|
SODIUM TETRADECYL SULFATE 1 % (10 MG/ML) INTRAVENOUS SOLUTION [41787]
|
Facility
OP
|
$46.88
|
|
|
Service Code
|
CPT J3490
|
| Hospital Charge Code |
1720348
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$9.38 |
| Max. Negotiated Rate |
$42.19 |
| Rate for Payer: Aetna of CA HMO/PPO |
$28.47
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$39.85
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$25.78
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$25.78
|
| Rate for Payer: BCBS Transplant Transplant |
$28.13
|
| Rate for Payer: Blue Shield of California Commercial |
$29.49
|
| Rate for Payer: Blue Shield of California EPN |
$22.92
|
| Rate for Payer: Cash Price |
$21.10
|
| Rate for Payer: Cash Price |
$21.10
|
| Rate for Payer: Central Health Plan Commercial |
$37.50
|
| Rate for Payer: Cigna of CA HMO |
$32.82
|
| Rate for Payer: Cigna of CA PPO |
$32.82
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$39.85
|
| Rate for Payer: EPIC Health Plan Commercial |
$18.75
|
| Rate for Payer: EPIC Health Plan Transplant |
$18.75
|
| Rate for Payer: Galaxy Health WC |
$39.85
|
| Rate for Payer: Global Benefits Group Commercial |
$28.13
|
| Rate for Payer: Health Management Network EPO/PPO |
$42.19
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$35.16
|
| Rate for Payer: IEHP medi-cal |
$16.41
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$31.27
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$9.38
|
| Rate for Payer: Multiplan Commercial |
$35.16
|
| Rate for Payer: Networks By Design Commercial |
$23.44
|
| Rate for Payer: Prime Health Services Commercial |
$39.85
|
| Rate for Payer: Riverside University Health MISP |
$18.75
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$28.13
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$28.13
|
| Rate for Payer: United Healthcare All Other Commercial |
$23.44
|
| Rate for Payer: United Healthcare All Other HMO |
$23.44
|
| Rate for Payer: United Healthcare HMO Rider |
$23.44
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$23.44
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$39.85
|
| Rate for Payer: Vantage Medical Group Senior |
$39.85
|
|
|
SODIUM TETRADECYL SULFATE 1 % (10 MG/ML) INTRAVENOUS SOLUTION [41787]
|
Facility
IP
|
$46.88
|
|
|
Service Code
|
CPT J3490
|
| Hospital Charge Code |
1720348
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$9.38 |
| Max. Negotiated Rate |
$42.19 |
| Rate for Payer: Blue Shield of California Commercial |
$35.16
|
| Rate for Payer: Blue Shield of California EPN |
$25.03
|
| Rate for Payer: Cash Price |
$21.10
|
| Rate for Payer: Central Health Plan Commercial |
$37.50
|
| Rate for Payer: Cigna of CA HMO |
$32.82
|
| Rate for Payer: Cigna of CA PPO |
$32.82
|
| Rate for Payer: EPIC Health Plan Commercial |
$18.75
|
| Rate for Payer: EPIC Health Plan Transplant |
$18.75
|
| Rate for Payer: Galaxy Health WC |
$39.85
|
| Rate for Payer: Global Benefits Group Commercial |
$28.13
|
| Rate for Payer: Health Management Network EPO/PPO |
$42.19
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$31.27
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$9.38
|
| Rate for Payer: Multiplan Commercial |
$35.16
|
| Rate for Payer: Networks By Design Commercial |
$23.44
|
| Rate for Payer: Prime Health Services Commercial |
$39.85
|
|
|
SODIUM TETRADECYL SULFATE 3 % (30 MG/ML) INTRAVENOUS SOLUTION [41793]
|
Facility
IP
|
$46.20
|
|
|
Service Code
|
NDC 24201-201-01
|
| Hospital Charge Code |
1720349
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$9.24 |
| Max. Negotiated Rate |
$41.58 |
| Rate for Payer: Blue Shield of California Commercial |
$34.65
|
| Rate for Payer: Blue Shield of California EPN |
$24.67
|
| Rate for Payer: Cash Price |
$20.79
|
| Rate for Payer: Central Health Plan Commercial |
$36.96
|
| Rate for Payer: EPIC Health Plan Commercial |
$18.48
|
| Rate for Payer: Galaxy Health WC |
$39.27
|
| Rate for Payer: Global Benefits Group Commercial |
$27.72
|
| Rate for Payer: Health Management Network EPO/PPO |
$41.58
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$30.82
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$9.24
|
| Rate for Payer: Multiplan Commercial |
$34.65
|
| Rate for Payer: Networks By Design Commercial |
$30.03
|
| Rate for Payer: Prime Health Services Commercial |
$39.27
|
|
|
SODIUM TETRADECYL SULFATE 3 % (30 MG/ML) INTRAVENOUS SOLUTION [41793]
|
Facility
OP
|
$46.88
|
|
|
Service Code
|
NDC 67457-163-02
|
| Hospital Charge Code |
1720349
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$9.38 |
| Max. Negotiated Rate |
$42.19 |
| Rate for Payer: Aetna of CA HMO/PPO |
$28.47
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$39.85
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$25.78
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$25.78
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$22.70
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$27.70
|
| Rate for Payer: BCBS Transplant Transplant |
$28.13
|
| Rate for Payer: Blue Shield of California Commercial |
$29.49
|
| Rate for Payer: Blue Shield of California EPN |
$22.92
|
| Rate for Payer: Cash Price |
$21.10
|
| Rate for Payer: Cash Price |
$21.10
|
| Rate for Payer: Central Health Plan Commercial |
$37.50
|
| Rate for Payer: Cigna of CA HMO |
$30.00
|
| Rate for Payer: Cigna of CA PPO |
$34.69
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$39.85
|
| Rate for Payer: EPIC Health Plan Commercial |
$18.75
|
| Rate for Payer: EPIC Health Plan Transplant |
$18.75
|
| Rate for Payer: Galaxy Health WC |
$39.85
|
| Rate for Payer: Global Benefits Group Commercial |
$28.13
|
| Rate for Payer: Health Management Network EPO/PPO |
$42.19
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$35.16
|
| Rate for Payer: IEHP medi-cal |
$16.41
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$31.27
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$9.38
|
| Rate for Payer: Multiplan Commercial |
$35.16
|
| Rate for Payer: Networks By Design Commercial |
$30.47
|
| Rate for Payer: Prime Health Services Commercial |
$39.85
|
| Rate for Payer: Riverside University Health MISP |
$18.75
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$28.13
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$28.13
|
| Rate for Payer: United Healthcare All Other Commercial |
$23.44
|
| Rate for Payer: United Healthcare All Other HMO |
$23.44
|
| Rate for Payer: United Healthcare HMO Rider |
$23.44
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$23.44
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$39.85
|
| Rate for Payer: Vantage Medical Group Senior |
$39.85
|
|
|
SODIUM TETRADECYL SULFATE 3 % (30 MG/ML) INTRAVENOUS SOLUTION [41793]
|
Facility
OP
|
$46.20
|
|
|
Service Code
|
NDC 24201-201-05
|
| Hospital Charge Code |
1720349
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$9.24 |
| Max. Negotiated Rate |
$41.58 |
| Rate for Payer: Aetna of CA HMO/PPO |
$28.06
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$39.27
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$25.41
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$25.41
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$22.37
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$27.29
|
| Rate for Payer: BCBS Transplant Transplant |
$27.72
|
| Rate for Payer: Blue Shield of California Commercial |
$29.06
|
| Rate for Payer: Blue Shield of California EPN |
$22.59
|
| Rate for Payer: Cash Price |
$20.79
|
| Rate for Payer: Cash Price |
$20.79
|
| Rate for Payer: Central Health Plan Commercial |
$36.96
|
| Rate for Payer: Cigna of CA HMO |
$29.57
|
| Rate for Payer: Cigna of CA PPO |
$34.19
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$39.27
|
| Rate for Payer: EPIC Health Plan Commercial |
$18.48
|
| Rate for Payer: EPIC Health Plan Transplant |
$18.48
|
| Rate for Payer: Galaxy Health WC |
$39.27
|
| Rate for Payer: Global Benefits Group Commercial |
$27.72
|
| Rate for Payer: Health Management Network EPO/PPO |
$41.58
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$34.65
|
| Rate for Payer: IEHP medi-cal |
$16.17
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$30.82
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$9.24
|
| Rate for Payer: Multiplan Commercial |
$34.65
|
| Rate for Payer: Networks By Design Commercial |
$30.03
|
| Rate for Payer: Prime Health Services Commercial |
$39.27
|
| Rate for Payer: Riverside University Health MISP |
$18.48
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$27.72
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$27.72
|
| Rate for Payer: United Healthcare All Other Commercial |
$23.10
|
| Rate for Payer: United Healthcare All Other HMO |
$23.10
|
| Rate for Payer: United Healthcare HMO Rider |
$23.10
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$23.10
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$39.27
|
| Rate for Payer: Vantage Medical Group Senior |
$39.27
|
|
|
SODIUM TETRADECYL SULFATE 3 % (30 MG/ML) INTRAVENOUS SOLUTION [41793]
|
Facility
OP
|
$46.20
|
|
|
Service Code
|
NDC 24201-201-01
|
| Hospital Charge Code |
1720349
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$9.24 |
| Max. Negotiated Rate |
$41.58 |
| Rate for Payer: Aetna of CA HMO/PPO |
$28.06
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$39.27
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$25.41
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$25.41
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$22.37
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$27.29
|
| Rate for Payer: BCBS Transplant Transplant |
$27.72
|
| Rate for Payer: Blue Shield of California Commercial |
$29.06
|
| Rate for Payer: Blue Shield of California EPN |
$22.59
|
| Rate for Payer: Cash Price |
$20.79
|
| Rate for Payer: Cash Price |
$20.79
|
| Rate for Payer: Central Health Plan Commercial |
$36.96
|
| Rate for Payer: Cigna of CA HMO |
$29.57
|
| Rate for Payer: Cigna of CA PPO |
$34.19
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$39.27
|
| Rate for Payer: EPIC Health Plan Commercial |
$18.48
|
| Rate for Payer: EPIC Health Plan Transplant |
$18.48
|
| Rate for Payer: Galaxy Health WC |
$39.27
|
| Rate for Payer: Global Benefits Group Commercial |
$27.72
|
| Rate for Payer: Health Management Network EPO/PPO |
$41.58
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$34.65
|
| Rate for Payer: IEHP medi-cal |
$16.17
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$30.82
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$9.24
|
| Rate for Payer: Multiplan Commercial |
$34.65
|
| Rate for Payer: Networks By Design Commercial |
$30.03
|
| Rate for Payer: Prime Health Services Commercial |
$39.27
|
| Rate for Payer: Riverside University Health MISP |
$18.48
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$27.72
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$27.72
|
| Rate for Payer: United Healthcare All Other Commercial |
$23.10
|
| Rate for Payer: United Healthcare All Other HMO |
$23.10
|
| Rate for Payer: United Healthcare HMO Rider |
$23.10
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$23.10
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$39.27
|
| Rate for Payer: Vantage Medical Group Senior |
$39.27
|
|
|
SODIUM TETRADECYL SULFATE 3 % (30 MG/ML) INTRAVENOUS SOLUTION [41793]
|
Facility
IP
|
$46.88
|
|
|
Service Code
|
NDC 67457-163-02
|
| Hospital Charge Code |
1720349
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$9.38 |
| Max. Negotiated Rate |
$42.19 |
| Rate for Payer: Blue Shield of California Commercial |
$35.16
|
| Rate for Payer: Blue Shield of California EPN |
$25.03
|
| Rate for Payer: Cash Price |
$21.10
|
| Rate for Payer: Central Health Plan Commercial |
$37.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$18.75
|
| Rate for Payer: Galaxy Health WC |
$39.85
|
| Rate for Payer: Global Benefits Group Commercial |
$28.13
|
| Rate for Payer: Health Management Network EPO/PPO |
$42.19
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$31.27
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$9.38
|
| Rate for Payer: Multiplan Commercial |
$35.16
|
| Rate for Payer: Networks By Design Commercial |
$30.47
|
| Rate for Payer: Prime Health Services Commercial |
$39.85
|
|
|
SODIUM TETRADECYL SULFATE 3 % (30 MG/ML) INTRAVENOUS SOLUTION [41793]
|
Facility
IP
|
$46.20
|
|
|
Service Code
|
NDC 24201-201-05
|
| Hospital Charge Code |
1720349
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$9.24 |
| Max. Negotiated Rate |
$41.58 |
| Rate for Payer: Blue Shield of California Commercial |
$34.65
|
| Rate for Payer: Blue Shield of California EPN |
$24.67
|
| Rate for Payer: Cash Price |
$20.79
|
| Rate for Payer: Central Health Plan Commercial |
$36.96
|
| Rate for Payer: EPIC Health Plan Commercial |
$18.48
|
| Rate for Payer: Galaxy Health WC |
$39.27
|
| Rate for Payer: Global Benefits Group Commercial |
$27.72
|
| Rate for Payer: Health Management Network EPO/PPO |
$41.58
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$30.82
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$9.24
|
| Rate for Payer: Multiplan Commercial |
$34.65
|
| Rate for Payer: Networks By Design Commercial |
$30.03
|
| Rate for Payer: Prime Health Services Commercial |
$39.27
|
|
|
SODIUM THIOSULFATE 12.5 GRAM/50 ML (250 MG/ML) INTRAVENOUS SOLUTION [7364]
|
Facility
IP
|
$2.14
|
|
|
Service Code
|
CPT J0208
|
| Hospital Charge Code |
NDG7364
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.43 |
| Max. Negotiated Rate |
$1.93 |
| Rate for Payer: Blue Shield of California Commercial |
$1.60
|
| Rate for Payer: Blue Shield of California EPN |
$1.14
|
| Rate for Payer: Cash Price |
$0.96
|
| Rate for Payer: Central Health Plan Commercial |
$1.71
|
| Rate for Payer: Cigna of CA HMO |
$1.50
|
| Rate for Payer: Cigna of CA PPO |
$1.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.86
|
| Rate for Payer: EPIC Health Plan Transplant |
$0.86
|
| Rate for Payer: Galaxy Health WC |
$1.82
|
| Rate for Payer: Global Benefits Group Commercial |
$1.28
|
| Rate for Payer: Health Management Network EPO/PPO |
$1.93
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1.43
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.43
|
| Rate for Payer: Multiplan Commercial |
$1.60
|
| Rate for Payer: Networks By Design Commercial |
$1.07
|
| Rate for Payer: Prime Health Services Commercial |
$1.82
|
|
|
SODIUM THIOSULFATE 12.5 GRAM/50 ML (250 MG/ML) INTRAVENOUS SOLUTION [7364]
|
Facility
OP
|
$2.14
|
|
|
Service Code
|
CPT J0208
|
| Hospital Charge Code |
NDG7364
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.43 |
| Max. Negotiated Rate |
$558.16 |
| Rate for Payer: Adventist Health Medi-Cal |
$96.19
|
| Rate for Payer: Aetna of CA HMO/PPO |
$558.16
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$120.24
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$105.81
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$105.81
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1.04
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1.26
|
| Rate for Payer: BCBS Transplant Transplant |
$1.28
|
| Rate for Payer: Blue Shield of California Commercial |
$1.35
|
| Rate for Payer: Blue Shield of California EPN |
$1.05
|
| Rate for Payer: Caremore Medicare Advantage |
$96.19
|
| Rate for Payer: Cash Price |
$0.96
|
| Rate for Payer: Cash Price |
$0.96
|
| Rate for Payer: Central Health Plan Commercial |
$1.71
|
| Rate for Payer: Cigna of CA HMO |
$1.50
|
| Rate for Payer: Cigna of CA PPO |
$1.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$120.24
|
| Rate for Payer: EPIC Health Plan Commercial |
$129.85
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$96.19
|
| Rate for Payer: EPIC Health Plan Transplant |
$96.19
|
| Rate for Payer: Galaxy Health WC |
$1.82
|
| Rate for Payer: Global Benefits Group Commercial |
$1.28
|
| Rate for Payer: Health Management Network EPO/PPO |
$1.93
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$1.60
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$157.75
|
| Rate for Payer: IEHP medi-cal |
$158.71
|
| Rate for Payer: IEHP Medicare Advantage |
$96.19
|
| Rate for Payer: Innovage PACE Commercial |
$144.28
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1.43
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$96.19
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.43
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$128.89
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$128.89
|
| Rate for Payer: Multiplan Commercial |
$1.60
|
| Rate for Payer: Networks By Design Commercial |
$1.07
|
| Rate for Payer: Prime Health Services Commercial |
$1.82
|
| Rate for Payer: Prime Health Services Medicare |
$101.96
|
| Rate for Payer: Riverside University Health MISP |
$105.81
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1.28
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1.28
|
| Rate for Payer: United Healthcare All Other Commercial |
$1.07
|
| Rate for Payer: United Healthcare All Other HMO |
$1.07
|
| Rate for Payer: United Healthcare HMO Rider |
$1.07
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1.07
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$120.24
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$105.81
|
| Rate for Payer: Vantage Medical Group Senior |
$105.81
|
|
|
SODIUM ZIRCONIUM CYCLOSILICATE 10 GRAM ORAL POWDER PACKET [222467]
|
Facility
IP
|
$31.26
|
|
|
Service Code
|
NDC 0310-1110-39
|
| Hospital Charge Code |
ERX222467
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$6.25 |
| Max. Negotiated Rate |
$28.13 |
| Rate for Payer: Blue Shield of California Commercial |
$23.44
|
| Rate for Payer: Blue Shield of California EPN |
$16.69
|
| Rate for Payer: Cash Price |
$14.07
|
| Rate for Payer: Central Health Plan Commercial |
$25.01
|
| Rate for Payer: Cigna of CA HMO |
$21.88
|
| Rate for Payer: Cigna of CA PPO |
$21.88
|
| Rate for Payer: EPIC Health Plan Commercial |
$12.50
|
| Rate for Payer: Galaxy Health WC |
$26.57
|
| Rate for Payer: Global Benefits Group Commercial |
$18.76
|
| Rate for Payer: Health Management Network EPO/PPO |
$28.13
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$20.85
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6.25
|
| Rate for Payer: Multiplan Commercial |
$23.44
|
| Rate for Payer: Networks By Design Commercial |
$20.32
|
| Rate for Payer: Prime Health Services Commercial |
$26.57
|
|
|
SODIUM ZIRCONIUM CYCLOSILICATE 10 GRAM ORAL POWDER PACKET [222467]
|
Facility
OP
|
$31.26
|
|
|
Service Code
|
NDC 0310-1110-01
|
| Hospital Charge Code |
ERX222467
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$6.25 |
| Max. Negotiated Rate |
$28.13 |
| Rate for Payer: Aetna of CA HMO/PPO |
$18.98
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$26.57
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$17.19
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$17.19
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$15.14
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$18.47
|
| Rate for Payer: BCBS Transplant Transplant |
$18.76
|
| Rate for Payer: Blue Shield of California Commercial |
$19.66
|
| Rate for Payer: Blue Shield of California EPN |
$15.29
|
| Rate for Payer: Cash Price |
$14.07
|
| Rate for Payer: Central Health Plan Commercial |
$25.01
|
| Rate for Payer: Cigna of CA HMO |
$21.88
|
| Rate for Payer: Cigna of CA PPO |
$21.88
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$26.57
|
| Rate for Payer: EPIC Health Plan Commercial |
$12.50
|
| Rate for Payer: EPIC Health Plan Transplant |
$12.50
|
| Rate for Payer: Galaxy Health WC |
$26.57
|
| Rate for Payer: Global Benefits Group Commercial |
$18.76
|
| Rate for Payer: Health Management Network EPO/PPO |
$28.13
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$23.44
|
| Rate for Payer: IEHP medi-cal |
$10.94
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$20.85
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6.25
|
| Rate for Payer: Multiplan Commercial |
$23.44
|
| Rate for Payer: Networks By Design Commercial |
$20.32
|
| Rate for Payer: Prime Health Services Commercial |
$26.57
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$18.76
|
| Rate for Payer: Riverside University Health MISP |
$12.50
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$18.76
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$18.76
|
| Rate for Payer: United Healthcare All Other Commercial |
$15.63
|
| Rate for Payer: United Healthcare All Other HMO |
$15.63
|
| Rate for Payer: United Healthcare HMO Rider |
$15.63
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$15.63
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$26.57
|
| Rate for Payer: Vantage Medical Group Senior |
$26.57
|
|
|
SODIUM ZIRCONIUM CYCLOSILICATE 10 GRAM ORAL POWDER PACKET [222467]
|
Facility
OP
|
$31.26
|
|
|
Service Code
|
NDC 0310-1110-39
|
| Hospital Charge Code |
ERX222467
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$6.25 |
| Max. Negotiated Rate |
$28.13 |
| Rate for Payer: Aetna of CA HMO/PPO |
$18.98
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$26.57
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$17.19
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$17.19
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$15.14
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$18.47
|
| Rate for Payer: BCBS Transplant Transplant |
$18.76
|
| Rate for Payer: Blue Shield of California Commercial |
$19.66
|
| Rate for Payer: Blue Shield of California EPN |
$15.29
|
| Rate for Payer: Cash Price |
$14.07
|
| Rate for Payer: Central Health Plan Commercial |
$25.01
|
| Rate for Payer: Cigna of CA HMO |
$21.88
|
| Rate for Payer: Cigna of CA PPO |
$21.88
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$26.57
|
| Rate for Payer: EPIC Health Plan Commercial |
$12.50
|
| Rate for Payer: EPIC Health Plan Transplant |
$12.50
|
| Rate for Payer: Galaxy Health WC |
$26.57
|
| Rate for Payer: Global Benefits Group Commercial |
$18.76
|
| Rate for Payer: Health Management Network EPO/PPO |
$28.13
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$23.44
|
| Rate for Payer: IEHP medi-cal |
$10.94
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$20.85
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6.25
|
| Rate for Payer: Multiplan Commercial |
$23.44
|
| Rate for Payer: Networks By Design Commercial |
$20.32
|
| Rate for Payer: Prime Health Services Commercial |
$26.57
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$18.76
|
| Rate for Payer: Riverside University Health MISP |
$12.50
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$18.76
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$18.76
|
| Rate for Payer: United Healthcare All Other Commercial |
$15.63
|
| Rate for Payer: United Healthcare All Other HMO |
$15.63
|
| Rate for Payer: United Healthcare HMO Rider |
$15.63
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$15.63
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$26.57
|
| Rate for Payer: Vantage Medical Group Senior |
$26.57
|
|
|
SODIUM ZIRCONIUM CYCLOSILICATE 10 GRAM ORAL POWDER PACKET [222467]
|
Facility
IP
|
$31.26
|
|
|
Service Code
|
NDC 0310-1110-01
|
| Hospital Charge Code |
ERX222467
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$6.25 |
| Max. Negotiated Rate |
$28.13 |
| Rate for Payer: Blue Shield of California Commercial |
$23.44
|
| Rate for Payer: Blue Shield of California EPN |
$16.69
|
| Rate for Payer: Cash Price |
$14.07
|
| Rate for Payer: Central Health Plan Commercial |
$25.01
|
| Rate for Payer: Cigna of CA HMO |
$21.88
|
| Rate for Payer: Cigna of CA PPO |
$21.88
|
| Rate for Payer: EPIC Health Plan Commercial |
$12.50
|
| Rate for Payer: Galaxy Health WC |
$26.57
|
| Rate for Payer: Global Benefits Group Commercial |
$18.76
|
| Rate for Payer: Health Management Network EPO/PPO |
$28.13
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$20.85
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6.25
|
| Rate for Payer: Multiplan Commercial |
$23.44
|
| Rate for Payer: Networks By Design Commercial |
$20.32
|
| Rate for Payer: Prime Health Services Commercial |
$26.57
|
|
|
SODIUM ZIRCONIUM CYCLOSILICATE 5 GRAM ORAL POWDER PACKET [222466]
|
Facility
OP
|
$31.26
|
|
|
Service Code
|
NDC 0310-1105-30
|
| Hospital Charge Code |
ERX222466
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$6.25 |
| Max. Negotiated Rate |
$28.13 |
| Rate for Payer: Aetna of CA HMO/PPO |
$18.98
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$26.57
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$17.19
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$17.19
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$15.14
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$18.47
|
| Rate for Payer: BCBS Transplant Transplant |
$18.76
|
| Rate for Payer: Blue Shield of California Commercial |
$19.66
|
| Rate for Payer: Blue Shield of California EPN |
$15.29
|
| Rate for Payer: Cash Price |
$14.07
|
| Rate for Payer: Central Health Plan Commercial |
$25.01
|
| Rate for Payer: Cigna of CA HMO |
$21.88
|
| Rate for Payer: Cigna of CA PPO |
$21.88
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$26.57
|
| Rate for Payer: EPIC Health Plan Commercial |
$12.50
|
| Rate for Payer: EPIC Health Plan Transplant |
$12.50
|
| Rate for Payer: Galaxy Health WC |
$26.57
|
| Rate for Payer: Global Benefits Group Commercial |
$18.76
|
| Rate for Payer: Health Management Network EPO/PPO |
$28.13
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$23.44
|
| Rate for Payer: IEHP medi-cal |
$10.94
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$20.85
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6.25
|
| Rate for Payer: Multiplan Commercial |
$23.44
|
| Rate for Payer: Networks By Design Commercial |
$20.32
|
| Rate for Payer: Prime Health Services Commercial |
$26.57
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$18.76
|
| Rate for Payer: Riverside University Health MISP |
$12.50
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$18.76
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$18.76
|
| Rate for Payer: United Healthcare All Other Commercial |
$15.63
|
| Rate for Payer: United Healthcare All Other HMO |
$15.63
|
| Rate for Payer: United Healthcare HMO Rider |
$15.63
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$15.63
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$26.57
|
| Rate for Payer: Vantage Medical Group Senior |
$26.57
|
|
|
SODIUM ZIRCONIUM CYCLOSILICATE 5 GRAM ORAL POWDER PACKET [222466]
|
Facility
OP
|
$31.26
|
|
|
Service Code
|
NDC 0310-1105-01
|
| Hospital Charge Code |
ERX222466
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$6.25 |
| Max. Negotiated Rate |
$28.13 |
| Rate for Payer: Aetna of CA HMO/PPO |
$18.98
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$26.57
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$17.19
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$17.19
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$15.14
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$18.47
|
| Rate for Payer: BCBS Transplant Transplant |
$18.76
|
| Rate for Payer: Blue Shield of California Commercial |
$19.66
|
| Rate for Payer: Blue Shield of California EPN |
$15.29
|
| Rate for Payer: Cash Price |
$14.07
|
| Rate for Payer: Central Health Plan Commercial |
$25.01
|
| Rate for Payer: Cigna of CA HMO |
$21.88
|
| Rate for Payer: Cigna of CA PPO |
$21.88
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$26.57
|
| Rate for Payer: EPIC Health Plan Commercial |
$12.50
|
| Rate for Payer: EPIC Health Plan Transplant |
$12.50
|
| Rate for Payer: Galaxy Health WC |
$26.57
|
| Rate for Payer: Global Benefits Group Commercial |
$18.76
|
| Rate for Payer: Health Management Network EPO/PPO |
$28.13
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$23.44
|
| Rate for Payer: IEHP medi-cal |
$10.94
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$20.85
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6.25
|
| Rate for Payer: Multiplan Commercial |
$23.44
|
| Rate for Payer: Networks By Design Commercial |
$20.32
|
| Rate for Payer: Prime Health Services Commercial |
$26.57
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$18.76
|
| Rate for Payer: Riverside University Health MISP |
$12.50
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$18.76
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$18.76
|
| Rate for Payer: United Healthcare All Other Commercial |
$15.63
|
| Rate for Payer: United Healthcare All Other HMO |
$15.63
|
| Rate for Payer: United Healthcare HMO Rider |
$15.63
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$15.63
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$26.57
|
| Rate for Payer: Vantage Medical Group Senior |
$26.57
|
|
|
SODIUM ZIRCONIUM CYCLOSILICATE 5 GRAM ORAL POWDER PACKET [222466]
|
Facility
IP
|
$31.26
|
|
|
Service Code
|
NDC 0310-1105-39
|
| Hospital Charge Code |
ERX222466
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$6.25 |
| Max. Negotiated Rate |
$28.13 |
| Rate for Payer: Blue Shield of California Commercial |
$23.44
|
| Rate for Payer: Blue Shield of California EPN |
$16.69
|
| Rate for Payer: Cash Price |
$14.07
|
| Rate for Payer: Central Health Plan Commercial |
$25.01
|
| Rate for Payer: Cigna of CA HMO |
$21.88
|
| Rate for Payer: Cigna of CA PPO |
$21.88
|
| Rate for Payer: EPIC Health Plan Commercial |
$12.50
|
| Rate for Payer: Galaxy Health WC |
$26.57
|
| Rate for Payer: Global Benefits Group Commercial |
$18.76
|
| Rate for Payer: Health Management Network EPO/PPO |
$28.13
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$20.85
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6.25
|
| Rate for Payer: Multiplan Commercial |
$23.44
|
| Rate for Payer: Networks By Design Commercial |
$20.32
|
| Rate for Payer: Prime Health Services Commercial |
$26.57
|
|
|
SODIUM ZIRCONIUM CYCLOSILICATE 5 GRAM ORAL POWDER PACKET [222466]
|
Facility
OP
|
$31.26
|
|
|
Service Code
|
NDC 0310-1105-39
|
| Hospital Charge Code |
ERX222466
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$6.25 |
| Max. Negotiated Rate |
$28.13 |
| Rate for Payer: Aetna of CA HMO/PPO |
$18.98
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$26.57
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$17.19
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$17.19
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$15.14
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$18.47
|
| Rate for Payer: BCBS Transplant Transplant |
$18.76
|
| Rate for Payer: Blue Shield of California Commercial |
$19.66
|
| Rate for Payer: Blue Shield of California EPN |
$15.29
|
| Rate for Payer: Cash Price |
$14.07
|
| Rate for Payer: Central Health Plan Commercial |
$25.01
|
| Rate for Payer: Cigna of CA HMO |
$21.88
|
| Rate for Payer: Cigna of CA PPO |
$21.88
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$26.57
|
| Rate for Payer: EPIC Health Plan Commercial |
$12.50
|
| Rate for Payer: EPIC Health Plan Transplant |
$12.50
|
| Rate for Payer: Galaxy Health WC |
$26.57
|
| Rate for Payer: Global Benefits Group Commercial |
$18.76
|
| Rate for Payer: Health Management Network EPO/PPO |
$28.13
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$23.44
|
| Rate for Payer: IEHP medi-cal |
$10.94
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$20.85
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6.25
|
| Rate for Payer: Multiplan Commercial |
$23.44
|
| Rate for Payer: Networks By Design Commercial |
$20.32
|
| Rate for Payer: Prime Health Services Commercial |
$26.57
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$18.76
|
| Rate for Payer: Riverside University Health MISP |
$12.50
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$18.76
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$18.76
|
| Rate for Payer: United Healthcare All Other Commercial |
$15.63
|
| Rate for Payer: United Healthcare All Other HMO |
$15.63
|
| Rate for Payer: United Healthcare HMO Rider |
$15.63
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$15.63
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$26.57
|
| Rate for Payer: Vantage Medical Group Senior |
$26.57
|
|
|
SODIUM ZIRCONIUM CYCLOSILICATE 5 GRAM ORAL POWDER PACKET [222466]
|
Facility
IP
|
$31.26
|
|
|
Service Code
|
NDC 0310-1105-30
|
| Hospital Charge Code |
ERX222466
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$6.25 |
| Max. Negotiated Rate |
$28.13 |
| Rate for Payer: Blue Shield of California Commercial |
$23.44
|
| Rate for Payer: Blue Shield of California EPN |
$16.69
|
| Rate for Payer: Cash Price |
$14.07
|
| Rate for Payer: Central Health Plan Commercial |
$25.01
|
| Rate for Payer: Cigna of CA HMO |
$21.88
|
| Rate for Payer: Cigna of CA PPO |
$21.88
|
| Rate for Payer: EPIC Health Plan Commercial |
$12.50
|
| Rate for Payer: Galaxy Health WC |
$26.57
|
| Rate for Payer: Global Benefits Group Commercial |
$18.76
|
| Rate for Payer: Health Management Network EPO/PPO |
$28.13
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$20.85
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6.25
|
| Rate for Payer: Multiplan Commercial |
$23.44
|
| Rate for Payer: Networks By Design Commercial |
$20.32
|
| Rate for Payer: Prime Health Services Commercial |
$26.57
|
|
|
SODIUM ZIRCONIUM CYCLOSILICATE 5 GRAM ORAL POWDER PACKET [222466]
|
Facility
IP
|
$31.26
|
|
|
Service Code
|
NDC 0310-1105-01
|
| Hospital Charge Code |
ERX222466
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$6.25 |
| Max. Negotiated Rate |
$28.13 |
| Rate for Payer: Blue Shield of California Commercial |
$23.44
|
| Rate for Payer: Blue Shield of California EPN |
$16.69
|
| Rate for Payer: Cash Price |
$14.07
|
| Rate for Payer: Central Health Plan Commercial |
$25.01
|
| Rate for Payer: Cigna of CA HMO |
$21.88
|
| Rate for Payer: Cigna of CA PPO |
$21.88
|
| Rate for Payer: EPIC Health Plan Commercial |
$12.50
|
| Rate for Payer: Galaxy Health WC |
$26.57
|
| Rate for Payer: Global Benefits Group Commercial |
$18.76
|
| Rate for Payer: Health Management Network EPO/PPO |
$28.13
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$20.85
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6.25
|
| Rate for Payer: Multiplan Commercial |
$23.44
|
| Rate for Payer: Networks By Design Commercial |
$20.32
|
| Rate for Payer: Prime Health Services Commercial |
$26.57
|
|
|
SOD POLYSTYRENE SULFONATE 30 GRAM-SORBITOL 40 GRAM/120 ML ENEMA [215514]
|
Facility
IP
|
$1.09
|
|
|
Service Code
|
NDC 46287-006-04
|
| Hospital Charge Code |
1748079
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.22 |
| Max. Negotiated Rate |
$0.98 |
| Rate for Payer: Blue Shield of California Commercial |
$0.82
|
| Rate for Payer: Blue Shield of California EPN |
$0.58
|
| Rate for Payer: Cash Price |
$0.49
|
| Rate for Payer: Central Health Plan Commercial |
$0.87
|
| Rate for Payer: Cigna of CA HMO |
$0.76
|
| Rate for Payer: Cigna of CA PPO |
$0.76
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.44
|
| Rate for Payer: Galaxy Health WC |
$0.93
|
| Rate for Payer: Global Benefits Group Commercial |
$0.65
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.98
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.73
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.22
|
| Rate for Payer: Multiplan Commercial |
$0.82
|
| Rate for Payer: Networks By Design Commercial |
$0.71
|
| Rate for Payer: Prime Health Services Commercial |
$0.93
|
|
|
SOD POLYSTYRENE SULFONATE 30 GRAM-SORBITOL 40 GRAM/120 ML ENEMA [215514]
|
Facility
OP
|
$1.09
|
|
|
Service Code
|
NDC 46287-006-04
|
| Hospital Charge Code |
1748079
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.22 |
| Max. Negotiated Rate |
$0.98 |
| Rate for Payer: Aetna of CA HMO/PPO |
$0.66
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$0.93
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$0.60
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$0.60
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$0.53
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.64
|
| Rate for Payer: BCBS Transplant Transplant |
$0.65
|
| Rate for Payer: Blue Shield of California Commercial |
$0.69
|
| Rate for Payer: Blue Shield of California EPN |
$0.53
|
| Rate for Payer: Cash Price |
$0.49
|
| Rate for Payer: Central Health Plan Commercial |
$0.87
|
| Rate for Payer: Cigna of CA HMO |
$0.76
|
| Rate for Payer: Cigna of CA PPO |
$0.76
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.93
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.44
|
| Rate for Payer: EPIC Health Plan Transplant |
$0.44
|
| Rate for Payer: Galaxy Health WC |
$0.93
|
| Rate for Payer: Global Benefits Group Commercial |
$0.65
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.98
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$0.82
|
| Rate for Payer: IEHP medi-cal |
$0.38
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.73
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.22
|
| Rate for Payer: Multiplan Commercial |
$0.82
|
| Rate for Payer: Networks By Design Commercial |
$0.71
|
| Rate for Payer: Prime Health Services Commercial |
$0.93
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$0.65
|
| Rate for Payer: Riverside University Health MISP |
$0.44
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.65
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.65
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.55
|
| Rate for Payer: United Healthcare All Other HMO |
$0.55
|
| Rate for Payer: United Healthcare HMO Rider |
$0.55
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.55
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.93
|
| Rate for Payer: Vantage Medical Group Senior |
$0.93
|
|
|
SOFT LENS ADJUNCTIVE SOLUTIONS EYE DROPS [117633]
|
Facility
IP
|
$0.49
|
|
|
Service Code
|
NDC 1011905220
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.10 |
| Max. Negotiated Rate |
$0.44 |
| Rate for Payer: Blue Shield of California Commercial |
$0.37
|
| Rate for Payer: Blue Shield of California EPN |
$0.26
|
| Rate for Payer: Cash Price |
$0.22
|
| Rate for Payer: Central Health Plan Commercial |
$0.39
|
| Rate for Payer: Cigna of CA HMO |
$0.34
|
| Rate for Payer: Cigna of CA PPO |
$0.34
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.20
|
| Rate for Payer: Galaxy Health WC |
$0.42
|
| Rate for Payer: Global Benefits Group Commercial |
$0.29
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.44
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.33
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.10
|
| Rate for Payer: Multiplan Commercial |
$0.37
|
| Rate for Payer: Networks By Design Commercial |
$0.32
|
| Rate for Payer: Prime Health Services Commercial |
$0.42
|
|
|
SOFT LENS ADJUNCTIVE SOLUTIONS EYE DROPS [117633]
|
Facility
OP
|
$0.49
|
|
|
Service Code
|
NDC 1011905220
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.10 |
| Max. Negotiated Rate |
$0.44 |
| Rate for Payer: Aetna of CA HMO/PPO |
$0.30
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$0.42
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$0.27
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$0.27
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$0.24
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.29
|
| Rate for Payer: BCBS Transplant Transplant |
$0.29
|
| Rate for Payer: Blue Shield of California Commercial |
$0.31
|
| Rate for Payer: Blue Shield of California EPN |
$0.24
|
| Rate for Payer: Cash Price |
$0.22
|
| Rate for Payer: Central Health Plan Commercial |
$0.39
|
| Rate for Payer: Cigna of CA HMO |
$0.34
|
| Rate for Payer: Cigna of CA PPO |
$0.34
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.42
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.20
|
| Rate for Payer: EPIC Health Plan Transplant |
$0.20
|
| Rate for Payer: Galaxy Health WC |
$0.42
|
| Rate for Payer: Global Benefits Group Commercial |
$0.29
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.44
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$0.37
|
| Rate for Payer: IEHP medi-cal |
$0.17
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.33
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.10
|
| Rate for Payer: Multiplan Commercial |
$0.37
|
| Rate for Payer: Networks By Design Commercial |
$0.32
|
| Rate for Payer: Prime Health Services Commercial |
$0.42
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$0.29
|
| Rate for Payer: Riverside University Health MISP |
$0.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.29
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.29
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.25
|
| Rate for Payer: United Healthcare All Other HMO |
$0.25
|
| Rate for Payer: United Healthcare HMO Rider |
$0.25
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.25
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.42
|
| Rate for Payer: Vantage Medical Group Senior |
$0.42
|
|
|
SOLIFENACIN 5 MG TABLET [40392]
|
Facility
OP
|
$0.48
|
|
|
Service Code
|
NDC 67877-527-30
|
| Hospital Charge Code |
1710977
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.10 |
| Max. Negotiated Rate |
$0.43 |
| Rate for Payer: Aetna of CA HMO/PPO |
$0.29
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$0.41
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$0.26
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$0.26
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$0.23
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.28
|
| Rate for Payer: BCBS Transplant Transplant |
$0.29
|
| Rate for Payer: Blue Shield of California Commercial |
$0.30
|
| Rate for Payer: Blue Shield of California EPN |
$0.23
|
| Rate for Payer: Cash Price |
$0.22
|
| Rate for Payer: Central Health Plan Commercial |
$0.38
|
| Rate for Payer: Cigna of CA HMO |
$0.34
|
| Rate for Payer: Cigna of CA PPO |
$0.34
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.41
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.19
|
| Rate for Payer: EPIC Health Plan Transplant |
$0.19
|
| Rate for Payer: Galaxy Health WC |
$0.41
|
| Rate for Payer: Global Benefits Group Commercial |
$0.29
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.43
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$0.36
|
| Rate for Payer: IEHP medi-cal |
$0.17
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.32
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.10
|
| Rate for Payer: Multiplan Commercial |
$0.36
|
| Rate for Payer: Networks By Design Commercial |
$0.31
|
| Rate for Payer: Prime Health Services Commercial |
$0.41
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$0.29
|
| Rate for Payer: Riverside University Health MISP |
$0.19
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.29
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.29
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.24
|
| Rate for Payer: United Healthcare All Other HMO |
$0.24
|
| Rate for Payer: United Healthcare HMO Rider |
$0.24
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.24
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.41
|
| Rate for Payer: Vantage Medical Group Senior |
$0.41
|
|
