|
DOCOSANOL 10 % TOPICAL CREAM [29287]
|
Facility
OP
|
$8.39
|
|
|
Service Code
|
NDC 46122-681-07
|
| Hospital Charge Code |
1743703
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$1.68 |
| Max. Negotiated Rate |
$7.55 |
| Rate for Payer: Aetna of CA HMO/PPO |
$5.10
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$7.13
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$4.61
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$4.61
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$4.06
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4.96
|
| Rate for Payer: BCBS Transplant Transplant |
$5.03
|
| Rate for Payer: Blue Shield of California Commercial |
$5.28
|
| Rate for Payer: Blue Shield of California EPN |
$4.10
|
| Rate for Payer: Cash Price |
$3.78
|
| Rate for Payer: Central Health Plan Commercial |
$6.71
|
| Rate for Payer: Cigna of CA HMO |
$5.87
|
| Rate for Payer: Cigna of CA PPO |
$5.87
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$7.13
|
| Rate for Payer: EPIC Health Plan Commercial |
$3.36
|
| Rate for Payer: EPIC Health Plan Transplant |
$3.36
|
| Rate for Payer: Galaxy Health WC |
$7.13
|
| Rate for Payer: Global Benefits Group Commercial |
$5.03
|
| Rate for Payer: Health Management Network EPO/PPO |
$7.55
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$6.29
|
| Rate for Payer: IEHP medi-cal |
$2.94
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$5.60
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.68
|
| Rate for Payer: Multiplan Commercial |
$6.29
|
| Rate for Payer: Networks By Design Commercial |
$5.45
|
| Rate for Payer: Prime Health Services Commercial |
$7.13
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$5.03
|
| Rate for Payer: Riverside University Health MISP |
$3.36
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$5.03
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$5.03
|
| Rate for Payer: United Healthcare All Other Commercial |
$4.20
|
| Rate for Payer: United Healthcare All Other HMO |
$4.20
|
| Rate for Payer: United Healthcare HMO Rider |
$4.20
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$4.20
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$7.13
|
| Rate for Payer: Vantage Medical Group Senior |
$7.13
|
|
|
DOCOSANOL 10 % TOPICAL CREAM [29287]
|
Facility
IP
|
$8.39
|
|
|
Service Code
|
NDC 46122-624-07
|
| Hospital Charge Code |
1743703
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$1.68 |
| Max. Negotiated Rate |
$7.55 |
| Rate for Payer: Blue Shield of California Commercial |
$6.29
|
| Rate for Payer: Blue Shield of California EPN |
$4.48
|
| Rate for Payer: Cash Price |
$3.78
|
| Rate for Payer: Central Health Plan Commercial |
$6.71
|
| Rate for Payer: Cigna of CA HMO |
$5.87
|
| Rate for Payer: Cigna of CA PPO |
$5.87
|
| Rate for Payer: EPIC Health Plan Commercial |
$3.36
|
| Rate for Payer: Galaxy Health WC |
$7.13
|
| Rate for Payer: Global Benefits Group Commercial |
$5.03
|
| Rate for Payer: Health Management Network EPO/PPO |
$7.55
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$5.60
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.68
|
| Rate for Payer: Multiplan Commercial |
$6.29
|
| Rate for Payer: Networks By Design Commercial |
$5.45
|
| Rate for Payer: Prime Health Services Commercial |
$7.13
|
|
|
DOCOSANOL 10 % TOPICAL CREAM [29287]
|
Facility
OP
|
$9.28
|
|
|
Service Code
|
NDC 0135-0200-01
|
| Hospital Charge Code |
1743703
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$1.86 |
| Max. Negotiated Rate |
$8.35 |
| Rate for Payer: Aetna of CA HMO/PPO |
$5.64
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$7.89
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$5.10
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$5.10
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$4.49
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5.48
|
| Rate for Payer: BCBS Transplant Transplant |
$5.57
|
| Rate for Payer: Blue Shield of California Commercial |
$5.84
|
| Rate for Payer: Blue Shield of California EPN |
$4.54
|
| Rate for Payer: Cash Price |
$4.18
|
| Rate for Payer: Central Health Plan Commercial |
$7.42
|
| Rate for Payer: Cigna of CA HMO |
$6.50
|
| Rate for Payer: Cigna of CA PPO |
$6.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$7.89
|
| Rate for Payer: EPIC Health Plan Commercial |
$3.71
|
| Rate for Payer: EPIC Health Plan Transplant |
$3.71
|
| Rate for Payer: Galaxy Health WC |
$7.89
|
| Rate for Payer: Global Benefits Group Commercial |
$5.57
|
| Rate for Payer: Health Management Network EPO/PPO |
$8.35
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$6.96
|
| Rate for Payer: IEHP medi-cal |
$3.25
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$6.19
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.86
|
| Rate for Payer: Multiplan Commercial |
$6.96
|
| Rate for Payer: Networks By Design Commercial |
$6.03
|
| Rate for Payer: Prime Health Services Commercial |
$7.89
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$5.57
|
| Rate for Payer: Riverside University Health MISP |
$3.71
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$5.57
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$5.57
|
| Rate for Payer: United Healthcare All Other Commercial |
$4.64
|
| Rate for Payer: United Healthcare All Other HMO |
$4.64
|
| Rate for Payer: United Healthcare HMO Rider |
$4.64
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$4.64
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$7.89
|
| Rate for Payer: Vantage Medical Group Senior |
$7.89
|
|
|
DOCOSANOL 10 % TOPICAL CREAM [29287]
|
Facility
OP
|
$9.28
|
|
|
Service Code
|
NDC 0766-0801-00
|
| Hospital Charge Code |
1743703
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$1.86 |
| Max. Negotiated Rate |
$8.35 |
| Rate for Payer: Aetna of CA HMO/PPO |
$5.64
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$7.89
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$5.10
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$5.10
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$4.49
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5.48
|
| Rate for Payer: BCBS Transplant Transplant |
$5.57
|
| Rate for Payer: Blue Shield of California Commercial |
$5.84
|
| Rate for Payer: Blue Shield of California EPN |
$4.54
|
| Rate for Payer: Cash Price |
$4.18
|
| Rate for Payer: Central Health Plan Commercial |
$7.42
|
| Rate for Payer: Cigna of CA HMO |
$6.50
|
| Rate for Payer: Cigna of CA PPO |
$6.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$7.89
|
| Rate for Payer: EPIC Health Plan Commercial |
$3.71
|
| Rate for Payer: EPIC Health Plan Transplant |
$3.71
|
| Rate for Payer: Galaxy Health WC |
$7.89
|
| Rate for Payer: Global Benefits Group Commercial |
$5.57
|
| Rate for Payer: Health Management Network EPO/PPO |
$8.35
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$6.96
|
| Rate for Payer: IEHP medi-cal |
$3.25
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$6.19
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.86
|
| Rate for Payer: Multiplan Commercial |
$6.96
|
| Rate for Payer: Networks By Design Commercial |
$6.03
|
| Rate for Payer: Prime Health Services Commercial |
$7.89
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$5.57
|
| Rate for Payer: Riverside University Health MISP |
$3.71
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$5.57
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$5.57
|
| Rate for Payer: United Healthcare All Other Commercial |
$4.64
|
| Rate for Payer: United Healthcare All Other HMO |
$4.64
|
| Rate for Payer: United Healthcare HMO Rider |
$4.64
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$4.64
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$7.89
|
| Rate for Payer: Vantage Medical Group Senior |
$7.89
|
|
|
DOCOSANOL 10 % TOPICAL CREAM [29287]
|
Facility
IP
|
$9.28
|
|
|
Service Code
|
NDC 0766-0801-00
|
| Hospital Charge Code |
1743703
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$1.86 |
| Max. Negotiated Rate |
$8.35 |
| Rate for Payer: Blue Shield of California Commercial |
$6.96
|
| Rate for Payer: Blue Shield of California EPN |
$4.96
|
| Rate for Payer: Cash Price |
$4.18
|
| Rate for Payer: Central Health Plan Commercial |
$7.42
|
| Rate for Payer: Cigna of CA HMO |
$6.50
|
| Rate for Payer: Cigna of CA PPO |
$6.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$3.71
|
| Rate for Payer: Galaxy Health WC |
$7.89
|
| Rate for Payer: Global Benefits Group Commercial |
$5.57
|
| Rate for Payer: Health Management Network EPO/PPO |
$8.35
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$6.19
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.86
|
| Rate for Payer: Multiplan Commercial |
$6.96
|
| Rate for Payer: Networks By Design Commercial |
$6.03
|
| Rate for Payer: Prime Health Services Commercial |
$7.89
|
|
|
DOCOSANOL 10 % TOPICAL CREAM [29287]
|
Facility
OP
|
$8.02
|
|
|
Service Code
|
NDC 61269-981-35
|
| Hospital Charge Code |
1743703
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$1.60 |
| Max. Negotiated Rate |
$7.22 |
| Rate for Payer: Aetna of CA HMO/PPO |
$4.87
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$6.82
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$4.41
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$4.41
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$3.88
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4.74
|
| Rate for Payer: BCBS Transplant Transplant |
$4.81
|
| Rate for Payer: Blue Shield of California Commercial |
$5.04
|
| Rate for Payer: Blue Shield of California EPN |
$3.92
|
| Rate for Payer: Cash Price |
$3.61
|
| Rate for Payer: Central Health Plan Commercial |
$6.42
|
| Rate for Payer: Cigna of CA HMO |
$5.61
|
| Rate for Payer: Cigna of CA PPO |
$5.61
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$6.82
|
| Rate for Payer: EPIC Health Plan Commercial |
$3.21
|
| Rate for Payer: EPIC Health Plan Transplant |
$3.21
|
| Rate for Payer: Galaxy Health WC |
$6.82
|
| Rate for Payer: Global Benefits Group Commercial |
$4.81
|
| Rate for Payer: Health Management Network EPO/PPO |
$7.22
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$6.02
|
| Rate for Payer: IEHP medi-cal |
$2.81
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$5.35
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.60
|
| Rate for Payer: Multiplan Commercial |
$6.02
|
| Rate for Payer: Networks By Design Commercial |
$5.21
|
| Rate for Payer: Prime Health Services Commercial |
$6.82
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$4.81
|
| Rate for Payer: Riverside University Health MISP |
$3.21
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$4.81
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$4.81
|
| Rate for Payer: United Healthcare All Other Commercial |
$4.01
|
| Rate for Payer: United Healthcare All Other HMO |
$4.01
|
| Rate for Payer: United Healthcare HMO Rider |
$4.01
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$4.01
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$6.82
|
| Rate for Payer: Vantage Medical Group Senior |
$6.82
|
|
|
DOCOSANOL 10 % TOPICAL CREAM [29287]
|
Facility
IP
|
$8.39
|
|
|
Service Code
|
NDC 46122-681-07
|
| Hospital Charge Code |
1743703
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$1.68 |
| Max. Negotiated Rate |
$7.55 |
| Rate for Payer: Blue Shield of California Commercial |
$6.29
|
| Rate for Payer: Blue Shield of California EPN |
$4.48
|
| Rate for Payer: Cash Price |
$3.78
|
| Rate for Payer: Central Health Plan Commercial |
$6.71
|
| Rate for Payer: Cigna of CA HMO |
$5.87
|
| Rate for Payer: Cigna of CA PPO |
$5.87
|
| Rate for Payer: EPIC Health Plan Commercial |
$3.36
|
| Rate for Payer: Galaxy Health WC |
$7.13
|
| Rate for Payer: Global Benefits Group Commercial |
$5.03
|
| Rate for Payer: Health Management Network EPO/PPO |
$7.55
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$5.60
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.68
|
| Rate for Payer: Multiplan Commercial |
$6.29
|
| Rate for Payer: Networks By Design Commercial |
$5.45
|
| Rate for Payer: Prime Health Services Commercial |
$7.13
|
|
|
DOCOSANOL 10 % TOPICAL CREAM [29287]
|
Facility
IP
|
$9.28
|
|
|
Service Code
|
NDC 0135-0200-01
|
| Hospital Charge Code |
1743703
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$1.86 |
| Max. Negotiated Rate |
$8.35 |
| Rate for Payer: Blue Shield of California Commercial |
$6.96
|
| Rate for Payer: Blue Shield of California EPN |
$4.96
|
| Rate for Payer: Cash Price |
$4.18
|
| Rate for Payer: Central Health Plan Commercial |
$7.42
|
| Rate for Payer: Cigna of CA HMO |
$6.50
|
| Rate for Payer: Cigna of CA PPO |
$6.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$3.71
|
| Rate for Payer: Galaxy Health WC |
$7.89
|
| Rate for Payer: Global Benefits Group Commercial |
$5.57
|
| Rate for Payer: Health Management Network EPO/PPO |
$8.35
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$6.19
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.86
|
| Rate for Payer: Multiplan Commercial |
$6.96
|
| Rate for Payer: Networks By Design Commercial |
$6.03
|
| Rate for Payer: Prime Health Services Commercial |
$7.89
|
|
|
DOCOSANOL 10 % TOPICAL CREAM [29287]
|
Facility
OP
|
$8.39
|
|
|
Service Code
|
NDC 46122-624-07
|
| Hospital Charge Code |
1743703
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$1.68 |
| Max. Negotiated Rate |
$7.55 |
| Rate for Payer: Aetna of CA HMO/PPO |
$5.10
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$7.13
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$4.61
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$4.61
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$4.06
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4.96
|
| Rate for Payer: BCBS Transplant Transplant |
$5.03
|
| Rate for Payer: Blue Shield of California Commercial |
$5.28
|
| Rate for Payer: Blue Shield of California EPN |
$4.10
|
| Rate for Payer: Cash Price |
$3.78
|
| Rate for Payer: Central Health Plan Commercial |
$6.71
|
| Rate for Payer: Cigna of CA HMO |
$5.87
|
| Rate for Payer: Cigna of CA PPO |
$5.87
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$7.13
|
| Rate for Payer: EPIC Health Plan Commercial |
$3.36
|
| Rate for Payer: EPIC Health Plan Transplant |
$3.36
|
| Rate for Payer: Galaxy Health WC |
$7.13
|
| Rate for Payer: Global Benefits Group Commercial |
$5.03
|
| Rate for Payer: Health Management Network EPO/PPO |
$7.55
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$6.29
|
| Rate for Payer: IEHP medi-cal |
$2.94
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$5.60
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.68
|
| Rate for Payer: Multiplan Commercial |
$6.29
|
| Rate for Payer: Networks By Design Commercial |
$5.45
|
| Rate for Payer: Prime Health Services Commercial |
$7.13
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$5.03
|
| Rate for Payer: Riverside University Health MISP |
$3.36
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$5.03
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$5.03
|
| Rate for Payer: United Healthcare All Other Commercial |
$4.20
|
| Rate for Payer: United Healthcare All Other HMO |
$4.20
|
| Rate for Payer: United Healthcare HMO Rider |
$4.20
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$4.20
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$7.13
|
| Rate for Payer: Vantage Medical Group Senior |
$7.13
|
|
|
DOCOSANOL 10 % TOPICAL CREAM [29287]
|
Facility
OP
|
$9.28
|
|
|
Service Code
|
NDC 766080155
|
| Hospital Charge Code |
1743703
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$1.86 |
| Max. Negotiated Rate |
$8.35 |
| Rate for Payer: Aetna of CA HMO/PPO |
$5.64
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$7.89
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$5.10
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$5.10
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$4.49
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5.48
|
| Rate for Payer: BCBS Transplant Transplant |
$5.57
|
| Rate for Payer: Blue Shield of California Commercial |
$5.84
|
| Rate for Payer: Blue Shield of California EPN |
$4.54
|
| Rate for Payer: Cash Price |
$4.18
|
| Rate for Payer: Central Health Plan Commercial |
$7.42
|
| Rate for Payer: Cigna of CA HMO |
$6.50
|
| Rate for Payer: Cigna of CA PPO |
$6.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$7.89
|
| Rate for Payer: EPIC Health Plan Commercial |
$3.71
|
| Rate for Payer: EPIC Health Plan Transplant |
$3.71
|
| Rate for Payer: Galaxy Health WC |
$7.89
|
| Rate for Payer: Global Benefits Group Commercial |
$5.57
|
| Rate for Payer: Health Management Network EPO/PPO |
$8.35
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$6.96
|
| Rate for Payer: IEHP medi-cal |
$3.25
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$6.19
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.86
|
| Rate for Payer: Multiplan Commercial |
$6.96
|
| Rate for Payer: Networks By Design Commercial |
$6.03
|
| Rate for Payer: Prime Health Services Commercial |
$7.89
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$5.57
|
| Rate for Payer: Riverside University Health MISP |
$3.71
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$5.57
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$5.57
|
| Rate for Payer: United Healthcare All Other Commercial |
$4.64
|
| Rate for Payer: United Healthcare All Other HMO |
$4.64
|
| Rate for Payer: United Healthcare HMO Rider |
$4.64
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$4.64
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$7.89
|
| Rate for Payer: Vantage Medical Group Senior |
$7.89
|
|
|
DOCOSANOL 10 % TOPICAL CREAM [29287]
|
Facility
IP
|
$9.28
|
|
|
Service Code
|
NDC 766080155
|
| Hospital Charge Code |
1743703
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$1.86 |
| Max. Negotiated Rate |
$8.35 |
| Rate for Payer: Blue Shield of California Commercial |
$6.96
|
| Rate for Payer: Blue Shield of California EPN |
$4.96
|
| Rate for Payer: Cash Price |
$4.18
|
| Rate for Payer: Central Health Plan Commercial |
$7.42
|
| Rate for Payer: Cigna of CA HMO |
$6.50
|
| Rate for Payer: Cigna of CA PPO |
$6.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$3.71
|
| Rate for Payer: Galaxy Health WC |
$7.89
|
| Rate for Payer: Global Benefits Group Commercial |
$5.57
|
| Rate for Payer: Health Management Network EPO/PPO |
$8.35
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$6.19
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.86
|
| Rate for Payer: Multiplan Commercial |
$6.96
|
| Rate for Payer: Networks By Design Commercial |
$6.03
|
| Rate for Payer: Prime Health Services Commercial |
$7.89
|
|
|
DOCOSANOL 10 % TOPICAL CREAM [29287]
|
Facility
IP
|
$8.02
|
|
|
Service Code
|
NDC 61269-981-35
|
| Hospital Charge Code |
1743703
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$1.60 |
| Max. Negotiated Rate |
$7.22 |
| Rate for Payer: Blue Shield of California Commercial |
$6.02
|
| Rate for Payer: Blue Shield of California EPN |
$4.28
|
| Rate for Payer: Cash Price |
$3.61
|
| Rate for Payer: Central Health Plan Commercial |
$6.42
|
| Rate for Payer: Cigna of CA HMO |
$5.61
|
| Rate for Payer: Cigna of CA PPO |
$5.61
|
| Rate for Payer: EPIC Health Plan Commercial |
$3.21
|
| Rate for Payer: Galaxy Health WC |
$6.82
|
| Rate for Payer: Global Benefits Group Commercial |
$4.81
|
| Rate for Payer: Health Management Network EPO/PPO |
$7.22
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$5.35
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.60
|
| Rate for Payer: Multiplan Commercial |
$6.02
|
| Rate for Payer: Networks By Design Commercial |
$5.21
|
| Rate for Payer: Prime Health Services Commercial |
$6.82
|
|
|
DOCUSATE SODIUM 100 MG CAPSULE [2566]
|
Facility
IP
|
$0.07
|
|
|
Service Code
|
NDC 46122-692-78
|
| Hospital Charge Code |
1710247
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.01 |
| Max. Negotiated Rate |
$0.06 |
| Rate for Payer: Blue Shield of California Commercial |
$0.05
|
| Rate for Payer: Blue Shield of California EPN |
$0.04
|
| Rate for Payer: Cash Price |
$0.03
|
| Rate for Payer: Central Health Plan Commercial |
$0.06
|
| Rate for Payer: Cigna of CA HMO |
$0.05
|
| Rate for Payer: Cigna of CA PPO |
$0.05
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.03
|
| Rate for Payer: Galaxy Health WC |
$0.06
|
| Rate for Payer: Global Benefits Group Commercial |
$0.04
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.06
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.05
|
| 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 |
$0.05
|
| Rate for Payer: Prime Health Services Commercial |
$0.06
|
|
|
DOCUSATE SODIUM 100 MG CAPSULE [2566]
|
Facility
IP
|
$0.02
|
|
|
Service Code
|
NDC 0904-6998-60
|
| Hospital Charge Code |
1710247
|
|
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
|
|
|
DOCUSATE SODIUM 100 MG CAPSULE [2566]
|
Facility
OP
|
$0.22
|
|
|
Service Code
|
NDC 60687-129-11
|
| Hospital Charge Code |
1710247
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.04 |
| Max. Negotiated Rate |
$0.20 |
| Rate for Payer: Aetna of CA HMO/PPO |
$0.13
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$0.19
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$0.12
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$0.12
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$0.11
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.13
|
| Rate for Payer: BCBS Transplant Transplant |
$0.13
|
| 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 |
$0.15
|
| Rate for Payer: Cigna of CA PPO |
$0.15
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.19
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.09
|
| Rate for Payer: EPIC Health Plan Transplant |
$0.09
|
| Rate for Payer: Galaxy Health WC |
$0.19
|
| Rate for Payer: Global Benefits Group Commercial |
$0.13
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.20
|
| 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 |
$0.04
|
| 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
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$0.13
|
| Rate for Payer: Riverside University Health MISP |
$0.09
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.13
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.13
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.11
|
| Rate for Payer: United Healthcare All Other HMO |
$0.11
|
| Rate for Payer: United Healthcare HMO Rider |
$0.11
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.11
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.19
|
| Rate for Payer: Vantage Medical Group Senior |
$0.19
|
|
|
DOCUSATE SODIUM 100 MG CAPSULE [2566]
|
Facility
IP
|
$0.22
|
|
|
Service Code
|
NDC 60687-129-11
|
| Hospital Charge Code |
1710247
|
|
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
|
|
|
DOCUSATE SODIUM 100 MG CAPSULE [2566]
|
Facility
IP
|
$0.22
|
|
|
Service Code
|
NDC 60687-129-01
|
| Hospital Charge Code |
1710247
|
|
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
|
|
|
DOCUSATE SODIUM 100 MG CAPSULE [2566]
|
Facility
IP
|
$0.04
|
|
|
Service Code
|
NDC 46122-692-85
|
| Hospital Charge Code |
1710247
|
|
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
|
|
|
DOCUSATE SODIUM 100 MG CAPSULE [2566]
|
Facility
IP
|
$0.02
|
|
|
Service Code
|
NDC 57896-401-10
|
| Hospital Charge Code |
1710247
|
|
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
|
|
|
DOCUSATE SODIUM 100 MG CAPSULE [2566]
|
Facility
OP
|
$0.22
|
|
|
Service Code
|
NDC 60687-129-01
|
| Hospital Charge Code |
1710247
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.04 |
| Max. Negotiated Rate |
$0.20 |
| Rate for Payer: Aetna of CA HMO/PPO |
$0.13
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$0.19
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$0.12
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$0.12
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$0.11
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.13
|
| Rate for Payer: BCBS Transplant Transplant |
$0.13
|
| 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 |
$0.15
|
| Rate for Payer: Cigna of CA PPO |
$0.15
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.19
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.09
|
| Rate for Payer: EPIC Health Plan Transplant |
$0.09
|
| Rate for Payer: Galaxy Health WC |
$0.19
|
| Rate for Payer: Global Benefits Group Commercial |
$0.13
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.20
|
| 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 |
$0.04
|
| 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
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$0.13
|
| Rate for Payer: Riverside University Health MISP |
$0.09
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.13
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.13
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.11
|
| Rate for Payer: United Healthcare All Other HMO |
$0.11
|
| Rate for Payer: United Healthcare HMO Rider |
$0.11
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.11
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.19
|
| Rate for Payer: Vantage Medical Group Senior |
$0.19
|
|
|
DOCUSATE SODIUM 100 MG CAPSULE [2566]
|
Facility
OP
|
$0.02
|
|
|
Service Code
|
NDC 57896-401-10
|
| Hospital Charge Code |
1710247
|
|
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
|
|
|
DOCUSATE SODIUM 100 MG CAPSULE [2566]
|
Facility
IP
|
$0.06
|
|
|
Service Code
|
NDC 0904-7183-61
|
| Hospital Charge Code |
1710247
|
|
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
|
|
|
DOCUSATE SODIUM 100 MG CAPSULE [2566]
|
Facility
OP
|
$0.04
|
|
|
Service Code
|
NDC 46122-692-85
|
| Hospital Charge Code |
1710247
|
|
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
|
|
|
DOCUSATE SODIUM 100 MG CAPSULE [2566]
|
Facility
OP
|
$0.02
|
|
|
Service Code
|
NDC 0904-6998-60
|
| Hospital Charge Code |
1710247
|
|
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
|
|
|
DOCUSATE SODIUM 100 MG CAPSULE [2566]
|
Facility
OP
|
$0.07
|
|
|
Service Code
|
NDC 46122-692-78
|
| Hospital Charge Code |
1710247
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.01 |
| Max. Negotiated Rate |
$0.06 |
| Rate for Payer: Aetna of CA HMO/PPO |
$0.04
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$0.06
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$0.04
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$0.04
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$0.03
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.04
|
| Rate for Payer: BCBS Transplant Transplant |
$0.04
|
| 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 |
$0.03
|
| Rate for Payer: Central Health Plan Commercial |
$0.06
|
| Rate for Payer: Cigna of CA HMO |
$0.05
|
| Rate for Payer: Cigna of CA PPO |
$0.05
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.06
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.03
|
| Rate for Payer: EPIC Health Plan Transplant |
$0.03
|
| Rate for Payer: Galaxy Health WC |
$0.06
|
| Rate for Payer: Global Benefits Group Commercial |
$0.04
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.06
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$0.05
|
| Rate for Payer: IEHP medi-cal |
$0.02
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.05
|
| 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 |
$0.05
|
| Rate for Payer: Prime Health Services Commercial |
$0.06
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$0.04
|
| Rate for Payer: Riverside University Health MISP |
$0.03
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.04
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.04
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.04
|
| Rate for Payer: United Healthcare All Other HMO |
$0.04
|
| Rate for Payer: United Healthcare HMO Rider |
$0.04
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.04
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.06
|
| Rate for Payer: Vantage Medical Group Senior |
$0.06
|
|
