|
LYMPHOMA, MYELOMA AND NON-ACUTE LEUKEMIA
|
Facility
|
IP
|
$17,644.16
|
|
|
Service Code
|
APR-DRG 6912
|
| Min. Negotiated Rate |
$13,534.93 |
| Max. Negotiated Rate |
$17,644.16 |
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$13,534.93
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$17,644.16
|
|
|
MACITENTAN 10 MG TABLET [203952]
|
Facility
|
IP
|
$447.39
|
|
|
Service Code
|
NDC 66215-501-30
|
| Hospital Charge Code |
ERX203952
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$107.37 |
| Max. Negotiated Rate |
$380.28 |
| Rate for Payer: Blue Shield of California Commercial |
$318.54
|
| Rate for Payer: Blue Shield of California EPN |
$229.06
|
| Rate for Payer: Cash Price |
$201.33
|
| Rate for Payer: Cigna of CA HMO |
$313.17
|
| Rate for Payer: Cigna of CA PPO |
$313.17
|
| Rate for Payer: EPIC Health Plan Commercial |
$178.96
|
| Rate for Payer: Galaxy Health WC |
$380.28
|
| Rate for Payer: Global Benefits Group Commercial |
$268.43
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$298.41
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$170.46
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$107.37
|
| Rate for Payer: Multiplan Commercial |
$357.91
|
| Rate for Payer: Networks By Design Commercial |
$290.80
|
| Rate for Payer: Prime Health Services Commercial |
$380.28
|
|
|
MACITENTAN 10 MG TABLET [203952]
|
Facility
|
OP
|
$447.39
|
|
|
Service Code
|
NDC 66215-501-15
|
| Hospital Charge Code |
ERX203952
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$107.37 |
| Max. Negotiated Rate |
$380.28 |
| Rate for Payer: Aetna of CA HMO/PPO |
$293.44
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$380.28
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$246.06
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$246.06
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$266.55
|
| Rate for Payer: Blue Distinction Transplant |
$268.43
|
| Rate for Payer: Blue Shield of California Commercial |
$329.73
|
| Rate for Payer: Blue Shield of California EPN |
$261.28
|
| Rate for Payer: Cash Price |
$201.33
|
| Rate for Payer: Cigna of CA HMO |
$313.17
|
| Rate for Payer: Cigna of CA PPO |
$313.17
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$380.28
|
| Rate for Payer: Dignity Health Media |
$380.28
|
| Rate for Payer: Dignity Health Medi-Cal |
$380.28
|
| Rate for Payer: EPIC Health Plan Commercial |
$178.96
|
| Rate for Payer: EPIC Health Plan Transplant |
$178.96
|
| Rate for Payer: Galaxy Health WC |
$380.28
|
| Rate for Payer: Global Benefits Group Commercial |
$268.43
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$335.54
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$298.41
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$170.46
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$107.37
|
| Rate for Payer: Multiplan Commercial |
$357.91
|
| Rate for Payer: Networks By Design Commercial |
$290.80
|
| Rate for Payer: Prime Health Services Commercial |
$380.28
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$268.43
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$268.43
|
| Rate for Payer: United Healthcare All Other Commercial |
$223.70
|
| Rate for Payer: United Healthcare All Other HMO |
$223.70
|
| Rate for Payer: United Healthcare HMO Rider |
$223.70
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$223.70
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$380.28
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$380.28
|
| Rate for Payer: Vantage Medical Group Senior |
$380.28
|
|
|
MACITENTAN 10 MG TABLET [203952]
|
Facility
|
IP
|
$447.39
|
|
|
Service Code
|
NDC 66215-501-15
|
| Hospital Charge Code |
ERX203952
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$107.37 |
| Max. Negotiated Rate |
$380.28 |
| Rate for Payer: Blue Shield of California Commercial |
$318.54
|
| Rate for Payer: Blue Shield of California EPN |
$229.06
|
| Rate for Payer: Cash Price |
$201.33
|
| Rate for Payer: Cigna of CA HMO |
$313.17
|
| Rate for Payer: Cigna of CA PPO |
$313.17
|
| Rate for Payer: EPIC Health Plan Commercial |
$178.96
|
| Rate for Payer: Galaxy Health WC |
$380.28
|
| Rate for Payer: Global Benefits Group Commercial |
$268.43
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$298.41
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$170.46
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$107.37
|
| Rate for Payer: Multiplan Commercial |
$357.91
|
| Rate for Payer: Networks By Design Commercial |
$290.80
|
| Rate for Payer: Prime Health Services Commercial |
$380.28
|
|
|
MACITENTAN 10 MG TABLET [203952]
|
Facility
|
OP
|
$447.39
|
|
|
Service Code
|
NDC 66215-501-30
|
| Hospital Charge Code |
ERX203952
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$107.37 |
| Max. Negotiated Rate |
$380.28 |
| Rate for Payer: Aetna of CA HMO/PPO |
$293.44
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$380.28
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$246.06
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$246.06
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$266.55
|
| Rate for Payer: Blue Distinction Transplant |
$268.43
|
| Rate for Payer: Blue Shield of California Commercial |
$329.73
|
| Rate for Payer: Blue Shield of California EPN |
$261.28
|
| Rate for Payer: Cash Price |
$201.33
|
| Rate for Payer: Cigna of CA HMO |
$313.17
|
| Rate for Payer: Cigna of CA PPO |
$313.17
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$380.28
|
| Rate for Payer: Dignity Health Media |
$380.28
|
| Rate for Payer: Dignity Health Medi-Cal |
$380.28
|
| Rate for Payer: EPIC Health Plan Commercial |
$178.96
|
| Rate for Payer: EPIC Health Plan Transplant |
$178.96
|
| Rate for Payer: Galaxy Health WC |
$380.28
|
| Rate for Payer: Global Benefits Group Commercial |
$268.43
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$335.54
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$298.41
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$170.46
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$107.37
|
| Rate for Payer: Multiplan Commercial |
$357.91
|
| Rate for Payer: Networks By Design Commercial |
$290.80
|
| Rate for Payer: Prime Health Services Commercial |
$380.28
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$268.43
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$268.43
|
| Rate for Payer: United Healthcare All Other Commercial |
$223.70
|
| Rate for Payer: United Healthcare All Other HMO |
$223.70
|
| Rate for Payer: United Healthcare HMO Rider |
$223.70
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$223.70
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$380.28
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$380.28
|
| Rate for Payer: Vantage Medical Group Senior |
$380.28
|
|
|
MAFENIDE 50 GRAM TOPICAL PACKET [23233]
|
Facility
|
IP
|
$167.95
|
|
|
Service Code
|
NDC 49884-902-52
|
| Hospital Charge Code |
1743697
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$40.31 |
| Max. Negotiated Rate |
$142.76 |
| Rate for Payer: Blue Shield of California Commercial |
$119.58
|
| Rate for Payer: Blue Shield of California EPN |
$85.99
|
| Rate for Payer: Cash Price |
$75.58
|
| Rate for Payer: Cigna of CA HMO |
$117.56
|
| Rate for Payer: Cigna of CA PPO |
$117.56
|
| Rate for Payer: EPIC Health Plan Commercial |
$67.18
|
| Rate for Payer: Galaxy Health WC |
$142.76
|
| Rate for Payer: Global Benefits Group Commercial |
$100.77
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$112.02
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$63.99
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$40.31
|
| Rate for Payer: Multiplan Commercial |
$134.36
|
| Rate for Payer: Networks By Design Commercial |
$109.17
|
| Rate for Payer: Prime Health Services Commercial |
$142.76
|
|
|
MAFENIDE 50 GRAM TOPICAL PACKET [23233]
|
Facility
|
OP
|
$167.95
|
|
|
Service Code
|
NDC 49884-902-52
|
| Hospital Charge Code |
1743697
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$40.31 |
| Max. Negotiated Rate |
$142.76 |
| Rate for Payer: Aetna of CA HMO/PPO |
$110.16
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$142.76
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$92.37
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$92.37
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$100.06
|
| Rate for Payer: Blue Distinction Transplant |
$100.77
|
| Rate for Payer: Blue Shield of California Commercial |
$123.78
|
| Rate for Payer: Blue Shield of California EPN |
$98.08
|
| Rate for Payer: Cash Price |
$75.58
|
| Rate for Payer: Cigna of CA HMO |
$117.56
|
| Rate for Payer: Cigna of CA PPO |
$117.56
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$142.76
|
| Rate for Payer: Dignity Health Media |
$142.76
|
| Rate for Payer: Dignity Health Medi-Cal |
$142.76
|
| Rate for Payer: EPIC Health Plan Commercial |
$67.18
|
| Rate for Payer: EPIC Health Plan Transplant |
$67.18
|
| Rate for Payer: Galaxy Health WC |
$142.76
|
| Rate for Payer: Global Benefits Group Commercial |
$100.77
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$125.96
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$112.02
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$63.99
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$40.31
|
| Rate for Payer: Multiplan Commercial |
$134.36
|
| Rate for Payer: Networks By Design Commercial |
$109.17
|
| Rate for Payer: Prime Health Services Commercial |
$142.76
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$100.77
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$100.77
|
| Rate for Payer: United Healthcare All Other Commercial |
$83.98
|
| Rate for Payer: United Healthcare All Other HMO |
$83.98
|
| Rate for Payer: United Healthcare HMO Rider |
$83.98
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$83.98
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$142.76
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$142.76
|
| Rate for Payer: Vantage Medical Group Senior |
$142.76
|
|
|
MAFENIDE 85 MG/G TOPICAL CREAM [10478]
|
Facility
|
IP
|
$1.28
|
|
|
Service Code
|
NDC 51079-623-81
|
| Hospital Charge Code |
NDG10478
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.31 |
| Max. Negotiated Rate |
$1.09 |
| Rate for Payer: Blue Shield of California Commercial |
$0.91
|
| Rate for Payer: Blue Shield of California EPN |
$0.66
|
| Rate for Payer: Cash Price |
$0.58
|
| Rate for Payer: Cigna of CA HMO |
$0.90
|
| Rate for Payer: Cigna of CA PPO |
$0.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.51
|
| Rate for Payer: Galaxy Health WC |
$1.09
|
| Rate for Payer: Global Benefits Group Commercial |
$0.77
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.85
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.49
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.31
|
| Rate for Payer: Multiplan Commercial |
$1.02
|
| Rate for Payer: Networks By Design Commercial |
$0.83
|
| Rate for Payer: Prime Health Services Commercial |
$1.09
|
|
|
MAFENIDE 85 MG/G TOPICAL CREAM [10478]
|
Facility
|
OP
|
$1.28
|
|
|
Service Code
|
NDC 51079-623-81
|
| Hospital Charge Code |
NDG10478
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.31 |
| Max. Negotiated Rate |
$1.09 |
| Rate for Payer: Aetna of CA HMO/PPO |
$0.84
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1.09
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.70
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.70
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.76
|
| Rate for Payer: Blue Distinction Transplant |
$0.77
|
| Rate for Payer: Blue Shield of California Commercial |
$0.94
|
| Rate for Payer: Blue Shield of California EPN |
$0.75
|
| Rate for Payer: Cash Price |
$0.58
|
| Rate for Payer: Cigna of CA HMO |
$0.90
|
| Rate for Payer: Cigna of CA PPO |
$0.90
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1.09
|
| Rate for Payer: Dignity Health Media |
$1.09
|
| Rate for Payer: Dignity Health Medi-Cal |
$1.09
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.51
|
| Rate for Payer: EPIC Health Plan Transplant |
$0.51
|
| Rate for Payer: Galaxy Health WC |
$1.09
|
| Rate for Payer: Global Benefits Group Commercial |
$0.77
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$0.96
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.85
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.49
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.31
|
| Rate for Payer: Multiplan Commercial |
$1.02
|
| Rate for Payer: Networks By Design Commercial |
$0.83
|
| Rate for Payer: Prime Health Services Commercial |
$1.09
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.77
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.77
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.64
|
| Rate for Payer: United Healthcare All Other HMO |
$0.64
|
| Rate for Payer: United Healthcare HMO Rider |
$0.64
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.64
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1.09
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1.09
|
| Rate for Payer: Vantage Medical Group Senior |
$1.09
|
|
|
MAFENIDE 85 MG/G TOPICAL CREAM [10478]
|
Facility
|
IP
|
$1.23
|
|
|
Service Code
|
NDC 51079-623-82
|
| Hospital Charge Code |
1743480
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.30 |
| Max. Negotiated Rate |
$1.05 |
| Rate for Payer: Blue Shield of California Commercial |
$0.88
|
| Rate for Payer: Blue Shield of California EPN |
$0.63
|
| Rate for Payer: Cash Price |
$0.55
|
| Rate for Payer: Cigna of CA HMO |
$0.86
|
| Rate for Payer: Cigna of CA PPO |
$0.86
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.49
|
| Rate for Payer: Galaxy Health WC |
$1.05
|
| Rate for Payer: Global Benefits Group Commercial |
$0.74
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.82
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.47
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.30
|
| Rate for Payer: Multiplan Commercial |
$0.98
|
| Rate for Payer: Networks By Design Commercial |
$0.80
|
| Rate for Payer: Prime Health Services Commercial |
$1.05
|
|
|
MAFENIDE 85 MG/G TOPICAL CREAM [10478]
|
Facility
|
OP
|
$1.23
|
|
|
Service Code
|
NDC 51079-623-82
|
| Hospital Charge Code |
1743480
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.30 |
| Max. Negotiated Rate |
$1.05 |
| Rate for Payer: Aetna of CA HMO/PPO |
$0.81
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1.05
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.68
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.68
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.73
|
| Rate for Payer: Blue Distinction Transplant |
$0.74
|
| Rate for Payer: Blue Shield of California Commercial |
$0.91
|
| Rate for Payer: Blue Shield of California EPN |
$0.72
|
| Rate for Payer: Cash Price |
$0.55
|
| Rate for Payer: Cigna of CA HMO |
$0.86
|
| Rate for Payer: Cigna of CA PPO |
$0.86
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1.05
|
| Rate for Payer: Dignity Health Media |
$1.05
|
| Rate for Payer: Dignity Health Medi-Cal |
$1.05
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.49
|
| Rate for Payer: EPIC Health Plan Transplant |
$0.49
|
| Rate for Payer: Galaxy Health WC |
$1.05
|
| Rate for Payer: Global Benefits Group Commercial |
$0.74
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$0.92
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.82
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.47
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.30
|
| Rate for Payer: Multiplan Commercial |
$0.98
|
| Rate for Payer: Networks By Design Commercial |
$0.80
|
| Rate for Payer: Prime Health Services Commercial |
$1.05
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.74
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.74
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.62
|
| Rate for Payer: United Healthcare All Other HMO |
$0.62
|
| Rate for Payer: United Healthcare HMO Rider |
$0.62
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.62
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1.05
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1.05
|
| Rate for Payer: Vantage Medical Group Senior |
$1.05
|
|
|
MAGNESIUM 64 MG (MAGNESIUM CHLORIDE) TABLET,DELAYED RELEASE [120162]
|
Facility
|
OP
|
$0.10
|
|
|
Service Code
|
NDC 6858500575
|
| Hospital Charge Code |
1712587
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.02 |
| Max. Negotiated Rate |
$0.09 |
| Rate for Payer: Aetna of CA HMO/PPO |
$0.07
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.09
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.06
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.06
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.06
|
| Rate for Payer: Blue Distinction Transplant |
$0.06
|
| Rate for Payer: Blue Shield of California Commercial |
$0.07
|
| Rate for Payer: Blue Shield of California EPN |
$0.06
|
| Rate for Payer: Cash Price |
$0.05
|
| Rate for Payer: Cigna of CA HMO |
$0.07
|
| Rate for Payer: Cigna of CA PPO |
$0.07
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.09
|
| Rate for Payer: Dignity Health Media |
$0.09
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.09
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.04
|
| Rate for Payer: EPIC Health Plan Transplant |
$0.04
|
| Rate for Payer: Galaxy Health WC |
$0.09
|
| Rate for Payer: Global Benefits Group Commercial |
$0.06
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$0.08
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.07
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.04
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.02
|
| Rate for Payer: Multiplan Commercial |
$0.08
|
| Rate for Payer: Networks By Design Commercial |
$0.07
|
| Rate for Payer: Prime Health Services Commercial |
$0.09
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.06
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.06
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.05
|
| Rate for Payer: United Healthcare All Other HMO |
$0.05
|
| Rate for Payer: United Healthcare HMO Rider |
$0.05
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.05
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.09
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.09
|
| Rate for Payer: Vantage Medical Group Senior |
$0.09
|
|
|
MAGNESIUM 64 MG (MAGNESIUM CHLORIDE) TABLET,DELAYED RELEASE [120162]
|
Facility
|
OP
|
$0.10
|
|
|
Service Code
|
NDC 1000670013
|
| Hospital Charge Code |
1712587
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.02 |
| Max. Negotiated Rate |
$0.09 |
| Rate for Payer: Aetna of CA HMO/PPO |
$0.07
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.09
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.06
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.06
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.06
|
| Rate for Payer: Blue Distinction Transplant |
$0.06
|
| Rate for Payer: Blue Shield of California Commercial |
$0.07
|
| Rate for Payer: Blue Shield of California EPN |
$0.06
|
| Rate for Payer: Cash Price |
$0.05
|
| Rate for Payer: Cigna of CA HMO |
$0.07
|
| Rate for Payer: Cigna of CA PPO |
$0.07
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.09
|
| Rate for Payer: Dignity Health Media |
$0.09
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.09
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.04
|
| Rate for Payer: EPIC Health Plan Transplant |
$0.04
|
| Rate for Payer: Galaxy Health WC |
$0.09
|
| Rate for Payer: Global Benefits Group Commercial |
$0.06
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$0.08
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.07
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.04
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.02
|
| Rate for Payer: Multiplan Commercial |
$0.08
|
| Rate for Payer: Networks By Design Commercial |
$0.07
|
| Rate for Payer: Prime Health Services Commercial |
$0.09
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.06
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.06
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.05
|
| Rate for Payer: United Healthcare All Other HMO |
$0.05
|
| Rate for Payer: United Healthcare HMO Rider |
$0.05
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.05
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.09
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.09
|
| Rate for Payer: Vantage Medical Group Senior |
$0.09
|
|
|
MAGNESIUM 64 MG (MAGNESIUM CHLORIDE) TABLET,DELAYED RELEASE [120162]
|
Facility
|
IP
|
$0.10
|
|
|
Service Code
|
NDC 6858500575
|
| Hospital Charge Code |
1712587
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.02 |
| Max. Negotiated Rate |
$0.09 |
| Rate for Payer: Blue Shield of California Commercial |
$0.07
|
| Rate for Payer: Blue Shield of California EPN |
$0.05
|
| Rate for Payer: Cash Price |
$0.05
|
| Rate for Payer: Cigna of CA HMO |
$0.07
|
| Rate for Payer: Cigna of CA PPO |
$0.07
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.04
|
| Rate for Payer: Galaxy Health WC |
$0.09
|
| Rate for Payer: Global Benefits Group Commercial |
$0.06
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.07
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.04
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.02
|
| Rate for Payer: Multiplan Commercial |
$0.08
|
| Rate for Payer: Networks By Design Commercial |
$0.07
|
| Rate for Payer: Prime Health Services Commercial |
$0.09
|
|
|
MAGNESIUM 64 MG (MAGNESIUM CHLORIDE) TABLET,DELAYED RELEASE [120162]
|
Facility
|
IP
|
$0.10
|
|
|
Service Code
|
NDC 1000670013
|
| Hospital Charge Code |
1712587
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.02 |
| Max. Negotiated Rate |
$0.09 |
| Rate for Payer: Blue Shield of California Commercial |
$0.07
|
| Rate for Payer: Blue Shield of California EPN |
$0.05
|
| Rate for Payer: Cash Price |
$0.05
|
| Rate for Payer: Cigna of CA HMO |
$0.07
|
| Rate for Payer: Cigna of CA PPO |
$0.07
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.04
|
| Rate for Payer: Galaxy Health WC |
$0.09
|
| Rate for Payer: Global Benefits Group Commercial |
$0.06
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.07
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.04
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.02
|
| Rate for Payer: Multiplan Commercial |
$0.08
|
| Rate for Payer: Networks By Design Commercial |
$0.07
|
| Rate for Payer: Prime Health Services Commercial |
$0.09
|
|
|
MAGNESIUM 71.5 MG (MAGNESIUM CHLORIDE) TABLET,DELAYED RELEASE [105730]
|
Facility
|
OP
|
$0.17
|
|
|
Service Code
|
NDC 6761810760
|
| Hospital Charge Code |
1712588
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.04 |
| Max. Negotiated Rate |
$0.14 |
| Rate for Payer: Aetna of CA HMO/PPO |
$0.11
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.14
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.09
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.09
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.10
|
| Rate for Payer: Blue Distinction Transplant |
$0.10
|
| Rate for Payer: Blue Shield of California Commercial |
$0.13
|
| Rate for Payer: Blue Shield of California EPN |
$0.10
|
| Rate for Payer: Cash Price |
$0.08
|
| Rate for Payer: Cigna of CA HMO |
$0.12
|
| Rate for Payer: Cigna of CA PPO |
$0.12
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.14
|
| Rate for Payer: Dignity Health Media |
$0.14
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.14
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.07
|
| Rate for Payer: EPIC Health Plan Transplant |
$0.07
|
| Rate for Payer: Galaxy Health WC |
$0.14
|
| Rate for Payer: Global Benefits Group Commercial |
$0.10
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$0.13
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.11
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.06
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.04
|
| Rate for Payer: Multiplan Commercial |
$0.14
|
| Rate for Payer: Networks By Design Commercial |
$0.11
|
| Rate for Payer: Prime Health Services Commercial |
$0.14
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.10
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.10
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.09
|
| Rate for Payer: United Healthcare All Other HMO |
$0.09
|
| Rate for Payer: United Healthcare HMO Rider |
$0.09
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.09
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.14
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.14
|
| Rate for Payer: Vantage Medical Group Senior |
$0.14
|
|
|
MAGNESIUM 71.5 MG (MAGNESIUM CHLORIDE) TABLET,DELAYED RELEASE [105730]
|
Facility
|
IP
|
$0.17
|
|
|
Service Code
|
NDC 6761810760
|
| Hospital Charge Code |
1712588
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.04 |
| Max. Negotiated Rate |
$0.14 |
| Rate for Payer: Blue Shield of California Commercial |
$0.12
|
| Rate for Payer: Blue Shield of California EPN |
$0.09
|
| Rate for Payer: Cash Price |
$0.08
|
| Rate for Payer: Cigna of CA HMO |
$0.12
|
| Rate for Payer: Cigna of CA PPO |
$0.12
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.07
|
| Rate for Payer: Galaxy Health WC |
$0.14
|
| Rate for Payer: Global Benefits Group Commercial |
$0.10
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.11
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.06
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.04
|
| Rate for Payer: Multiplan Commercial |
$0.14
|
| Rate for Payer: Networks By Design Commercial |
$0.11
|
| Rate for Payer: Prime Health Services Commercial |
$0.14
|
|
|
MAGNESIUM CHLORIDE ORAL SOLUTION COMPOUND 2 MEQ/ML [4080294]
|
Facility
|
IP
|
$0.11
|
|
|
Service Code
|
NDC 9994-0802-94
|
| Hospital Charge Code |
1715089
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.03 |
| Max. Negotiated Rate |
$0.09 |
| Rate for Payer: Blue Shield of California Commercial |
$0.08
|
| Rate for Payer: Blue Shield of California EPN |
$0.06
|
| Rate for Payer: Cash Price |
$0.05
|
| Rate for Payer: Cigna of CA HMO |
$0.08
|
| Rate for Payer: Cigna of CA PPO |
$0.08
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.04
|
| Rate for Payer: Galaxy Health WC |
$0.09
|
| Rate for Payer: Global Benefits Group Commercial |
$0.07
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.07
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.04
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.03
|
| Rate for Payer: Multiplan Commercial |
$0.09
|
| Rate for Payer: Networks By Design Commercial |
$0.07
|
| Rate for Payer: Prime Health Services Commercial |
$0.09
|
|
|
MAGNESIUM CHLORIDE ORAL SOLUTION COMPOUND 2 MEQ/ML [4080294]
|
Facility
|
OP
|
$0.11
|
|
|
Service Code
|
NDC 9994-0802-94
|
| Hospital Charge Code |
1715089
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.03 |
| Max. Negotiated Rate |
$0.09 |
| Rate for Payer: Aetna of CA HMO/PPO |
$0.07
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.09
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.06
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.06
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.07
|
| Rate for Payer: Blue Distinction Transplant |
$0.07
|
| Rate for Payer: Blue Shield of California Commercial |
$0.08
|
| Rate for Payer: Blue Shield of California EPN |
$0.06
|
| Rate for Payer: Cash Price |
$0.05
|
| Rate for Payer: Cigna of CA HMO |
$0.08
|
| Rate for Payer: Cigna of CA PPO |
$0.08
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.09
|
| Rate for Payer: Dignity Health Media |
$0.09
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.09
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.04
|
| Rate for Payer: EPIC Health Plan Transplant |
$0.04
|
| Rate for Payer: Galaxy Health WC |
$0.09
|
| Rate for Payer: Global Benefits Group Commercial |
$0.07
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$0.08
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.07
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.04
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.03
|
| Rate for Payer: Multiplan Commercial |
$0.09
|
| Rate for Payer: Networks By Design Commercial |
$0.07
|
| Rate for Payer: Prime Health Services Commercial |
$0.09
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.07
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.07
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.06
|
| Rate for Payer: United Healthcare All Other HMO |
$0.06
|
| Rate for Payer: United Healthcare HMO Rider |
$0.06
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.06
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.09
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.09
|
| Rate for Payer: Vantage Medical Group Senior |
$0.09
|
|
|
MAGNESIUM CITRATE ORAL SOLUTION [4712]
|
Facility
|
OP
|
$0.01
|
|
|
Service Code
|
NDC 69452-390-98
|
| Hospital Charge Code |
1719128
|
|
Hospital Revenue Code
|
259
|
| Max. Negotiated Rate |
$0.01 |
| Rate for Payer: Aetna of CA HMO/PPO |
$0.01
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.01
|
| 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: 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) 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
|
|
|
MAGNESIUM CITRATE ORAL SOLUTION [4712]
|
Facility
|
IP
|
$0.01
|
|
|
Service Code
|
NDC 69452-390-98
|
| Hospital Charge Code |
1719128
|
|
Hospital Revenue Code
|
259
|
| 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: Cigna of CA HMO |
$0.01
|
| Rate for Payer: Cigna of CA PPO |
$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
|
|
|
MAGNESIUM CITRATE ORAL SOLUTION [4712]
|
Facility
|
OP
|
$0.05
|
|
|
Service Code
|
NDC 0869-0166-38
|
| Hospital Charge Code |
1719128
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.01 |
| Max. Negotiated Rate |
$0.04 |
| Rate for Payer: Aetna of CA HMO/PPO |
$0.03
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.04
|
| 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 |
$0.03
|
| Rate for Payer: Blue Distinction Transplant |
$0.03
|
| 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 |
$0.02
|
| 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 |
$0.04
|
| Rate for Payer: Dignity Health Media |
$0.04
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.04
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.02
|
| Rate for Payer: EPIC Health Plan Transplant |
$0.02
|
| Rate for Payer: Galaxy Health WC |
$0.04
|
| Rate for Payer: Global Benefits Group Commercial |
$0.03
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$0.04
|
| 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 |
$0.04
|
| Rate for Payer: Networks By Design Commercial |
$0.03
|
| Rate for Payer: Prime Health Services Commercial |
$0.04
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.03
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.03
|
| 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 |
$0.04
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.04
|
| Rate for Payer: Vantage Medical Group Senior |
$0.04
|
|
|
MAGNESIUM CITRATE ORAL SOLUTION [4712]
|
Facility
|
IP
|
$0.05
|
|
|
Service Code
|
NDC 0869-0166-38
|
| Hospital Charge Code |
1719128
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.01 |
| Max. Negotiated Rate |
$0.04 |
| 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 |
$0.02
|
| 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 |
$0.04
|
| Rate for Payer: Global Benefits Group Commercial |
$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 |
$0.04
|
| Rate for Payer: Networks By Design Commercial |
$0.03
|
| Rate for Payer: Prime Health Services Commercial |
$0.04
|
|
|
MAGNESIUM GLUCONATE 27 MG MAGNESIUM (500 MG) TABLET [118246]
|
Facility
|
OP
|
$0.17
|
|
|
Service Code
|
NDC 6025817201
|
| Hospital Charge Code |
1710072
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.04 |
| Max. Negotiated Rate |
$0.14 |
| Rate for Payer: Aetna of CA HMO/PPO |
$0.11
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.14
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.09
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.09
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.10
|
| Rate for Payer: Blue Distinction Transplant |
$0.10
|
| Rate for Payer: Blue Shield of California Commercial |
$0.13
|
| Rate for Payer: Blue Shield of California EPN |
$0.10
|
| Rate for Payer: Cash Price |
$0.08
|
| Rate for Payer: Cigna of CA HMO |
$0.12
|
| Rate for Payer: Cigna of CA PPO |
$0.12
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.14
|
| Rate for Payer: Dignity Health Media |
$0.14
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.14
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.07
|
| Rate for Payer: EPIC Health Plan Transplant |
$0.07
|
| Rate for Payer: Galaxy Health WC |
$0.14
|
| Rate for Payer: Global Benefits Group Commercial |
$0.10
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$0.13
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.11
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.06
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.04
|
| Rate for Payer: Multiplan Commercial |
$0.14
|
| Rate for Payer: Networks By Design Commercial |
$0.11
|
| Rate for Payer: Prime Health Services Commercial |
$0.14
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.10
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.10
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.09
|
| Rate for Payer: United Healthcare All Other HMO |
$0.09
|
| Rate for Payer: United Healthcare HMO Rider |
$0.09
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.09
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.14
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.14
|
| Rate for Payer: Vantage Medical Group Senior |
$0.14
|
|
|
MAGNESIUM GLUCONATE 27 MG MAGNESIUM (500 MG) TABLET [118246]
|
Facility
|
IP
|
$0.17
|
|
|
Service Code
|
NDC 6025817201
|
| Hospital Charge Code |
1710072
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.04 |
| Max. Negotiated Rate |
$0.14 |
| Rate for Payer: Blue Shield of California Commercial |
$0.12
|
| Rate for Payer: Blue Shield of California EPN |
$0.09
|
| Rate for Payer: Cash Price |
$0.08
|
| Rate for Payer: Cigna of CA HMO |
$0.12
|
| Rate for Payer: Cigna of CA PPO |
$0.12
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.07
|
| Rate for Payer: Galaxy Health WC |
$0.14
|
| Rate for Payer: Global Benefits Group Commercial |
$0.10
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.11
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.06
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.04
|
| Rate for Payer: Multiplan Commercial |
$0.14
|
| Rate for Payer: Networks By Design Commercial |
$0.11
|
| Rate for Payer: Prime Health Services Commercial |
$0.14
|
|
