|
PHENYTOIN SODIUM EXTENDED 100 MG CAPSULE [6257]
|
Facility
IP
|
$0.62
|
|
|
Service Code
|
NDC 51672-4111-1
|
| Hospital Charge Code |
1710147
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.12 |
| Max. Negotiated Rate |
$34,005.88 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$34,005.88
|
| Rate for Payer: Blue Shield of California Commercial |
$0.47
|
| Rate for Payer: Blue Shield of California EPN |
$0.33
|
| Rate for Payer: Cash Price |
$0.28
|
| Rate for Payer: Cash Price |
$0.28
|
| Rate for Payer: Central Health Plan Commercial |
$0.50
|
| Rate for Payer: Cigna of CA HMO |
$0.43
|
| Rate for Payer: Cigna of CA PPO |
$0.43
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.25
|
| Rate for Payer: Galaxy Health WC |
$0.53
|
| Rate for Payer: Global Benefits Group Commercial |
$0.37
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.56
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.41
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.12
|
| Rate for Payer: Multiplan Commercial |
$0.47
|
| Rate for Payer: Networks By Design Commercial |
$0.40
|
| Rate for Payer: Prime Health Services Commercial |
$0.53
|
|
|
PHENYTOIN SODIUM EXTENDED 100 MG CAPSULE [6257]
|
Facility
OP
|
$0.64
|
|
|
Service Code
|
NDC 68084-376-01
|
| Hospital Charge Code |
1710147
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.13 |
| Max. Negotiated Rate |
$0.58 |
| Rate for Payer: Aetna of CA HMO/PPO |
$0.39
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$0.54
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$0.35
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$0.35
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$0.31
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.38
|
| Rate for Payer: BCBS Transplant Transplant |
$0.38
|
| Rate for Payer: Blue Shield of California Commercial |
$0.40
|
| Rate for Payer: Blue Shield of California EPN |
$0.31
|
| Rate for Payer: Cash Price |
$0.29
|
| Rate for Payer: Central Health Plan Commercial |
$0.51
|
| Rate for Payer: Cigna of CA HMO |
$0.45
|
| Rate for Payer: Cigna of CA PPO |
$0.45
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.54
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.26
|
| Rate for Payer: EPIC Health Plan Transplant |
$0.26
|
| Rate for Payer: Galaxy Health WC |
$0.54
|
| Rate for Payer: Global Benefits Group Commercial |
$0.38
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.58
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$0.48
|
| Rate for Payer: IEHP medi-cal |
$0.22
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.43
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.13
|
| Rate for Payer: Multiplan Commercial |
$0.48
|
| Rate for Payer: Networks By Design Commercial |
$0.42
|
| Rate for Payer: Prime Health Services Commercial |
$0.54
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$0.38
|
| Rate for Payer: Riverside University Health MISP |
$0.26
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.38
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.38
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.32
|
| Rate for Payer: United Healthcare All Other HMO |
$0.32
|
| Rate for Payer: United Healthcare HMO Rider |
$0.32
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.32
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.54
|
| Rate for Payer: Vantage Medical Group Senior |
$0.54
|
|
|
PHENYTOIN SODIUM EXTENDED 100 MG CAPSULE [6257]
|
Facility
IP
|
$0.64
|
|
|
Service Code
|
NDC 68084-376-11
|
| Hospital Charge Code |
1710147
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.13 |
| Max. Negotiated Rate |
$34,005.88 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$34,005.88
|
| Rate for Payer: Blue Shield of California Commercial |
$0.48
|
| Rate for Payer: Blue Shield of California EPN |
$0.34
|
| Rate for Payer: Cash Price |
$0.29
|
| Rate for Payer: Cash Price |
$0.29
|
| Rate for Payer: Central Health Plan Commercial |
$0.51
|
| Rate for Payer: Cigna of CA HMO |
$0.45
|
| Rate for Payer: Cigna of CA PPO |
$0.45
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.26
|
| Rate for Payer: Galaxy Health WC |
$0.54
|
| Rate for Payer: Global Benefits Group Commercial |
$0.38
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.58
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.43
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.13
|
| Rate for Payer: Multiplan Commercial |
$0.48
|
| Rate for Payer: Networks By Design Commercial |
$0.42
|
| Rate for Payer: Prime Health Services Commercial |
$0.54
|
|
|
PHENYTOIN SODIUM EXTENDED 30 MG CAPSULE [11019]
|
Facility
IP
|
$1.66
|
|
|
Service Code
|
NDC 0071-3740-66
|
| Hospital Charge Code |
1710163
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.33 |
| Max. Negotiated Rate |
$34,005.88 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$34,005.88
|
| Rate for Payer: Blue Shield of California Commercial |
$1.24
|
| Rate for Payer: Blue Shield of California EPN |
$0.89
|
| Rate for Payer: Cash Price |
$0.75
|
| Rate for Payer: Cash Price |
$0.75
|
| Rate for Payer: Central Health Plan Commercial |
$1.33
|
| Rate for Payer: Cigna of CA HMO |
$1.16
|
| Rate for Payer: Cigna of CA PPO |
$1.16
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.66
|
| Rate for Payer: Galaxy Health WC |
$1.41
|
| Rate for Payer: Global Benefits Group Commercial |
$1.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$1.49
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1.11
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.33
|
| Rate for Payer: Multiplan Commercial |
$1.24
|
| Rate for Payer: Networks By Design Commercial |
$1.08
|
| Rate for Payer: Prime Health Services Commercial |
$1.41
|
|
|
PHENYTOIN SODIUM EXTENDED 30 MG CAPSULE [11019]
|
Facility
OP
|
$1.66
|
|
|
Service Code
|
NDC 0071-3740-66
|
| Hospital Charge Code |
1710163
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.33 |
| Max. Negotiated Rate |
$1.49 |
| Rate for Payer: Aetna of CA HMO/PPO |
$1.01
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$1.41
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$0.91
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$0.91
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$0.80
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.98
|
| Rate for Payer: BCBS Transplant Transplant |
$1.00
|
| Rate for Payer: Blue Shield of California Commercial |
$1.04
|
| Rate for Payer: Blue Shield of California EPN |
$0.81
|
| Rate for Payer: Cash Price |
$0.75
|
| Rate for Payer: Central Health Plan Commercial |
$1.33
|
| Rate for Payer: Cigna of CA HMO |
$1.16
|
| Rate for Payer: Cigna of CA PPO |
$1.16
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1.41
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.66
|
| Rate for Payer: EPIC Health Plan Transplant |
$0.66
|
| Rate for Payer: Galaxy Health WC |
$1.41
|
| Rate for Payer: Global Benefits Group Commercial |
$1.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$1.49
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$1.24
|
| Rate for Payer: IEHP medi-cal |
$0.58
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1.11
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.33
|
| Rate for Payer: Multiplan Commercial |
$1.24
|
| Rate for Payer: Networks By Design Commercial |
$1.08
|
| Rate for Payer: Prime Health Services Commercial |
$1.41
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$1.00
|
| Rate for Payer: Riverside University Health MISP |
$0.66
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.83
|
| Rate for Payer: United Healthcare All Other HMO |
$0.83
|
| Rate for Payer: United Healthcare HMO Rider |
$0.83
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.83
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1.41
|
| Rate for Payer: Vantage Medical Group Senior |
$1.41
|
|
|
PHOS-NAK ORAL SOLN CMPND 25 MG/ML (0.8 MMOL/ML) [4080310]
|
Facility
OP
|
$0.04
|
|
|
Service Code
|
NDC 9994-0803-10
|
| Hospital Charge Code |
NDG2867
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.01 |
| Max. Negotiated Rate |
$0.04 |
| Rate for Payer: Aetna of CA HMO/PPO |
$0.02
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$0.03
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$0.02
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$0.02
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$0.02
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.02
|
| Rate for Payer: BCBS Transplant Transplant |
$0.02
|
| Rate for Payer: Blue Shield of California Commercial |
$0.03
|
| Rate for Payer: Blue Shield of California EPN |
$0.02
|
| Rate for Payer: Cash Price |
$0.02
|
| Rate for Payer: Central Health Plan Commercial |
$0.03
|
| 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: 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 Management Network EPO/PPO |
$0.04
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$0.03
|
| Rate for Payer: IEHP medi-cal |
$0.01
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.03
|
| 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: Redlands Yucaipa Medical Group Commercial/Senior |
$0.02
|
| Rate for Payer: Riverside University Health MISP |
$0.02
|
| 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 Medi-Cal |
$0.03
|
| Rate for Payer: Vantage Medical Group Senior |
$0.03
|
|
|
PHOS-NAK ORAL SOLN CMPND 25 MG/ML (0.8 MMOL/ML) [4080310]
|
Facility
IP
|
$0.04
|
|
|
Service Code
|
NDC 9994-0803-10
|
| Hospital Charge Code |
NDG2867
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.01 |
| Max. Negotiated Rate |
$34,005.88 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$34,005.88
|
| Rate for Payer: Blue Shield of California Commercial |
$0.03
|
| Rate for Payer: Blue Shield of California EPN |
$0.02
|
| Rate for Payer: Cash Price |
$0.02
|
| Rate for Payer: Cash Price |
$0.02
|
| Rate for Payer: Central Health Plan Commercial |
$0.03
|
| 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: Health Management Network EPO/PPO |
$0.04
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.03
|
| 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
|
|
|
PHOSPHATE DIALYSIS SOLN WITHOUT DEXTR K 4 MEQ-CA 2.5 MEQ-PO4 1 MMOL/L [212681]
|
Facility
IP
|
$0.01
|
|
|
Service Code
|
NDC 24571-116-06
|
| Hospital Charge Code |
NDG212681
|
|
Hospital Revenue Code
|
250
|
| Max. Negotiated Rate |
$34,005.88 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$34,005.88
|
| Rate for Payer: Blue Shield of California Commercial |
$0.01
|
| Rate for Payer: Blue Shield of California EPN |
$0.01
|
| Rate for Payer: Central Health Plan Commercial |
$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: Health Management Network EPO/PPO |
$0.01
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.01
|
| 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
|
|
|
PHOSPHATE DIALYSIS SOLN WITHOUT DEXTR K 4 MEQ-CA 2.5 MEQ-PO4 1 MMOL/L [212681]
|
Facility
OP
|
$0.01
|
|
|
Service Code
|
NDC 24571-116-05
|
| Hospital Charge Code |
NDG212681
|
|
Hospital Revenue Code
|
250
|
| Max. Negotiated Rate |
$0.01 |
| Rate for Payer: Aetna of CA HMO/PPO |
$0.01
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$0.01
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$0.01
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$0.01
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$0.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.01
|
| Rate for Payer: BCBS Transplant Transplant |
$0.01
|
| Rate for Payer: Blue Shield of California Commercial |
$0.01
|
| Rate for Payer: Blue Shield of California EPN |
$0.00
|
| Rate for Payer: Central Health Plan Commercial |
$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: 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 Management Network EPO/PPO |
$0.01
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$0.01
|
| Rate for Payer: IEHP medi-cal |
$0.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.01
|
| 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: Riverside University Health MISP |
$0.00
|
| 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 Medi-Cal |
$0.01
|
| Rate for Payer: Vantage Medical Group Senior |
$0.01
|
|
|
PHOSPHATE DIALYSIS SOLN WITHOUT DEXTR K 4 MEQ-CA 2.5 MEQ-PO4 1 MMOL/L [212681]
|
Facility
OP
|
$0.01
|
|
|
Service Code
|
NDC 24571-116-06
|
| Hospital Charge Code |
NDG212681
|
|
Hospital Revenue Code
|
250
|
| Max. Negotiated Rate |
$0.01 |
| Rate for Payer: Aetna of CA HMO/PPO |
$0.01
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$0.01
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$0.01
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$0.01
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$0.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.01
|
| Rate for Payer: BCBS Transplant Transplant |
$0.01
|
| Rate for Payer: Blue Shield of California Commercial |
$0.01
|
| Rate for Payer: Blue Shield of California EPN |
$0.00
|
| Rate for Payer: Central Health Plan Commercial |
$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: 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 Management Network EPO/PPO |
$0.01
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$0.01
|
| Rate for Payer: IEHP medi-cal |
$0.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.01
|
| 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: Riverside University Health MISP |
$0.00
|
| 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 Medi-Cal |
$0.01
|
| Rate for Payer: Vantage Medical Group Senior |
$0.01
|
|
|
PHOSPHATE DIALYSIS SOLN WITHOUT DEXTR K 4 MEQ-CA 2.5 MEQ-PO4 1 MMOL/L [212681]
|
Facility
IP
|
$0.01
|
|
|
Service Code
|
NDC 24571-116-05
|
| Hospital Charge Code |
NDG212681
|
|
Hospital Revenue Code
|
250
|
| Max. Negotiated Rate |
$34,005.88 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$34,005.88
|
| Rate for Payer: Blue Shield of California Commercial |
$0.01
|
| Rate for Payer: Blue Shield of California EPN |
$0.01
|
| Rate for Payer: Central Health Plan Commercial |
$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: Health Management Network EPO/PPO |
$0.01
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.01
|
| 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
|
|
|
PHOSPHATE DIALY SOLN W-OUT CALCIUM,DEX K 4 MEQ-MG 1.5 MEQ-PO4 1 MMOL/L [212682]
|
Facility
IP
|
$0.01
|
|
|
Service Code
|
NDC 24571-117-05
|
| Hospital Charge Code |
NDG212682
|
|
Hospital Revenue Code
|
250
|
| Max. Negotiated Rate |
$34,005.88 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$34,005.88
|
| Rate for Payer: Blue Shield of California Commercial |
$0.01
|
| Rate for Payer: Blue Shield of California EPN |
$0.01
|
| Rate for Payer: Central Health Plan Commercial |
$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: Health Management Network EPO/PPO |
$0.01
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.01
|
| 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
|
|
|
PHOSPHATE DIALY SOLN W-OUT CALCIUM,DEX K 4 MEQ-MG 1.5 MEQ-PO4 1 MMOL/L [212682]
|
Facility
OP
|
$0.01
|
|
|
Service Code
|
NDC 24571-117-05
|
| Hospital Charge Code |
NDG212682
|
|
Hospital Revenue Code
|
250
|
| Max. Negotiated Rate |
$0.01 |
| Rate for Payer: Aetna of CA HMO/PPO |
$0.01
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$0.01
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$0.01
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$0.01
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$0.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.01
|
| Rate for Payer: BCBS Transplant Transplant |
$0.01
|
| Rate for Payer: Blue Shield of California Commercial |
$0.01
|
| Rate for Payer: Blue Shield of California EPN |
$0.00
|
| Rate for Payer: Central Health Plan Commercial |
$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: 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 Management Network EPO/PPO |
$0.01
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$0.01
|
| Rate for Payer: IEHP medi-cal |
$0.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.01
|
| 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: Riverside University Health MISP |
$0.00
|
| 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 Medi-Cal |
$0.01
|
| Rate for Payer: Vantage Medical Group Senior |
$0.01
|
|
|
PHOSPHORATED CARBOHYDRATE ORAL SOLUTION [11022]
|
Facility
IP
|
$0.03
|
|
|
Service Code
|
NDC 1093939933
|
| Hospital Charge Code |
1719016
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.01 |
| Max. Negotiated Rate |
$34,005.88 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$34,005.88
|
| 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: Cash Price |
$0.01
|
| Rate for Payer: Central Health Plan Commercial |
$0.02
|
| 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: Health Management Network EPO/PPO |
$0.03
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.02
|
| 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
|
|
|
PHOSPHORATED CARBOHYDRATE ORAL SOLUTION [11022]
|
Facility
OP
|
$0.03
|
|
|
Service Code
|
NDC 1093939933
|
| Hospital Charge Code |
1719016
|
|
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: AlphaCare Medical Group Commercial/Exchange |
$0.03
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$0.02
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$0.02
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$0.01
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.02
|
| Rate for Payer: BCBS Transplant Transplant |
$0.02
|
| Rate for Payer: Blue Shield of California Commercial |
$0.02
|
| Rate for Payer: Blue Shield of California EPN |
$0.01
|
| Rate for Payer: Cash Price |
$0.01
|
| Rate for Payer: Central Health Plan Commercial |
$0.02
|
| 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: 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 Management Network EPO/PPO |
$0.03
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$0.02
|
| Rate for Payer: IEHP medi-cal |
$0.01
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.02
|
| 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: Redlands Yucaipa Medical Group Commercial/Senior |
$0.02
|
| Rate for Payer: Riverside University Health MISP |
$0.01
|
| 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 Medi-Cal |
$0.03
|
| Rate for Payer: Vantage Medical Group Senior |
$0.03
|
|
|
PHYSOSTIGMINE 1 MG/ML INJECTION SOLUTION [6270]
|
Facility
IP
|
$46.97
|
|
|
Service Code
|
NDC 17478-510-02
|
| Hospital Charge Code |
1720007
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$9.39 |
| Max. Negotiated Rate |
$34,005.88 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$34,005.88
|
| Rate for Payer: Blue Shield of California Commercial |
$35.23
|
| Rate for Payer: Blue Shield of California EPN |
$25.08
|
| Rate for Payer: Cash Price |
$21.14
|
| Rate for Payer: Cash Price |
$21.14
|
| Rate for Payer: Central Health Plan Commercial |
$37.58
|
| Rate for Payer: EPIC Health Plan Commercial |
$18.79
|
| Rate for Payer: Galaxy Health WC |
$39.92
|
| Rate for Payer: Global Benefits Group Commercial |
$28.18
|
| Rate for Payer: Health Management Network EPO/PPO |
$42.27
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$31.33
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$9.39
|
| Rate for Payer: Multiplan Commercial |
$35.23
|
| Rate for Payer: Networks By Design Commercial |
$30.53
|
| Rate for Payer: Prime Health Services Commercial |
$39.92
|
|
|
PHYSOSTIGMINE 1 MG/ML INJECTION SOLUTION [6270]
|
Facility
OP
|
$46.97
|
|
|
Service Code
|
NDC 17478-510-02
|
| Hospital Charge Code |
1720007
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$9.39 |
| Max. Negotiated Rate |
$42.27 |
| Rate for Payer: Aetna of CA HMO/PPO |
$28.52
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$39.92
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$25.83
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$25.83
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$22.74
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$27.75
|
| Rate for Payer: BCBS Transplant Transplant |
$28.18
|
| Rate for Payer: Blue Shield of California Commercial |
$29.54
|
| Rate for Payer: Blue Shield of California EPN |
$22.97
|
| Rate for Payer: Cash Price |
$21.14
|
| Rate for Payer: Cash Price |
$21.14
|
| Rate for Payer: Central Health Plan Commercial |
$37.58
|
| Rate for Payer: Cigna of CA HMO |
$30.06
|
| Rate for Payer: Cigna of CA PPO |
$34.76
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$39.92
|
| Rate for Payer: EPIC Health Plan Commercial |
$18.79
|
| Rate for Payer: EPIC Health Plan Transplant |
$18.79
|
| Rate for Payer: Galaxy Health WC |
$39.92
|
| Rate for Payer: Global Benefits Group Commercial |
$28.18
|
| Rate for Payer: Health Management Network EPO/PPO |
$42.27
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$35.23
|
| Rate for Payer: IEHP medi-cal |
$16.44
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$31.33
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$9.39
|
| Rate for Payer: Multiplan Commercial |
$35.23
|
| Rate for Payer: Networks By Design Commercial |
$30.53
|
| Rate for Payer: Prime Health Services Commercial |
$39.92
|
| Rate for Payer: Riverside University Health MISP |
$18.79
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$28.18
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$28.18
|
| Rate for Payer: United Healthcare All Other Commercial |
$23.48
|
| Rate for Payer: United Healthcare All Other HMO |
$23.48
|
| Rate for Payer: United Healthcare HMO Rider |
$23.48
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$23.48
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$39.92
|
| Rate for Payer: Vantage Medical Group Senior |
$39.92
|
|
|
PHYTONADIONE (VITAMIN K1) 10 MG/ML INJECTION SOLUTION [11023]
|
Facility
IP
|
$51.32
|
|
|
Service Code
|
CPT J3430
|
| Hospital Charge Code |
1720131
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$10.26 |
| Max. Negotiated Rate |
$34,005.88 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$34,005.88
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$34,005.88
|
| Rate for Payer: Blue Shield of California Commercial |
$38.49
|
| Rate for Payer: Blue Shield of California Commercial |
$44.07
|
| Rate for Payer: Blue Shield of California EPN |
$27.40
|
| Rate for Payer: Blue Shield of California EPN |
$31.38
|
| Rate for Payer: Cash Price |
$26.44
|
| Rate for Payer: Cash Price |
$26.44
|
| Rate for Payer: Cash Price |
$23.09
|
| Rate for Payer: Cash Price |
$23.09
|
| Rate for Payer: Central Health Plan Commercial |
$41.06
|
| Rate for Payer: Central Health Plan Commercial |
$47.01
|
| Rate for Payer: Cigna of CA HMO |
$35.92
|
| Rate for Payer: Cigna of CA HMO |
$41.13
|
| Rate for Payer: Cigna of CA PPO |
$35.92
|
| Rate for Payer: Cigna of CA PPO |
$41.13
|
| Rate for Payer: EPIC Health Plan Commercial |
$20.53
|
| Rate for Payer: EPIC Health Plan Commercial |
$23.50
|
| Rate for Payer: EPIC Health Plan Transplant |
$23.50
|
| Rate for Payer: EPIC Health Plan Transplant |
$20.53
|
| Rate for Payer: Galaxy Health WC |
$43.62
|
| Rate for Payer: Galaxy Health WC |
$49.95
|
| Rate for Payer: Global Benefits Group Commercial |
$35.26
|
| Rate for Payer: Global Benefits Group Commercial |
$30.79
|
| Rate for Payer: Health Management Network EPO/PPO |
$46.19
|
| Rate for Payer: Health Management Network EPO/PPO |
$52.88
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$34.23
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$39.19
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$11.75
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$10.26
|
| Rate for Payer: Multiplan Commercial |
$38.49
|
| Rate for Payer: Multiplan Commercial |
$44.07
|
| Rate for Payer: Networks By Design Commercial |
$25.66
|
| Rate for Payer: Networks By Design Commercial |
$29.38
|
| Rate for Payer: Prime Health Services Commercial |
$43.62
|
| Rate for Payer: Prime Health Services Commercial |
$49.95
|
|
|
PHYTONADIONE (VITAMIN K1) 10 MG/ML INJECTION SOLUTION [11023]
|
Facility
OP
|
$51.32
|
|
|
Service Code
|
CPT J3430
|
| Hospital Charge Code |
1720131
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$2.85 |
| Max. Negotiated Rate |
$46.19 |
| Rate for Payer: Aetna of CA HMO/PPO |
$17.98
|
| Rate for Payer: Aetna of CA HMO/PPO |
$17.98
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$49.95
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$43.62
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$32.32
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$28.23
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$32.32
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$28.23
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$8.59
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$8.59
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$9.41
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$9.41
|
| Rate for Payer: BCBS Transplant Transplant |
$30.79
|
| Rate for Payer: BCBS Transplant Transplant |
$35.26
|
| Rate for Payer: Blue Shield of California Commercial |
$5.61
|
| Rate for Payer: Blue Shield of California Commercial |
$5.61
|
| Rate for Payer: Blue Shield of California EPN |
$5.10
|
| Rate for Payer: Blue Shield of California EPN |
$5.10
|
| Rate for Payer: Cash Price |
$26.44
|
| Rate for Payer: Cash Price |
$26.44
|
| Rate for Payer: Cash Price |
$23.09
|
| Rate for Payer: Cash Price |
$23.09
|
| Rate for Payer: Central Health Plan Commercial |
$47.01
|
| Rate for Payer: Central Health Plan Commercial |
$41.06
|
| Rate for Payer: Cigna of CA HMO |
$41.13
|
| Rate for Payer: Cigna of CA HMO |
$35.92
|
| Rate for Payer: Cigna of CA PPO |
$41.13
|
| Rate for Payer: Cigna of CA PPO |
$35.92
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$43.62
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$49.95
|
| Rate for Payer: EPIC Health Plan Commercial |
$23.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$20.53
|
| Rate for Payer: EPIC Health Plan Transplant |
$20.53
|
| Rate for Payer: EPIC Health Plan Transplant |
$23.50
|
| Rate for Payer: Galaxy Health WC |
$43.62
|
| Rate for Payer: Galaxy Health WC |
$49.95
|
| Rate for Payer: Global Benefits Group Commercial |
$35.26
|
| Rate for Payer: Global Benefits Group Commercial |
$30.79
|
| Rate for Payer: Health Management Network EPO/PPO |
$52.88
|
| Rate for Payer: Health Management Network EPO/PPO |
$46.19
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$38.49
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$44.07
|
| Rate for Payer: IEHP medi-cal |
$2.85
|
| Rate for Payer: IEHP medi-cal |
$2.85
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$39.19
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$34.23
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$10.26
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$11.75
|
| Rate for Payer: Multiplan Commercial |
$38.49
|
| Rate for Payer: Multiplan Commercial |
$44.07
|
| Rate for Payer: Networks By Design Commercial |
$25.66
|
| Rate for Payer: Networks By Design Commercial |
$29.38
|
| Rate for Payer: Prime Health Services Commercial |
$43.62
|
| Rate for Payer: Prime Health Services Commercial |
$49.95
|
| Rate for Payer: Riverside University Health MISP |
$23.50
|
| Rate for Payer: Riverside University Health MISP |
$20.53
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$30.79
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$35.26
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$30.79
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$35.26
|
| Rate for Payer: United Healthcare All Other Commercial |
$29.38
|
| Rate for Payer: United Healthcare All Other Commercial |
$25.66
|
| Rate for Payer: United Healthcare All Other HMO |
$25.66
|
| Rate for Payer: United Healthcare All Other HMO |
$29.38
|
| Rate for Payer: United Healthcare HMO Rider |
$25.66
|
| Rate for Payer: United Healthcare HMO Rider |
$29.38
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$29.38
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$25.66
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$43.62
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$49.95
|
| Rate for Payer: Vantage Medical Group Senior |
$43.62
|
| Rate for Payer: Vantage Medical Group Senior |
$49.95
|
|
|
PHYTONADIONE (VITAMIN K1) 1 MG/0.5 ML INJECTION SOLUTION [110478]
|
Facility
OP
|
$11.39
|
|
|
Service Code
|
CPT J3430
|
| Hospital Charge Code |
NDG110478
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$2.28 |
| Max. Negotiated Rate |
$17.98 |
| Rate for Payer: Aetna of CA HMO/PPO |
$17.98
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$9.68
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$6.26
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$6.26
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$8.59
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$9.41
|
| Rate for Payer: BCBS Transplant Transplant |
$6.83
|
| Rate for Payer: Blue Shield of California Commercial |
$5.61
|
| Rate for Payer: Blue Shield of California EPN |
$5.10
|
| Rate for Payer: Cash Price |
$5.13
|
| Rate for Payer: Cash Price |
$5.13
|
| Rate for Payer: Central Health Plan Commercial |
$9.11
|
| Rate for Payer: Cigna of CA HMO |
$7.97
|
| Rate for Payer: Cigna of CA PPO |
$7.97
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$9.68
|
| Rate for Payer: EPIC Health Plan Commercial |
$4.56
|
| Rate for Payer: EPIC Health Plan Transplant |
$4.56
|
| Rate for Payer: Galaxy Health WC |
$9.68
|
| Rate for Payer: Global Benefits Group Commercial |
$6.83
|
| Rate for Payer: Health Management Network EPO/PPO |
$10.25
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$8.54
|
| Rate for Payer: IEHP medi-cal |
$2.85
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$7.60
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.28
|
| Rate for Payer: Multiplan Commercial |
$8.54
|
| Rate for Payer: Networks By Design Commercial |
$5.70
|
| Rate for Payer: Prime Health Services Commercial |
$9.68
|
| Rate for Payer: Riverside University Health MISP |
$4.56
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$6.83
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$6.83
|
| Rate for Payer: United Healthcare All Other Commercial |
$5.70
|
| Rate for Payer: United Healthcare All Other HMO |
$5.70
|
| Rate for Payer: United Healthcare HMO Rider |
$5.70
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$5.70
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$9.68
|
| Rate for Payer: Vantage Medical Group Senior |
$9.68
|
|
|
PHYTONADIONE (VITAMIN K1) 1 MG/0.5 ML INJECTION SOLUTION [110478]
|
Facility
IP
|
$11.39
|
|
|
Service Code
|
CPT J3430
|
| Hospital Charge Code |
NDG110478
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$2.28 |
| Max. Negotiated Rate |
$34,005.88 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$34,005.88
|
| Rate for Payer: Blue Shield of California Commercial |
$8.54
|
| Rate for Payer: Blue Shield of California EPN |
$6.08
|
| Rate for Payer: Cash Price |
$5.13
|
| Rate for Payer: Cash Price |
$5.13
|
| Rate for Payer: Central Health Plan Commercial |
$9.11
|
| Rate for Payer: Cigna of CA HMO |
$7.97
|
| Rate for Payer: Cigna of CA PPO |
$7.97
|
| Rate for Payer: EPIC Health Plan Commercial |
$4.56
|
| Rate for Payer: EPIC Health Plan Transplant |
$4.56
|
| Rate for Payer: Galaxy Health WC |
$9.68
|
| Rate for Payer: Global Benefits Group Commercial |
$6.83
|
| Rate for Payer: Health Management Network EPO/PPO |
$10.25
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$7.60
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.28
|
| Rate for Payer: Multiplan Commercial |
$8.54
|
| Rate for Payer: Networks By Design Commercial |
$5.70
|
| Rate for Payer: Prime Health Services Commercial |
$9.68
|
|
|
PHYTONADIONE (VITAMIN K1) 1 MG/0.5 ML INJECTION SYRINGE [6271]
|
Facility
IP
|
$59.35
|
|
|
Service Code
|
CPT J3430
|
| Hospital Charge Code |
1720082
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$11.87 |
| Max. Negotiated Rate |
$34,005.88 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$34,005.88
|
| Rate for Payer: Blue Shield of California Commercial |
$44.51
|
| Rate for Payer: Blue Shield of California EPN |
$31.69
|
| Rate for Payer: Cash Price |
$26.71
|
| Rate for Payer: Cash Price |
$26.71
|
| Rate for Payer: Central Health Plan Commercial |
$47.48
|
| Rate for Payer: Cigna of CA HMO |
$41.54
|
| Rate for Payer: Cigna of CA PPO |
$41.54
|
| Rate for Payer: EPIC Health Plan Commercial |
$23.74
|
| Rate for Payer: EPIC Health Plan Transplant |
$23.74
|
| Rate for Payer: Galaxy Health WC |
$50.45
|
| Rate for Payer: Global Benefits Group Commercial |
$35.61
|
| Rate for Payer: Health Management Network EPO/PPO |
$53.42
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$39.59
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$11.87
|
| Rate for Payer: Multiplan Commercial |
$44.51
|
| Rate for Payer: Networks By Design Commercial |
$29.68
|
| Rate for Payer: Prime Health Services Commercial |
$50.45
|
|
|
PHYTONADIONE (VITAMIN K1) 1 MG/0.5 ML INJECTION SYRINGE [6271]
|
Facility
OP
|
$59.35
|
|
|
Service Code
|
CPT J3430
|
| Hospital Charge Code |
1720082
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$2.85 |
| Max. Negotiated Rate |
$53.42 |
| Rate for Payer: Aetna of CA HMO/PPO |
$17.98
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$50.45
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$32.64
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$32.64
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$8.59
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$9.41
|
| Rate for Payer: BCBS Transplant Transplant |
$35.61
|
| Rate for Payer: Blue Shield of California Commercial |
$5.61
|
| Rate for Payer: Blue Shield of California EPN |
$5.10
|
| Rate for Payer: Cash Price |
$26.71
|
| Rate for Payer: Cash Price |
$26.71
|
| Rate for Payer: Central Health Plan Commercial |
$47.48
|
| Rate for Payer: Cigna of CA HMO |
$41.54
|
| Rate for Payer: Cigna of CA PPO |
$41.54
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$50.45
|
| Rate for Payer: EPIC Health Plan Commercial |
$23.74
|
| Rate for Payer: EPIC Health Plan Transplant |
$23.74
|
| Rate for Payer: Galaxy Health WC |
$50.45
|
| Rate for Payer: Global Benefits Group Commercial |
$35.61
|
| Rate for Payer: Health Management Network EPO/PPO |
$53.42
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$44.51
|
| Rate for Payer: IEHP medi-cal |
$2.85
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$39.59
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$11.87
|
| Rate for Payer: Multiplan Commercial |
$44.51
|
| Rate for Payer: Networks By Design Commercial |
$29.68
|
| Rate for Payer: Prime Health Services Commercial |
$50.45
|
| Rate for Payer: Riverside University Health MISP |
$23.74
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$35.61
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$35.61
|
| Rate for Payer: United Healthcare All Other Commercial |
$29.68
|
| Rate for Payer: United Healthcare All Other HMO |
$29.68
|
| Rate for Payer: United Healthcare HMO Rider |
$29.68
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$29.68
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$50.45
|
| Rate for Payer: Vantage Medical Group Senior |
$50.45
|
|
|
PHYTONADIONE (VITAMIN K1) 1 MG/0.5 ML ORAL SYRINGE [4081654]
|
Facility
IP
|
$59.35
|
|
|
Service Code
|
CPT J3430
|
| Hospital Charge Code |
1720082
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$11.87 |
| Max. Negotiated Rate |
$34,005.88 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$34,005.88
|
| Rate for Payer: Blue Shield of California Commercial |
$44.51
|
| Rate for Payer: Blue Shield of California EPN |
$31.69
|
| Rate for Payer: Cash Price |
$26.71
|
| Rate for Payer: Cash Price |
$26.71
|
| Rate for Payer: Central Health Plan Commercial |
$47.48
|
| Rate for Payer: Cigna of CA HMO |
$41.54
|
| Rate for Payer: Cigna of CA PPO |
$41.54
|
| Rate for Payer: EPIC Health Plan Commercial |
$23.74
|
| Rate for Payer: EPIC Health Plan Transplant |
$23.74
|
| Rate for Payer: Galaxy Health WC |
$50.45
|
| Rate for Payer: Global Benefits Group Commercial |
$35.61
|
| Rate for Payer: Health Management Network EPO/PPO |
$53.42
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$39.59
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$11.87
|
| Rate for Payer: Multiplan Commercial |
$44.51
|
| Rate for Payer: Networks By Design Commercial |
$29.68
|
| Rate for Payer: Prime Health Services Commercial |
$50.45
|
|
|
PHYTONADIONE (VITAMIN K1) 1 MG/0.5 ML ORAL SYRINGE [4081654]
|
Facility
OP
|
$59.35
|
|
|
Service Code
|
CPT J3430
|
| Hospital Charge Code |
1720082
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$2.85 |
| Max. Negotiated Rate |
$53.42 |
| Rate for Payer: Aetna of CA HMO/PPO |
$17.98
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$50.45
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$32.64
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$32.64
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$8.59
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$9.41
|
| Rate for Payer: BCBS Transplant Transplant |
$35.61
|
| Rate for Payer: Blue Shield of California Commercial |
$5.61
|
| Rate for Payer: Blue Shield of California EPN |
$5.10
|
| Rate for Payer: Cash Price |
$26.71
|
| Rate for Payer: Cash Price |
$26.71
|
| Rate for Payer: Central Health Plan Commercial |
$47.48
|
| Rate for Payer: Cigna of CA HMO |
$41.54
|
| Rate for Payer: Cigna of CA PPO |
$41.54
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$50.45
|
| Rate for Payer: EPIC Health Plan Commercial |
$23.74
|
| Rate for Payer: EPIC Health Plan Transplant |
$23.74
|
| Rate for Payer: Galaxy Health WC |
$50.45
|
| Rate for Payer: Global Benefits Group Commercial |
$35.61
|
| Rate for Payer: Health Management Network EPO/PPO |
$53.42
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$44.51
|
| Rate for Payer: IEHP medi-cal |
$2.85
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$39.59
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$11.87
|
| Rate for Payer: Multiplan Commercial |
$44.51
|
| Rate for Payer: Networks By Design Commercial |
$29.68
|
| Rate for Payer: Prime Health Services Commercial |
$50.45
|
| Rate for Payer: Riverside University Health MISP |
$23.74
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$35.61
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$35.61
|
| Rate for Payer: United Healthcare All Other Commercial |
$29.68
|
| Rate for Payer: United Healthcare All Other HMO |
$29.68
|
| Rate for Payer: United Healthcare HMO Rider |
$29.68
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$29.68
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$50.45
|
| Rate for Payer: Vantage Medical Group Senior |
$50.45
|
|
