|
SEVELAMER CARBONATE 0.8 GRAM ORAL POWDER PACKET [99694]
|
Facility
|
IP
|
$2.33
|
|
|
Service Code
|
NDC 0115-1365-29
|
| Hospital Charge Code |
1712471
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.56 |
| Max. Negotiated Rate |
$1.98 |
| Rate for Payer: Blue Shield of California Commercial |
$1.66
|
| Rate for Payer: Blue Shield of California EPN |
$1.19
|
| Rate for Payer: Cash Price |
$1.05
|
| Rate for Payer: Cigna of CA HMO |
$1.63
|
| Rate for Payer: Cigna of CA PPO |
$1.63
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.93
|
| Rate for Payer: Galaxy Health WC |
$1.98
|
| Rate for Payer: Global Benefits Group Commercial |
$1.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1.55
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.89
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.56
|
| Rate for Payer: Multiplan Commercial |
$1.86
|
| Rate for Payer: Networks By Design Commercial |
$1.51
|
| Rate for Payer: Prime Health Services Commercial |
$1.98
|
|
|
SEVELAMER CARBONATE 0.8 GRAM ORAL POWDER PACKET [99694]
|
Facility
|
OP
|
$2.33
|
|
|
Service Code
|
NDC 0115-1365-29
|
| Hospital Charge Code |
1712471
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.56 |
| Max. Negotiated Rate |
$1.98 |
| Rate for Payer: Aetna of CA HMO/PPO |
$1.53
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1.98
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1.28
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1.28
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1.39
|
| Rate for Payer: Blue Distinction Transplant |
$1.40
|
| Rate for Payer: Blue Shield of California Commercial |
$1.72
|
| Rate for Payer: Blue Shield of California EPN |
$1.36
|
| Rate for Payer: Cash Price |
$1.05
|
| Rate for Payer: Cigna of CA HMO |
$1.63
|
| Rate for Payer: Cigna of CA PPO |
$1.63
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1.98
|
| Rate for Payer: Dignity Health Media |
$1.98
|
| Rate for Payer: Dignity Health Medi-Cal |
$1.98
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.93
|
| Rate for Payer: EPIC Health Plan Transplant |
$0.93
|
| Rate for Payer: Galaxy Health WC |
$1.98
|
| Rate for Payer: Global Benefits Group Commercial |
$1.40
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$1.75
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1.55
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.89
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.56
|
| Rate for Payer: Multiplan Commercial |
$1.86
|
| Rate for Payer: Networks By Design Commercial |
$1.51
|
| Rate for Payer: Prime Health Services Commercial |
$1.98
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$1.16
|
| Rate for Payer: United Healthcare All Other HMO |
$1.16
|
| Rate for Payer: United Healthcare HMO Rider |
$1.16
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1.16
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1.98
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1.98
|
| Rate for Payer: Vantage Medical Group Senior |
$1.98
|
|
|
SEVELAMER CARBONATE 0.8 GRAM ORAL POWDER PACKET [99694]
|
Facility
|
IP
|
$11.35
|
|
|
Service Code
|
NDC 43598-478-01
|
| Hospital Charge Code |
1712471
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$2.72 |
| Max. Negotiated Rate |
$9.65 |
| Rate for Payer: Blue Shield of California Commercial |
$8.08
|
| Rate for Payer: Blue Shield of California EPN |
$5.81
|
| Rate for Payer: Cash Price |
$5.11
|
| Rate for Payer: Cigna of CA HMO |
$7.94
|
| Rate for Payer: Cigna of CA PPO |
$7.94
|
| Rate for Payer: EPIC Health Plan Commercial |
$4.54
|
| Rate for Payer: Galaxy Health WC |
$9.65
|
| Rate for Payer: Global Benefits Group Commercial |
$6.81
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$7.57
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4.32
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.72
|
| Rate for Payer: Multiplan Commercial |
$9.08
|
| Rate for Payer: Networks By Design Commercial |
$7.38
|
| Rate for Payer: Prime Health Services Commercial |
$9.65
|
|
|
SEVELAMER CARBONATE 0.8 GRAM ORAL POWDER PACKET [99694]
|
Facility
|
OP
|
$2.33
|
|
|
Service Code
|
NDC 0115-1365-30
|
| Hospital Charge Code |
1712471
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.56 |
| Max. Negotiated Rate |
$1.98 |
| Rate for Payer: Aetna of CA HMO/PPO |
$1.53
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1.98
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1.28
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1.28
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1.39
|
| Rate for Payer: Blue Distinction Transplant |
$1.40
|
| Rate for Payer: Blue Shield of California Commercial |
$1.72
|
| Rate for Payer: Blue Shield of California EPN |
$1.36
|
| Rate for Payer: Cash Price |
$1.05
|
| Rate for Payer: Cigna of CA HMO |
$1.63
|
| Rate for Payer: Cigna of CA PPO |
$1.63
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1.98
|
| Rate for Payer: Dignity Health Media |
$1.98
|
| Rate for Payer: Dignity Health Medi-Cal |
$1.98
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.93
|
| Rate for Payer: EPIC Health Plan Transplant |
$0.93
|
| Rate for Payer: Galaxy Health WC |
$1.98
|
| Rate for Payer: Global Benefits Group Commercial |
$1.40
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$1.75
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1.55
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.89
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.56
|
| Rate for Payer: Multiplan Commercial |
$1.86
|
| Rate for Payer: Networks By Design Commercial |
$1.51
|
| Rate for Payer: Prime Health Services Commercial |
$1.98
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$1.16
|
| Rate for Payer: United Healthcare All Other HMO |
$1.16
|
| Rate for Payer: United Healthcare HMO Rider |
$1.16
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1.16
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1.98
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1.98
|
| Rate for Payer: Vantage Medical Group Senior |
$1.98
|
|
|
SEVELAMER CARBONATE 0.8 GRAM ORAL POWDER PACKET [99694]
|
Facility
|
IP
|
$2.33
|
|
|
Service Code
|
NDC 0115-1365-30
|
| Hospital Charge Code |
1712471
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.56 |
| Max. Negotiated Rate |
$1.98 |
| Rate for Payer: Blue Shield of California Commercial |
$1.66
|
| Rate for Payer: Blue Shield of California EPN |
$1.19
|
| Rate for Payer: Cash Price |
$1.05
|
| Rate for Payer: Cigna of CA HMO |
$1.63
|
| Rate for Payer: Cigna of CA PPO |
$1.63
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.93
|
| Rate for Payer: Galaxy Health WC |
$1.98
|
| Rate for Payer: Global Benefits Group Commercial |
$1.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1.55
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.89
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.56
|
| Rate for Payer: Multiplan Commercial |
$1.86
|
| Rate for Payer: Networks By Design Commercial |
$1.51
|
| Rate for Payer: Prime Health Services Commercial |
$1.98
|
|
|
SEVELAMER CARBONATE 0.8 GRAM ORAL POWDER PACKET [99694]
|
Facility
|
OP
|
$2.27
|
|
|
Service Code
|
NDC 65862-930-08
|
| Hospital Charge Code |
1712471
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.54 |
| Max. Negotiated Rate |
$1.93 |
| Rate for Payer: Aetna of CA HMO/PPO |
$1.49
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1.93
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1.25
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1.35
|
| Rate for Payer: Blue Distinction Transplant |
$1.36
|
| Rate for Payer: Blue Shield of California Commercial |
$1.67
|
| Rate for Payer: Blue Shield of California EPN |
$1.33
|
| Rate for Payer: Cash Price |
$1.02
|
| Rate for Payer: Cigna of CA HMO |
$1.59
|
| Rate for Payer: Cigna of CA PPO |
$1.59
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1.93
|
| Rate for Payer: Dignity Health Media |
$1.93
|
| Rate for Payer: Dignity Health Medi-Cal |
$1.93
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.91
|
| Rate for Payer: EPIC Health Plan Transplant |
$0.91
|
| Rate for Payer: Galaxy Health WC |
$1.93
|
| Rate for Payer: Global Benefits Group Commercial |
$1.36
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$1.70
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1.51
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.86
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.54
|
| Rate for Payer: Multiplan Commercial |
$1.82
|
| Rate for Payer: Networks By Design Commercial |
$1.48
|
| Rate for Payer: Prime Health Services Commercial |
$1.93
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1.36
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1.36
|
| Rate for Payer: United Healthcare All Other Commercial |
$1.14
|
| Rate for Payer: United Healthcare All Other HMO |
$1.14
|
| Rate for Payer: United Healthcare HMO Rider |
$1.14
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1.14
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1.93
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1.93
|
| Rate for Payer: Vantage Medical Group Senior |
$1.93
|
|
|
SEVELAMER CARBONATE 0.8 GRAM ORAL POWDER PACKET [99694]
|
Facility
|
IP
|
$2.27
|
|
|
Service Code
|
NDC 65862-930-08
|
| Hospital Charge Code |
1712471
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.54 |
| Max. Negotiated Rate |
$1.93 |
| Rate for Payer: Blue Shield of California Commercial |
$1.62
|
| Rate for Payer: Blue Shield of California EPN |
$1.16
|
| Rate for Payer: Cash Price |
$1.02
|
| Rate for Payer: Cigna of CA HMO |
$1.59
|
| Rate for Payer: Cigna of CA PPO |
$1.59
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.91
|
| Rate for Payer: Galaxy Health WC |
$1.93
|
| Rate for Payer: Global Benefits Group Commercial |
$1.36
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1.51
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.86
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.54
|
| Rate for Payer: Multiplan Commercial |
$1.82
|
| Rate for Payer: Networks By Design Commercial |
$1.48
|
| Rate for Payer: Prime Health Services Commercial |
$1.93
|
|
|
SEVELAMER CARBONATE 0.8 GRAM ORAL POWDER PACKET [99694]
|
Facility
|
OP
|
$2.27
|
|
|
Service Code
|
NDC 65862-930-90
|
| Hospital Charge Code |
1712471
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.54 |
| Max. Negotiated Rate |
$1.93 |
| Rate for Payer: Aetna of CA HMO/PPO |
$1.49
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1.93
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1.25
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1.35
|
| Rate for Payer: Blue Distinction Transplant |
$1.36
|
| Rate for Payer: Blue Shield of California Commercial |
$1.67
|
| Rate for Payer: Blue Shield of California EPN |
$1.33
|
| Rate for Payer: Cash Price |
$1.02
|
| Rate for Payer: Cigna of CA HMO |
$1.59
|
| Rate for Payer: Cigna of CA PPO |
$1.59
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1.93
|
| Rate for Payer: Dignity Health Media |
$1.93
|
| Rate for Payer: Dignity Health Medi-Cal |
$1.93
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.91
|
| Rate for Payer: EPIC Health Plan Transplant |
$0.91
|
| Rate for Payer: Galaxy Health WC |
$1.93
|
| Rate for Payer: Global Benefits Group Commercial |
$1.36
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$1.70
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1.51
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.86
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.54
|
| Rate for Payer: Multiplan Commercial |
$1.82
|
| Rate for Payer: Networks By Design Commercial |
$1.48
|
| Rate for Payer: Prime Health Services Commercial |
$1.93
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1.36
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1.36
|
| Rate for Payer: United Healthcare All Other Commercial |
$1.14
|
| Rate for Payer: United Healthcare All Other HMO |
$1.14
|
| Rate for Payer: United Healthcare HMO Rider |
$1.14
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1.14
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1.93
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1.93
|
| Rate for Payer: Vantage Medical Group Senior |
$1.93
|
|
|
SEVELAMER CARBONATE 0.8 GRAM ORAL POWDER PACKET [99694]
|
Facility
|
IP
|
$2.27
|
|
|
Service Code
|
NDC 65862-930-90
|
| Hospital Charge Code |
1712471
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.54 |
| Max. Negotiated Rate |
$1.93 |
| Rate for Payer: Blue Shield of California Commercial |
$1.62
|
| Rate for Payer: Blue Shield of California EPN |
$1.16
|
| Rate for Payer: Cash Price |
$1.02
|
| Rate for Payer: Cigna of CA HMO |
$1.59
|
| Rate for Payer: Cigna of CA PPO |
$1.59
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.91
|
| Rate for Payer: Galaxy Health WC |
$1.93
|
| Rate for Payer: Global Benefits Group Commercial |
$1.36
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1.51
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.86
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.54
|
| Rate for Payer: Multiplan Commercial |
$1.82
|
| Rate for Payer: Networks By Design Commercial |
$1.48
|
| Rate for Payer: Prime Health Services Commercial |
$1.93
|
|
|
SEVELAMER CARBONATE 0.8 GRAM ORAL POWDER PACKET [99694]
|
Facility
|
OP
|
$11.35
|
|
|
Service Code
|
NDC 43598-478-90
|
| Hospital Charge Code |
1712471
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$2.72 |
| Max. Negotiated Rate |
$9.65 |
| Rate for Payer: Aetna of CA HMO/PPO |
$7.44
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$9.65
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$6.24
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$6.24
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$6.76
|
| Rate for Payer: Blue Distinction Transplant |
$6.81
|
| Rate for Payer: Blue Shield of California Commercial |
$8.36
|
| Rate for Payer: Blue Shield of California EPN |
$6.63
|
| Rate for Payer: Cash Price |
$5.11
|
| Rate for Payer: Cigna of CA HMO |
$7.94
|
| Rate for Payer: Cigna of CA PPO |
$7.94
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$9.65
|
| Rate for Payer: Dignity Health Media |
$9.65
|
| Rate for Payer: Dignity Health Medi-Cal |
$9.65
|
| Rate for Payer: EPIC Health Plan Commercial |
$4.54
|
| Rate for Payer: EPIC Health Plan Transplant |
$4.54
|
| Rate for Payer: Galaxy Health WC |
$9.65
|
| Rate for Payer: Global Benefits Group Commercial |
$6.81
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$8.51
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$7.57
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4.32
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.72
|
| Rate for Payer: Multiplan Commercial |
$9.08
|
| Rate for Payer: Networks By Design Commercial |
$7.38
|
| Rate for Payer: Prime Health Services Commercial |
$9.65
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$6.81
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$6.81
|
| Rate for Payer: United Healthcare All Other Commercial |
$5.68
|
| Rate for Payer: United Healthcare All Other HMO |
$5.68
|
| Rate for Payer: United Healthcare HMO Rider |
$5.68
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$5.68
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$9.65
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$9.65
|
| Rate for Payer: Vantage Medical Group Senior |
$9.65
|
|
|
SEVELAMER CARBONATE 2.4 GRAM ORAL POWDER PACKET [99695]
|
Facility
|
IP
|
$2.27
|
|
|
Service Code
|
NDC 65862-931-08
|
| Hospital Charge Code |
1712470
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.54 |
| Max. Negotiated Rate |
$1.93 |
| Rate for Payer: Blue Shield of California Commercial |
$1.62
|
| Rate for Payer: Blue Shield of California EPN |
$1.16
|
| Rate for Payer: Cash Price |
$1.02
|
| Rate for Payer: Cigna of CA HMO |
$1.59
|
| Rate for Payer: Cigna of CA PPO |
$1.59
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.91
|
| Rate for Payer: Galaxy Health WC |
$1.93
|
| Rate for Payer: Global Benefits Group Commercial |
$1.36
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1.51
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.86
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.54
|
| Rate for Payer: Multiplan Commercial |
$1.82
|
| Rate for Payer: Networks By Design Commercial |
$1.48
|
| Rate for Payer: Prime Health Services Commercial |
$1.93
|
|
|
SEVELAMER CARBONATE 2.4 GRAM ORAL POWDER PACKET [99695]
|
Facility
|
OP
|
$21.42
|
|
|
Service Code
|
NDC 58468-0131-2
|
| Hospital Charge Code |
1712470
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$5.14 |
| Max. Negotiated Rate |
$18.21 |
| Rate for Payer: Aetna of CA HMO/PPO |
$14.05
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$18.21
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$11.78
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$11.78
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$12.76
|
| Rate for Payer: Blue Distinction Transplant |
$12.85
|
| Rate for Payer: Blue Shield of California Commercial |
$15.79
|
| Rate for Payer: Blue Shield of California EPN |
$12.51
|
| Rate for Payer: Cash Price |
$9.64
|
| Rate for Payer: Cigna of CA HMO |
$14.99
|
| Rate for Payer: Cigna of CA PPO |
$14.99
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$18.21
|
| Rate for Payer: Dignity Health Media |
$18.21
|
| Rate for Payer: Dignity Health Medi-Cal |
$18.21
|
| Rate for Payer: EPIC Health Plan Commercial |
$8.57
|
| Rate for Payer: EPIC Health Plan Transplant |
$8.57
|
| Rate for Payer: Galaxy Health WC |
$18.21
|
| Rate for Payer: Global Benefits Group Commercial |
$12.85
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$16.06
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$14.29
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$8.16
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5.14
|
| Rate for Payer: Multiplan Commercial |
$17.14
|
| Rate for Payer: Networks By Design Commercial |
$13.92
|
| Rate for Payer: Prime Health Services Commercial |
$18.21
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$12.85
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$12.85
|
| Rate for Payer: United Healthcare All Other Commercial |
$10.71
|
| Rate for Payer: United Healthcare All Other HMO |
$10.71
|
| Rate for Payer: United Healthcare HMO Rider |
$10.71
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$10.71
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$18.21
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$18.21
|
| Rate for Payer: Vantage Medical Group Senior |
$18.21
|
|
|
SEVELAMER CARBONATE 2.4 GRAM ORAL POWDER PACKET [99695]
|
Facility
|
OP
|
$11.35
|
|
|
Service Code
|
NDC 0955-1054-01
|
| Hospital Charge Code |
1712470
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$2.72 |
| Max. Negotiated Rate |
$9.65 |
| Rate for Payer: Aetna of CA HMO/PPO |
$7.44
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$9.65
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$6.24
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$6.24
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$6.76
|
| Rate for Payer: Blue Distinction Transplant |
$6.81
|
| Rate for Payer: Blue Shield of California Commercial |
$8.36
|
| Rate for Payer: Blue Shield of California EPN |
$6.63
|
| Rate for Payer: Cash Price |
$5.11
|
| Rate for Payer: Cigna of CA HMO |
$7.94
|
| Rate for Payer: Cigna of CA PPO |
$7.94
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$9.65
|
| Rate for Payer: Dignity Health Media |
$9.65
|
| Rate for Payer: Dignity Health Medi-Cal |
$9.65
|
| Rate for Payer: EPIC Health Plan Commercial |
$4.54
|
| Rate for Payer: EPIC Health Plan Transplant |
$4.54
|
| Rate for Payer: Galaxy Health WC |
$9.65
|
| Rate for Payer: Global Benefits Group Commercial |
$6.81
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$8.51
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$7.57
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4.32
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.72
|
| Rate for Payer: Multiplan Commercial |
$9.08
|
| Rate for Payer: Networks By Design Commercial |
$7.38
|
| Rate for Payer: Prime Health Services Commercial |
$9.65
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$6.81
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$6.81
|
| Rate for Payer: United Healthcare All Other Commercial |
$5.68
|
| Rate for Payer: United Healthcare All Other HMO |
$5.68
|
| Rate for Payer: United Healthcare HMO Rider |
$5.68
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$5.68
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$9.65
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$9.65
|
| Rate for Payer: Vantage Medical Group Senior |
$9.65
|
|
|
SEVELAMER CARBONATE 2.4 GRAM ORAL POWDER PACKET [99695]
|
Facility
|
IP
|
$21.42
|
|
|
Service Code
|
NDC 58468-0131-2
|
| Hospital Charge Code |
1712470
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$5.14 |
| Max. Negotiated Rate |
$18.21 |
| Rate for Payer: Blue Shield of California Commercial |
$15.25
|
| Rate for Payer: Blue Shield of California EPN |
$10.97
|
| Rate for Payer: Cash Price |
$9.64
|
| Rate for Payer: Cigna of CA HMO |
$14.99
|
| Rate for Payer: Cigna of CA PPO |
$14.99
|
| Rate for Payer: EPIC Health Plan Commercial |
$8.57
|
| Rate for Payer: Galaxy Health WC |
$18.21
|
| Rate for Payer: Global Benefits Group Commercial |
$12.85
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$14.29
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$8.16
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5.14
|
| Rate for Payer: Multiplan Commercial |
$17.14
|
| Rate for Payer: Networks By Design Commercial |
$13.92
|
| Rate for Payer: Prime Health Services Commercial |
$18.21
|
|
|
SEVELAMER CARBONATE 2.4 GRAM ORAL POWDER PACKET [99695]
|
Facility
|
OP
|
$11.35
|
|
|
Service Code
|
NDC 43598-479-90
|
| Hospital Charge Code |
1712470
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$2.72 |
| Max. Negotiated Rate |
$9.65 |
| Rate for Payer: Aetna of CA HMO/PPO |
$7.44
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$9.65
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$6.24
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$6.24
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$6.76
|
| Rate for Payer: Blue Distinction Transplant |
$6.81
|
| Rate for Payer: Blue Shield of California Commercial |
$8.36
|
| Rate for Payer: Blue Shield of California EPN |
$6.63
|
| Rate for Payer: Cash Price |
$5.11
|
| Rate for Payer: Cigna of CA HMO |
$7.94
|
| Rate for Payer: Cigna of CA PPO |
$7.94
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$9.65
|
| Rate for Payer: Dignity Health Media |
$9.65
|
| Rate for Payer: Dignity Health Medi-Cal |
$9.65
|
| Rate for Payer: EPIC Health Plan Commercial |
$4.54
|
| Rate for Payer: EPIC Health Plan Transplant |
$4.54
|
| Rate for Payer: Galaxy Health WC |
$9.65
|
| Rate for Payer: Global Benefits Group Commercial |
$6.81
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$8.51
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$7.57
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4.32
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.72
|
| Rate for Payer: Multiplan Commercial |
$9.08
|
| Rate for Payer: Networks By Design Commercial |
$7.38
|
| Rate for Payer: Prime Health Services Commercial |
$9.65
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$6.81
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$6.81
|
| Rate for Payer: United Healthcare All Other Commercial |
$5.68
|
| Rate for Payer: United Healthcare All Other HMO |
$5.68
|
| Rate for Payer: United Healthcare HMO Rider |
$5.68
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$5.68
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$9.65
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$9.65
|
| Rate for Payer: Vantage Medical Group Senior |
$9.65
|
|
|
SEVELAMER CARBONATE 2.4 GRAM ORAL POWDER PACKET [99695]
|
Facility
|
OP
|
$21.42
|
|
|
Service Code
|
NDC 58468-0131-1
|
| Hospital Charge Code |
1712470
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$5.14 |
| Max. Negotiated Rate |
$18.21 |
| Rate for Payer: Aetna of CA HMO/PPO |
$14.05
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$18.21
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$11.78
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$11.78
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$12.76
|
| Rate for Payer: Blue Distinction Transplant |
$12.85
|
| Rate for Payer: Blue Shield of California Commercial |
$15.79
|
| Rate for Payer: Blue Shield of California EPN |
$12.51
|
| Rate for Payer: Cash Price |
$9.64
|
| Rate for Payer: Cigna of CA HMO |
$14.99
|
| Rate for Payer: Cigna of CA PPO |
$14.99
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$18.21
|
| Rate for Payer: Dignity Health Media |
$18.21
|
| Rate for Payer: Dignity Health Medi-Cal |
$18.21
|
| Rate for Payer: EPIC Health Plan Commercial |
$8.57
|
| Rate for Payer: EPIC Health Plan Transplant |
$8.57
|
| Rate for Payer: Galaxy Health WC |
$18.21
|
| Rate for Payer: Global Benefits Group Commercial |
$12.85
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$16.06
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$14.29
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$8.16
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5.14
|
| Rate for Payer: Multiplan Commercial |
$17.14
|
| Rate for Payer: Networks By Design Commercial |
$13.92
|
| Rate for Payer: Prime Health Services Commercial |
$18.21
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$12.85
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$12.85
|
| Rate for Payer: United Healthcare All Other Commercial |
$10.71
|
| Rate for Payer: United Healthcare All Other HMO |
$10.71
|
| Rate for Payer: United Healthcare HMO Rider |
$10.71
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$10.71
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$18.21
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$18.21
|
| Rate for Payer: Vantage Medical Group Senior |
$18.21
|
|
|
SEVELAMER CARBONATE 2.4 GRAM ORAL POWDER PACKET [99695]
|
Facility
|
IP
|
$11.35
|
|
|
Service Code
|
NDC 43598-479-01
|
| Hospital Charge Code |
1712470
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$2.72 |
| Max. Negotiated Rate |
$9.65 |
| Rate for Payer: Blue Shield of California Commercial |
$8.08
|
| Rate for Payer: Blue Shield of California EPN |
$5.81
|
| Rate for Payer: Cash Price |
$5.11
|
| Rate for Payer: Cigna of CA HMO |
$7.94
|
| Rate for Payer: Cigna of CA PPO |
$7.94
|
| Rate for Payer: EPIC Health Plan Commercial |
$4.54
|
| Rate for Payer: Galaxy Health WC |
$9.65
|
| Rate for Payer: Global Benefits Group Commercial |
$6.81
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$7.57
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4.32
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.72
|
| Rate for Payer: Multiplan Commercial |
$9.08
|
| Rate for Payer: Networks By Design Commercial |
$7.38
|
| Rate for Payer: Prime Health Services Commercial |
$9.65
|
|
|
SEVELAMER CARBONATE 2.4 GRAM ORAL POWDER PACKET [99695]
|
Facility
|
OP
|
$11.35
|
|
|
Service Code
|
NDC 0955-1054-90
|
| Hospital Charge Code |
1712470
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$2.72 |
| Max. Negotiated Rate |
$9.65 |
| Rate for Payer: Aetna of CA HMO/PPO |
$7.44
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$9.65
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$6.24
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$6.24
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$6.76
|
| Rate for Payer: Blue Distinction Transplant |
$6.81
|
| Rate for Payer: Blue Shield of California Commercial |
$8.36
|
| Rate for Payer: Blue Shield of California EPN |
$6.63
|
| Rate for Payer: Cash Price |
$5.11
|
| Rate for Payer: Cigna of CA HMO |
$7.94
|
| Rate for Payer: Cigna of CA PPO |
$7.94
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$9.65
|
| Rate for Payer: Dignity Health Media |
$9.65
|
| Rate for Payer: Dignity Health Medi-Cal |
$9.65
|
| Rate for Payer: EPIC Health Plan Commercial |
$4.54
|
| Rate for Payer: EPIC Health Plan Transplant |
$4.54
|
| Rate for Payer: Galaxy Health WC |
$9.65
|
| Rate for Payer: Global Benefits Group Commercial |
$6.81
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$8.51
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$7.57
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4.32
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.72
|
| Rate for Payer: Multiplan Commercial |
$9.08
|
| Rate for Payer: Networks By Design Commercial |
$7.38
|
| Rate for Payer: Prime Health Services Commercial |
$9.65
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$6.81
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$6.81
|
| Rate for Payer: United Healthcare All Other Commercial |
$5.68
|
| Rate for Payer: United Healthcare All Other HMO |
$5.68
|
| Rate for Payer: United Healthcare HMO Rider |
$5.68
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$5.68
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$9.65
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$9.65
|
| Rate for Payer: Vantage Medical Group Senior |
$9.65
|
|
|
SEVELAMER CARBONATE 2.4 GRAM ORAL POWDER PACKET [99695]
|
Facility
|
OP
|
$2.27
|
|
|
Service Code
|
NDC 65862-931-08
|
| Hospital Charge Code |
1712470
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.54 |
| Max. Negotiated Rate |
$1.93 |
| Rate for Payer: Aetna of CA HMO/PPO |
$1.49
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1.93
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1.25
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1.35
|
| Rate for Payer: Blue Distinction Transplant |
$1.36
|
| Rate for Payer: Blue Shield of California Commercial |
$1.67
|
| Rate for Payer: Blue Shield of California EPN |
$1.33
|
| Rate for Payer: Cash Price |
$1.02
|
| Rate for Payer: Cigna of CA HMO |
$1.59
|
| Rate for Payer: Cigna of CA PPO |
$1.59
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1.93
|
| Rate for Payer: Dignity Health Media |
$1.93
|
| Rate for Payer: Dignity Health Medi-Cal |
$1.93
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.91
|
| Rate for Payer: EPIC Health Plan Transplant |
$0.91
|
| Rate for Payer: Galaxy Health WC |
$1.93
|
| Rate for Payer: Global Benefits Group Commercial |
$1.36
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$1.70
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1.51
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.86
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.54
|
| Rate for Payer: Multiplan Commercial |
$1.82
|
| Rate for Payer: Networks By Design Commercial |
$1.48
|
| Rate for Payer: Prime Health Services Commercial |
$1.93
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1.36
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1.36
|
| Rate for Payer: United Healthcare All Other Commercial |
$1.14
|
| Rate for Payer: United Healthcare All Other HMO |
$1.14
|
| Rate for Payer: United Healthcare HMO Rider |
$1.14
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1.14
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1.93
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1.93
|
| Rate for Payer: Vantage Medical Group Senior |
$1.93
|
|
|
SEVELAMER CARBONATE 2.4 GRAM ORAL POWDER PACKET [99695]
|
Facility
|
IP
|
$11.35
|
|
|
Service Code
|
NDC 43598-479-90
|
| Hospital Charge Code |
1712470
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$2.72 |
| Max. Negotiated Rate |
$9.65 |
| Rate for Payer: Blue Shield of California Commercial |
$8.08
|
| Rate for Payer: Blue Shield of California EPN |
$5.81
|
| Rate for Payer: Cash Price |
$5.11
|
| Rate for Payer: Cigna of CA HMO |
$7.94
|
| Rate for Payer: Cigna of CA PPO |
$7.94
|
| Rate for Payer: EPIC Health Plan Commercial |
$4.54
|
| Rate for Payer: Galaxy Health WC |
$9.65
|
| Rate for Payer: Global Benefits Group Commercial |
$6.81
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$7.57
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4.32
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.72
|
| Rate for Payer: Multiplan Commercial |
$9.08
|
| Rate for Payer: Networks By Design Commercial |
$7.38
|
| Rate for Payer: Prime Health Services Commercial |
$9.65
|
|
|
SEVELAMER CARBONATE 2.4 GRAM ORAL POWDER PACKET [99695]
|
Facility
|
OP
|
$11.35
|
|
|
Service Code
|
NDC 43598-479-01
|
| Hospital Charge Code |
1712470
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$2.72 |
| Max. Negotiated Rate |
$9.65 |
| Rate for Payer: Aetna of CA HMO/PPO |
$7.44
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$9.65
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$6.24
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$6.24
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$6.76
|
| Rate for Payer: Blue Distinction Transplant |
$6.81
|
| Rate for Payer: Blue Shield of California Commercial |
$8.36
|
| Rate for Payer: Blue Shield of California EPN |
$6.63
|
| Rate for Payer: Cash Price |
$5.11
|
| Rate for Payer: Cigna of CA HMO |
$7.94
|
| Rate for Payer: Cigna of CA PPO |
$7.94
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$9.65
|
| Rate for Payer: Dignity Health Media |
$9.65
|
| Rate for Payer: Dignity Health Medi-Cal |
$9.65
|
| Rate for Payer: EPIC Health Plan Commercial |
$4.54
|
| Rate for Payer: EPIC Health Plan Transplant |
$4.54
|
| Rate for Payer: Galaxy Health WC |
$9.65
|
| Rate for Payer: Global Benefits Group Commercial |
$6.81
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$8.51
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$7.57
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4.32
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.72
|
| Rate for Payer: Multiplan Commercial |
$9.08
|
| Rate for Payer: Networks By Design Commercial |
$7.38
|
| Rate for Payer: Prime Health Services Commercial |
$9.65
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$6.81
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$6.81
|
| Rate for Payer: United Healthcare All Other Commercial |
$5.68
|
| Rate for Payer: United Healthcare All Other HMO |
$5.68
|
| Rate for Payer: United Healthcare HMO Rider |
$5.68
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$5.68
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$9.65
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$9.65
|
| Rate for Payer: Vantage Medical Group Senior |
$9.65
|
|
|
SEVELAMER CARBONATE 2.4 GRAM ORAL POWDER PACKET [99695]
|
Facility
|
IP
|
$21.42
|
|
|
Service Code
|
NDC 58468-0131-1
|
| Hospital Charge Code |
1712470
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$5.14 |
| Max. Negotiated Rate |
$18.21 |
| Rate for Payer: Blue Shield of California Commercial |
$15.25
|
| Rate for Payer: Blue Shield of California EPN |
$10.97
|
| Rate for Payer: Cash Price |
$9.64
|
| Rate for Payer: Cigna of CA HMO |
$14.99
|
| Rate for Payer: Cigna of CA PPO |
$14.99
|
| Rate for Payer: EPIC Health Plan Commercial |
$8.57
|
| Rate for Payer: Galaxy Health WC |
$18.21
|
| Rate for Payer: Global Benefits Group Commercial |
$12.85
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$14.29
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$8.16
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5.14
|
| Rate for Payer: Multiplan Commercial |
$17.14
|
| Rate for Payer: Networks By Design Commercial |
$13.92
|
| Rate for Payer: Prime Health Services Commercial |
$18.21
|
|
|
SEVELAMER CARBONATE 2.4 GRAM ORAL POWDER PACKET [99695]
|
Facility
|
IP
|
$11.35
|
|
|
Service Code
|
NDC 0955-1054-90
|
| Hospital Charge Code |
1712470
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$2.72 |
| Max. Negotiated Rate |
$9.65 |
| Rate for Payer: Blue Shield of California Commercial |
$8.08
|
| Rate for Payer: Blue Shield of California EPN |
$5.81
|
| Rate for Payer: Cash Price |
$5.11
|
| Rate for Payer: Cigna of CA HMO |
$7.94
|
| Rate for Payer: Cigna of CA PPO |
$7.94
|
| Rate for Payer: EPIC Health Plan Commercial |
$4.54
|
| Rate for Payer: Galaxy Health WC |
$9.65
|
| Rate for Payer: Global Benefits Group Commercial |
$6.81
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$7.57
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4.32
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.72
|
| Rate for Payer: Multiplan Commercial |
$9.08
|
| Rate for Payer: Networks By Design Commercial |
$7.38
|
| Rate for Payer: Prime Health Services Commercial |
$9.65
|
|
|
SEVELAMER CARBONATE 2.4 GRAM ORAL POWDER PACKET [99695]
|
Facility
|
IP
|
$11.35
|
|
|
Service Code
|
NDC 0955-1054-01
|
| Hospital Charge Code |
1712470
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$2.72 |
| Max. Negotiated Rate |
$9.65 |
| Rate for Payer: Blue Shield of California Commercial |
$8.08
|
| Rate for Payer: Blue Shield of California EPN |
$5.81
|
| Rate for Payer: Cash Price |
$5.11
|
| Rate for Payer: Cigna of CA HMO |
$7.94
|
| Rate for Payer: Cigna of CA PPO |
$7.94
|
| Rate for Payer: EPIC Health Plan Commercial |
$4.54
|
| Rate for Payer: Galaxy Health WC |
$9.65
|
| Rate for Payer: Global Benefits Group Commercial |
$6.81
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$7.57
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4.32
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.72
|
| Rate for Payer: Multiplan Commercial |
$9.08
|
| Rate for Payer: Networks By Design Commercial |
$7.38
|
| Rate for Payer: Prime Health Services Commercial |
$9.65
|
|
|
SEVELAMER CARBONATE 800 MG TABLET [89201]
|
Facility
|
OP
|
$2.28
|
|
|
Service Code
|
NDC 68094-034-64
|
| Hospital Charge Code |
1712469
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.55 |
| Max. Negotiated Rate |
$1.94 |
| Rate for Payer: Aetna of CA HMO/PPO |
$1.50
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1.94
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1.25
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1.36
|
| Rate for Payer: Blue Distinction Transplant |
$1.37
|
| Rate for Payer: Blue Shield of California Commercial |
$1.68
|
| Rate for Payer: Blue Shield of California EPN |
$1.33
|
| Rate for Payer: Cash Price |
$1.03
|
| Rate for Payer: Cigna of CA HMO |
$1.60
|
| Rate for Payer: Cigna of CA PPO |
$1.60
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1.94
|
| Rate for Payer: Dignity Health Media |
$1.94
|
| Rate for Payer: Dignity Health Medi-Cal |
$1.94
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.91
|
| Rate for Payer: EPIC Health Plan Transplant |
$0.91
|
| Rate for Payer: Galaxy Health WC |
$1.94
|
| Rate for Payer: Global Benefits Group Commercial |
$1.37
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$1.71
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1.52
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.87
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.55
|
| Rate for Payer: Multiplan Commercial |
$1.82
|
| Rate for Payer: Networks By Design Commercial |
$1.48
|
| Rate for Payer: Prime Health Services Commercial |
$1.94
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1.37
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1.37
|
| Rate for Payer: United Healthcare All Other Commercial |
$1.14
|
| Rate for Payer: United Healthcare All Other HMO |
$1.14
|
| Rate for Payer: United Healthcare HMO Rider |
$1.14
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1.14
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1.94
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1.94
|
| Rate for Payer: Vantage Medical Group Senior |
$1.94
|
|
