SENNOSIDES 8.6 MG TABLET [11349]
|
Facility
OP
|
$0.04
|
|
Service Code
|
NDC 0904-6522-61
|
Hospital Charge Code |
1710631
|
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
|
|
SENNOSIDES 8.6 MG TABLET [11349]
|
Facility
IP
|
$0.02
|
|
Service Code
|
NDC 69618-640-01
|
Hospital Charge Code |
1710631
|
Hospital Revenue Code
|
259
|
Max. Negotiated Rate |
$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 |
$0.01
|
Rate for Payer: Cigna of CA PPO |
$0.01
|
Rate for Payer: EPIC Health Plan Commercial |
$0.01
|
Rate for Payer: Galaxy Health WC |
$0.02
|
Rate for Payer: Global Benefits Group Commercial |
$0.01
|
Rate for Payer: Health Management Network EPO/PPO |
$0.02
|
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 |
$0.02
|
Rate for Payer: Networks By Design Commercial |
$0.01
|
Rate for Payer: Prime Health Services Commercial |
$0.02
|
|
SENNOSIDES 8.6 MG TABLET [11349]
|
Facility
IP
|
$0.04
|
|
Service Code
|
NDC 71399-8245-3
|
Hospital Charge Code |
1710631
|
Hospital Revenue Code
|
259
|
Min. Negotiated Rate |
$0.01 |
Max. Negotiated Rate |
$0.04 |
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: 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
|
|
SENNOSIDES 8.6 MG TABLET [11349]
|
Facility
OP
|
$0.04
|
|
Service Code
|
NDC 71399-8245-3
|
Hospital Charge Code |
1710631
|
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
|
|
SENNOSIDES 8.6 MG TABLET [11349]
|
Facility
OP
|
$0.01
|
|
Service Code
|
NDC 0904-7252-80
|
Hospital Charge Code |
1710631
|
Hospital Revenue Code
|
259
|
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: Redlands Yucaipa Medical Group Commercial/Senior |
$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
|
|
SENNOSIDES 8.6 MG TABLET [11349]
|
Facility
OP
|
$0.02
|
|
Service Code
|
NDC 0904-6725-59
|
Hospital Charge Code |
1710631
|
Hospital Revenue Code
|
259
|
Max. Negotiated Rate |
$0.02 |
Rate for Payer: Aetna of CA HMO/PPO |
$0.01
|
Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$0.02
|
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 |
$0.01
|
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 |
$0.01
|
Rate for Payer: Cash Price |
$0.01
|
Rate for Payer: Central Health Plan Commercial |
$0.02
|
Rate for Payer: Cigna of CA HMO |
$0.01
|
Rate for Payer: Cigna of CA PPO |
$0.01
|
Rate for Payer: Dignity Health Commercial/Exchange |
$0.02
|
Rate for Payer: EPIC Health Plan Commercial |
$0.01
|
Rate for Payer: EPIC Health Plan Transplant |
$0.01
|
Rate for Payer: Galaxy Health WC |
$0.02
|
Rate for Payer: Global Benefits Group Commercial |
$0.01
|
Rate for Payer: Health Management Network EPO/PPO |
$0.02
|
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 |
$0.01
|
Rate for Payer: LLUH Dept of Risk Management WC |
$0.00
|
Rate for Payer: Multiplan Commercial |
$0.02
|
Rate for Payer: Networks By Design Commercial |
$0.01
|
Rate for Payer: Prime Health Services Commercial |
$0.02
|
Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$0.01
|
Rate for Payer: Riverside University Health MISP |
$0.01
|
Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.01
|
Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.01
|
Rate for Payer: United Healthcare All Other Commercial |
$0.01
|
Rate for Payer: United Healthcare All Other HMO |
$0.01
|
Rate for Payer: United Healthcare HMO Rider |
$0.01
|
Rate for Payer: United Healthcare Select/Navigate/Core |
$0.01
|
Rate for Payer: Vantage Medical Group Medi-Cal |
$0.02
|
Rate for Payer: Vantage Medical Group Senior |
$0.02
|
|
SENNOSIDES 8.6 MG TABLET [11349]
|
Facility
IP
|
$0.06
|
|
Service Code
|
NDC 46122-702-78
|
Hospital Charge Code |
1710631
|
Hospital Revenue Code
|
259
|
Min. Negotiated Rate |
$0.01 |
Max. Negotiated Rate |
$0.05 |
Rate for Payer: Blue Shield of California Commercial |
$0.05
|
Rate for Payer: Blue Shield of California EPN |
$0.03
|
Rate for Payer: Cash Price |
$0.03
|
Rate for Payer: Central Health Plan Commercial |
$0.05
|
Rate for Payer: Cigna of CA HMO |
$0.04
|
Rate for Payer: Cigna of CA PPO |
$0.04
|
Rate for Payer: EPIC Health Plan Commercial |
$0.02
|
Rate for Payer: Galaxy Health WC |
$0.05
|
Rate for Payer: Global Benefits Group Commercial |
$0.04
|
Rate for Payer: Health Management Network EPO/PPO |
$0.05
|
Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.04
|
Rate for Payer: LLUH Dept of Risk Management WC |
$0.01
|
Rate for Payer: Multiplan Commercial |
$0.05
|
Rate for Payer: Networks By Design Commercial |
$0.04
|
Rate for Payer: Prime Health Services Commercial |
$0.05
|
|
SENNOSIDES 8.6 MG TABLET [11349]
|
Facility
IP
|
$0.04
|
|
Service Code
|
NDC 0904-6522-61
|
Hospital Charge Code |
1710631
|
Hospital Revenue Code
|
259
|
Min. Negotiated Rate |
$0.01 |
Max. Negotiated Rate |
$0.04 |
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: 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
|
|
SENNOSIDES 8.6 MG TABLET [11349]
|
Facility
OP
|
$0.03
|
|
Service Code
|
NDC 70677-0058-1
|
Hospital Charge Code |
1710631
|
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
|
|
SENNOSIDES 8.6 MG TABLET [11349]
|
Facility
IP
|
$0.05
|
|
Service Code
|
NDC 8770143173
|
Hospital Charge Code |
1710631
|
Hospital Revenue Code
|
259
|
Min. Negotiated Rate |
$0.01 |
Max. Negotiated Rate |
$0.05 |
Rate for Payer: Blue Shield of California Commercial |
$0.04
|
Rate for Payer: Blue Shield of California EPN |
$0.03
|
Rate for Payer: Cash Price |
$0.02
|
Rate for Payer: Central Health Plan Commercial |
$0.04
|
Rate for Payer: Cigna of CA HMO |
$0.04
|
Rate for Payer: Cigna of CA PPO |
$0.04
|
Rate for Payer: EPIC Health Plan Commercial |
$0.02
|
Rate for Payer: Galaxy Health WC |
$0.04
|
Rate for Payer: Global Benefits Group Commercial |
$0.03
|
Rate for Payer: Health Management Network EPO/PPO |
$0.05
|
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 |
$0.04
|
Rate for Payer: Networks By Design Commercial |
$0.03
|
Rate for Payer: Prime Health Services Commercial |
$0.04
|
|
SENNOSIDES 8.6 MG TABLET [11349]
|
Facility
IP
|
$0.22
|
|
Service Code
|
NDC 67618-300-10
|
Hospital Charge Code |
1710631
|
Hospital Revenue Code
|
259
|
Min. Negotiated Rate |
$0.04 |
Max. Negotiated Rate |
$0.20 |
Rate for Payer: Blue Shield of California Commercial |
$0.17
|
Rate for Payer: Blue Shield of California EPN |
$0.12
|
Rate for Payer: Cash Price |
$0.10
|
Rate for Payer: Central Health Plan Commercial |
$0.18
|
Rate for Payer: Cigna of CA HMO |
$0.15
|
Rate for Payer: Cigna of CA PPO |
$0.15
|
Rate for Payer: EPIC Health Plan Commercial |
$0.09
|
Rate for Payer: Galaxy Health WC |
$0.19
|
Rate for Payer: Global Benefits Group Commercial |
$0.13
|
Rate for Payer: Health Management Network EPO/PPO |
$0.20
|
Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.15
|
Rate for Payer: LLUH Dept of Risk Management WC |
$0.04
|
Rate for Payer: Multiplan Commercial |
$0.17
|
Rate for Payer: Networks By Design Commercial |
$0.14
|
Rate for Payer: Prime Health Services Commercial |
$0.19
|
|
SENNOSIDES 8.8 MG/5 ML ORAL SYRUP [15168]
|
Facility
IP
|
$0.04
|
|
Service Code
|
NDC 69618-069-58
|
Hospital Charge Code |
1715722
|
Hospital Revenue Code
|
259
|
Min. Negotiated Rate |
$0.01 |
Max. Negotiated Rate |
$0.04 |
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: 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
|
|
SENNOSIDES 8.8 MG/5 ML ORAL SYRUP [15168]
|
Facility
IP
|
$0.04
|
|
Service Code
|
NDC 71399-8237-8
|
Hospital Charge Code |
1715722
|
Hospital Revenue Code
|
259
|
Min. Negotiated Rate |
$0.01 |
Max. Negotiated Rate |
$0.04 |
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: 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
|
|
SENNOSIDES 8.8 MG/5 ML ORAL SYRUP [15168]
|
Facility
OP
|
$0.04
|
|
Service Code
|
NDC 71399-8237-8
|
Hospital Charge Code |
1715722
|
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
|
|
SENNOSIDES 8.8 MG/5 ML ORAL SYRUP [15168]
|
Facility
OP
|
$0.04
|
|
Service Code
|
NDC 69618-069-58
|
Hospital Charge Code |
1715722
|
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
|
|
SEPTICEMIA AND DISSEMINATED INFECTIONS
|
Facility
IP
|
$8,706.66
|
|
Service Code
|
APR-DRG 7202
|
Min. Negotiated Rate |
$7,306.28 |
Max. Negotiated Rate |
$8,706.66 |
Rate for Payer: Adventist Health Medi-Cal |
$7,306.28
|
Rate for Payer: IEHP medi-cal |
$8,706.66
|
|
SEPTICEMIA AND DISSEMINATED INFECTIONS
|
Facility
IP
|
$6,769.91
|
|
Service Code
|
APR-DRG 7201
|
Min. Negotiated Rate |
$5,681.04 |
Max. Negotiated Rate |
$6,769.91 |
Rate for Payer: Adventist Health Medi-Cal |
$5,681.04
|
Rate for Payer: IEHP medi-cal |
$6,769.91
|
|
SEPTICEMIA AND DISSEMINATED INFECTIONS
|
Facility
IP
|
$12,796.37
|
|
Service Code
|
APR-DRG 7203
|
Min. Negotiated Rate |
$10,738.21 |
Max. Negotiated Rate |
$12,796.37 |
Rate for Payer: Adventist Health Medi-Cal |
$10,738.21
|
Rate for Payer: IEHP medi-cal |
$12,796.37
|
|
SEPTICEMIA AND DISSEMINATED INFECTIONS
|
Facility
IP
|
$22,323.90
|
|
Service Code
|
APR-DRG 7204
|
Min. Negotiated Rate |
$18,733.34 |
Max. Negotiated Rate |
$22,323.90 |
Rate for Payer: Adventist Health Medi-Cal |
$18,733.34
|
Rate for Payer: IEHP medi-cal |
$22,323.90
|
|
Septoplasty or submucous resection, with or without cartilage scoring, contouring or replacement with graft
|
Facility
OP
|
$15,354.00
|
|
Service Code
|
CPT 30520
|
Hospital Revenue Code
|
360
|
Min. Negotiated Rate |
$4,022.69 |
Max. Negotiated Rate |
$15,354.00 |
Rate for Payer: Adventist Health Medi-Cal |
$4,022.69
|
Rate for Payer: Aetna of CA HMO/PPO |
$10,567.00
|
Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$6,034.04
|
Rate for Payer: AlphaCare Medical Group Medi-Cal |
$4,424.96
|
Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$4,022.69
|
Rate for Payer: Anthem Blue Cross of CA Exchange |
$8,405.00
|
Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$10,254.00
|
Rate for Payer: Blue Shield of California Commercial |
$5,824.53
|
Rate for Payer: Blue Shield of California EPN |
$4,183.44
|
Rate for Payer: Caremore Medicare Advantage |
$4,022.69
|
Rate for Payer: Dignity Health Commercial/Exchange |
$6,034.04
|
Rate for Payer: EPIC Health Plan Commercial |
$5,430.63
|
Rate for Payer: EPIC Health Plan Medicare/Senior |
$4,022.69
|
Rate for Payer: EPIC Health Plan Transplant |
$4,022.69
|
Rate for Payer: Heritage Provider Network Commercial/Senior |
$6,597.21
|
Rate for Payer: IEHP medi-cal |
$6,637.44
|
Rate for Payer: IEHP Medicare Advantage |
$4,022.69
|
Rate for Payer: Innovage PACE Commercial |
$6,034.04
|
Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4,022.69
|
Rate for Payer: Molina Healthcare of CA Medi-Cal |
$5,390.40
|
Rate for Payer: Molina Healthcare of CA Medicare |
$5,390.40
|
Rate for Payer: Prime Health Services Medicare |
$4,264.05
|
Rate for Payer: Riverside University Health MISP |
$4,424.96
|
Rate for Payer: United Healthcare All Other Commercial |
$11,375.00
|
Rate for Payer: United Healthcare All Other HMO |
$15,354.00
|
Rate for Payer: United Healthcare HMO Rider |
$9,681.00
|
Rate for Payer: United Healthcare Select/Navigate/Core |
$8,852.00
|
Rate for Payer: Vantage Medical Group Commercial/Exchange |
$6,034.04
|
Rate for Payer: Vantage Medical Group Medi-Cal |
$4,424.96
|
Rate for Payer: Vantage Medical Group Senior |
$4,022.69
|
|
SERTRALINE 100 MG TABLET [11350]
|
Facility
OP
|
$0.11
|
|
Service Code
|
NDC 65862-013-30
|
Hospital Charge Code |
1711555
|
Hospital Revenue Code
|
259
|
Min. Negotiated Rate |
$0.02 |
Max. Negotiated Rate |
$0.10 |
Rate for Payer: Aetna of CA HMO/PPO |
$0.07
|
Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$0.09
|
Rate for Payer: AlphaCare Medical Group Medi-Cal |
$0.06
|
Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$0.06
|
Rate for Payer: Anthem Blue Cross of CA Exchange |
$0.05
|
Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.06
|
Rate for Payer: BCBS Transplant Transplant |
$0.07
|
Rate for Payer: Blue Shield of California Commercial |
$0.07
|
Rate for Payer: Blue Shield of California EPN |
$0.05
|
Rate for Payer: Cash Price |
$0.05
|
Rate for Payer: Central Health Plan Commercial |
$0.09
|
Rate for Payer: Cigna of CA HMO |
$0.08
|
Rate for Payer: Cigna of CA PPO |
$0.08
|
Rate for Payer: Dignity Health Commercial/Exchange |
$0.09
|
Rate for Payer: EPIC Health Plan Commercial |
$0.04
|
Rate for Payer: EPIC Health Plan Transplant |
$0.04
|
Rate for Payer: Galaxy Health WC |
$0.09
|
Rate for Payer: Global Benefits Group Commercial |
$0.07
|
Rate for Payer: Health Management Network EPO/PPO |
$0.10
|
Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$0.08
|
Rate for Payer: IEHP medi-cal |
$0.04
|
Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.07
|
Rate for Payer: LLUH Dept of Risk Management WC |
$0.02
|
Rate for Payer: Multiplan Commercial |
$0.08
|
Rate for Payer: Networks By Design Commercial |
$0.07
|
Rate for Payer: Prime Health Services Commercial |
$0.09
|
Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$0.07
|
Rate for Payer: Riverside University Health MISP |
$0.04
|
Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.07
|
Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.07
|
Rate for Payer: United Healthcare All Other Commercial |
$0.06
|
Rate for Payer: United Healthcare All Other HMO |
$0.06
|
Rate for Payer: United Healthcare HMO Rider |
$0.06
|
Rate for Payer: United Healthcare Select/Navigate/Core |
$0.06
|
Rate for Payer: Vantage Medical Group Medi-Cal |
$0.09
|
Rate for Payer: Vantage Medical Group Senior |
$0.09
|
|
SERTRALINE 100 MG TABLET [11350]
|
Facility
IP
|
$0.53
|
|
Service Code
|
NDC 60687-253-11
|
Hospital Charge Code |
1711555
|
Hospital Revenue Code
|
259
|
Min. Negotiated Rate |
$0.11 |
Max. Negotiated Rate |
$0.48 |
Rate for Payer: Blue Shield of California Commercial |
$0.40
|
Rate for Payer: Blue Shield of California EPN |
$0.28
|
Rate for Payer: Cash Price |
$0.24
|
Rate for Payer: Central Health Plan Commercial |
$0.42
|
Rate for Payer: Cigna of CA HMO |
$0.37
|
Rate for Payer: Cigna of CA PPO |
$0.37
|
Rate for Payer: EPIC Health Plan Commercial |
$0.21
|
Rate for Payer: Galaxy Health WC |
$0.45
|
Rate for Payer: Global Benefits Group Commercial |
$0.32
|
Rate for Payer: Health Management Network EPO/PPO |
$0.48
|
Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.35
|
Rate for Payer: LLUH Dept of Risk Management WC |
$0.11
|
Rate for Payer: Multiplan Commercial |
$0.40
|
Rate for Payer: Networks By Design Commercial |
$0.34
|
Rate for Payer: Prime Health Services Commercial |
$0.45
|
|
SERTRALINE 100 MG TABLET [11350]
|
Facility
OP
|
$0.12
|
|
Service Code
|
NDC 68180-353-06
|
Hospital Charge Code |
1711555
|
Hospital Revenue Code
|
259
|
Min. Negotiated Rate |
$0.02 |
Max. Negotiated Rate |
$0.11 |
Rate for Payer: Aetna of CA HMO/PPO |
$0.07
|
Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$0.10
|
Rate for Payer: AlphaCare Medical Group Medi-Cal |
$0.07
|
Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$0.07
|
Rate for Payer: Anthem Blue Cross of CA Exchange |
$0.06
|
Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.07
|
Rate for Payer: BCBS Transplant Transplant |
$0.07
|
Rate for Payer: Blue Shield of California Commercial |
$0.08
|
Rate for Payer: Blue Shield of California EPN |
$0.06
|
Rate for Payer: Cash Price |
$0.05
|
Rate for Payer: Central Health Plan Commercial |
$0.10
|
Rate for Payer: Cigna of CA HMO |
$0.08
|
Rate for Payer: Cigna of CA PPO |
$0.08
|
Rate for Payer: Dignity Health Commercial/Exchange |
$0.10
|
Rate for Payer: EPIC Health Plan Commercial |
$0.05
|
Rate for Payer: EPIC Health Plan Transplant |
$0.05
|
Rate for Payer: Galaxy Health WC |
$0.10
|
Rate for Payer: Global Benefits Group Commercial |
$0.07
|
Rate for Payer: Health Management Network EPO/PPO |
$0.11
|
Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$0.09
|
Rate for Payer: IEHP medi-cal |
$0.04
|
Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.08
|
Rate for Payer: LLUH Dept of Risk Management WC |
$0.02
|
Rate for Payer: Multiplan Commercial |
$0.09
|
Rate for Payer: Networks By Design Commercial |
$0.08
|
Rate for Payer: Prime Health Services Commercial |
$0.10
|
Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$0.07
|
Rate for Payer: Riverside University Health MISP |
$0.05
|
Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.07
|
Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.07
|
Rate for Payer: United Healthcare All Other Commercial |
$0.06
|
Rate for Payer: United Healthcare All Other HMO |
$0.06
|
Rate for Payer: United Healthcare HMO Rider |
$0.06
|
Rate for Payer: United Healthcare Select/Navigate/Core |
$0.06
|
Rate for Payer: Vantage Medical Group Medi-Cal |
$0.10
|
Rate for Payer: Vantage Medical Group Senior |
$0.10
|
|
SERTRALINE 100 MG TABLET [11350]
|
Facility
IP
|
$0.23
|
|
Service Code
|
NDC 69097-835-02
|
Hospital Charge Code |
1711555
|
Hospital Revenue Code
|
259
|
Min. Negotiated Rate |
$0.05 |
Max. Negotiated Rate |
$0.21 |
Rate for Payer: Blue Shield of California Commercial |
$0.17
|
Rate for Payer: Blue Shield of California EPN |
$0.12
|
Rate for Payer: Cash Price |
$0.10
|
Rate for Payer: Central Health Plan Commercial |
$0.18
|
Rate for Payer: Cigna of CA HMO |
$0.16
|
Rate for Payer: Cigna of CA PPO |
$0.16
|
Rate for Payer: EPIC Health Plan Commercial |
$0.09
|
Rate for Payer: Galaxy Health WC |
$0.20
|
Rate for Payer: Global Benefits Group Commercial |
$0.14
|
Rate for Payer: Health Management Network EPO/PPO |
$0.21
|
Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.15
|
Rate for Payer: LLUH Dept of Risk Management WC |
$0.05
|
Rate for Payer: Multiplan Commercial |
$0.17
|
Rate for Payer: Networks By Design Commercial |
$0.15
|
Rate for Payer: Prime Health Services Commercial |
$0.20
|
|
SERTRALINE 100 MG TABLET [11350]
|
Facility
OP
|
$0.23
|
|
Service Code
|
NDC 69097-835-02
|
Hospital Charge Code |
1711555
|
Hospital Revenue Code
|
259
|
Min. Negotiated Rate |
$0.05 |
Max. Negotiated Rate |
$0.21 |
Rate for Payer: Aetna of CA HMO/PPO |
$0.14
|
Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$0.20
|
Rate for Payer: AlphaCare Medical Group Medi-Cal |
$0.13
|
Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$0.13
|
Rate for Payer: Anthem Blue Cross of CA Exchange |
$0.11
|
Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.14
|
Rate for Payer: BCBS Transplant Transplant |
$0.14
|
Rate for Payer: Blue Shield of California Commercial |
$0.14
|
Rate for Payer: Blue Shield of California EPN |
$0.11
|
Rate for Payer: Cash Price |
$0.10
|
Rate for Payer: Central Health Plan Commercial |
$0.18
|
Rate for Payer: Cigna of CA HMO |
$0.16
|
Rate for Payer: Cigna of CA PPO |
$0.16
|
Rate for Payer: Dignity Health Commercial/Exchange |
$0.20
|
Rate for Payer: EPIC Health Plan Commercial |
$0.09
|
Rate for Payer: EPIC Health Plan Transplant |
$0.09
|
Rate for Payer: Galaxy Health WC |
$0.20
|
Rate for Payer: Global Benefits Group Commercial |
$0.14
|
Rate for Payer: Health Management Network EPO/PPO |
$0.21
|
Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$0.17
|
Rate for Payer: IEHP medi-cal |
$0.08
|
Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.15
|
Rate for Payer: LLUH Dept of Risk Management WC |
$0.05
|
Rate for Payer: Multiplan Commercial |
$0.17
|
Rate for Payer: Networks By Design Commercial |
$0.15
|
Rate for Payer: Prime Health Services Commercial |
$0.20
|
Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$0.14
|
Rate for Payer: Riverside University Health MISP |
$0.09
|
Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.14
|
Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.14
|
Rate for Payer: United Healthcare All Other Commercial |
$0.12
|
Rate for Payer: United Healthcare All Other HMO |
$0.12
|
Rate for Payer: United Healthcare HMO Rider |
$0.12
|
Rate for Payer: United Healthcare Select/Navigate/Core |
$0.12
|
Rate for Payer: Vantage Medical Group Medi-Cal |
$0.20
|
Rate for Payer: Vantage Medical Group Senior |
$0.20
|
|