|
POSACONAZOLE 200 MG/5 ML (40 MG/ML) ORAL SUSPENSION [77371]
|
Facility
|
OP
|
$16.45
|
|
|
Service Code
|
NDC 0085-1328-01
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$2.98 |
| Max. Negotiated Rate |
$13.98 |
| Rate for Payer: Adventist Health Commercial |
$3.29
|
| Rate for Payer: Aetna of CA Gatekeeper |
$8.79
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$11.30
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$13.98
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$9.05
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$12.34
|
| Rate for Payer: Blue Shield of California Commercial |
$10.03
|
| Rate for Payer: Blue Shield of California EPN |
$8.03
|
| Rate for Payer: Cash Price |
$9.05
|
| Rate for Payer: Cigna of CA HMO/PPO |
$10.69
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$13.98
|
| Rate for Payer: Dignity Health Medi-Cal |
$13.98
|
| Rate for Payer: Dignity Health Senior |
$13.98
|
| Rate for Payer: EPIC Health Plan Commercial |
$10.53
|
| Rate for Payer: Heritage Provider Network Commercial |
$10.18
|
| Rate for Payer: Heritage Provider Network Senior |
$10.18
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$7.85
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2.98
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.11
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$11.52
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$11.52
|
| Rate for Payer: Multiplan Commercial |
$12.34
|
| Rate for Payer: TriValley Medical Group Commercial |
$6.58
|
| Rate for Payer: TriValley Medical Group Senior |
$6.58
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$8.22
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$8.22
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$13.98
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$13.98
|
| Rate for Payer: Vantage Medical Group Senior |
$13.98
|
|
|
POSACONAZOLE 200 MG/5 ML (40 MG/ML) ORAL SUSPENSION [77371]
|
Facility
|
IP
|
$16.45
|
|
|
Service Code
|
NDC 0085-1328-01
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$2.98 |
| Max. Negotiated Rate |
$12.34 |
| Rate for Payer: Adventist Health Commercial |
$3.29
|
| Rate for Payer: Cash Price |
$9.05
|
| Rate for Payer: EPIC Health Plan Commercial |
$8.88
|
| Rate for Payer: Heritage Provider Network Commercial |
$11.14
|
| Rate for Payer: Heritage Provider Network Senior |
$11.14
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2.98
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.11
|
| Rate for Payer: Multiplan Commercial |
$12.34
|
|
|
POSACONAZOLE 300 MG/16.7 ML INTRAVENOUS SOLUTION [205239]
|
Facility
|
OP
|
$38.12
|
|
|
Service Code
|
NDC 0085-4331-01
|
| Hospital Charge Code |
901700004
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$6.90 |
| Max. Negotiated Rate |
$32.40 |
| Rate for Payer: Adventist Health Commercial |
$7.62
|
| Rate for Payer: Aetna of CA Gatekeeper |
$20.38
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$26.19
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$32.40
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$20.97
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$28.59
|
| Rate for Payer: Blue Shield of California Commercial |
$23.25
|
| Rate for Payer: Blue Shield of California EPN |
$18.60
|
| Rate for Payer: Cash Price |
$20.96
|
| Rate for Payer: Cigna of CA HMO/PPO |
$24.78
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$32.40
|
| Rate for Payer: Dignity Health Medi-Cal |
$32.40
|
| Rate for Payer: Dignity Health Senior |
$32.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$24.40
|
| Rate for Payer: Heritage Provider Network Commercial |
$23.60
|
| Rate for Payer: Heritage Provider Network Senior |
$23.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$18.18
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$6.90
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$9.53
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$26.68
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$26.68
|
| Rate for Payer: Multiplan Commercial |
$28.59
|
| Rate for Payer: TriValley Medical Group Commercial |
$15.25
|
| Rate for Payer: TriValley Medical Group Senior |
$15.25
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$19.06
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$19.06
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$32.40
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$32.40
|
| Rate for Payer: Vantage Medical Group Senior |
$32.40
|
|
|
POSACONAZOLE 300 MG/16.7 ML INTRAVENOUS SOLUTION [205239]
|
Facility
|
OP
|
$19.40
|
|
|
Service Code
|
NDC 68462-904-01
|
| Hospital Charge Code |
901700004
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$3.51 |
| Max. Negotiated Rate |
$16.49 |
| Rate for Payer: Adventist Health Commercial |
$3.88
|
| Rate for Payer: Aetna of CA Gatekeeper |
$10.37
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$13.33
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$16.49
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$10.67
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$14.55
|
| Rate for Payer: Blue Shield of California Commercial |
$11.83
|
| Rate for Payer: Blue Shield of California EPN |
$9.47
|
| Rate for Payer: Cash Price |
$10.67
|
| Rate for Payer: Cigna of CA HMO/PPO |
$12.61
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$16.49
|
| Rate for Payer: Dignity Health Medi-Cal |
$16.49
|
| Rate for Payer: Dignity Health Senior |
$16.49
|
| Rate for Payer: EPIC Health Plan Commercial |
$12.42
|
| Rate for Payer: Heritage Provider Network Commercial |
$12.01
|
| Rate for Payer: Heritage Provider Network Senior |
$12.01
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$9.25
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3.51
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.85
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$13.58
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$13.58
|
| Rate for Payer: Multiplan Commercial |
$14.55
|
| Rate for Payer: TriValley Medical Group Commercial |
$7.76
|
| Rate for Payer: TriValley Medical Group Senior |
$7.76
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$9.70
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$9.70
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$16.49
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$16.49
|
| Rate for Payer: Vantage Medical Group Senior |
$16.49
|
|
|
POSACONAZOLE 300 MG/16.7 ML INTRAVENOUS SOLUTION [205239]
|
Facility
|
IP
|
$38.12
|
|
|
Service Code
|
NDC 0085-4331-01
|
| Hospital Charge Code |
901700004
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$6.90 |
| Max. Negotiated Rate |
$28.59 |
| Rate for Payer: Adventist Health Commercial |
$7.62
|
| Rate for Payer: Cash Price |
$20.96
|
| Rate for Payer: EPIC Health Plan Commercial |
$20.58
|
| Rate for Payer: Heritage Provider Network Commercial |
$25.81
|
| Rate for Payer: Heritage Provider Network Senior |
$25.81
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$6.90
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$9.53
|
| Rate for Payer: Multiplan Commercial |
$28.59
|
|
|
POSACONAZOLE 300 MG/16.7 ML INTRAVENOUS SOLUTION [205239]
|
Facility
|
OP
|
$36.21
|
|
|
Service Code
|
NDC 67457-665-20
|
| Hospital Charge Code |
901700004
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$6.55 |
| Max. Negotiated Rate |
$30.78 |
| Rate for Payer: Adventist Health Commercial |
$7.24
|
| Rate for Payer: Aetna of CA Gatekeeper |
$19.35
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$24.88
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$30.78
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$19.92
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$27.16
|
| Rate for Payer: Blue Shield of California Commercial |
$22.09
|
| Rate for Payer: Blue Shield of California EPN |
$17.67
|
| Rate for Payer: Cash Price |
$19.92
|
| Rate for Payer: Cigna of CA HMO/PPO |
$23.54
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$30.78
|
| Rate for Payer: Dignity Health Medi-Cal |
$30.78
|
| Rate for Payer: Dignity Health Senior |
$30.78
|
| Rate for Payer: EPIC Health Plan Commercial |
$23.17
|
| Rate for Payer: Heritage Provider Network Commercial |
$22.41
|
| Rate for Payer: Heritage Provider Network Senior |
$22.41
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$17.27
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$6.55
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$9.05
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$25.35
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$25.35
|
| Rate for Payer: Multiplan Commercial |
$27.16
|
| Rate for Payer: TriValley Medical Group Commercial |
$14.48
|
| Rate for Payer: TriValley Medical Group Senior |
$14.48
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$18.11
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$18.11
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$30.78
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$30.78
|
| Rate for Payer: Vantage Medical Group Senior |
$30.78
|
|
|
POSACONAZOLE 300 MG/16.7 ML INTRAVENOUS SOLUTION [205239]
|
Facility
|
IP
|
$36.21
|
|
|
Service Code
|
NDC 67457-665-20
|
| Hospital Charge Code |
901700004
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$6.55 |
| Max. Negotiated Rate |
$27.16 |
| Rate for Payer: Adventist Health Commercial |
$7.24
|
| Rate for Payer: Cash Price |
$19.92
|
| Rate for Payer: EPIC Health Plan Commercial |
$19.55
|
| Rate for Payer: Heritage Provider Network Commercial |
$24.51
|
| Rate for Payer: Heritage Provider Network Senior |
$24.51
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$6.55
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$9.05
|
| Rate for Payer: Multiplan Commercial |
$27.16
|
|
|
POSACONAZOLE 300 MG/16.7 ML INTRAVENOUS SOLUTION [205239]
|
Facility
|
IP
|
$19.40
|
|
|
Service Code
|
NDC 68462-904-01
|
| Hospital Charge Code |
901700004
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$3.51 |
| Max. Negotiated Rate |
$14.55 |
| Rate for Payer: Adventist Health Commercial |
$3.88
|
| Rate for Payer: Cash Price |
$10.67
|
| Rate for Payer: EPIC Health Plan Commercial |
$10.48
|
| Rate for Payer: Heritage Provider Network Commercial |
$13.13
|
| Rate for Payer: Heritage Provider Network Senior |
$13.13
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3.51
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.85
|
| Rate for Payer: Multiplan Commercial |
$14.55
|
|
|
POTASSIUM ACETATE 2 MEQ/ML INTRAVENOUS SOLUTION [6420]
|
Facility
|
OP
|
$0.27
|
|
|
Service Code
|
NDC 0409-3294-51
|
| Hospital Charge Code |
901700004
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.05 |
| Max. Negotiated Rate |
$0.23 |
| Rate for Payer: Adventist Health Commercial |
$0.05
|
| Rate for Payer: Aetna of CA Gatekeeper |
$0.14
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$0.19
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.23
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.15
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.20
|
| Rate for Payer: Blue Shield of California Commercial |
$0.16
|
| Rate for Payer: Blue Shield of California EPN |
$0.13
|
| Rate for Payer: Cash Price |
$0.15
|
| Rate for Payer: Cigna of CA HMO/PPO |
$0.18
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.23
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.23
|
| Rate for Payer: Dignity Health Senior |
$0.23
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.17
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.17
|
| Rate for Payer: Heritage Provider Network Senior |
$0.17
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$0.13
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.05
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.07
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$0.19
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$0.19
|
| Rate for Payer: Multiplan Commercial |
$0.20
|
| Rate for Payer: TriValley Medical Group Commercial |
$0.11
|
| Rate for Payer: TriValley Medical Group Senior |
$0.11
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$0.14
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$0.14
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.23
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.23
|
| Rate for Payer: Vantage Medical Group Senior |
$0.23
|
|
|
POTASSIUM ACETATE 2 MEQ/ML INTRAVENOUS SOLUTION [6420]
|
Facility
|
IP
|
$0.32
|
|
|
Service Code
|
NDC 51754-2001-4
|
| Hospital Charge Code |
901700004
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.06 |
| Max. Negotiated Rate |
$0.24 |
| Rate for Payer: Adventist Health Commercial |
$0.06
|
| Rate for Payer: Cash Price |
$0.18
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.17
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.22
|
| Rate for Payer: Heritage Provider Network Senior |
$0.22
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.06
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.08
|
| Rate for Payer: Multiplan Commercial |
$0.24
|
|
|
POTASSIUM ACETATE 2 MEQ/ML INTRAVENOUS SOLUTION [6420]
|
Facility
|
IP
|
$0.32
|
|
|
Service Code
|
NDC 0409-8183-11
|
| Hospital Charge Code |
901700004
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.06 |
| Max. Negotiated Rate |
$0.24 |
| Rate for Payer: Adventist Health Commercial |
$0.06
|
| Rate for Payer: Cash Price |
$0.18
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.17
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.22
|
| Rate for Payer: Heritage Provider Network Senior |
$0.22
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.06
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.08
|
| Rate for Payer: Multiplan Commercial |
$0.24
|
|
|
POTASSIUM ACETATE 2 MEQ/ML INTRAVENOUS SOLUTION [6420]
|
Facility
|
OP
|
$0.32
|
|
|
Service Code
|
NDC 51754-2001-4
|
| Hospital Charge Code |
901700004
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.06 |
| Max. Negotiated Rate |
$0.27 |
| Rate for Payer: Adventist Health Commercial |
$0.06
|
| Rate for Payer: Aetna of CA Gatekeeper |
$0.17
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$0.22
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.27
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.18
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.24
|
| Rate for Payer: Blue Shield of California Commercial |
$0.20
|
| Rate for Payer: Blue Shield of California EPN |
$0.16
|
| Rate for Payer: Cash Price |
$0.18
|
| Rate for Payer: Cigna of CA HMO/PPO |
$0.21
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.27
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.27
|
| Rate for Payer: Dignity Health Senior |
$0.27
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.20
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.20
|
| Rate for Payer: Heritage Provider Network Senior |
$0.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$0.15
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.06
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.08
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$0.22
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$0.22
|
| Rate for Payer: Multiplan Commercial |
$0.24
|
| Rate for Payer: TriValley Medical Group Commercial |
$0.13
|
| Rate for Payer: TriValley Medical Group Senior |
$0.13
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$0.16
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$0.16
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.27
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.27
|
| Rate for Payer: Vantage Medical Group Senior |
$0.27
|
|
|
POTASSIUM ACETATE 2 MEQ/ML INTRAVENOUS SOLUTION [6420]
|
Facility
|
OP
|
$0.32
|
|
|
Service Code
|
NDC 0409-8183-11
|
| Hospital Charge Code |
901700004
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.06 |
| Max. Negotiated Rate |
$0.27 |
| Rate for Payer: Adventist Health Commercial |
$0.06
|
| Rate for Payer: Aetna of CA Gatekeeper |
$0.17
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$0.22
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.27
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.18
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.24
|
| Rate for Payer: Blue Shield of California Commercial |
$0.20
|
| Rate for Payer: Blue Shield of California EPN |
$0.16
|
| Rate for Payer: Cash Price |
$0.18
|
| Rate for Payer: Cigna of CA HMO/PPO |
$0.21
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.27
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.27
|
| Rate for Payer: Dignity Health Senior |
$0.27
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.20
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.20
|
| Rate for Payer: Heritage Provider Network Senior |
$0.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$0.15
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.06
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.08
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$0.22
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$0.22
|
| Rate for Payer: Multiplan Commercial |
$0.24
|
| Rate for Payer: TriValley Medical Group Commercial |
$0.13
|
| Rate for Payer: TriValley Medical Group Senior |
$0.13
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$0.16
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$0.16
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.27
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.27
|
| Rate for Payer: Vantage Medical Group Senior |
$0.27
|
|
|
POTASSIUM ACETATE 2 MEQ/ML INTRAVENOUS SOLUTION [6420]
|
Facility
|
IP
|
$0.27
|
|
|
Service Code
|
NDC 0409-3294-51
|
| Hospital Charge Code |
901700004
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.05 |
| Max. Negotiated Rate |
$0.20 |
| Rate for Payer: Adventist Health Commercial |
$0.05
|
| Rate for Payer: Cash Price |
$0.15
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.15
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.18
|
| Rate for Payer: Heritage Provider Network Senior |
$0.18
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.05
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.07
|
| Rate for Payer: Multiplan Commercial |
$0.20
|
|
|
POTASSIUM ACETATE 2 MEQ/ML INTRAVENOUS SOLUTION [6420]
|
Facility
|
IP
|
$0.27
|
|
|
Service Code
|
NDC 0409-3294-61
|
| Hospital Charge Code |
901700004
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.05 |
| Max. Negotiated Rate |
$0.20 |
| Rate for Payer: Adventist Health Commercial |
$0.05
|
| Rate for Payer: Cash Price |
$0.15
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.15
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.18
|
| Rate for Payer: Heritage Provider Network Senior |
$0.18
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.05
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.07
|
| Rate for Payer: Multiplan Commercial |
$0.20
|
|
|
POTASSIUM ACETATE 2 MEQ/ML INTRAVENOUS SOLUTION [6420]
|
Facility
|
IP
|
$0.32
|
|
|
Service Code
|
NDC 0409-8183-01
|
| Hospital Charge Code |
901700004
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.06 |
| Max. Negotiated Rate |
$0.24 |
| Rate for Payer: Adventist Health Commercial |
$0.06
|
| Rate for Payer: Cash Price |
$0.18
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.17
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.22
|
| Rate for Payer: Heritage Provider Network Senior |
$0.22
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.06
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.08
|
| Rate for Payer: Multiplan Commercial |
$0.24
|
|
|
POTASSIUM ACETATE 2 MEQ/ML INTRAVENOUS SOLUTION [6420]
|
Facility
|
OP
|
$0.26
|
|
|
Service Code
|
NDC 51754-2004-1
|
| Hospital Charge Code |
901700004
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.05 |
| Max. Negotiated Rate |
$0.22 |
| Rate for Payer: Adventist Health Commercial |
$0.05
|
| Rate for Payer: Aetna of CA Gatekeeper |
$0.14
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$0.18
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.22
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.14
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.20
|
| Rate for Payer: Blue Shield of California Commercial |
$0.16
|
| Rate for Payer: Blue Shield of California EPN |
$0.13
|
| Rate for Payer: Cash Price |
$0.15
|
| Rate for Payer: Cigna of CA HMO/PPO |
$0.17
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.22
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.22
|
| Rate for Payer: Dignity Health Senior |
$0.22
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.17
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.16
|
| Rate for Payer: Heritage Provider Network Senior |
$0.16
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$0.12
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.05
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.07
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$0.18
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$0.18
|
| Rate for Payer: Multiplan Commercial |
$0.20
|
| Rate for Payer: TriValley Medical Group Commercial |
$0.10
|
| Rate for Payer: TriValley Medical Group Senior |
$0.10
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$0.13
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$0.13
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.22
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.22
|
| Rate for Payer: Vantage Medical Group Senior |
$0.22
|
|
|
POTASSIUM ACETATE 2 MEQ/ML INTRAVENOUS SOLUTION [6420]
|
Facility
|
IP
|
$0.26
|
|
|
Service Code
|
NDC 51754-2004-1
|
| Hospital Charge Code |
901700004
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.05 |
| Max. Negotiated Rate |
$0.20 |
| Rate for Payer: Adventist Health Commercial |
$0.05
|
| Rate for Payer: Cash Price |
$0.15
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.14
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.18
|
| Rate for Payer: Heritage Provider Network Senior |
$0.18
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.05
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.07
|
| Rate for Payer: Multiplan Commercial |
$0.20
|
|
|
POTASSIUM ACETATE 2 MEQ/ML INTRAVENOUS SOLUTION [6420]
|
Facility
|
OP
|
$0.27
|
|
|
Service Code
|
NDC 0409-3294-61
|
| Hospital Charge Code |
901700004
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.05 |
| Max. Negotiated Rate |
$0.23 |
| Rate for Payer: Adventist Health Commercial |
$0.05
|
| Rate for Payer: Aetna of CA Gatekeeper |
$0.14
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$0.19
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.23
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.15
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.20
|
| Rate for Payer: Blue Shield of California Commercial |
$0.16
|
| Rate for Payer: Blue Shield of California EPN |
$0.13
|
| Rate for Payer: Cash Price |
$0.15
|
| Rate for Payer: Cigna of CA HMO/PPO |
$0.18
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.23
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.23
|
| Rate for Payer: Dignity Health Senior |
$0.23
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.17
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.17
|
| Rate for Payer: Heritage Provider Network Senior |
$0.17
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$0.13
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.05
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.07
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$0.19
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$0.19
|
| Rate for Payer: Multiplan Commercial |
$0.20
|
| Rate for Payer: TriValley Medical Group Commercial |
$0.11
|
| Rate for Payer: TriValley Medical Group Senior |
$0.11
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$0.14
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$0.14
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.23
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.23
|
| Rate for Payer: Vantage Medical Group Senior |
$0.23
|
|
|
POTASSIUM ACETATE 2 MEQ/ML INTRAVENOUS SOLUTION [6420]
|
Facility
|
OP
|
$0.32
|
|
|
Service Code
|
NDC 0409-8183-01
|
| Hospital Charge Code |
901700004
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.06 |
| Max. Negotiated Rate |
$0.27 |
| Rate for Payer: Adventist Health Commercial |
$0.06
|
| Rate for Payer: Aetna of CA Gatekeeper |
$0.17
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$0.22
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.27
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.18
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.24
|
| Rate for Payer: Blue Shield of California Commercial |
$0.20
|
| Rate for Payer: Blue Shield of California EPN |
$0.16
|
| Rate for Payer: Cash Price |
$0.18
|
| Rate for Payer: Cigna of CA HMO/PPO |
$0.21
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.27
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.27
|
| Rate for Payer: Dignity Health Senior |
$0.27
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.20
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.20
|
| Rate for Payer: Heritage Provider Network Senior |
$0.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$0.15
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.06
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.08
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$0.22
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$0.22
|
| Rate for Payer: Multiplan Commercial |
$0.24
|
| Rate for Payer: TriValley Medical Group Commercial |
$0.13
|
| Rate for Payer: TriValley Medical Group Senior |
$0.13
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$0.16
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$0.16
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.27
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.27
|
| Rate for Payer: Vantage Medical Group Senior |
$0.27
|
|
|
POTASSIUM ACETATE ORAL SOLUTION (IV FORM) 2 MEQ/ML [4080437]
|
Facility
|
IP
|
$0.03
|
|
|
Service Code
|
NDC 9994-0804-37
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.01 |
| Max. Negotiated Rate |
$0.02 |
| Rate for Payer: Adventist Health Commercial |
$0.01
|
| Rate for Payer: Cash Price |
$0.02
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.02
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.02
|
| Rate for Payer: Heritage Provider Network Senior |
$0.02
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.01
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.01
|
| Rate for Payer: Multiplan Commercial |
$0.02
|
|
|
POTASSIUM ACETATE ORAL SOLUTION (IV FORM) 2 MEQ/ML [4080437]
|
Facility
|
OP
|
$0.03
|
|
|
Service Code
|
NDC 9994-0804-37
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.01 |
| Max. Negotiated Rate |
$0.03 |
| Rate for Payer: Adventist Health Commercial |
$0.01
|
| Rate for Payer: Aetna of CA Gatekeeper |
$0.02
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$0.02
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.03
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.02
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$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 |
$0.02
|
| Rate for Payer: Cigna of CA HMO/PPO |
$0.02
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.03
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.03
|
| Rate for Payer: Dignity Health Senior |
$0.03
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.02
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.02
|
| Rate for Payer: Heritage Provider Network Senior |
$0.02
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$0.01
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.01
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.01
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$0.02
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$0.02
|
| Rate for Payer: Multiplan Commercial |
$0.02
|
| Rate for Payer: TriValley Medical Group Commercial |
$0.01
|
| Rate for Payer: TriValley Medical Group Senior |
$0.01
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$0.02
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$0.02
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.03
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.03
|
| Rate for Payer: Vantage Medical Group Senior |
$0.03
|
|
|
POTASSIUM CHLORIDE 20 MEQ/15 ML ORAL LIQUID [6432]
|
Facility
|
OP
|
$0.28
|
|
|
Service Code
|
NDC 81033-220-15
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.05 |
| Max. Negotiated Rate |
$0.24 |
| Rate for Payer: Adventist Health Commercial |
$0.06
|
| Rate for Payer: Aetna of CA Gatekeeper |
$0.15
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$0.19
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.24
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.15
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.21
|
| Rate for Payer: Blue Shield of California Commercial |
$0.17
|
| Rate for Payer: Blue Shield of California EPN |
$0.14
|
| Rate for Payer: Cash Price |
$0.15
|
| Rate for Payer: Cigna of CA HMO/PPO |
$0.18
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.24
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.24
|
| Rate for Payer: Dignity Health Senior |
$0.24
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.18
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.17
|
| Rate for Payer: Heritage Provider Network Senior |
$0.17
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$0.13
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.05
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.07
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$0.20
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$0.20
|
| Rate for Payer: Multiplan Commercial |
$0.21
|
| Rate for Payer: TriValley Medical Group Commercial |
$0.11
|
| Rate for Payer: TriValley Medical Group Senior |
$0.11
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$0.14
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$0.14
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.24
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.24
|
| Rate for Payer: Vantage Medical Group Senior |
$0.24
|
|
|
POTASSIUM CHLORIDE 20 MEQ/15 ML ORAL LIQUID [6432]
|
Facility
|
IP
|
$0.47
|
|
|
Service Code
|
NDC 9999-6432-02
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.09 |
| Max. Negotiated Rate |
$0.35 |
| Rate for Payer: Adventist Health Commercial |
$0.09
|
| Rate for Payer: Cash Price |
$0.26
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.25
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.32
|
| Rate for Payer: Heritage Provider Network Senior |
$0.32
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.09
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.12
|
| Rate for Payer: Multiplan Commercial |
$0.35
|
|
|
POTASSIUM CHLORIDE 20 MEQ/15 ML ORAL LIQUID [6432]
|
Facility
|
IP
|
$0.28
|
|
|
Service Code
|
NDC 81033-220-15
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.05 |
| Max. Negotiated Rate |
$0.21 |
| Rate for Payer: Adventist Health Commercial |
$0.06
|
| Rate for Payer: Cash Price |
$0.15
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.15
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.19
|
| Rate for Payer: Heritage Provider Network Senior |
$0.19
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.05
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.07
|
| Rate for Payer: Multiplan Commercial |
$0.21
|
|
