|
PHENOBARBITAL 97.2 MG TABLET [6220]
|
Facility
|
IP
|
$1.14
|
|
|
Service Code
|
NDC 16571-668-01
|
| Hospital Charge Code |
1730199
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.27 |
| Max. Negotiated Rate |
$0.97 |
| Rate for Payer: Blue Shield of California Commercial |
$0.81
|
| Rate for Payer: Blue Shield of California EPN |
$0.58
|
| Rate for Payer: Cash Price |
$0.51
|
| Rate for Payer: Cigna of CA HMO |
$0.80
|
| Rate for Payer: Cigna of CA PPO |
$0.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.46
|
| Rate for Payer: Galaxy Health WC |
$0.97
|
| Rate for Payer: Global Benefits Group Commercial |
$0.68
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.76
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.43
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.27
|
| Rate for Payer: Multiplan Commercial |
$0.91
|
| Rate for Payer: Networks By Design Commercial |
$0.74
|
| Rate for Payer: Prime Health Services Commercial |
$0.97
|
|
|
PHENOBARBITAL ORAL SOLUTION (IV FORM) 65 MG/ML [4081110]
|
Facility
|
OP
|
$1.63
|
|
|
Service Code
|
NDC 9994-0811-10
|
| Hospital Charge Code |
NDC4081110
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.39 |
| Max. Negotiated Rate |
$1.39 |
| Rate for Payer: Aetna of CA HMO/PPO |
$1.07
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1.39
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.90
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.90
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.97
|
| Rate for Payer: Blue Distinction Transplant |
$0.98
|
| Rate for Payer: Blue Shield of California Commercial |
$1.20
|
| Rate for Payer: Blue Shield of California EPN |
$0.95
|
| Rate for Payer: Cash Price |
$0.73
|
| Rate for Payer: Cigna of CA HMO |
$1.14
|
| Rate for Payer: Cigna of CA PPO |
$1.14
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1.39
|
| Rate for Payer: Dignity Health Media |
$1.39
|
| Rate for Payer: Dignity Health Medi-Cal |
$1.39
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.65
|
| Rate for Payer: EPIC Health Plan Transplant |
$0.65
|
| Rate for Payer: Galaxy Health WC |
$1.39
|
| Rate for Payer: Global Benefits Group Commercial |
$0.98
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$1.22
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1.09
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.62
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.39
|
| Rate for Payer: Multiplan Commercial |
$1.30
|
| Rate for Payer: Networks By Design Commercial |
$1.06
|
| Rate for Payer: Prime Health Services Commercial |
$1.39
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.98
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.98
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.82
|
| Rate for Payer: United Healthcare All Other HMO |
$0.82
|
| Rate for Payer: United Healthcare HMO Rider |
$0.82
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.82
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1.39
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1.39
|
| Rate for Payer: Vantage Medical Group Senior |
$1.39
|
|
|
PHENOBARBITAL ORAL SOLUTION (IV FORM) 65 MG/ML [4081110]
|
Facility
|
IP
|
$1.63
|
|
|
Service Code
|
NDC 9994-0811-10
|
| Hospital Charge Code |
NDC4081110
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.39 |
| Max. Negotiated Rate |
$1.39 |
| Rate for Payer: Blue Shield of California Commercial |
$1.16
|
| Rate for Payer: Blue Shield of California EPN |
$0.83
|
| Rate for Payer: Cash Price |
$0.73
|
| Rate for Payer: Cigna of CA HMO |
$1.14
|
| Rate for Payer: Cigna of CA PPO |
$1.14
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.65
|
| Rate for Payer: Galaxy Health WC |
$1.39
|
| Rate for Payer: Global Benefits Group Commercial |
$0.98
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1.09
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.62
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.39
|
| Rate for Payer: Multiplan Commercial |
$1.30
|
| Rate for Payer: Networks By Design Commercial |
$1.06
|
| Rate for Payer: Prime Health Services Commercial |
$1.39
|
|
|
PHENOBARBITAL SODIUM 65 MG/ML INJECTION SOLUTION [6224]
|
Facility
|
IP
|
$26.18
|
|
|
Service Code
|
NDC 42494-415-01
|
| Hospital Charge Code |
1720211
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$6.28 |
| Max. Negotiated Rate |
$22.25 |
| Rate for Payer: Blue Shield of California Commercial |
$18.64
|
| Rate for Payer: Blue Shield of California EPN |
$13.40
|
| Rate for Payer: Cash Price |
$11.78
|
| Rate for Payer: Cigna of CA HMO |
$18.33
|
| Rate for Payer: Cigna of CA PPO |
$18.33
|
| Rate for Payer: EPIC Health Plan Commercial |
$10.47
|
| Rate for Payer: EPIC Health Plan Transplant |
$10.47
|
| Rate for Payer: Galaxy Health WC |
$22.25
|
| Rate for Payer: Global Benefits Group Commercial |
$15.71
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$17.46
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$9.97
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6.28
|
| Rate for Payer: Multiplan Commercial |
$20.94
|
| Rate for Payer: Networks By Design Commercial |
$13.09
|
| Rate for Payer: Prime Health Services Commercial |
$22.25
|
| Rate for Payer: United Healthcare All Other Commercial |
$9.89
|
| Rate for Payer: United Healthcare All Other HMO |
$9.66
|
| Rate for Payer: United Healthcare HMO Rider |
$9.45
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$8.64
|
|
|
PHENOBARBITAL SODIUM 65 MG/ML INJECTION SOLUTION [6224]
|
Facility
|
OP
|
$31.63
|
|
|
Service Code
|
NDC 0641-0476-21
|
| Hospital Charge Code |
1720211
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$7.59 |
| Max. Negotiated Rate |
$26.89 |
| Rate for Payer: Aetna of CA HMO/PPO |
$20.75
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$26.89
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$17.40
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$17.40
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$18.85
|
| Rate for Payer: Blue Distinction Transplant |
$18.98
|
| Rate for Payer: Blue Shield of California Commercial |
$23.31
|
| Rate for Payer: Blue Shield of California EPN |
$18.47
|
| Rate for Payer: Cash Price |
$14.23
|
| Rate for Payer: Cigna of CA HMO |
$22.14
|
| Rate for Payer: Cigna of CA PPO |
$22.14
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$26.89
|
| Rate for Payer: Dignity Health Media |
$26.89
|
| Rate for Payer: Dignity Health Medi-Cal |
$26.89
|
| Rate for Payer: EPIC Health Plan Commercial |
$12.65
|
| Rate for Payer: EPIC Health Plan Transplant |
$12.65
|
| Rate for Payer: Galaxy Health WC |
$26.89
|
| Rate for Payer: Global Benefits Group Commercial |
$18.98
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$23.72
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$21.10
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$12.05
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$7.59
|
| Rate for Payer: Multiplan Commercial |
$25.30
|
| Rate for Payer: Networks By Design Commercial |
$15.82
|
| Rate for Payer: Prime Health Services Commercial |
$26.89
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$18.98
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$18.98
|
| Rate for Payer: United Healthcare All Other Commercial |
$15.82
|
| Rate for Payer: United Healthcare All Other HMO |
$15.82
|
| Rate for Payer: United Healthcare HMO Rider |
$15.82
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$15.82
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$26.89
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$26.89
|
| Rate for Payer: Vantage Medical Group Senior |
$26.89
|
|
|
PHENOBARBITAL SODIUM 65 MG/ML INJECTION SOLUTION [6224]
|
Facility
|
IP
|
$31.63
|
|
|
Service Code
|
NDC 0641-0476-25
|
| Hospital Charge Code |
1720211
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$7.59 |
| Max. Negotiated Rate |
$26.89 |
| Rate for Payer: Blue Shield of California Commercial |
$22.52
|
| Rate for Payer: Blue Shield of California EPN |
$16.19
|
| Rate for Payer: Cash Price |
$14.23
|
| Rate for Payer: Cigna of CA HMO |
$22.14
|
| Rate for Payer: Cigna of CA PPO |
$22.14
|
| Rate for Payer: EPIC Health Plan Commercial |
$12.65
|
| Rate for Payer: EPIC Health Plan Transplant |
$12.65
|
| Rate for Payer: Galaxy Health WC |
$26.89
|
| Rate for Payer: Global Benefits Group Commercial |
$18.98
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$21.10
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$12.05
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$7.59
|
| Rate for Payer: Multiplan Commercial |
$25.30
|
| Rate for Payer: Networks By Design Commercial |
$15.82
|
| Rate for Payer: Prime Health Services Commercial |
$26.89
|
| Rate for Payer: United Healthcare All Other Commercial |
$11.94
|
| Rate for Payer: United Healthcare All Other HMO |
$11.67
|
| Rate for Payer: United Healthcare HMO Rider |
$11.41
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$10.44
|
|
|
PHENOBARBITAL SODIUM 65 MG/ML INJECTION SOLUTION [6224]
|
Facility
|
IP
|
$31.63
|
|
|
Service Code
|
NDC 0641-0476-21
|
| Hospital Charge Code |
1720211
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$7.59 |
| Max. Negotiated Rate |
$26.89 |
| Rate for Payer: Blue Shield of California Commercial |
$22.52
|
| Rate for Payer: Blue Shield of California EPN |
$16.19
|
| Rate for Payer: Cash Price |
$14.23
|
| Rate for Payer: Cigna of CA HMO |
$22.14
|
| Rate for Payer: Cigna of CA PPO |
$22.14
|
| Rate for Payer: EPIC Health Plan Commercial |
$12.65
|
| Rate for Payer: EPIC Health Plan Transplant |
$12.65
|
| Rate for Payer: Galaxy Health WC |
$26.89
|
| Rate for Payer: Global Benefits Group Commercial |
$18.98
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$21.10
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$12.05
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$7.59
|
| Rate for Payer: Multiplan Commercial |
$25.30
|
| Rate for Payer: Networks By Design Commercial |
$15.82
|
| Rate for Payer: Prime Health Services Commercial |
$26.89
|
| Rate for Payer: United Healthcare All Other Commercial |
$11.94
|
| Rate for Payer: United Healthcare All Other HMO |
$11.67
|
| Rate for Payer: United Healthcare HMO Rider |
$11.41
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$10.44
|
|
|
PHENOBARBITAL SODIUM 65 MG/ML INJECTION SOLUTION [6224]
|
Facility
|
OP
|
$26.18
|
|
|
Service Code
|
NDC 42494-415-01
|
| Hospital Charge Code |
1720211
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$6.28 |
| Max. Negotiated Rate |
$22.25 |
| Rate for Payer: Aetna of CA HMO/PPO |
$17.17
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$22.25
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$14.40
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$14.40
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$15.60
|
| Rate for Payer: Blue Distinction Transplant |
$15.71
|
| Rate for Payer: Blue Shield of California Commercial |
$19.29
|
| Rate for Payer: Blue Shield of California EPN |
$15.29
|
| Rate for Payer: Cash Price |
$11.78
|
| Rate for Payer: Cigna of CA HMO |
$18.33
|
| Rate for Payer: Cigna of CA PPO |
$18.33
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$22.25
|
| Rate for Payer: Dignity Health Media |
$22.25
|
| Rate for Payer: Dignity Health Medi-Cal |
$22.25
|
| Rate for Payer: EPIC Health Plan Commercial |
$10.47
|
| Rate for Payer: EPIC Health Plan Transplant |
$10.47
|
| Rate for Payer: Galaxy Health WC |
$22.25
|
| Rate for Payer: Global Benefits Group Commercial |
$15.71
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$19.64
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$17.46
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$9.97
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6.28
|
| Rate for Payer: Multiplan Commercial |
$20.94
|
| Rate for Payer: Networks By Design Commercial |
$13.09
|
| Rate for Payer: Prime Health Services Commercial |
$22.25
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$15.71
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$15.71
|
| Rate for Payer: United Healthcare All Other Commercial |
$13.09
|
| Rate for Payer: United Healthcare All Other HMO |
$13.09
|
| Rate for Payer: United Healthcare HMO Rider |
$13.09
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$13.09
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$22.25
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$22.25
|
| Rate for Payer: Vantage Medical Group Senior |
$22.25
|
|
|
PHENOBARBITAL SODIUM 65 MG/ML INJECTION SOLUTION [6224]
|
Facility
|
OP
|
$31.63
|
|
|
Service Code
|
NDC 0641-0476-25
|
| Hospital Charge Code |
1720211
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$7.59 |
| Max. Negotiated Rate |
$26.89 |
| Rate for Payer: Aetna of CA HMO/PPO |
$20.75
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$26.89
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$17.40
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$17.40
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$18.85
|
| Rate for Payer: Blue Distinction Transplant |
$18.98
|
| Rate for Payer: Blue Shield of California Commercial |
$23.31
|
| Rate for Payer: Blue Shield of California EPN |
$18.47
|
| Rate for Payer: Cash Price |
$14.23
|
| Rate for Payer: Cigna of CA HMO |
$22.14
|
| Rate for Payer: Cigna of CA PPO |
$22.14
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$26.89
|
| Rate for Payer: Dignity Health Media |
$26.89
|
| Rate for Payer: Dignity Health Medi-Cal |
$26.89
|
| Rate for Payer: EPIC Health Plan Commercial |
$12.65
|
| Rate for Payer: EPIC Health Plan Transplant |
$12.65
|
| Rate for Payer: Galaxy Health WC |
$26.89
|
| Rate for Payer: Global Benefits Group Commercial |
$18.98
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$23.72
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$21.10
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$12.05
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$7.59
|
| Rate for Payer: Multiplan Commercial |
$25.30
|
| Rate for Payer: Networks By Design Commercial |
$15.82
|
| Rate for Payer: Prime Health Services Commercial |
$26.89
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$18.98
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$18.98
|
| Rate for Payer: United Healthcare All Other Commercial |
$15.82
|
| Rate for Payer: United Healthcare All Other HMO |
$15.82
|
| Rate for Payer: United Healthcare HMO Rider |
$15.82
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$15.82
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$26.89
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$26.89
|
| Rate for Payer: Vantage Medical Group Senior |
$26.89
|
|
|
PHENOBARBITAL SODIUM 65 MG/ML INJECTION SOLUTION [6224]
|
Facility
|
OP
|
$26.18
|
|
|
Service Code
|
NDC 42494-415-25
|
| Hospital Charge Code |
1720211
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$6.28 |
| Max. Negotiated Rate |
$22.25 |
| Rate for Payer: Aetna of CA HMO/PPO |
$17.17
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$22.25
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$14.40
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$14.40
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$15.60
|
| Rate for Payer: Blue Distinction Transplant |
$15.71
|
| Rate for Payer: Blue Shield of California Commercial |
$19.29
|
| Rate for Payer: Blue Shield of California EPN |
$15.29
|
| Rate for Payer: Cash Price |
$11.78
|
| Rate for Payer: Cigna of CA HMO |
$18.33
|
| Rate for Payer: Cigna of CA PPO |
$18.33
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$22.25
|
| Rate for Payer: Dignity Health Media |
$22.25
|
| Rate for Payer: Dignity Health Medi-Cal |
$22.25
|
| Rate for Payer: EPIC Health Plan Commercial |
$10.47
|
| Rate for Payer: EPIC Health Plan Transplant |
$10.47
|
| Rate for Payer: Galaxy Health WC |
$22.25
|
| Rate for Payer: Global Benefits Group Commercial |
$15.71
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$19.64
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$17.46
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$9.97
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6.28
|
| Rate for Payer: Multiplan Commercial |
$20.94
|
| Rate for Payer: Networks By Design Commercial |
$13.09
|
| Rate for Payer: Prime Health Services Commercial |
$22.25
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$15.71
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$15.71
|
| Rate for Payer: United Healthcare All Other Commercial |
$13.09
|
| Rate for Payer: United Healthcare All Other HMO |
$13.09
|
| Rate for Payer: United Healthcare HMO Rider |
$13.09
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$13.09
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$22.25
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$22.25
|
| Rate for Payer: Vantage Medical Group Senior |
$22.25
|
|
|
PHENOBARBITAL SODIUM 65 MG/ML INJECTION SOLUTION [6224]
|
Facility
|
IP
|
$26.18
|
|
|
Service Code
|
NDC 42494-415-25
|
| Hospital Charge Code |
1720211
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$6.28 |
| Max. Negotiated Rate |
$22.25 |
| Rate for Payer: Blue Shield of California Commercial |
$18.64
|
| Rate for Payer: Blue Shield of California EPN |
$13.40
|
| Rate for Payer: Cash Price |
$11.78
|
| Rate for Payer: Cigna of CA HMO |
$18.33
|
| Rate for Payer: Cigna of CA PPO |
$18.33
|
| Rate for Payer: EPIC Health Plan Commercial |
$10.47
|
| Rate for Payer: EPIC Health Plan Transplant |
$10.47
|
| Rate for Payer: Galaxy Health WC |
$22.25
|
| Rate for Payer: Global Benefits Group Commercial |
$15.71
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$17.46
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$9.97
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6.28
|
| Rate for Payer: Multiplan Commercial |
$20.94
|
| Rate for Payer: Networks By Design Commercial |
$13.09
|
| Rate for Payer: Prime Health Services Commercial |
$22.25
|
| Rate for Payer: United Healthcare All Other Commercial |
$9.89
|
| Rate for Payer: United Healthcare All Other HMO |
$9.66
|
| Rate for Payer: United Healthcare HMO Rider |
$9.45
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$8.64
|
|
|
PHENOL 1.4 % MUCOSAL AEROSOL SPRAY [27889]
|
Facility
|
OP
|
$0.01
|
|
|
Service Code
|
NDC 46122-749-76
|
| Hospital Charge Code |
1743517
|
|
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
|
|
|
PHENOL 1.4 % MUCOSAL AEROSOL SPRAY [27889]
|
Facility
|
IP
|
$0.03
|
|
|
Service Code
|
NDC 7811201103
|
| Hospital Charge Code |
1743517
|
|
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
|
|
|
PHENOL 1.4 % MUCOSAL AEROSOL SPRAY [27889]
|
Facility
|
IP
|
$0.01
|
|
|
Service Code
|
NDC 46122-749-76
|
| Hospital Charge Code |
1743517
|
|
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
|
|
|
PHENOL 1.4 % MUCOSAL AEROSOL SPRAY [27889]
|
Facility
|
IP
|
$0.02
|
|
|
Service Code
|
NDC 0904-6305-21
|
| Hospital Charge Code |
1743517
|
|
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
|
|
|
PHENOL 1.4 % MUCOSAL AEROSOL SPRAY [27889]
|
Facility
|
OP
|
$0.02
|
|
|
Service Code
|
NDC 0904-6305-21
|
| Hospital Charge Code |
1743517
|
|
Hospital Revenue Code
|
259
|
| Max. Negotiated Rate |
$0.02 |
| Rate for Payer: Aetna of CA HMO/PPO |
$0.01
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.02
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.01
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.01
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.01
|
| Rate for Payer: Blue Distinction Transplant |
$0.01
|
| Rate for Payer: Blue Shield of California Commercial |
$0.01
|
| Rate for Payer: Blue Shield of California EPN |
$0.01
|
| Rate for Payer: Cash Price |
$0.01
|
| Rate for Payer: Cigna of CA HMO |
$0.01
|
| Rate for Payer: Cigna of CA PPO |
$0.01
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.02
|
| Rate for Payer: Dignity Health Media |
$0.02
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.02
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.01
|
| Rate for Payer: EPIC Health Plan Transplant |
$0.01
|
| Rate for Payer: Galaxy Health WC |
$0.02
|
| Rate for Payer: Global Benefits Group Commercial |
$0.01
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$0.02
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.01
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.01
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.00
|
| Rate for Payer: Multiplan Commercial |
$0.02
|
| Rate for Payer: Networks By Design Commercial |
$0.01
|
| Rate for Payer: Prime Health Services Commercial |
$0.02
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.01
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.01
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.01
|
| Rate for Payer: United Healthcare All Other HMO |
$0.01
|
| Rate for Payer: United Healthcare HMO Rider |
$0.01
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.01
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.02
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.02
|
| Rate for Payer: Vantage Medical Group Senior |
$0.02
|
|
|
PHENOL 1.4 % MUCOSAL AEROSOL SPRAY [27889]
|
Facility
|
IP
|
$0.02
|
|
|
Service Code
|
NDC 0536-1228-58
|
| Hospital Charge Code |
1743517
|
|
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
|
|
|
PHENOL 1.4 % MUCOSAL AEROSOL SPRAY [27889]
|
Facility
|
OP
|
$0.03
|
|
|
Service Code
|
NDC 7811201103
|
| Hospital Charge Code |
1743517
|
|
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: Alpha Care Medical Group Commercial/Exchange |
$0.03
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.02
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.02
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.02
|
| Rate for Payer: Blue Distinction Transplant |
$0.02
|
| Rate for Payer: Blue Shield of California Commercial |
$0.02
|
| 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) 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: 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
|
|
|
PHENOL 1.4 % MUCOSAL AEROSOL SPRAY [27889]
|
Facility
|
OP
|
$0.02
|
|
|
Service Code
|
NDC 0536-1228-58
|
| Hospital Charge Code |
1743517
|
|
Hospital Revenue Code
|
259
|
| Max. Negotiated Rate |
$0.02 |
| Rate for Payer: Aetna of CA HMO/PPO |
$0.01
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.02
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.01
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.01
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.01
|
| Rate for Payer: Blue Distinction Transplant |
$0.01
|
| Rate for Payer: Blue Shield of California Commercial |
$0.01
|
| Rate for Payer: Blue Shield of California EPN |
$0.01
|
| Rate for Payer: Cash Price |
$0.01
|
| Rate for Payer: Cigna of CA HMO |
$0.01
|
| Rate for Payer: Cigna of CA PPO |
$0.01
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.02
|
| Rate for Payer: Dignity Health Media |
$0.02
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.02
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.01
|
| Rate for Payer: EPIC Health Plan Transplant |
$0.01
|
| Rate for Payer: Galaxy Health WC |
$0.02
|
| Rate for Payer: Global Benefits Group Commercial |
$0.01
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$0.02
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.01
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.01
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.00
|
| Rate for Payer: Multiplan Commercial |
$0.02
|
| Rate for Payer: Networks By Design Commercial |
$0.01
|
| Rate for Payer: Prime Health Services Commercial |
$0.02
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.01
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.01
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.01
|
| Rate for Payer: United Healthcare All Other HMO |
$0.01
|
| Rate for Payer: United Healthcare HMO Rider |
$0.01
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.01
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.02
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.02
|
| Rate for Payer: Vantage Medical Group Senior |
$0.02
|
|
|
PHENOL 1.5 %-GLYCERIN 33 % MUCOSAL SPRAY [208269]
|
Facility
|
IP
|
$0.04
|
|
|
Service Code
|
NDC 7811200068
|
| Hospital Charge Code |
NDG208269B
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.01 |
| Max. Negotiated Rate |
$0.03 |
| Rate for Payer: Blue Shield of California Commercial |
$0.03
|
| Rate for Payer: Blue Shield of California EPN |
$0.02
|
| Rate for Payer: Cash Price |
$0.02
|
| Rate for Payer: Cigna of CA HMO |
$0.03
|
| Rate for Payer: Cigna of CA PPO |
$0.03
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.02
|
| Rate for Payer: Galaxy Health WC |
$0.03
|
| Rate for Payer: Global Benefits Group Commercial |
$0.02
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.03
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.02
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.01
|
| Rate for Payer: Multiplan Commercial |
$0.03
|
| Rate for Payer: Networks By Design Commercial |
$0.03
|
| Rate for Payer: Prime Health Services Commercial |
$0.03
|
|
|
PHENOL 1.5 %-GLYCERIN 33 % MUCOSAL SPRAY [208269]
|
Facility
|
OP
|
$0.04
|
|
|
Service Code
|
NDC 7811200068
|
| Hospital Charge Code |
NDG208269B
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.01 |
| Max. Negotiated Rate |
$0.03 |
| Rate for Payer: Aetna of CA HMO/PPO |
$0.03
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.03
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.02
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.02
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.02
|
| Rate for Payer: Blue Distinction Transplant |
$0.02
|
| Rate for Payer: Blue Shield of California Commercial |
$0.03
|
| Rate for Payer: Blue Shield of California EPN |
$0.02
|
| Rate for Payer: Cash Price |
$0.02
|
| Rate for Payer: Cigna of CA HMO |
$0.03
|
| Rate for Payer: Cigna of CA PPO |
$0.03
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.03
|
| Rate for Payer: Dignity Health Media |
$0.03
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.03
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.02
|
| Rate for Payer: EPIC Health Plan Transplant |
$0.02
|
| Rate for Payer: Galaxy Health WC |
$0.03
|
| Rate for Payer: Global Benefits Group Commercial |
$0.02
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$0.03
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.03
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.02
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.01
|
| Rate for Payer: Multiplan Commercial |
$0.03
|
| Rate for Payer: Networks By Design Commercial |
$0.03
|
| Rate for Payer: Prime Health Services Commercial |
$0.03
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.02
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.02
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.02
|
| Rate for Payer: United Healthcare All Other HMO |
$0.02
|
| Rate for Payer: United Healthcare HMO Rider |
$0.02
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.02
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.03
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.03
|
| Rate for Payer: Vantage Medical Group Senior |
$0.03
|
|
|
PHENOXYBENZAMINE ORAL SUSPENSION COMPOUND 2 MG/ML [4080319]
|
Facility
|
OP
|
$1.95
|
|
|
Service Code
|
NDC 9994-0803-19
|
| Hospital Charge Code |
1715015
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.47 |
| Max. Negotiated Rate |
$1.66 |
| Rate for Payer: Aetna of CA HMO/PPO |
$1.28
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1.66
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1.07
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1.07
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1.16
|
| Rate for Payer: Blue Distinction Transplant |
$1.17
|
| Rate for Payer: Blue Shield of California Commercial |
$1.44
|
| Rate for Payer: Blue Shield of California EPN |
$1.14
|
| Rate for Payer: Cash Price |
$0.88
|
| Rate for Payer: Cigna of CA HMO |
$1.36
|
| Rate for Payer: Cigna of CA PPO |
$1.36
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1.66
|
| Rate for Payer: Dignity Health Media |
$1.66
|
| Rate for Payer: Dignity Health Medi-Cal |
$1.66
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.78
|
| Rate for Payer: EPIC Health Plan Transplant |
$0.78
|
| Rate for Payer: Galaxy Health WC |
$1.66
|
| Rate for Payer: Global Benefits Group Commercial |
$1.17
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$1.46
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1.30
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.74
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.47
|
| Rate for Payer: Multiplan Commercial |
$1.56
|
| Rate for Payer: Networks By Design Commercial |
$1.27
|
| Rate for Payer: Prime Health Services Commercial |
$1.66
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1.17
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1.17
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.98
|
| Rate for Payer: United Healthcare All Other HMO |
$0.98
|
| Rate for Payer: United Healthcare HMO Rider |
$0.98
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.98
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1.66
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1.66
|
| Rate for Payer: Vantage Medical Group Senior |
$1.66
|
|
|
PHENOXYBENZAMINE ORAL SUSPENSION COMPOUND 2 MG/ML [4080319]
|
Facility
|
IP
|
$1.95
|
|
|
Service Code
|
NDC 9994-0803-19
|
| Hospital Charge Code |
1715015
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.47 |
| Max. Negotiated Rate |
$1.66 |
| Rate for Payer: Blue Shield of California Commercial |
$1.39
|
| Rate for Payer: Blue Shield of California EPN |
$1.00
|
| Rate for Payer: Cash Price |
$0.88
|
| Rate for Payer: Cigna of CA HMO |
$1.36
|
| Rate for Payer: Cigna of CA PPO |
$1.36
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.78
|
| Rate for Payer: Galaxy Health WC |
$1.66
|
| Rate for Payer: Global Benefits Group Commercial |
$1.17
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1.30
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.74
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.47
|
| Rate for Payer: Multiplan Commercial |
$1.56
|
| Rate for Payer: Networks By Design Commercial |
$1.27
|
| Rate for Payer: Prime Health Services Commercial |
$1.66
|
|
|
PHENTOLAMINE 5 MG INJECTION SOLUTION [10947]
|
Facility
|
IP
|
$503.76
|
|
|
Service Code
|
CPT J2760
|
| Hospital Charge Code |
1720203
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$120.90 |
| Max. Negotiated Rate |
$428.20 |
| Rate for Payer: Blue Shield of California Commercial |
$358.68
|
| Rate for Payer: Blue Shield of California Commercial |
$418.63
|
| Rate for Payer: Blue Shield of California EPN |
$257.93
|
| Rate for Payer: Blue Shield of California EPN |
$301.04
|
| Rate for Payer: Cash Price |
$226.69
|
| Rate for Payer: Cash Price |
$264.58
|
| Rate for Payer: Cigna of CA HMO |
$352.63
|
| Rate for Payer: Cigna of CA HMO |
$411.57
|
| Rate for Payer: Cigna of CA PPO |
$411.57
|
| Rate for Payer: Cigna of CA PPO |
$352.63
|
| Rate for Payer: EPIC Health Plan Commercial |
$235.18
|
| Rate for Payer: EPIC Health Plan Commercial |
$201.50
|
| Rate for Payer: EPIC Health Plan Transplant |
$201.50
|
| Rate for Payer: EPIC Health Plan Transplant |
$235.18
|
| Rate for Payer: Galaxy Health WC |
$428.20
|
| Rate for Payer: Galaxy Health WC |
$499.77
|
| Rate for Payer: Global Benefits Group Commercial |
$352.78
|
| Rate for Payer: Global Benefits Group Commercial |
$302.26
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$392.17
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$336.01
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$191.93
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$224.01
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$120.90
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$141.11
|
| Rate for Payer: Multiplan Commercial |
$403.01
|
| Rate for Payer: Multiplan Commercial |
$470.37
|
| Rate for Payer: Networks By Design Commercial |
$251.88
|
| Rate for Payer: Networks By Design Commercial |
$293.98
|
| Rate for Payer: Prime Health Services Commercial |
$428.20
|
| Rate for Payer: Prime Health Services Commercial |
$499.77
|
| Rate for Payer: United Healthcare All Other Commercial |
$190.22
|
| Rate for Payer: United Healthcare All Other Commercial |
$222.01
|
| Rate for Payer: United Healthcare All Other HMO |
$185.79
|
| Rate for Payer: United Healthcare All Other HMO |
$216.84
|
| Rate for Payer: United Healthcare HMO Rider |
$181.76
|
| Rate for Payer: United Healthcare HMO Rider |
$212.14
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$166.24
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$194.03
|
|
|
PHENTOLAMINE 5 MG INJECTION SOLUTION [10947]
|
Facility
|
OP
|
$503.76
|
|
|
Service Code
|
CPT J2760
|
| Hospital Charge Code |
1720203
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$62.17 |
| Max. Negotiated Rate |
$2,810.09 |
| Rate for Payer: Aetna of CA HMO/PPO |
$2,810.09
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,810.09
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$558.50
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$558.50
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$491.48
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$491.48
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$491.48
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$491.48
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$62.17
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$62.17
|
| Rate for Payer: Blue Distinction Transplant |
$352.78
|
| Rate for Payer: Blue Distinction Transplant |
$302.26
|
| Rate for Payer: Blue Shield of California Commercial |
$433.33
|
| Rate for Payer: Blue Shield of California Commercial |
$371.27
|
| Rate for Payer: Blue Shield of California EPN |
$518.83
|
| Rate for Payer: Blue Shield of California EPN |
$518.83
|
| Rate for Payer: Cash Price |
$264.58
|
| Rate for Payer: Cash Price |
$226.69
|
| Rate for Payer: Cash Price |
$264.58
|
| Rate for Payer: Cash Price |
$226.69
|
| Rate for Payer: Cigna of CA HMO |
$411.57
|
| Rate for Payer: Cigna of CA HMO |
$352.63
|
| Rate for Payer: Cigna of CA PPO |
$352.63
|
| Rate for Payer: Cigna of CA PPO |
$411.57
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$670.20
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$670.20
|
| Rate for Payer: Dignity Health Media |
$446.80
|
| Rate for Payer: Dignity Health Media |
$446.80
|
| Rate for Payer: Dignity Health Medi-Cal |
$491.48
|
| Rate for Payer: Dignity Health Medi-Cal |
$491.48
|
| Rate for Payer: EPIC Health Plan Commercial |
$603.18
|
| Rate for Payer: EPIC Health Plan Commercial |
$603.18
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$446.80
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$446.80
|
| Rate for Payer: EPIC Health Plan Transplant |
$446.80
|
| Rate for Payer: EPIC Health Plan Transplant |
$446.80
|
| Rate for Payer: Galaxy Health WC |
$428.20
|
| Rate for Payer: Galaxy Health WC |
$499.77
|
| Rate for Payer: Global Benefits Group Commercial |
$302.26
|
| Rate for Payer: Global Benefits Group Commercial |
$352.78
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$377.82
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$440.97
|
| Rate for Payer: Heritage Provider Network Commercial |
$732.75
|
| Rate for Payer: Heritage Provider Network Commercial |
$732.75
|
| Rate for Payer: Heritage Provider Network Transplant |
$732.75
|
| Rate for Payer: Heritage Provider Network Transplant |
$732.75
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$723.81
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$723.81
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal Transplant |
$723.81
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal Transplant |
$723.81
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$446.80
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$446.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$336.01
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$392.17
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$857.39
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$857.39
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$446.80
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$446.80
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$120.90
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$141.11
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$562.96
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$562.96
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$598.71
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$598.71
|
| Rate for Payer: Multiplan Commercial |
$403.01
|
| Rate for Payer: Multiplan Commercial |
$470.37
|
| Rate for Payer: Networks By Design Commercial |
$293.98
|
| Rate for Payer: Networks By Design Commercial |
$251.88
|
| Rate for Payer: Prime Health Services Commercial |
$428.20
|
| Rate for Payer: Prime Health Services Commercial |
$499.77
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$352.78
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$302.26
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$352.78
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$302.26
|
| Rate for Payer: United Healthcare All Other Commercial |
$293.98
|
| Rate for Payer: United Healthcare All Other Commercial |
$251.88
|
| Rate for Payer: United Healthcare All Other HMO |
$251.88
|
| Rate for Payer: United Healthcare All Other HMO |
$293.98
|
| Rate for Payer: United Healthcare HMO Rider |
$251.88
|
| Rate for Payer: United Healthcare HMO Rider |
$293.98
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$251.88
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$293.98
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$670.20
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$670.20
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$491.48
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$491.48
|
| Rate for Payer: Vantage Medical Group Senior |
$446.80
|
| Rate for Payer: Vantage Medical Group Senior |
$446.80
|
|
