0.36
|
|
BISACODYL 10 MG RECTAL SUPPOSITORY [1080]
|
Facility
OP
|
$1.33
|
|
Service Code
|
NDC 8142102101
|
Hospital Charge Code |
1748045
|
Hospital Revenue Code
|
259
|
Min. Negotiated Rate |
$0.32 |
Max. Negotiated Rate |
$1.13 |
Rate for Payer: Aetna of CA HMO/PPO |
$0.87
|
Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$1.13
|
Rate for Payer: AlphaCare Medical Group Medi-Cal |
$0.73
|
Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$0.73
|
Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.79
|
Rate for Payer: BCBS Transplant Transplant |
$0.80
|
Rate for Payer: Blue Shield of California Commercial |
$0.98
|
Rate for Payer: Blue Shield of California EPN |
$0.78
|
Rate for Payer: Cash Price |
$0.60
|
Rate for Payer: Cigna of CA HMO |
$0.93
|
Rate for Payer: Cigna of CA PPO |
$0.93
|
Rate for Payer: Dignity Health Commercial/Exchange |
$1.13
|
Rate for Payer: Dignity Health Media |
$1.13
|
Rate for Payer: Dignity Health Medi-Cal |
$1.13
|
Rate for Payer: EPIC Health Plan Commercial |
$0.53
|
Rate for Payer: EPIC Health Plan Transplant |
$0.53
|
Rate for Payer: Galaxy Health WC |
$1.13
|
Rate for Payer: Global Benefits Group Commercial |
$0.80
|
Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$1.00
|
Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.89
|
Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.51
|
Rate for Payer: LLUH Dept of Risk Management WC |
$0.32
|
Rate for Payer: Multiplan Commercial |
$1.06
|
Rate for Payer: Networks By Design Commercial |
$0.86
|
Rate for Payer: Prime Health Services Commercial |
$1.13
|
Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$0.80
|
Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.80
|
Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.80
|
Rate for Payer: United Healthcare All Other Commercial |
$0.67
|
Rate for Payer: United Healthcare All Other HMO |
$0.67
|
Rate for Payer: United Healthcare HMO Rider |
$0.67
|
Rate for Payer: United Healthcare Select/Navigate/Core |
$0.67
|
Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1.13
|
Rate for Payer: Vantage Medical Group Medi-Cal |
$1.13
|
Rate for Payer: Vantage Medical Group Senior |
$1.13
|
|
BISACODYL 10 MG RECTAL SUPPOSITORY [1080]
|
Facility
IP
|
$0.42
|
|
Service Code
|
NDC 0574-7050-12
|
Hospital Charge Code |
1748045
|
Hospital Revenue Code
|
259
|
Min. Negotiated Rate |
$0.10 |
Max. Negotiated Rate |
$0.36 |
Rate for Payer: Blue Shield of California Commercial |
$0.30
|
Rate for Payer: Blue Shield of California EPN |
$0.22
|
Rate for Payer: Cash Price |
$0.19
|
Rate for Payer: Cigna of CA HMO |
$0.29
|
Rate for Payer: Cigna of CA PPO |
$0.29
|
Rate for Payer: EPIC Health Plan Commercial |
$0.17
|
Rate for Payer: Galaxy Health WC |
$0.36
|
Rate for Payer: Global Benefits Group Commercial |
$0.25
|
Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.28
|
Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.16
|
Rate for Payer: LLUH Dept of Risk Management WC |
$0.10
|
Rate for Payer: Multiplan Commercial |
$0.34
|
Rate for Payer: Networks By Design Commercial |
$0.27
|
Rate for Payer: Prime Health Services Commercial |
$0.36
|
|
BISACODYL 10 MG RECTAL SUPPOSITORY [1080]
|
Facility
OP
|
$0.28
|
|
Service Code
|
NDC 58980-415-01
|
Hospital Charge Code |
1748045
|
Hospital Revenue Code
|
259
|
Min. Negotiated Rate |
$0.07 |
Max. Negotiated Rate |
$0.24 |
Rate for Payer: Aetna of CA HMO/PPO |
$0.18
|
Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$0.24
|
Rate for Payer: AlphaCare Medical Group Medi-Cal |
$0.15
|
Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$0.15
|
Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.17
|
Rate for Payer: BCBS Transplant Transplant |
$0.17
|
Rate for Payer: Blue Shield of California Commercial |
$0.21
|
Rate for Payer: Blue Shield of California EPN |
$0.16
|
Rate for Payer: Cash Price |
$0.13
|
Rate for Payer: Cigna of CA HMO |
$0.20
|
Rate for Payer: Cigna of CA PPO |
$0.20
|
Rate for Payer: Dignity Health Commercial/Exchange |
$0.24
|
Rate for Payer: Dignity Health Media |
$0.24
|
Rate for Payer: Dignity Health Medi-Cal |
$0.24
|
Rate for Payer: EPIC Health Plan Commercial |
$0.11
|
Rate for Payer: EPIC Health Plan Transplant |
$0.11
|
Rate for Payer: Galaxy Health WC |
$0.24
|
Rate for Payer: Global Benefits Group Commercial |
$0.17
|
Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$0.21
|
Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.19
|
Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.11
|
Rate for Payer: LLUH Dept of Risk Management WC |
$0.07
|
Rate for Payer: Multiplan Commercial |
$0.22
|
Rate for Payer: Networks By Design Commercial |
$0.18
|
Rate for Payer: Prime Health Services Commercial |
$0.24
|
Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$0.17
|
Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.17
|
Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.17
|
Rate for Payer: United Healthcare All Other Commercial |
$0.14
|
Rate for Payer: United Healthcare All Other HMO |
$0.14
|
Rate for Payer: United Healthcare HMO Rider |
$0.14
|
Rate for Payer: United Healthcare Select/Navigate/Core |
$0.14
|
Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.24
|
Rate for Payer: Vantage Medical Group Medi-Cal |
$0.24
|
Rate for Payer: Vantage Medical Group Senior |
$0.24
|
|
BISACODYL 10 MG RECTAL SUPPOSITORY [1080]
|
Facility
OP
|
$0.32
|
|
Service Code
|
NDC 0574-7050-50
|
Hospital Charge Code |
1748045
|
Hospital Revenue Code
|
259
|
Min. Negotiated Rate |
$0.08 |
Max. Negotiated Rate |
$0.27 |
Rate for Payer: BCBS Transplant Transplant |
$0.19
|
Rate for Payer: Aetna of CA HMO/PPO |
$0.21
|
Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$0.27
|
Rate for Payer: AlphaCare Medical Group Medi-Cal |
$0.18
|
Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$0.18
|
Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.19
|
Rate for Payer: Blue Shield of California Commercial |
$0.24
|
Rate for Payer: Blue Shield of California EPN |
$0.19
|
Rate for Payer: Cash Price |
$0.14
|
Rate for Payer: Cigna of CA HMO |
$0.22
|
Rate for Payer: Cigna of CA PPO |
$0.22
|
Rate for Payer: Dignity Health Commercial/Exchange |
$0.27
|
Rate for Payer: Dignity Health Media |
$0.27
|
Rate for Payer: Dignity Health Medi-Cal |
$0.27
|
Rate for Payer: EPIC Health Plan Commercial |
$0.13
|
Rate for Payer: EPIC Health Plan Transplant |
$0.13
|
Rate for Payer: Galaxy Health WC |
$0.27
|
Rate for Payer: Global Benefits Group Commercial |
$0.19
|
Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$0.24
|
Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.21
|
Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.12
|
Rate for Payer: LLUH Dept of Risk Management WC |
$0.08
|
Rate for Payer: Multiplan Commercial |
$0.26
|
Rate for Payer: Networks By Design Commercial |
$0.21
|
Rate for Payer: Prime Health Services Commercial |
$0.27
|
Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$0.19
|
Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.19
|
Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.19
|
Rate for Payer: United Healthcare All Other Commercial |
$0.16
|
Rate for Payer: United Healthcare All Other HMO |
$0.16
|
Rate for Payer: United Healthcare HMO Rider |
$0.16
|
Rate for Payer: United Healthcare Select/Navigate/Core |
$0.16
|
Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.27
|
Rate for Payer: Vantage Medical Group Medi-Cal |
$0.27
|
Rate for Payer: Vantage Medical Group Senior |
$0.27
|
|
BISACODYL 10 MG RECTAL SUPPOSITORY [1080]
|
Facility
IP
|
$0.31
|
|
Service Code
|
NDC 71399-8460-5
|
Hospital Charge Code |
1748045
|
Hospital Revenue Code
|
259
|
Min. Negotiated Rate |
$0.07 |
Max. Negotiated Rate |
$0.26 |
Rate for Payer: Blue Shield of California Commercial |
$0.22
|
Rate for Payer: Blue Shield of California EPN |
$0.16
|
Rate for Payer: Cash Price |
$0.14
|
Rate for Payer: Cigna of CA HMO |
$0.22
|
Rate for Payer: Cigna of CA PPO |
$0.22
|
Rate for Payer: EPIC Health Plan Commercial |
$0.12
|
Rate for Payer: Galaxy Health WC |
$0.26
|
Rate for Payer: Global Benefits Group Commercial |
$0.19
|
Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.21
|
Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.12
|
Rate for Payer: LLUH Dept of Risk Management WC |
$0.07
|
Rate for Payer: Multiplan Commercial |
$0.25
|
Rate for Payer: Networks By Design Commercial |
$0.20
|
Rate for Payer: Prime Health Services Commercial |
$0.26
|
|
BISACODYL 5 MG TABLET,DELAYED RELEASE [1079]
|
Facility
OP
|
$0.03
|
|
Service Code
|
NDC 0904-6407-61
|
Hospital Charge Code |
1710522
|
Hospital Revenue Code
|
259
|
Min. Negotiated Rate |
$0.01 |
Max. Negotiated Rate |
$0.03 |
Rate for Payer: Aetna of CA HMO/PPO |
$0.02
|
Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$0.03
|
Rate for Payer: AlphaCare Medical Group Medi-Cal |
$0.02
|
Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$0.02
|
Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.02
|
Rate for Payer: BCBS Transplant Transplant |
$0.02
|
Rate for Payer: Blue Shield of California Commercial |
$0.02
|
Rate for Payer: Blue Shield of California EPN |
$0.02
|
Rate for Payer: Cash Price |
$0.01
|
Rate for Payer: Cigna of CA HMO |
$0.02
|
Rate for Payer: Cigna of CA PPO |
$0.02
|
Rate for Payer: Dignity Health Commercial/Exchange |
$0.03
|
Rate for Payer: Dignity Health Media |
$0.03
|
Rate for Payer: Dignity Health Medi-Cal |
$0.03
|
Rate for Payer: EPIC Health Plan Commercial |
$0.01
|
Rate for Payer: EPIC Health Plan Transplant |
$0.01
|
Rate for Payer: Galaxy Health WC |
$0.03
|
Rate for Payer: Global Benefits Group Commercial |
$0.02
|
Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$0.02
|
Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.02
|
Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.01
|
Rate for Payer: LLUH Dept of Risk Management WC |
$0.01
|
Rate for Payer: Multiplan Commercial |
$0.02
|
Rate for Payer: Networks By Design Commercial |
$0.02
|
Rate for Payer: Prime Health Services Commercial |
$0.03
|
Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$0.02
|
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
|
|
BISACODYL 5 MG TABLET,DELAYED RELEASE [1079]
|
Facility
IP
|
$0.02
|
|
Service Code
|
NDC 0904-6748-60
|
Hospital Charge Code |
1710522
|
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
|
|
BISACODYL 5 MG TABLET,DELAYED RELEASE [1079]
|
Facility
IP
|
$0.02
|
|
Service Code
|
NDC 57896-441-01
|
Hospital Charge Code |
1710522
|
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
|
|
BISACODYL 5 MG TABLET,DELAYED RELEASE [1079]
|
Facility
OP
|
$0.02
|
|
Service Code
|
NDC 57896-441-01
|
Hospital Charge Code |
1710522
|
Hospital Revenue Code
|
259
|
Max. Negotiated Rate |
$0.02 |
Rate for Payer: Aetna of CA HMO/PPO |
$0.01
|
Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$0.02
|
Rate for Payer: AlphaCare Medical Group Medi-Cal |
$0.01
|
Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$0.01
|
Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.01
|
Rate for Payer: BCBS Transplant 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 Transplant 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: Redlands Yucaipa Medical Group Commercial/Senior |
$0.01
|
Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.01
|
Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.01
|
Rate for Payer: United Healthcare All Other Commercial |
$0.01
|
Rate for Payer: United Healthcare All Other HMO |
$0.01
|
Rate for Payer: United Healthcare HMO Rider |
$0.01
|
Rate for Payer: United Healthcare Select/Navigate/Core |
$0.01
|
Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.02
|
Rate for Payer: Vantage Medical Group Medi-Cal |
$0.02
|
Rate for Payer: Vantage Medical Group Senior |
$0.02
|
|
BISACODYL 5 MG TABLET,DELAYED RELEASE [1079]
|
Facility
IP
|
$0.03
|
|
Service Code
|
NDC 0904-6407-61
|
Hospital Charge Code |
1710522
|
Hospital Revenue Code
|
259
|
Min. Negotiated Rate |
$0.01 |
Max. Negotiated Rate |
$0.03 |
Rate for Payer: Blue Shield of California Commercial |
$0.02
|
Rate for Payer: Blue Shield of California EPN |
$0.02
|
Rate for Payer: Cash Price |
$0.01
|
Rate for Payer: Cigna of CA HMO |
$0.02
|
Rate for Payer: Cigna of CA PPO |
$0.02
|
Rate for Payer: EPIC Health Plan Commercial |
$0.01
|
Rate for Payer: Galaxy Health WC |
$0.03
|
Rate for Payer: Global Benefits Group Commercial |
$0.02
|
Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.02
|
Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.01
|
Rate for Payer: LLUH Dept of Risk Management WC |
$0.01
|
Rate for Payer: Multiplan Commercial |
$0.02
|
Rate for Payer: Networks By Design Commercial |
$0.02
|
Rate for Payer: Prime Health Services Commercial |
$0.03
|
|
BISACODYL 5 MG TABLET,DELAYED RELEASE [1079]
|
Facility
OP
|
$0.02
|
|
Service Code
|
NDC 0904-6748-60
|
Hospital Charge Code |
1710522
|
Hospital Revenue Code
|
259
|
Max. Negotiated Rate |
$0.02 |
Rate for Payer: Aetna of CA HMO/PPO |
$0.01
|
Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$0.02
|
Rate for Payer: AlphaCare Medical Group Medi-Cal |
$0.01
|
Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$0.01
|
Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.01
|
Rate for Payer: BCBS Transplant 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 Transplant 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: Redlands Yucaipa Medical Group Commercial/Senior |
$0.01
|
Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.01
|
Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.01
|
Rate for Payer: United Healthcare All Other Commercial |
$0.01
|
Rate for Payer: United Healthcare All Other HMO |
$0.01
|
Rate for Payer: United Healthcare HMO Rider |
$0.01
|
Rate for Payer: United Healthcare Select/Navigate/Core |
$0.01
|
Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.02
|
Rate for Payer: Vantage Medical Group Medi-Cal |
$0.02
|
Rate for Payer: Vantage Medical Group Senior |
$0.02
|
|