|
ACETAZOLAMIDE ER 500 MG CAPSULE,EXTENDED RELEASE [8962]
|
Facility
OP
|
$5.31
|
|
|
Service Code
|
NDC 50268-042-11
|
| Hospital Charge Code |
1710308
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$1.27 |
| Max. Negotiated Rate |
$4.51 |
| Rate for Payer: Aetna of CA HMO/PPO |
$3.48
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$4.51
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$2.92
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$2.92
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3.16
|
| Rate for Payer: BCBS Transplant Transplant |
$3.19
|
| Rate for Payer: Blue Shield of California Commercial |
$3.91
|
| Rate for Payer: Blue Shield of California EPN |
$3.10
|
| Rate for Payer: Cash Price |
$2.39
|
| Rate for Payer: Cigna of CA HMO |
$3.72
|
| Rate for Payer: Cigna of CA PPO |
$3.72
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$4.51
|
| Rate for Payer: Dignity Health Media |
$4.51
|
| Rate for Payer: Dignity Health Medi-Cal |
$4.51
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.12
|
| Rate for Payer: EPIC Health Plan Transplant |
$2.12
|
| Rate for Payer: Galaxy Health WC |
$4.51
|
| Rate for Payer: Global Benefits Group Commercial |
$3.19
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$3.98
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3.54
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2.02
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.27
|
| Rate for Payer: Multiplan Commercial |
$4.25
|
| Rate for Payer: Networks By Design Commercial |
$3.45
|
| Rate for Payer: Prime Health Services Commercial |
$4.51
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$3.19
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3.19
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$3.19
|
| Rate for Payer: United Healthcare All Other Commercial |
$2.66
|
| Rate for Payer: United Healthcare All Other HMO |
$2.66
|
| Rate for Payer: United Healthcare HMO Rider |
$2.66
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2.66
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$4.51
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4.51
|
| Rate for Payer: Vantage Medical Group Senior |
$4.51
|
|
|
ACETAZOLAMIDE ER 500 MG CAPSULE,EXTENDED RELEASE [8962]
|
Facility
IP
|
$0.60
|
|
|
Service Code
|
NDC 50742-233-01
|
| Hospital Charge Code |
1710308
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.14 |
| Max. Negotiated Rate |
$0.51 |
| Rate for Payer: Blue Shield of California Commercial |
$0.43
|
| Rate for Payer: Blue Shield of California EPN |
$0.31
|
| Rate for Payer: Cash Price |
$0.27
|
| Rate for Payer: Cigna of CA HMO |
$0.42
|
| Rate for Payer: Cigna of CA PPO |
$0.42
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.24
|
| Rate for Payer: Galaxy Health WC |
$0.51
|
| Rate for Payer: Global Benefits Group Commercial |
$0.36
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.40
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.23
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.14
|
| Rate for Payer: Multiplan Commercial |
$0.48
|
| Rate for Payer: Networks By Design Commercial |
$0.39
|
| Rate for Payer: Prime Health Services Commercial |
$0.51
|
|
|
ACETAZOLAMIDE ER 500 MG CAPSULE,EXTENDED RELEASE [8962]
|
Facility
OP
|
$0.90
|
|
|
Service Code
|
NDC 42571-243-01
|
| Hospital Charge Code |
1710308
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.22 |
| Max. Negotiated Rate |
$0.77 |
| Rate for Payer: Aetna of CA HMO/PPO |
$0.59
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$0.77
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$0.50
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$0.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.54
|
| Rate for Payer: BCBS Transplant Transplant |
$0.54
|
| Rate for Payer: Blue Shield of California Commercial |
$0.66
|
| Rate for Payer: Blue Shield of California EPN |
$0.53
|
| Rate for Payer: Cash Price |
$0.41
|
| Rate for Payer: Cigna of CA HMO |
$0.63
|
| Rate for Payer: Cigna of CA PPO |
$0.63
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.77
|
| Rate for Payer: Dignity Health Media |
$0.77
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.77
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.36
|
| Rate for Payer: EPIC Health Plan Transplant |
$0.36
|
| Rate for Payer: Galaxy Health WC |
$0.77
|
| Rate for Payer: Global Benefits Group Commercial |
$0.54
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$0.68
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.60
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.34
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.22
|
| Rate for Payer: Multiplan Commercial |
$0.72
|
| Rate for Payer: Networks By Design Commercial |
$0.59
|
| Rate for Payer: Prime Health Services Commercial |
$0.77
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$0.54
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.54
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.54
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.45
|
| Rate for Payer: United Healthcare All Other HMO |
$0.45
|
| Rate for Payer: United Healthcare HMO Rider |
$0.45
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.45
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.77
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.77
|
| Rate for Payer: Vantage Medical Group Senior |
$0.77
|
|
|
ACETAZOLAMIDE ER 500 MG CAPSULE,EXTENDED RELEASE [8962]
|
Facility
IP
|
$0.90
|
|
|
Service Code
|
NDC 42571-243-01
|
| Hospital Charge Code |
1710308
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.22 |
| Max. Negotiated Rate |
$0.77 |
| Rate for Payer: Blue Shield of California Commercial |
$0.64
|
| Rate for Payer: Blue Shield of California EPN |
$0.46
|
| Rate for Payer: Cash Price |
$0.41
|
| Rate for Payer: Cigna of CA HMO |
$0.63
|
| Rate for Payer: Cigna of CA PPO |
$0.63
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.36
|
| Rate for Payer: Galaxy Health WC |
$0.77
|
| Rate for Payer: Global Benefits Group Commercial |
$0.54
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.60
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.34
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.22
|
| Rate for Payer: Multiplan Commercial |
$0.72
|
| Rate for Payer: Networks By Design Commercial |
$0.59
|
| Rate for Payer: Prime Health Services Commercial |
$0.77
|
|
|
ACETAZOLAMIDE ER 500 MG CAPSULE,EXTENDED RELEASE [8962]
|
Facility
OP
|
$0.60
|
|
|
Service Code
|
NDC 50742-233-01
|
| Hospital Charge Code |
1710308
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.14 |
| Max. Negotiated Rate |
$0.51 |
| Rate for Payer: Aetna of CA HMO/PPO |
$0.39
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$0.51
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$0.33
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$0.33
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.36
|
| Rate for Payer: BCBS Transplant Transplant |
$0.36
|
| Rate for Payer: Blue Shield of California Commercial |
$0.44
|
| Rate for Payer: Blue Shield of California EPN |
$0.35
|
| Rate for Payer: Cash Price |
$0.27
|
| Rate for Payer: Cigna of CA HMO |
$0.42
|
| Rate for Payer: Cigna of CA PPO |
$0.42
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.51
|
| Rate for Payer: Dignity Health Media |
$0.51
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.51
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.24
|
| Rate for Payer: EPIC Health Plan Transplant |
$0.24
|
| Rate for Payer: Galaxy Health WC |
$0.51
|
| Rate for Payer: Global Benefits Group Commercial |
$0.36
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$0.45
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.40
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.23
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.14
|
| Rate for Payer: Multiplan Commercial |
$0.48
|
| Rate for Payer: Networks By Design Commercial |
$0.39
|
| Rate for Payer: Prime Health Services Commercial |
$0.51
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$0.36
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.36
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.36
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.30
|
| Rate for Payer: United Healthcare All Other HMO |
$0.30
|
| Rate for Payer: United Healthcare HMO Rider |
$0.30
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.30
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.51
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.51
|
| Rate for Payer: Vantage Medical Group Senior |
$0.51
|
|
|
ACETAZOLAMIDE ER 500 MG CAPSULE,EXTENDED RELEASE [8962]
|
Facility
IP
|
$5.31
|
|
|
Service Code
|
NDC 50268-042-11
|
| Hospital Charge Code |
1710308
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$1.27 |
| Max. Negotiated Rate |
$4.51 |
| Rate for Payer: Blue Shield of California Commercial |
$3.78
|
| Rate for Payer: Blue Shield of California EPN |
$2.72
|
| Rate for Payer: Cash Price |
$2.39
|
| Rate for Payer: Cigna of CA HMO |
$3.72
|
| Rate for Payer: Cigna of CA PPO |
$3.72
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.12
|
| Rate for Payer: Galaxy Health WC |
$4.51
|
| Rate for Payer: Global Benefits Group Commercial |
$3.19
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3.54
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2.02
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.27
|
| Rate for Payer: Multiplan Commercial |
$4.25
|
| Rate for Payer: Networks By Design Commercial |
$3.45
|
| Rate for Payer: Prime Health Services Commercial |
$4.51
|
|
|
ACETAZOLAMIDE ORAL SUSPENSION COMPOUND 25 MG/ML [4080233]
|
Facility
IP
|
$2.77
|
|
|
Service Code
|
NDC 9994-0802-33
|
| Hospital Charge Code |
ERX4080233
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.66 |
| Max. Negotiated Rate |
$2.35 |
| Rate for Payer: Blue Shield of California Commercial |
$1.97
|
| Rate for Payer: Blue Shield of California EPN |
$1.42
|
| Rate for Payer: Cash Price |
$1.25
|
| Rate for Payer: Cigna of CA HMO |
$1.94
|
| Rate for Payer: Cigna of CA PPO |
$1.94
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.11
|
| Rate for Payer: Galaxy Health WC |
$2.35
|
| Rate for Payer: Global Benefits Group Commercial |
$1.66
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1.85
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1.06
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.66
|
| Rate for Payer: Multiplan Commercial |
$2.22
|
| Rate for Payer: Networks By Design Commercial |
$1.80
|
| Rate for Payer: Prime Health Services Commercial |
$2.35
|
|
|
ACETAZOLAMIDE ORAL SUSPENSION COMPOUND 25 MG/ML [4080233]
|
Facility
OP
|
$2.77
|
|
|
Service Code
|
NDC 9994-0802-33
|
| Hospital Charge Code |
ERX4080233
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.66 |
| Max. Negotiated Rate |
$2.35 |
| Rate for Payer: Aetna of CA HMO/PPO |
$1.82
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$2.35
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$1.52
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$1.52
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1.65
|
| Rate for Payer: BCBS Transplant Transplant |
$1.66
|
| Rate for Payer: Blue Shield of California Commercial |
$2.04
|
| Rate for Payer: Blue Shield of California EPN |
$1.62
|
| Rate for Payer: Cash Price |
$1.25
|
| Rate for Payer: Cigna of CA HMO |
$1.94
|
| Rate for Payer: Cigna of CA PPO |
$1.94
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2.35
|
| Rate for Payer: Dignity Health Media |
$2.35
|
| Rate for Payer: Dignity Health Medi-Cal |
$2.35
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.11
|
| Rate for Payer: EPIC Health Plan Transplant |
$1.11
|
| Rate for Payer: Galaxy Health WC |
$2.35
|
| Rate for Payer: Global Benefits Group Commercial |
$1.66
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$2.08
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1.85
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1.06
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.66
|
| Rate for Payer: Multiplan Commercial |
$2.22
|
| Rate for Payer: Networks By Design Commercial |
$1.80
|
| Rate for Payer: Prime Health Services Commercial |
$2.35
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$1.66
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1.66
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1.66
|
| Rate for Payer: United Healthcare All Other Commercial |
$1.38
|
| Rate for Payer: United Healthcare All Other HMO |
$1.38
|
| Rate for Payer: United Healthcare HMO Rider |
$1.38
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1.38
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2.35
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2.35
|
| Rate for Payer: Vantage Medical Group Senior |
$2.35
|
|
|
ACETIC ACID 0.25 % IRRIGATION SOLUTION [8963]
|
Facility
IP
|
$0.01
|
|
|
Service Code
|
NDC 0264-2304-00
|
| Hospital Charge Code |
1770001
|
|
Hospital Revenue Code
|
250
|
| Max. Negotiated Rate |
$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: EPIC Health Plan Commercial |
$0.00
|
| Rate for Payer: Galaxy Health WC |
$0.01
|
| 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 |
$0.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.00
|
| Rate for Payer: Multiplan Commercial |
$0.01
|
| Rate for Payer: Networks By Design Commercial |
$0.01
|
| Rate for Payer: Prime Health Services Commercial |
$0.01
|
|
|
ACETIC ACID 0.25 % IRRIGATION SOLUTION [8963]
|
Facility
OP
|
$0.01
|
|
|
Service Code
|
NDC 0264-2304-00
|
| Hospital Charge Code |
1770001
|
|
Hospital Revenue Code
|
250
|
| Max. Negotiated Rate |
$0.01 |
| Rate for Payer: Aetna of CA HMO/PPO |
$0.01
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$0.01
|
| 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: Cigna of CA HMO |
$0.01
|
| Rate for Payer: Cigna of CA PPO |
$0.01
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.01
|
| Rate for Payer: Dignity Health Media |
$0.01
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.01
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.00
|
| Rate for Payer: EPIC Health Plan Transplant |
$0.00
|
| Rate for Payer: Galaxy Health WC |
$0.01
|
| Rate for Payer: Global Benefits Group Commercial |
$0.01
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$0.01
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.01
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.00
|
| Rate for Payer: Multiplan Commercial |
$0.01
|
| Rate for Payer: Networks By Design Commercial |
$0.01
|
| Rate for Payer: Prime Health Services Commercial |
$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 |
$0.01
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.01
|
| Rate for Payer: Vantage Medical Group Senior |
$0.01
|
|
|
ACETIC ACID 2 % EAR SOLUTION [17801]
|
Facility
OP
|
$2.24
|
|
|
Service Code
|
NDC 52817-816-15
|
| Hospital Charge Code |
1740195
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.54 |
| Max. Negotiated Rate |
$1.90 |
| Rate for Payer: Aetna of CA HMO/PPO |
$1.47
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$1.90
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$1.23
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$1.23
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1.33
|
| Rate for Payer: BCBS Transplant Transplant |
$1.34
|
| Rate for Payer: Blue Shield of California Commercial |
$1.65
|
| Rate for Payer: Blue Shield of California EPN |
$1.31
|
| Rate for Payer: Cash Price |
$1.01
|
| Rate for Payer: Cigna of CA HMO |
$1.57
|
| Rate for Payer: Cigna of CA PPO |
$1.57
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1.90
|
| Rate for Payer: Dignity Health Media |
$1.90
|
| Rate for Payer: Dignity Health Medi-Cal |
$1.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.90
|
| Rate for Payer: EPIC Health Plan Transplant |
$0.90
|
| Rate for Payer: Galaxy Health WC |
$1.90
|
| Rate for Payer: Global Benefits Group Commercial |
$1.34
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$1.68
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1.49
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.85
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.54
|
| Rate for Payer: Multiplan Commercial |
$1.79
|
| Rate for Payer: Networks By Design Commercial |
$1.46
|
| Rate for Payer: Prime Health Services Commercial |
$1.90
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$1.34
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1.34
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1.34
|
| Rate for Payer: United Healthcare All Other Commercial |
$1.12
|
| Rate for Payer: United Healthcare All Other HMO |
$1.12
|
| Rate for Payer: United Healthcare HMO Rider |
$1.12
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1.12
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1.90
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1.90
|
| Rate for Payer: Vantage Medical Group Senior |
$1.90
|
|
|
ACETIC ACID 2 % EAR SOLUTION [17801]
|
Facility
IP
|
$2.24
|
|
|
Service Code
|
NDC 52817-816-15
|
| Hospital Charge Code |
1740195
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.54 |
| Max. Negotiated Rate |
$1.90 |
| Rate for Payer: Blue Shield of California Commercial |
$1.59
|
| Rate for Payer: Blue Shield of California EPN |
$1.15
|
| Rate for Payer: Cash Price |
$1.01
|
| Rate for Payer: Cigna of CA HMO |
$1.57
|
| Rate for Payer: Cigna of CA PPO |
$1.57
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.90
|
| Rate for Payer: Galaxy Health WC |
$1.90
|
| Rate for Payer: Global Benefits Group Commercial |
$1.34
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1.49
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.85
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.54
|
| Rate for Payer: Multiplan Commercial |
$1.79
|
| Rate for Payer: Networks By Design Commercial |
$1.46
|
| Rate for Payer: Prime Health Services Commercial |
$1.90
|
|
|
ACETIC ACID (BULK) 3 % LIQUID [15091]
|
Facility
OP
|
$0.04
|
|
|
Service Code
|
NDC 5155200516
|
| Hospital Charge Code |
NDG15091
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.01 |
| Max. Negotiated Rate |
$0.03 |
| Rate for Payer: Aetna of CA HMO/PPO |
$0.03
|
| 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 |
$0.03
|
| Rate for Payer: Blue Shield of California EPN |
$0.02
|
| Rate for Payer: Cash Price |
$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 Transplant 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
|
|
|
ACETIC ACID (BULK) 3 % LIQUID [15091]
|
Facility
IP
|
$0.04
|
|
|
Service Code
|
NDC 5155200516
|
| Hospital Charge Code |
NDG15091
|
|
Hospital Revenue Code
|
250
|
| 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: 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
|
|
|
ACETYLCHOLINE CHLORIDE 1 % (10 MG/ML) INTRAOCULAR KIT [32559]
|
Facility
OP
|
$145.63
|
|
|
Service Code
|
NDC 24208-539-20
|
| Hospital Charge Code |
1740086
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$34.95 |
| Max. Negotiated Rate |
$123.79 |
| Rate for Payer: Galaxy Health WC |
$123.79
|
| Rate for Payer: Aetna of CA HMO/PPO |
$95.52
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$123.79
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$80.10
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$80.10
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$86.77
|
| Rate for Payer: BCBS Transplant Transplant |
$87.38
|
| Rate for Payer: Blue Shield of California Commercial |
$107.33
|
| Rate for Payer: Blue Shield of California EPN |
$85.05
|
| Rate for Payer: Cash Price |
$65.53
|
| Rate for Payer: Cigna of CA HMO |
$101.94
|
| Rate for Payer: Cigna of CA PPO |
$101.94
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$123.79
|
| Rate for Payer: Dignity Health Media |
$123.79
|
| Rate for Payer: Dignity Health Medi-Cal |
$123.79
|
| Rate for Payer: EPIC Health Plan Commercial |
$58.25
|
| Rate for Payer: EPIC Health Plan Transplant |
$58.25
|
| Rate for Payer: Global Benefits Group Commercial |
$87.38
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$109.22
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$97.14
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$55.49
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$34.95
|
| Rate for Payer: Multiplan Commercial |
$116.50
|
| Rate for Payer: Networks By Design Commercial |
$94.66
|
| Rate for Payer: Prime Health Services Commercial |
$123.79
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$87.38
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$87.38
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$87.38
|
| Rate for Payer: United Healthcare All Other Commercial |
$72.82
|
| Rate for Payer: United Healthcare All Other HMO |
$72.82
|
| Rate for Payer: United Healthcare HMO Rider |
$72.82
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$72.82
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$123.79
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$123.79
|
| Rate for Payer: Vantage Medical Group Senior |
$123.79
|
|
|
ACETYLCHOLINE CHLORIDE 1 % (10 MG/ML) INTRAOCULAR KIT [32559]
|
Facility
IP
|
$145.63
|
|
|
Service Code
|
NDC 24208-539-20
|
| Hospital Charge Code |
1740086
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$34.95 |
| Max. Negotiated Rate |
$123.79 |
| Rate for Payer: Blue Shield of California Commercial |
$103.69
|
| Rate for Payer: Blue Shield of California EPN |
$74.56
|
| Rate for Payer: Cash Price |
$65.53
|
| Rate for Payer: Cigna of CA HMO |
$101.94
|
| Rate for Payer: Cigna of CA PPO |
$101.94
|
| Rate for Payer: EPIC Health Plan Commercial |
$58.25
|
| Rate for Payer: Galaxy Health WC |
$123.79
|
| Rate for Payer: Global Benefits Group Commercial |
$87.38
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$97.14
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$55.49
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$34.95
|
| Rate for Payer: Multiplan Commercial |
$116.50
|
| Rate for Payer: Networks By Design Commercial |
$94.66
|
| Rate for Payer: Prime Health Services Commercial |
$123.79
|
|
|
ACETYLCYSTEINE 100 MG/ML (10 %) SOLUTION [122]
|
Facility
IP
|
$0.73
|
|
|
Service Code
|
NDC 63323-691-30
|
| Hospital Charge Code |
NDG122
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.18 |
| Max. Negotiated Rate |
$0.62 |
| Rate for Payer: Blue Shield of California Commercial |
$0.52
|
| Rate for Payer: Blue Shield of California EPN |
$0.37
|
| Rate for Payer: Cash Price |
$0.33
|
| Rate for Payer: Cigna of CA HMO |
$0.51
|
| Rate for Payer: Cigna of CA PPO |
$0.51
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.29
|
| Rate for Payer: Galaxy Health WC |
$0.62
|
| Rate for Payer: Global Benefits Group Commercial |
$0.44
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.49
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.28
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.18
|
| Rate for Payer: Multiplan Commercial |
$0.58
|
| Rate for Payer: Networks By Design Commercial |
$0.47
|
| Rate for Payer: Prime Health Services Commercial |
$0.62
|
|
|
ACETYLCYSTEINE 100 MG/ML (10 %) SOLUTION [122]
|
Facility
IP
|
$0.51
|
|
|
Service Code
|
NDC 0409-3307-03
|
| Hospital Charge Code |
NDG122
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.12 |
| Max. Negotiated Rate |
$0.43 |
| Rate for Payer: Blue Shield of California Commercial |
$0.36
|
| Rate for Payer: Blue Shield of California EPN |
$0.26
|
| Rate for Payer: Cash Price |
$0.23
|
| Rate for Payer: Cigna of CA HMO |
$0.36
|
| Rate for Payer: Cigna of CA PPO |
$0.36
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.20
|
| Rate for Payer: Galaxy Health WC |
$0.43
|
| Rate for Payer: Global Benefits Group Commercial |
$0.31
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.34
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.19
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.12
|
| Rate for Payer: Multiplan Commercial |
$0.41
|
| Rate for Payer: Networks By Design Commercial |
$0.33
|
| Rate for Payer: Prime Health Services Commercial |
$0.43
|
|
|
ACETYLCYSTEINE 100 MG/ML (10 %) SOLUTION [122]
|
Facility
OP
|
$0.73
|
|
|
Service Code
|
NDC 63323-691-30
|
| Hospital Charge Code |
NDG122
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.18 |
| Max. Negotiated Rate |
$0.62 |
| Rate for Payer: Aetna of CA HMO/PPO |
$0.48
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$0.62
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$0.40
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$0.40
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.43
|
| Rate for Payer: BCBS Transplant Transplant |
$0.44
|
| Rate for Payer: Blue Shield of California Commercial |
$0.54
|
| Rate for Payer: Blue Shield of California EPN |
$0.43
|
| Rate for Payer: Cash Price |
$0.33
|
| Rate for Payer: Cigna of CA HMO |
$0.51
|
| Rate for Payer: Cigna of CA PPO |
$0.51
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.62
|
| Rate for Payer: Dignity Health Media |
$0.62
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.62
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.29
|
| Rate for Payer: EPIC Health Plan Transplant |
$0.29
|
| Rate for Payer: Galaxy Health WC |
$0.62
|
| Rate for Payer: Global Benefits Group Commercial |
$0.44
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$0.55
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.49
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.28
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.18
|
| Rate for Payer: Multiplan Commercial |
$0.58
|
| Rate for Payer: Networks By Design Commercial |
$0.47
|
| Rate for Payer: Prime Health Services Commercial |
$0.62
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$0.44
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.44
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.44
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.37
|
| Rate for Payer: United Healthcare All Other HMO |
$0.37
|
| Rate for Payer: United Healthcare HMO Rider |
$0.37
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.37
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.62
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.62
|
| Rate for Payer: Vantage Medical Group Senior |
$0.62
|
|
|
ACETYLCYSTEINE 100 MG/ML (10 %) SOLUTION [122]
|
Facility
OP
|
$3.36
|
|
|
Service Code
|
NDC 63323-695-04
|
| Hospital Charge Code |
1781091
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.81 |
| Max. Negotiated Rate |
$2.86 |
| Rate for Payer: Aetna of CA HMO/PPO |
$2.20
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$2.86
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$1.85
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$1.85
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2.00
|
| Rate for Payer: BCBS Transplant Transplant |
$2.02
|
| Rate for Payer: Blue Shield of California Commercial |
$2.48
|
| Rate for Payer: Blue Shield of California EPN |
$1.96
|
| Rate for Payer: Cash Price |
$1.51
|
| Rate for Payer: Cigna of CA HMO |
$2.35
|
| Rate for Payer: Cigna of CA PPO |
$2.35
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2.86
|
| Rate for Payer: Dignity Health Media |
$2.86
|
| Rate for Payer: Dignity Health Medi-Cal |
$2.86
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.34
|
| Rate for Payer: EPIC Health Plan Transplant |
$1.34
|
| Rate for Payer: Galaxy Health WC |
$2.86
|
| Rate for Payer: Global Benefits Group Commercial |
$2.02
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$2.52
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2.24
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1.28
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.81
|
| Rate for Payer: Multiplan Commercial |
$2.69
|
| Rate for Payer: Networks By Design Commercial |
$2.18
|
| Rate for Payer: Prime Health Services Commercial |
$2.86
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$2.02
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2.02
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2.02
|
| Rate for Payer: United Healthcare All Other Commercial |
$1.68
|
| Rate for Payer: United Healthcare All Other HMO |
$1.68
|
| Rate for Payer: United Healthcare HMO Rider |
$1.68
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1.68
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2.86
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2.86
|
| Rate for Payer: Vantage Medical Group Senior |
$2.86
|
|
|
ACETYLCYSTEINE 100 MG/ML (10 %) SOLUTION [122]
|
Facility
OP
|
$0.51
|
|
|
Service Code
|
NDC 0409-3307-03
|
| Hospital Charge Code |
NDG122
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.12 |
| Max. Negotiated Rate |
$0.43 |
| Rate for Payer: Aetna of CA HMO/PPO |
$0.33
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$0.43
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$0.28
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$0.28
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.30
|
| Rate for Payer: BCBS Transplant Transplant |
$0.31
|
| Rate for Payer: Blue Shield of California Commercial |
$0.38
|
| Rate for Payer: Blue Shield of California EPN |
$0.30
|
| Rate for Payer: Cash Price |
$0.23
|
| Rate for Payer: Cigna of CA HMO |
$0.36
|
| Rate for Payer: Cigna of CA PPO |
$0.36
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.43
|
| Rate for Payer: Dignity Health Media |
$0.43
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.43
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.20
|
| Rate for Payer: EPIC Health Plan Transplant |
$0.20
|
| Rate for Payer: Galaxy Health WC |
$0.43
|
| Rate for Payer: Global Benefits Group Commercial |
$0.31
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$0.38
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.34
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.19
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.12
|
| Rate for Payer: Multiplan Commercial |
$0.41
|
| Rate for Payer: Networks By Design Commercial |
$0.33
|
| Rate for Payer: Prime Health Services Commercial |
$0.43
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$0.31
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.31
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.31
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.26
|
| Rate for Payer: United Healthcare All Other HMO |
$0.26
|
| Rate for Payer: United Healthcare HMO Rider |
$0.26
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.26
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.43
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.43
|
| Rate for Payer: Vantage Medical Group Senior |
$0.43
|
|
|
ACETYLCYSTEINE 100 MG/ML (10 %) SOLUTION [122]
|
Facility
IP
|
$2.77
|
|
|
Service Code
|
NDC 0517-7504-25
|
| Hospital Charge Code |
1781091
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.66 |
| Max. Negotiated Rate |
$2.35 |
| Rate for Payer: Blue Shield of California Commercial |
$1.97
|
| Rate for Payer: Blue Shield of California EPN |
$1.42
|
| Rate for Payer: Cash Price |
$1.25
|
| Rate for Payer: Cigna of CA HMO |
$1.94
|
| Rate for Payer: Cigna of CA PPO |
$1.94
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.11
|
| Rate for Payer: Galaxy Health WC |
$2.35
|
| Rate for Payer: Global Benefits Group Commercial |
$1.66
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1.85
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1.06
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.66
|
| Rate for Payer: Multiplan Commercial |
$2.22
|
| Rate for Payer: Networks By Design Commercial |
$1.80
|
| Rate for Payer: Prime Health Services Commercial |
$2.35
|
|
|
ACETYLCYSTEINE 100 MG/ML (10 %) SOLUTION [122]
|
Facility
IP
|
$3.36
|
|
|
Service Code
|
NDC 63323-695-04
|
| Hospital Charge Code |
1781091
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.81 |
| Max. Negotiated Rate |
$2.86 |
| Rate for Payer: Blue Shield of California Commercial |
$2.39
|
| Rate for Payer: Blue Shield of California EPN |
$1.72
|
| Rate for Payer: Cash Price |
$1.51
|
| Rate for Payer: Cigna of CA HMO |
$2.35
|
| Rate for Payer: Cigna of CA PPO |
$2.35
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.34
|
| Rate for Payer: Galaxy Health WC |
$2.86
|
| Rate for Payer: Global Benefits Group Commercial |
$2.02
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2.24
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1.28
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.81
|
| Rate for Payer: Multiplan Commercial |
$2.69
|
| Rate for Payer: Networks By Design Commercial |
$2.18
|
| Rate for Payer: Prime Health Services Commercial |
$2.86
|
|
|
ACETYLCYSTEINE 100 MG/ML (10 %) SOLUTION [122]
|
Facility
OP
|
$2.77
|
|
|
Service Code
|
NDC 0517-7504-25
|
| Hospital Charge Code |
1781091
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.66 |
| Max. Negotiated Rate |
$2.35 |
| Rate for Payer: Aetna of CA HMO/PPO |
$1.82
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$2.35
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$1.52
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$1.52
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1.65
|
| Rate for Payer: BCBS Transplant Transplant |
$1.66
|
| Rate for Payer: Blue Shield of California Commercial |
$2.04
|
| Rate for Payer: Blue Shield of California EPN |
$1.62
|
| Rate for Payer: Cash Price |
$1.25
|
| Rate for Payer: Cigna of CA HMO |
$1.94
|
| Rate for Payer: Cigna of CA PPO |
$1.94
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2.35
|
| Rate for Payer: Dignity Health Media |
$2.35
|
| Rate for Payer: Dignity Health Medi-Cal |
$2.35
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.11
|
| Rate for Payer: EPIC Health Plan Transplant |
$1.11
|
| Rate for Payer: Galaxy Health WC |
$2.35
|
| Rate for Payer: Global Benefits Group Commercial |
$1.66
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$2.08
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1.85
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1.06
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.66
|
| Rate for Payer: Multiplan Commercial |
$2.22
|
| Rate for Payer: Networks By Design Commercial |
$1.80
|
| Rate for Payer: Prime Health Services Commercial |
$2.35
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$1.66
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1.66
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1.66
|
| Rate for Payer: United Healthcare All Other Commercial |
$1.38
|
| Rate for Payer: United Healthcare All Other HMO |
$1.38
|
| Rate for Payer: United Healthcare HMO Rider |
$1.38
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1.38
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2.35
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2.35
|
| Rate for Payer: Vantage Medical Group Senior |
$2.35
|
|
|
ACETYLCYSTEINE 200 MG/ML (20 %) INTRAVENOUS SOLUTION [38303]
|
Facility
OP
|
$7.52
|
|
|
Service Code
|
CPT J0132
|
| Hospital Charge Code |
1721126
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.80 |
| Max. Negotiated Rate |
$23.90 |
| Rate for Payer: Aetna of CA HMO/PPO |
$4.42
|
| Rate for Payer: Aetna of CA HMO/PPO |
$4.42
|
| Rate for Payer: Aetna of CA HMO/PPO |
$4.42
|
| Rate for Payer: Aetna of CA HMO/PPO |
$4.42
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$3.74
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$1.26
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$6.38
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$6.39
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$4.12
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$2.42
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$0.81
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$4.14
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$2.42
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$0.81
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$4.14
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$4.12
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$23.90
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$23.90
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$23.90
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$23.90
|
| Rate for Payer: BCBS Transplant Transplant |
$0.89
|
| Rate for Payer: BCBS Transplant Transplant |
$4.51
|
| Rate for Payer: BCBS Transplant Transplant |
$2.64
|
| Rate for Payer: BCBS Transplant Transplant |
$4.50
|
| Rate for Payer: Blue Shield of California Commercial |
$3.24
|
| Rate for Payer: Blue Shield of California Commercial |
$1.09
|
| Rate for Payer: Blue Shield of California Commercial |
$5.53
|
| Rate for Payer: Blue Shield of California Commercial |
$5.54
|
| Rate for Payer: Blue Shield of California EPN |
$3.25
|
| Rate for Payer: Blue Shield of California EPN |
$3.25
|
| Rate for Payer: Blue Shield of California EPN |
$3.25
|
| Rate for Payer: Blue Shield of California EPN |
$3.25
|
| Rate for Payer: Cash Price |
$3.38
|
| Rate for Payer: Cash Price |
$3.38
|
| Rate for Payer: Cash Price |
$3.38
|
| Rate for Payer: Cash Price |
$1.98
|
| Rate for Payer: Cash Price |
$3.38
|
| Rate for Payer: Cash Price |
$0.67
|
| Rate for Payer: Cash Price |
$0.67
|
| Rate for Payer: Cash Price |
$1.98
|
| Rate for Payer: Cigna of CA HMO |
$5.26
|
| Rate for Payer: Cigna of CA HMO |
$1.04
|
| Rate for Payer: Cigna of CA HMO |
$5.25
|
| Rate for Payer: Cigna of CA HMO |
$3.08
|
| Rate for Payer: Cigna of CA PPO |
$1.04
|
| Rate for Payer: Cigna of CA PPO |
$5.26
|
| Rate for Payer: Cigna of CA PPO |
$3.08
|
| Rate for Payer: Cigna of CA PPO |
$5.25
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3.74
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$6.38
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1.26
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$6.39
|
| Rate for Payer: Dignity Health Media |
$1.26
|
| Rate for Payer: Dignity Health Media |
$3.74
|
| Rate for Payer: Dignity Health Media |
$6.38
|
| Rate for Payer: Dignity Health Media |
$6.39
|
| Rate for Payer: Dignity Health Medi-Cal |
$1.26
|
| Rate for Payer: Dignity Health Medi-Cal |
$6.38
|
| Rate for Payer: Dignity Health Medi-Cal |
$3.74
|
| Rate for Payer: Dignity Health Medi-Cal |
$6.39
|
| Rate for Payer: EPIC Health Plan Commercial |
$3.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.59
|
| Rate for Payer: EPIC Health Plan Commercial |
$3.01
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.76
|
| Rate for Payer: EPIC Health Plan Transplant |
$0.59
|
| Rate for Payer: EPIC Health Plan Transplant |
$3.01
|
| Rate for Payer: EPIC Health Plan Transplant |
$3.00
|
| Rate for Payer: EPIC Health Plan Transplant |
$1.76
|
| Rate for Payer: Galaxy Health WC |
$6.39
|
| Rate for Payer: Galaxy Health WC |
$1.26
|
| Rate for Payer: Galaxy Health WC |
$6.38
|
| Rate for Payer: Galaxy Health WC |
$3.74
|
| Rate for Payer: Global Benefits Group Commercial |
$0.89
|
| Rate for Payer: Global Benefits Group Commercial |
$2.64
|
| Rate for Payer: Global Benefits Group Commercial |
$4.51
|
| Rate for Payer: Global Benefits Group Commercial |
$4.50
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$1.11
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$5.64
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$3.30
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$5.62
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.99
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2.93
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$5.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$5.02
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$9.80
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$9.80
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$9.80
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$9.80
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.80
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.06
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.80
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.36
|
| Rate for Payer: Multiplan Commercial |
$3.52
|
| Rate for Payer: Multiplan Commercial |
$1.18
|
| Rate for Payer: Multiplan Commercial |
$6.00
|
| Rate for Payer: Multiplan Commercial |
$6.02
|
| Rate for Payer: Networks By Design Commercial |
$0.74
|
| Rate for Payer: Networks By Design Commercial |
$3.76
|
| Rate for Payer: Networks By Design Commercial |
$2.20
|
| Rate for Payer: Networks By Design Commercial |
$3.75
|
| Rate for Payer: Prime Health Services Commercial |
$6.39
|
| Rate for Payer: Prime Health Services Commercial |
$3.74
|
| Rate for Payer: Prime Health Services Commercial |
$6.38
|
| Rate for Payer: Prime Health Services Commercial |
$1.26
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2.64
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.89
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$4.50
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$4.51
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.89
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$4.50
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$4.51
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2.64
|
| Rate for Payer: United Healthcare All Other Commercial |
$2.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$3.75
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.74
|
| Rate for Payer: United Healthcare All Other Commercial |
$3.76
|
| Rate for Payer: United Healthcare All Other HMO |
$3.75
|
| Rate for Payer: United Healthcare All Other HMO |
$2.20
|
| Rate for Payer: United Healthcare All Other HMO |
$0.74
|
| Rate for Payer: United Healthcare All Other HMO |
$3.76
|
| Rate for Payer: United Healthcare HMO Rider |
$0.74
|
| Rate for Payer: United Healthcare HMO Rider |
$2.20
|
| Rate for Payer: United Healthcare HMO Rider |
$3.75
|
| Rate for Payer: United Healthcare HMO Rider |
$3.76
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3.75
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2.20
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.74
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3.76
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1.26
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3.74
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$6.38
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$6.39
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$6.38
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1.26
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$3.74
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$6.39
|
| Rate for Payer: Vantage Medical Group Senior |
$3.74
|
| Rate for Payer: Vantage Medical Group Senior |
$1.26
|
| Rate for Payer: Vantage Medical Group Senior |
$6.38
|
| Rate for Payer: Vantage Medical Group Senior |
$6.39
|
|
