|
POTASSIUM CITRATE-CITRIC ACID 1,100 MG-334 MG/5 ML ORAL SOLUTION [22646]
|
Facility
|
OP
|
$0.16
|
|
|
Service Code
|
NDC 5865731216
|
| Hospital Charge Code |
1717203
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.04 |
| Max. Negotiated Rate |
$0.14 |
| Rate for Payer: Aetna of CA HMO/PPO |
$0.10
|
| 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 |
$0.12
|
| Rate for Payer: Blue Shield of California EPN |
$0.09
|
| Rate for Payer: Cash Price |
$0.07
|
| Rate for Payer: Cigna of CA HMO |
$0.11
|
| Rate for Payer: Cigna of CA PPO |
$0.11
|
| 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 |
$0.06
|
| Rate for Payer: EPIC Health Plan Transplant |
$0.06
|
| 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 |
$0.12
|
| 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 |
$0.13
|
| Rate for Payer: Networks By Design Commercial |
$0.10
|
| 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 |
$0.08
|
| Rate for Payer: United Healthcare All Other HMO |
$0.08
|
| Rate for Payer: United Healthcare HMO Rider |
$0.08
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.08
|
| 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
|
|
|
POTASSIUM CITRATE-CITRIC ACID 1,100 MG-334 MG/5 ML ORAL SOLUTION [22646]
|
Facility
|
OP
|
$0.16
|
|
|
Service Code
|
NDC 6025800316
|
| Hospital Charge Code |
1717203
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.04 |
| Max. Negotiated Rate |
$0.14 |
| Rate for Payer: Aetna of CA HMO/PPO |
$0.10
|
| 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 |
$0.12
|
| Rate for Payer: Blue Shield of California EPN |
$0.09
|
| Rate for Payer: Cash Price |
$0.07
|
| Rate for Payer: Cigna of CA HMO |
$0.11
|
| Rate for Payer: Cigna of CA PPO |
$0.11
|
| 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 |
$0.06
|
| Rate for Payer: EPIC Health Plan Transplant |
$0.06
|
| 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 |
$0.12
|
| 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 |
$0.13
|
| Rate for Payer: Networks By Design Commercial |
$0.10
|
| 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 |
$0.08
|
| Rate for Payer: United Healthcare All Other HMO |
$0.08
|
| Rate for Payer: United Healthcare HMO Rider |
$0.08
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.08
|
| 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
|
|
|
POTASSIUM CITRATE-CITRIC ACID 1,100 MG-334 MG/5 ML ORAL SOLUTION [22646]
|
Facility
|
IP
|
$0.16
|
|
|
Service Code
|
NDC 6025800316
|
| Hospital Charge Code |
1717203
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.04 |
| Max. Negotiated Rate |
$0.14 |
| Rate for Payer: Blue Shield of California Commercial |
$0.11
|
| Rate for Payer: Blue Shield of California EPN |
$0.08
|
| Rate for Payer: Cash Price |
$0.07
|
| Rate for Payer: Cigna of CA HMO |
$0.11
|
| Rate for Payer: Cigna of CA PPO |
$0.11
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.06
|
| 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 |
$0.13
|
| Rate for Payer: Networks By Design Commercial |
$0.10
|
| Rate for Payer: Prime Health Services Commercial |
$0.14
|
|
|
POTASSIUM CITRATE-CITRIC ACID 1,100 MG-334 MG/5 ML ORAL SOLUTION [22646]
|
Facility
|
OP
|
$0.09
|
|
|
Service Code
|
NDC 121067616
|
| Hospital Charge Code |
1717203
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.02 |
| Max. Negotiated Rate |
$0.08 |
| Rate for Payer: Aetna of CA HMO/PPO |
$0.06
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.08
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.05
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.05
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.05
|
| Rate for Payer: Blue Distinction Transplant |
$0.05
|
| 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 |
$0.04
|
| Rate for Payer: Cigna of CA HMO |
$0.06
|
| Rate for Payer: Cigna of CA PPO |
$0.06
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.08
|
| Rate for Payer: Dignity Health Media |
$0.08
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.08
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.04
|
| Rate for Payer: EPIC Health Plan Transplant |
$0.04
|
| Rate for Payer: Galaxy Health WC |
$0.08
|
| Rate for Payer: Global Benefits Group Commercial |
$0.05
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$0.07
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.06
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.03
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.02
|
| Rate for Payer: Multiplan Commercial |
$0.07
|
| Rate for Payer: Networks By Design Commercial |
$0.06
|
| Rate for Payer: Prime Health Services Commercial |
$0.08
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.05
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.05
|
| 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 |
$0.08
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.08
|
| Rate for Payer: Vantage Medical Group Senior |
$0.08
|
|
|
POTASSIUM CITRATE ER 10 MEQ (1,080 MG) TABLET,EXTENDED RELEASE [11083]
|
Facility
|
IP
|
$2.57
|
|
|
Service Code
|
NDC 0178-0610-01
|
| Hospital Charge Code |
1711951
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.62 |
| Max. Negotiated Rate |
$2.18 |
| Rate for Payer: Blue Shield of California Commercial |
$1.83
|
| Rate for Payer: Blue Shield of California EPN |
$1.32
|
| Rate for Payer: Cash Price |
$1.16
|
| Rate for Payer: Cigna of CA HMO |
$1.80
|
| Rate for Payer: Cigna of CA PPO |
$1.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.03
|
| Rate for Payer: Galaxy Health WC |
$2.18
|
| Rate for Payer: Global Benefits Group Commercial |
$1.54
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1.71
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.98
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.62
|
| Rate for Payer: Multiplan Commercial |
$2.06
|
| Rate for Payer: Networks By Design Commercial |
$1.67
|
| Rate for Payer: Prime Health Services Commercial |
$2.18
|
|
|
POTASSIUM CITRATE ER 10 MEQ (1,080 MG) TABLET,EXTENDED RELEASE [11083]
|
Facility
|
OP
|
$2.57
|
|
|
Service Code
|
NDC 0178-0610-01
|
| Hospital Charge Code |
1711951
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.62 |
| Max. Negotiated Rate |
$2.18 |
| Rate for Payer: Aetna of CA HMO/PPO |
$1.69
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2.18
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1.41
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1.41
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1.53
|
| Rate for Payer: Blue Distinction Transplant |
$1.54
|
| Rate for Payer: Blue Shield of California Commercial |
$1.89
|
| Rate for Payer: Blue Shield of California EPN |
$1.50
|
| Rate for Payer: Cash Price |
$1.16
|
| Rate for Payer: Cigna of CA HMO |
$1.80
|
| Rate for Payer: Cigna of CA PPO |
$1.80
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2.18
|
| Rate for Payer: Dignity Health Media |
$2.18
|
| Rate for Payer: Dignity Health Medi-Cal |
$2.18
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.03
|
| Rate for Payer: EPIC Health Plan Transplant |
$1.03
|
| Rate for Payer: Galaxy Health WC |
$2.18
|
| Rate for Payer: Global Benefits Group Commercial |
$1.54
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$1.93
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1.71
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.98
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.62
|
| Rate for Payer: Multiplan Commercial |
$2.06
|
| Rate for Payer: Networks By Design Commercial |
$1.67
|
| Rate for Payer: Prime Health Services Commercial |
$2.18
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1.54
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1.54
|
| Rate for Payer: United Healthcare All Other Commercial |
$1.28
|
| Rate for Payer: United Healthcare All Other HMO |
$1.28
|
| Rate for Payer: United Healthcare HMO Rider |
$1.28
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1.28
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2.18
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2.18
|
| Rate for Payer: Vantage Medical Group Senior |
$2.18
|
|
|
POTASSIUM CITRATE ER 10 MEQ (1,080 MG) TABLET,EXTENDED RELEASE [11083]
|
Facility
|
IP
|
$1.70
|
|
|
Service Code
|
NDC 0245-0071-11
|
| Hospital Charge Code |
1711951
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.41 |
| Max. Negotiated Rate |
$1.44 |
| Rate for Payer: Blue Shield of California Commercial |
$1.21
|
| Rate for Payer: Blue Shield of California EPN |
$0.87
|
| Rate for Payer: Cash Price |
$0.77
|
| Rate for Payer: Cigna of CA HMO |
$1.19
|
| Rate for Payer: Cigna of CA PPO |
$1.19
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.68
|
| Rate for Payer: Galaxy Health WC |
$1.44
|
| Rate for Payer: Global Benefits Group Commercial |
$1.02
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1.13
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.65
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.41
|
| Rate for Payer: Multiplan Commercial |
$1.36
|
| Rate for Payer: Networks By Design Commercial |
$1.10
|
| Rate for Payer: Prime Health Services Commercial |
$1.44
|
|
|
POTASSIUM CITRATE ER 10 MEQ (1,080 MG) TABLET,EXTENDED RELEASE [11083]
|
Facility
|
OP
|
$2.89
|
|
|
Service Code
|
NDC 68084-850-32
|
| Hospital Charge Code |
1711951
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.69 |
| Max. Negotiated Rate |
$2.46 |
| Rate for Payer: Aetna of CA HMO/PPO |
$1.90
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2.46
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1.59
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1.59
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1.72
|
| Rate for Payer: Blue Distinction Transplant |
$1.73
|
| Rate for Payer: Blue Shield of California Commercial |
$2.13
|
| Rate for Payer: Blue Shield of California EPN |
$1.69
|
| Rate for Payer: Cash Price |
$1.30
|
| Rate for Payer: Cigna of CA HMO |
$2.02
|
| Rate for Payer: Cigna of CA PPO |
$2.02
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2.46
|
| Rate for Payer: Dignity Health Media |
$2.46
|
| Rate for Payer: Dignity Health Medi-Cal |
$2.46
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.16
|
| Rate for Payer: EPIC Health Plan Transplant |
$1.16
|
| Rate for Payer: Galaxy Health WC |
$2.46
|
| Rate for Payer: Global Benefits Group Commercial |
$1.73
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$2.17
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1.93
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1.10
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.69
|
| Rate for Payer: Multiplan Commercial |
$2.31
|
| Rate for Payer: Networks By Design Commercial |
$1.88
|
| Rate for Payer: Prime Health Services Commercial |
$2.46
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1.73
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1.73
|
| Rate for Payer: United Healthcare All Other Commercial |
$1.44
|
| Rate for Payer: United Healthcare All Other HMO |
$1.44
|
| Rate for Payer: United Healthcare HMO Rider |
$1.44
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1.44
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2.46
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2.46
|
| Rate for Payer: Vantage Medical Group Senior |
$2.46
|
|
|
POTASSIUM CITRATE ER 10 MEQ (1,080 MG) TABLET,EXTENDED RELEASE [11083]
|
Facility
|
IP
|
$2.89
|
|
|
Service Code
|
NDC 68084-850-33
|
| Hospital Charge Code |
1711951
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.69 |
| Max. Negotiated Rate |
$2.46 |
| Rate for Payer: Blue Shield of California Commercial |
$2.06
|
| Rate for Payer: Blue Shield of California EPN |
$1.48
|
| Rate for Payer: Cash Price |
$1.30
|
| Rate for Payer: Cigna of CA HMO |
$2.02
|
| Rate for Payer: Cigna of CA PPO |
$2.02
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.16
|
| Rate for Payer: Galaxy Health WC |
$2.46
|
| Rate for Payer: Global Benefits Group Commercial |
$1.73
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1.93
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1.10
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.69
|
| Rate for Payer: Multiplan Commercial |
$2.31
|
| Rate for Payer: Networks By Design Commercial |
$1.88
|
| Rate for Payer: Prime Health Services Commercial |
$2.46
|
|
|
POTASSIUM CITRATE ER 10 MEQ (1,080 MG) TABLET,EXTENDED RELEASE [11083]
|
Facility
|
OP
|
$1.70
|
|
|
Service Code
|
NDC 0245-0071-11
|
| Hospital Charge Code |
1711951
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.41 |
| Max. Negotiated Rate |
$1.44 |
| Rate for Payer: Aetna of CA HMO/PPO |
$1.12
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1.44
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.94
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.94
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1.01
|
| Rate for Payer: Blue Distinction Transplant |
$1.02
|
| Rate for Payer: Blue Shield of California Commercial |
$1.25
|
| Rate for Payer: Blue Shield of California EPN |
$0.99
|
| Rate for Payer: Cash Price |
$0.77
|
| Rate for Payer: Cigna of CA HMO |
$1.19
|
| Rate for Payer: Cigna of CA PPO |
$1.19
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1.44
|
| Rate for Payer: Dignity Health Media |
$1.44
|
| Rate for Payer: Dignity Health Medi-Cal |
$1.44
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.68
|
| Rate for Payer: EPIC Health Plan Transplant |
$0.68
|
| Rate for Payer: Galaxy Health WC |
$1.44
|
| Rate for Payer: Global Benefits Group Commercial |
$1.02
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$1.28
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1.13
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.65
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.41
|
| Rate for Payer: Multiplan Commercial |
$1.36
|
| Rate for Payer: Networks By Design Commercial |
$1.10
|
| Rate for Payer: Prime Health Services Commercial |
$1.44
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1.02
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1.02
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.85
|
| Rate for Payer: United Healthcare All Other HMO |
$0.85
|
| Rate for Payer: United Healthcare HMO Rider |
$0.85
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.85
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1.44
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1.44
|
| Rate for Payer: Vantage Medical Group Senior |
$1.44
|
|
|
POTASSIUM CITRATE ER 10 MEQ (1,080 MG) TABLET,EXTENDED RELEASE [11083]
|
Facility
|
OP
|
$2.89
|
|
|
Service Code
|
NDC 68084-850-33
|
| Hospital Charge Code |
1711951
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.69 |
| Max. Negotiated Rate |
$2.46 |
| Rate for Payer: Aetna of CA HMO/PPO |
$1.90
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2.46
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1.59
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1.59
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1.72
|
| Rate for Payer: Blue Distinction Transplant |
$1.73
|
| Rate for Payer: Blue Shield of California Commercial |
$2.13
|
| Rate for Payer: Blue Shield of California EPN |
$1.69
|
| Rate for Payer: Cash Price |
$1.30
|
| Rate for Payer: Cigna of CA HMO |
$2.02
|
| Rate for Payer: Cigna of CA PPO |
$2.02
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2.46
|
| Rate for Payer: Dignity Health Media |
$2.46
|
| Rate for Payer: Dignity Health Medi-Cal |
$2.46
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.16
|
| Rate for Payer: EPIC Health Plan Transplant |
$1.16
|
| Rate for Payer: Galaxy Health WC |
$2.46
|
| Rate for Payer: Global Benefits Group Commercial |
$1.73
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$2.17
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1.93
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1.10
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.69
|
| Rate for Payer: Multiplan Commercial |
$2.31
|
| Rate for Payer: Networks By Design Commercial |
$1.88
|
| Rate for Payer: Prime Health Services Commercial |
$2.46
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1.73
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1.73
|
| Rate for Payer: United Healthcare All Other Commercial |
$1.44
|
| Rate for Payer: United Healthcare All Other HMO |
$1.44
|
| Rate for Payer: United Healthcare HMO Rider |
$1.44
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1.44
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2.46
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2.46
|
| Rate for Payer: Vantage Medical Group Senior |
$2.46
|
|
|
POTASSIUM CITRATE ER 10 MEQ (1,080 MG) TABLET,EXTENDED RELEASE [11083]
|
Facility
|
OP
|
$0.40
|
|
|
Service Code
|
NDC 0591-2729-01
|
| Hospital Charge Code |
1711951
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.10 |
| Max. Negotiated Rate |
$0.34 |
| Rate for Payer: Aetna of CA HMO/PPO |
$0.26
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.34
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.22
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.22
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.24
|
| Rate for Payer: Blue Distinction Transplant |
$0.24
|
| Rate for Payer: Blue Shield of California Commercial |
$0.29
|
| Rate for Payer: Blue Shield of California EPN |
$0.23
|
| Rate for Payer: Cash Price |
$0.18
|
| Rate for Payer: Cigna of CA HMO |
$0.28
|
| Rate for Payer: Cigna of CA PPO |
$0.28
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.34
|
| Rate for Payer: Dignity Health Media |
$0.34
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.34
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.16
|
| Rate for Payer: EPIC Health Plan Transplant |
$0.16
|
| Rate for Payer: Galaxy Health WC |
$0.34
|
| Rate for Payer: Global Benefits Group Commercial |
$0.24
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$0.30
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.27
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.15
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.10
|
| Rate for Payer: Multiplan Commercial |
$0.32
|
| Rate for Payer: Networks By Design Commercial |
$0.26
|
| Rate for Payer: Prime Health Services Commercial |
$0.34
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.24
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.24
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.20
|
| Rate for Payer: United Healthcare All Other HMO |
$0.20
|
| Rate for Payer: United Healthcare HMO Rider |
$0.20
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.20
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.34
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.34
|
| Rate for Payer: Vantage Medical Group Senior |
$0.34
|
|
|
POTASSIUM CITRATE ER 10 MEQ (1,080 MG) TABLET,EXTENDED RELEASE [11083]
|
Facility
|
IP
|
$0.40
|
|
|
Service Code
|
NDC 0591-2729-01
|
| Hospital Charge Code |
1711951
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.10 |
| Max. Negotiated Rate |
$0.34 |
| Rate for Payer: Blue Shield of California Commercial |
$0.28
|
| Rate for Payer: Blue Shield of California EPN |
$0.20
|
| Rate for Payer: Cash Price |
$0.18
|
| Rate for Payer: Cigna of CA HMO |
$0.28
|
| Rate for Payer: Cigna of CA PPO |
$0.28
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.16
|
| Rate for Payer: Galaxy Health WC |
$0.34
|
| Rate for Payer: Global Benefits Group Commercial |
$0.24
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.27
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.15
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.10
|
| Rate for Payer: Multiplan Commercial |
$0.32
|
| Rate for Payer: Networks By Design Commercial |
$0.26
|
| Rate for Payer: Prime Health Services Commercial |
$0.34
|
|
|
POTASSIUM CITRATE ER 10 MEQ (1,080 MG) TABLET,EXTENDED RELEASE [11083]
|
Facility
|
IP
|
$2.89
|
|
|
Service Code
|
NDC 68084-850-32
|
| Hospital Charge Code |
1711951
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.69 |
| Max. Negotiated Rate |
$2.46 |
| Rate for Payer: Blue Shield of California Commercial |
$2.06
|
| Rate for Payer: Blue Shield of California EPN |
$1.48
|
| Rate for Payer: Cash Price |
$1.30
|
| Rate for Payer: Cigna of CA HMO |
$2.02
|
| Rate for Payer: Cigna of CA PPO |
$2.02
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.16
|
| Rate for Payer: Galaxy Health WC |
$2.46
|
| Rate for Payer: Global Benefits Group Commercial |
$1.73
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1.93
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1.10
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.69
|
| Rate for Payer: Multiplan Commercial |
$2.31
|
| Rate for Payer: Networks By Design Commercial |
$1.88
|
| Rate for Payer: Prime Health Services Commercial |
$2.46
|
|
|
POTASSIUM CITRATE ER 5 MEQ (540 MG) TABLET,EXTENDED RELEASE [11084]
|
Facility
|
IP
|
$1.83
|
|
|
Service Code
|
NDC 0178-0600-01
|
| Hospital Charge Code |
1711944
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.44 |
| Max. Negotiated Rate |
$1.56 |
| Rate for Payer: Blue Shield of California Commercial |
$1.30
|
| Rate for Payer: Blue Shield of California EPN |
$0.94
|
| Rate for Payer: Cash Price |
$0.82
|
| Rate for Payer: Cigna of CA HMO |
$1.28
|
| Rate for Payer: Cigna of CA PPO |
$1.28
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.73
|
| Rate for Payer: Galaxy Health WC |
$1.56
|
| Rate for Payer: Global Benefits Group Commercial |
$1.10
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1.22
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.70
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.44
|
| Rate for Payer: Multiplan Commercial |
$1.46
|
| Rate for Payer: Networks By Design Commercial |
$1.19
|
| Rate for Payer: Prime Health Services Commercial |
$1.56
|
|
|
POTASSIUM CITRATE ER 5 MEQ (540 MG) TABLET,EXTENDED RELEASE [11084]
|
Facility
|
OP
|
$1.83
|
|
|
Service Code
|
NDC 0178-0600-01
|
| Hospital Charge Code |
1711944
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.44 |
| Max. Negotiated Rate |
$1.56 |
| Rate for Payer: Aetna of CA HMO/PPO |
$1.20
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1.56
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1.01
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1.01
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1.09
|
| Rate for Payer: Blue Distinction Transplant |
$1.10
|
| Rate for Payer: Blue Shield of California Commercial |
$1.35
|
| Rate for Payer: Blue Shield of California EPN |
$1.07
|
| Rate for Payer: Cash Price |
$0.82
|
| Rate for Payer: Cigna of CA HMO |
$1.28
|
| Rate for Payer: Cigna of CA PPO |
$1.28
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1.56
|
| Rate for Payer: Dignity Health Media |
$1.56
|
| Rate for Payer: Dignity Health Medi-Cal |
$1.56
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.73
|
| Rate for Payer: EPIC Health Plan Transplant |
$0.73
|
| Rate for Payer: Galaxy Health WC |
$1.56
|
| Rate for Payer: Global Benefits Group Commercial |
$1.10
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$1.37
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1.22
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.70
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.44
|
| Rate for Payer: Multiplan Commercial |
$1.46
|
| Rate for Payer: Networks By Design Commercial |
$1.19
|
| Rate for Payer: Prime Health Services Commercial |
$1.56
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1.10
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1.10
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.92
|
| Rate for Payer: United Healthcare All Other HMO |
$0.92
|
| Rate for Payer: United Healthcare HMO Rider |
$0.92
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.92
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1.56
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1.56
|
| Rate for Payer: Vantage Medical Group Senior |
$1.56
|
|
|
POTASSIUM IODIDE 1 GRAM/ML ORAL SOLUTION [6445]
|
Facility
|
IP
|
$17.20
|
|
|
Service Code
|
NDC 71740-112-30
|
| Hospital Charge Code |
1716023
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$4.13 |
| Max. Negotiated Rate |
$14.62 |
| Rate for Payer: Blue Shield of California Commercial |
$12.25
|
| Rate for Payer: Blue Shield of California EPN |
$8.81
|
| Rate for Payer: Cash Price |
$7.74
|
| Rate for Payer: Cigna of CA HMO |
$12.04
|
| Rate for Payer: Cigna of CA PPO |
$12.04
|
| Rate for Payer: EPIC Health Plan Commercial |
$6.88
|
| Rate for Payer: Galaxy Health WC |
$14.62
|
| Rate for Payer: Global Benefits Group Commercial |
$10.32
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$11.47
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$6.55
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.13
|
| Rate for Payer: Multiplan Commercial |
$13.76
|
| Rate for Payer: Networks By Design Commercial |
$11.18
|
| Rate for Payer: Prime Health Services Commercial |
$14.62
|
|
|
POTASSIUM IODIDE 1 GRAM/ML ORAL SOLUTION [6445]
|
Facility
|
OP
|
$17.20
|
|
|
Service Code
|
NDC 71740-112-30
|
| Hospital Charge Code |
1716023
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$4.13 |
| Max. Negotiated Rate |
$14.62 |
| Rate for Payer: Aetna of CA HMO/PPO |
$11.28
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$14.62
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$9.46
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$9.46
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$10.25
|
| Rate for Payer: Blue Distinction Transplant |
$10.32
|
| Rate for Payer: Blue Shield of California Commercial |
$12.68
|
| Rate for Payer: Blue Shield of California EPN |
$10.04
|
| Rate for Payer: Cash Price |
$7.74
|
| Rate for Payer: Cigna of CA HMO |
$12.04
|
| Rate for Payer: Cigna of CA PPO |
$12.04
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$14.62
|
| Rate for Payer: Dignity Health Media |
$14.62
|
| Rate for Payer: Dignity Health Medi-Cal |
$14.62
|
| Rate for Payer: EPIC Health Plan Commercial |
$6.88
|
| Rate for Payer: EPIC Health Plan Transplant |
$6.88
|
| Rate for Payer: Galaxy Health WC |
$14.62
|
| Rate for Payer: Global Benefits Group Commercial |
$10.32
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$12.90
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$11.47
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$6.55
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.13
|
| Rate for Payer: Multiplan Commercial |
$13.76
|
| Rate for Payer: Networks By Design Commercial |
$11.18
|
| Rate for Payer: Prime Health Services Commercial |
$14.62
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$10.32
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$10.32
|
| Rate for Payer: United Healthcare All Other Commercial |
$8.60
|
| Rate for Payer: United Healthcare All Other HMO |
$8.60
|
| Rate for Payer: United Healthcare HMO Rider |
$8.60
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$8.60
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$14.62
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$14.62
|
| Rate for Payer: Vantage Medical Group Senior |
$14.62
|
|
|
POTASSIUM PHOS-MONO-DIBASIC 3 MMOL/ML (4.7 MEQ POTASSIUM/ML) IV SOLN [227459]
|
Facility
|
OP
|
$2.39
|
|
|
Service Code
|
NDC 46287-024-10
|
| Hospital Charge Code |
NDG227459
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.57 |
| Max. Negotiated Rate |
$2.03 |
| Rate for Payer: Aetna of CA HMO/PPO |
$1.57
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2.03
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1.31
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1.31
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1.42
|
| Rate for Payer: Blue Distinction Transplant |
$1.43
|
| Rate for Payer: Blue Shield of California Commercial |
$1.76
|
| Rate for Payer: Blue Shield of California EPN |
$1.40
|
| Rate for Payer: Cash Price |
$1.08
|
| Rate for Payer: Cigna of CA HMO |
$1.53
|
| Rate for Payer: Cigna of CA PPO |
$1.77
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2.03
|
| Rate for Payer: Dignity Health Media |
$2.03
|
| Rate for Payer: Dignity Health Medi-Cal |
$2.03
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.96
|
| Rate for Payer: EPIC Health Plan Transplant |
$0.96
|
| Rate for Payer: Galaxy Health WC |
$2.03
|
| Rate for Payer: Global Benefits Group Commercial |
$1.43
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$1.79
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1.59
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.91
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.57
|
| Rate for Payer: Multiplan Commercial |
$1.91
|
| Rate for Payer: Networks By Design Commercial |
$1.55
|
| Rate for Payer: Prime Health Services Commercial |
$2.03
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1.43
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1.43
|
| Rate for Payer: United Healthcare All Other Commercial |
$1.20
|
| Rate for Payer: United Healthcare All Other HMO |
$1.20
|
| Rate for Payer: United Healthcare HMO Rider |
$1.20
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1.20
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2.03
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2.03
|
| Rate for Payer: Vantage Medical Group Senior |
$2.03
|
|
|
POTASSIUM PHOS-MONO-DIBASIC 3 MMOL/ML (4.7 MEQ POTASSIUM/ML) IV SOLN [227459]
|
Facility
|
IP
|
$2.39
|
|
|
Service Code
|
NDC 46287-024-10
|
| Hospital Charge Code |
NDG227459
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.57 |
| Max. Negotiated Rate |
$2.03 |
| Rate for Payer: Blue Shield of California Commercial |
$1.70
|
| Rate for Payer: Blue Shield of California EPN |
$1.22
|
| Rate for Payer: Cash Price |
$1.08
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.96
|
| Rate for Payer: Galaxy Health WC |
$2.03
|
| Rate for Payer: Global Benefits Group Commercial |
$1.43
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1.59
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.91
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.57
|
| Rate for Payer: Multiplan Commercial |
$1.91
|
| Rate for Payer: Networks By Design Commercial |
$1.55
|
| Rate for Payer: Prime Health Services Commercial |
$2.03
|
|
|
POTASSIUM PHOS-MONO-DIBASIC 3 MMOL/ML (4.7 MEQ POTASSIUM/ML) IV SOLN [227459]
|
Facility
|
OP
|
$2.39
|
|
|
Service Code
|
NDC 46287-024-15
|
| Hospital Charge Code |
NDG227459
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.57 |
| Max. Negotiated Rate |
$2.03 |
| Rate for Payer: Aetna of CA HMO/PPO |
$1.57
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2.03
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1.31
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1.31
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1.42
|
| Rate for Payer: Blue Distinction Transplant |
$1.43
|
| Rate for Payer: Blue Shield of California Commercial |
$1.76
|
| Rate for Payer: Blue Shield of California EPN |
$1.40
|
| Rate for Payer: Cash Price |
$1.08
|
| Rate for Payer: Cigna of CA HMO |
$1.53
|
| Rate for Payer: Cigna of CA PPO |
$1.77
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2.03
|
| Rate for Payer: Dignity Health Media |
$2.03
|
| Rate for Payer: Dignity Health Medi-Cal |
$2.03
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.96
|
| Rate for Payer: EPIC Health Plan Transplant |
$0.96
|
| Rate for Payer: Galaxy Health WC |
$2.03
|
| Rate for Payer: Global Benefits Group Commercial |
$1.43
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$1.79
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1.59
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.91
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.57
|
| Rate for Payer: Multiplan Commercial |
$1.91
|
| Rate for Payer: Networks By Design Commercial |
$1.55
|
| Rate for Payer: Prime Health Services Commercial |
$2.03
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1.43
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1.43
|
| Rate for Payer: United Healthcare All Other Commercial |
$1.20
|
| Rate for Payer: United Healthcare All Other HMO |
$1.20
|
| Rate for Payer: United Healthcare HMO Rider |
$1.20
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1.20
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2.03
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2.03
|
| Rate for Payer: Vantage Medical Group Senior |
$2.03
|
|
|
POTASSIUM PHOS-MONO-DIBASIC 3 MMOL/ML (4.7 MEQ POTASSIUM/ML) IV SOLN [227459]
|
Facility
|
IP
|
$2.39
|
|
|
Service Code
|
NDC 46287-024-15
|
| Hospital Charge Code |
NDG227459
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.57 |
| Max. Negotiated Rate |
$2.03 |
| Rate for Payer: Blue Shield of California Commercial |
$1.70
|
| Rate for Payer: Blue Shield of California EPN |
$1.22
|
| Rate for Payer: Cash Price |
$1.08
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.96
|
| Rate for Payer: Galaxy Health WC |
$2.03
|
| Rate for Payer: Global Benefits Group Commercial |
$1.43
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1.59
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.91
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.57
|
| Rate for Payer: Multiplan Commercial |
$1.91
|
| Rate for Payer: Networks By Design Commercial |
$1.55
|
| Rate for Payer: Prime Health Services Commercial |
$2.03
|
|
|
POTASSIUM PHOSPHATE, MONOBASIC 500 MG SOLUBLE TABLET [11087]
|
Facility
|
IP
|
$0.58
|
|
|
Service Code
|
NDC 0486-1111-01
|
| Hospital Charge Code |
1712612
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.14 |
| Max. Negotiated Rate |
$0.49 |
| Rate for Payer: Blue Shield of California Commercial |
$0.41
|
| Rate for Payer: Blue Shield of California EPN |
$0.30
|
| Rate for Payer: Cash Price |
$0.26
|
| Rate for Payer: Cigna of CA HMO |
$0.41
|
| Rate for Payer: Cigna of CA PPO |
$0.41
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.23
|
| Rate for Payer: Galaxy Health WC |
$0.49
|
| Rate for Payer: Global Benefits Group Commercial |
$0.35
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.39
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.22
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.14
|
| Rate for Payer: Multiplan Commercial |
$0.46
|
| Rate for Payer: Networks By Design Commercial |
$0.38
|
| Rate for Payer: Prime Health Services Commercial |
$0.49
|
|
|
POTASSIUM PHOSPHATE, MONOBASIC 500 MG SOLUBLE TABLET [11087]
|
Facility
|
OP
|
$0.58
|
|
|
Service Code
|
NDC 0486-1111-01
|
| Hospital Charge Code |
1712612
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.14 |
| Max. Negotiated Rate |
$0.49 |
| Rate for Payer: Aetna of CA HMO/PPO |
$0.38
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.49
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.32
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.32
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.35
|
| Rate for Payer: Blue Distinction Transplant |
$0.35
|
| Rate for Payer: Blue Shield of California Commercial |
$0.43
|
| Rate for Payer: Blue Shield of California EPN |
$0.34
|
| Rate for Payer: Cash Price |
$0.26
|
| Rate for Payer: Cigna of CA HMO |
$0.41
|
| Rate for Payer: Cigna of CA PPO |
$0.41
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.49
|
| Rate for Payer: Dignity Health Media |
$0.49
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.49
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.23
|
| Rate for Payer: EPIC Health Plan Transplant |
$0.23
|
| Rate for Payer: Galaxy Health WC |
$0.49
|
| Rate for Payer: Global Benefits Group Commercial |
$0.35
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$0.44
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.39
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.22
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.14
|
| Rate for Payer: Multiplan Commercial |
$0.46
|
| Rate for Payer: Networks By Design Commercial |
$0.38
|
| Rate for Payer: Prime Health Services Commercial |
$0.49
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.35
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.35
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.29
|
| Rate for Payer: United Healthcare All Other HMO |
$0.29
|
| Rate for Payer: United Healthcare HMO Rider |
$0.29
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.29
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.49
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.49
|
| Rate for Payer: Vantage Medical Group Senior |
$0.49
|
|
|
POTASSIUM, SODIUM PHOSPHATES 280 MG-160 MG-250 MG ORAL POWDER PACKET [70284]
|
Facility
|
IP
|
$0.38
|
|
|
Service Code
|
NDC 7135101001
|
| Hospital Charge Code |
1713105
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.09 |
| Max. Negotiated Rate |
$0.32 |
| Rate for Payer: Blue Shield of California Commercial |
$0.27
|
| Rate for Payer: Blue Shield of California EPN |
$0.19
|
| Rate for Payer: Cash Price |
$0.17
|
| Rate for Payer: Cigna of CA HMO |
$0.27
|
| Rate for Payer: Cigna of CA PPO |
$0.27
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.15
|
| Rate for Payer: Galaxy Health WC |
$0.32
|
| Rate for Payer: Global Benefits Group Commercial |
$0.23
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.25
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.14
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.09
|
| Rate for Payer: Multiplan Commercial |
$0.30
|
| Rate for Payer: Networks By Design Commercial |
$0.25
|
| Rate for Payer: Prime Health Services Commercial |
$0.32
|
|
