POTASSIUM CHLORIDE 20 MEQ/15 ML ORAL LIQUID [6432]
|
Facility
IP
|
$0.85
|
|
Service Code
|
NDC 66689-048-50
|
Hospital Charge Code |
1716014
|
Hospital Revenue Code
|
259
|
Min. Negotiated Rate |
$0.15 |
Max. Negotiated Rate |
$0.64 |
Rate for Payer: Adventist Health Commercial |
$0.17
|
Rate for Payer: Aetna of CA Non-Gatekeeper |
$0.58
|
Rate for Payer: Cash Price |
$0.38
|
Rate for Payer: EPIC Health Plan Commercial |
$0.46
|
Rate for Payer: Heritage Provider Network Commercial |
$0.58
|
Rate for Payer: Heritage Provider Network Senior |
$0.58
|
Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.15
|
Rate for Payer: LLUH Dept of Risk Management WC |
$0.21
|
Rate for Payer: Multiplan Commercial |
$0.64
|
|
POTASSIUM CHLORIDE 20 MEQ/15 ML ORAL LIQUID [6432]
|
Facility
OP
|
$0.47
|
|
Service Code
|
NDC 9999-6432-02
|
Hospital Charge Code |
1716022
|
Hospital Revenue Code
|
259
|
Min. Negotiated Rate |
$0.09 |
Max. Negotiated Rate |
$0.40 |
Rate for Payer: Adventist Health Commercial |
$0.09
|
Rate for Payer: Aetna of CA Gatekeeper |
$0.25
|
Rate for Payer: Aetna of CA Non-Gatekeeper |
$0.32
|
Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$0.40
|
Rate for Payer: AlphaCare Medical Group Medi-Cal |
$0.26
|
Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$0.35
|
Rate for Payer: Blue Shield of California Commercial |
$0.29
|
Rate for Payer: Blue Shield of California EPN |
$0.28
|
Rate for Payer: Cash Price |
$0.21
|
Rate for Payer: Cigna of CA HMO/PPO |
$0.31
|
Rate for Payer: Dignity Health Commercial/Exchange |
$0.40
|
Rate for Payer: Dignity Health Medi-Cal |
$0.40
|
Rate for Payer: Dignity Health Senior |
$0.40
|
Rate for Payer: EPIC Health Plan Commercial |
$0.30
|
Rate for Payer: Heritage Provider Network Commercial |
$0.29
|
Rate for Payer: Heritage Provider Network Senior |
$0.29
|
Rate for Payer: Kaiser Permanente of CA Commercial |
$0.23
|
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
|
Rate for Payer: Vantage Medical Group Medi-Cal |
$0.40
|
Rate for Payer: Vantage Medical Group Senior |
$0.40
|
|
POTASSIUM CHLORIDE 20 MEQ/15 ML ORAL LIQUID [6432]
|
Facility
OP
|
$0.85
|
|
Service Code
|
NDC 66689-048-50
|
Hospital Charge Code |
1716014
|
Hospital Revenue Code
|
259
|
Min. Negotiated Rate |
$0.15 |
Max. Negotiated Rate |
$0.72 |
Rate for Payer: Adventist Health Commercial |
$0.17
|
Rate for Payer: Aetna of CA Gatekeeper |
$0.45
|
Rate for Payer: Aetna of CA Non-Gatekeeper |
$0.58
|
Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$0.72
|
Rate for Payer: AlphaCare Medical Group Medi-Cal |
$0.47
|
Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$0.64
|
Rate for Payer: Blue Shield of California Commercial |
$0.53
|
Rate for Payer: Blue Shield of California EPN |
$0.50
|
Rate for Payer: Cash Price |
$0.38
|
Rate for Payer: Cigna of CA HMO/PPO |
$0.55
|
Rate for Payer: Dignity Health Commercial/Exchange |
$0.72
|
Rate for Payer: Dignity Health Medi-Cal |
$0.72
|
Rate for Payer: Dignity Health Senior |
$0.72
|
Rate for Payer: EPIC Health Plan Commercial |
$0.54
|
Rate for Payer: Heritage Provider Network Commercial |
$0.53
|
Rate for Payer: Heritage Provider Network Senior |
$0.53
|
Rate for Payer: Kaiser Permanente of CA Commercial |
$0.41
|
Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.15
|
Rate for Payer: LLUH Dept of Risk Management WC |
$0.21
|
Rate for Payer: Multiplan Commercial |
$0.64
|
Rate for Payer: Vantage Medical Group Medi-Cal |
$0.72
|
Rate for Payer: Vantage Medical Group Senior |
$0.72
|
|
POTASSIUM CHLORIDE 20 MEQ/50 ML IN STERILE WATER INTRAVENOUS PIGGYBACK [11077]
|
Facility
IP
|
$0.09
|
|
Service Code
|
CPT J3480
|
Hospital Charge Code |
1771235
|
Hospital Revenue Code
|
636
|
Min. Negotiated Rate |
$0.02 |
Max. Negotiated Rate |
$0.07 |
Rate for Payer: Adventist Health Commercial |
$0.02
|
Rate for Payer: Adventist Health Commercial |
$0.02
|
Rate for Payer: Aetna of CA Non-Gatekeeper |
$0.06
|
Rate for Payer: Aetna of CA Non-Gatekeeper |
$0.08
|
Rate for Payer: Cash Price |
$0.04
|
Rate for Payer: Cash Price |
$0.05
|
Rate for Payer: Cigna of CA HMO/PPO |
$0.04
|
Rate for Payer: Cigna of CA HMO/PPO |
$0.06
|
Rate for Payer: EPIC Health Plan Commercial |
$0.06
|
Rate for Payer: EPIC Health Plan Commercial |
$0.05
|
Rate for Payer: Heritage Provider Network Commercial |
$0.06
|
Rate for Payer: Heritage Provider Network Commercial |
$0.08
|
Rate for Payer: Heritage Provider Network Senior |
$0.08
|
Rate for Payer: Heritage Provider Network Senior |
$0.06
|
Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.02
|
Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.02
|
Rate for Payer: LLUH Dept of Risk Management WC |
$0.02
|
Rate for Payer: LLUH Dept of Risk Management WC |
$0.03
|
Rate for Payer: Multiplan Commercial |
$0.07
|
Rate for Payer: Multiplan Commercial |
$0.09
|
Rate for Payer: United Healthcare All Other HMO/non HMO |
$0.04
|
Rate for Payer: United Healthcare All Other HMO/non HMO |
$0.03
|
Rate for Payer: United Healthcare Navigate/Select/Select+ |
$0.04
|
Rate for Payer: United Healthcare Navigate/Select/Select+ |
$0.03
|
|
POTASSIUM CHLORIDE 20 MEQ/50 ML IN STERILE WATER INTRAVENOUS PIGGYBACK [11077]
|
Facility
OP
|
$0.09
|
|
Service Code
|
CPT J3480
|
Hospital Charge Code |
1771235
|
Hospital Revenue Code
|
636
|
Min. Negotiated Rate |
$0.02 |
Max. Negotiated Rate |
$1.39 |
Rate for Payer: Adventist Health Commercial |
$0.02
|
Rate for Payer: Adventist Health Commercial |
$0.02
|
Rate for Payer: Aetna of CA Gatekeeper |
$0.29
|
Rate for Payer: Aetna of CA Gatekeeper |
$0.29
|
Rate for Payer: Aetna of CA Non-Gatekeeper |
$0.08
|
Rate for Payer: Aetna of CA Non-Gatekeeper |
$0.06
|
Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$0.10
|
Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$0.08
|
Rate for Payer: AlphaCare Medical Group Medi-Cal |
$0.07
|
Rate for Payer: AlphaCare Medical Group Medi-Cal |
$0.05
|
Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$0.07
|
Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$0.09
|
Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1.39
|
Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1.39
|
Rate for Payer: Blue Shield of California Commercial |
$0.24
|
Rate for Payer: Blue Shield of California Commercial |
$0.24
|
Rate for Payer: Blue Shield of California EPN |
$0.24
|
Rate for Payer: Blue Shield of California EPN |
$0.24
|
Rate for Payer: Cash Price |
$0.04
|
Rate for Payer: Cash Price |
$0.05
|
Rate for Payer: Cash Price |
$0.04
|
Rate for Payer: Cash Price |
$0.05
|
Rate for Payer: Cigna of CA HMO/PPO |
$0.04
|
Rate for Payer: Cigna of CA HMO/PPO |
$0.06
|
Rate for Payer: Dignity Health Commercial/Exchange |
$0.10
|
Rate for Payer: Dignity Health Commercial/Exchange |
$0.08
|
Rate for Payer: Dignity Health Medi-Cal |
$0.10
|
Rate for Payer: Dignity Health Medi-Cal |
$0.08
|
Rate for Payer: Dignity Health Senior |
$0.08
|
Rate for Payer: Dignity Health Senior |
$0.10
|
Rate for Payer: EPIC Health Plan Commercial |
$0.06
|
Rate for Payer: EPIC Health Plan Commercial |
$0.08
|
Rate for Payer: Heritage Provider Network Commercial |
$0.06
|
Rate for Payer: Heritage Provider Network Commercial |
$0.04
|
Rate for Payer: Heritage Provider Network Senior |
$0.04
|
Rate for Payer: Heritage Provider Network Senior |
$0.06
|
Rate for Payer: Kaiser Permanente of CA Commercial |
$0.04
|
Rate for Payer: Kaiser Permanente of CA Commercial |
$0.06
|
Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.02
|
Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.02
|
Rate for Payer: LLUH Dept of Risk Management WC |
$0.02
|
Rate for Payer: LLUH Dept of Risk Management WC |
$0.03
|
Rate for Payer: Multiplan Commercial |
$0.09
|
Rate for Payer: Multiplan Commercial |
$0.07
|
Rate for Payer: United Healthcare All Other HMO/non HMO |
$0.03
|
Rate for Payer: United Healthcare All Other HMO/non HMO |
$0.04
|
Rate for Payer: United Healthcare Navigate/Select/Select+ |
$0.03
|
Rate for Payer: United Healthcare Navigate/Select/Select+ |
$0.04
|
Rate for Payer: Vantage Medical Group Medi-Cal |
$0.08
|
Rate for Payer: Vantage Medical Group Medi-Cal |
$0.10
|
Rate for Payer: Vantage Medical Group Senior |
$0.10
|
Rate for Payer: Vantage Medical Group Senior |
$0.08
|
|
POTASSIUM CHLORIDE 20 MEQ/L IN 0.45 % SODIUM CHLORIDE INTRAVENOUS SOLN [36046]
|
Facility
OP
|
$0.01
|
|
Service Code
|
CPT J3480
|
Hospital Charge Code |
1759935
|
Hospital Revenue Code
|
636
|
Max. Negotiated Rate |
$1.39 |
Rate for Payer: Adventist Health Commercial |
$0.00
|
Rate for Payer: Aetna of CA Gatekeeper |
$0.29
|
Rate for Payer: Aetna of CA Non-Gatekeeper |
$0.01
|
Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$0.01
|
Rate for Payer: AlphaCare Medical Group Medi-Cal |
$0.01
|
Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$0.01
|
Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1.39
|
Rate for Payer: Blue Shield of California Commercial |
$0.24
|
Rate for Payer: Blue Shield of California EPN |
$0.24
|
Rate for Payer: Cigna of CA HMO/PPO |
$0.00
|
Rate for Payer: Dignity Health Commercial/Exchange |
$0.01
|
Rate for Payer: Dignity Health Medi-Cal |
$0.01
|
Rate for Payer: Dignity Health Senior |
$0.01
|
Rate for Payer: EPIC Health Plan Commercial |
$0.01
|
Rate for Payer: Heritage Provider Network Commercial |
$0.00
|
Rate for Payer: Heritage Provider Network Senior |
$0.00
|
Rate for Payer: Kaiser Permanente of CA Commercial |
$0.00
|
Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.00
|
Rate for Payer: LLUH Dept of Risk Management WC |
$0.00
|
Rate for Payer: Multiplan Commercial |
$0.01
|
Rate for Payer: United Healthcare All Other HMO/non HMO |
$0.00
|
Rate for Payer: United Healthcare Navigate/Select/Select+ |
$0.00
|
Rate for Payer: Vantage Medical Group Medi-Cal |
$0.01
|
Rate for Payer: Vantage Medical Group Senior |
$0.01
|
|
POTASSIUM CHLORIDE 20 MEQ/L IN 0.45 % SODIUM CHLORIDE INTRAVENOUS SOLN [36046]
|
Facility
IP
|
$0.01
|
|
Service Code
|
CPT J3480
|
Hospital Charge Code |
1759935
|
Hospital Revenue Code
|
636
|
Max. Negotiated Rate |
$0.01 |
Rate for Payer: Adventist Health Commercial |
$0.00
|
Rate for Payer: Aetna of CA Non-Gatekeeper |
$0.01
|
Rate for Payer: Cigna of CA HMO/PPO |
$0.00
|
Rate for Payer: EPIC Health Plan Commercial |
$0.01
|
Rate for Payer: Heritage Provider Network Commercial |
$0.01
|
Rate for Payer: Heritage Provider Network Senior |
$0.01
|
Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.00
|
Rate for Payer: LLUH Dept of Risk Management WC |
$0.00
|
Rate for Payer: Multiplan Commercial |
$0.01
|
Rate for Payer: United Healthcare All Other HMO/non HMO |
$0.00
|
Rate for Payer: United Healthcare Navigate/Select/Select+ |
$0.00
|
|
POTASSIUM CHLORIDE 20 MEQ/L IN 0.9 % SODIUM CHLORIDE INTRAVENOUS [11081]
|
Facility
OP
|
$0.01
|
|
Service Code
|
CPT J3480
|
Hospital Charge Code |
1771271
|
Hospital Revenue Code
|
636
|
Max. Negotiated Rate |
$1.39 |
Rate for Payer: Adventist Health Commercial |
$0.00
|
Rate for Payer: Aetna of CA Gatekeeper |
$0.29
|
Rate for Payer: Aetna of CA Non-Gatekeeper |
$0.01
|
Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$0.01
|
Rate for Payer: AlphaCare Medical Group Medi-Cal |
$0.01
|
Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$0.01
|
Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1.39
|
Rate for Payer: Blue Shield of California Commercial |
$0.24
|
Rate for Payer: Blue Shield of California EPN |
$0.24
|
Rate for Payer: Cigna of CA HMO/PPO |
$0.00
|
Rate for Payer: Dignity Health Commercial/Exchange |
$0.01
|
Rate for Payer: Dignity Health Medi-Cal |
$0.01
|
Rate for Payer: Dignity Health Senior |
$0.01
|
Rate for Payer: EPIC Health Plan Commercial |
$0.01
|
Rate for Payer: Heritage Provider Network Commercial |
$0.00
|
Rate for Payer: Heritage Provider Network Senior |
$0.00
|
Rate for Payer: Kaiser Permanente of CA Commercial |
$0.00
|
Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.00
|
Rate for Payer: LLUH Dept of Risk Management WC |
$0.00
|
Rate for Payer: Multiplan Commercial |
$0.01
|
Rate for Payer: United Healthcare All Other HMO/non HMO |
$0.00
|
Rate for Payer: United Healthcare Navigate/Select/Select+ |
$0.00
|
Rate for Payer: Vantage Medical Group Medi-Cal |
$0.01
|
Rate for Payer: Vantage Medical Group Senior |
$0.01
|
|
POTASSIUM CHLORIDE 20 MEQ/L IN 0.9 % SODIUM CHLORIDE INTRAVENOUS [11081]
|
Facility
IP
|
$0.01
|
|
Service Code
|
CPT J3480
|
Hospital Charge Code |
1771271
|
Hospital Revenue Code
|
636
|
Max. Negotiated Rate |
$0.01 |
Rate for Payer: Adventist Health Commercial |
$0.00
|
Rate for Payer: Aetna of CA Non-Gatekeeper |
$0.01
|
Rate for Payer: Cigna of CA HMO/PPO |
$0.00
|
Rate for Payer: EPIC Health Plan Commercial |
$0.01
|
Rate for Payer: Heritage Provider Network Commercial |
$0.01
|
Rate for Payer: Heritage Provider Network Senior |
$0.01
|
Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.00
|
Rate for Payer: LLUH Dept of Risk Management WC |
$0.00
|
Rate for Payer: Multiplan Commercial |
$0.01
|
Rate for Payer: United Healthcare All Other HMO/non HMO |
$0.00
|
Rate for Payer: United Healthcare Navigate/Select/Select+ |
$0.00
|
|
POTASSIUM CHLORIDE 20 MEQ/L IN D5-0.9 % SODIUM CHLORIDE INTRAVENOUS [9795]
|
Facility
OP
|
$0.01
|
|
Service Code
|
CPT J3480
|
Hospital Charge Code |
NDG9795
|
Hospital Revenue Code
|
636
|
Max. Negotiated Rate |
$1.39 |
Rate for Payer: Adventist Health Commercial |
$0.00
|
Rate for Payer: Aetna of CA Gatekeeper |
$0.29
|
Rate for Payer: Aetna of CA Non-Gatekeeper |
$0.01
|
Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$0.01
|
Rate for Payer: AlphaCare Medical Group Medi-Cal |
$0.01
|
Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$0.01
|
Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1.39
|
Rate for Payer: Blue Shield of California Commercial |
$0.24
|
Rate for Payer: Blue Shield of California EPN |
$0.24
|
Rate for Payer: Cigna of CA HMO/PPO |
$0.00
|
Rate for Payer: Dignity Health Commercial/Exchange |
$0.01
|
Rate for Payer: Dignity Health Medi-Cal |
$0.01
|
Rate for Payer: Dignity Health Senior |
$0.01
|
Rate for Payer: EPIC Health Plan Commercial |
$0.01
|
Rate for Payer: Heritage Provider Network Commercial |
$0.00
|
Rate for Payer: Heritage Provider Network Senior |
$0.00
|
Rate for Payer: Kaiser Permanente of CA Commercial |
$0.00
|
Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.00
|
Rate for Payer: LLUH Dept of Risk Management WC |
$0.00
|
Rate for Payer: Multiplan Commercial |
$0.01
|
Rate for Payer: United Healthcare All Other HMO/non HMO |
$0.00
|
Rate for Payer: United Healthcare Navigate/Select/Select+ |
$0.00
|
Rate for Payer: Vantage Medical Group Medi-Cal |
$0.01
|
Rate for Payer: Vantage Medical Group Senior |
$0.01
|
|
POTASSIUM CHLORIDE 20 MEQ/L IN D5-0.9 % SODIUM CHLORIDE INTRAVENOUS [9795]
|
Facility
IP
|
$0.01
|
|
Service Code
|
CPT J3480
|
Hospital Charge Code |
NDG9795
|
Hospital Revenue Code
|
636
|
Max. Negotiated Rate |
$0.01 |
Rate for Payer: Adventist Health Commercial |
$0.00
|
Rate for Payer: Aetna of CA Non-Gatekeeper |
$0.01
|
Rate for Payer: Cigna of CA HMO/PPO |
$0.00
|
Rate for Payer: EPIC Health Plan Commercial |
$0.01
|
Rate for Payer: Heritage Provider Network Commercial |
$0.01
|
Rate for Payer: Heritage Provider Network Senior |
$0.01
|
Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.00
|
Rate for Payer: LLUH Dept of Risk Management WC |
$0.00
|
Rate for Payer: Multiplan Commercial |
$0.01
|
Rate for Payer: United Healthcare All Other HMO/non HMO |
$0.00
|
Rate for Payer: United Healthcare Navigate/Select/Select+ |
$0.00
|
|
POTASSIUM CHLORIDE 20 MEQ/L IN DEXTROSE 5 %-0.2 % SODIUM CHLORIDE IV [9800]
|
Facility
IP
|
$0.01
|
|
Service Code
|
CPT J3480
|
Hospital Charge Code |
1771238
|
Hospital Revenue Code
|
636
|
Max. Negotiated Rate |
$0.01 |
Rate for Payer: Adventist Health Commercial |
$0.00
|
Rate for Payer: Aetna of CA Non-Gatekeeper |
$0.01
|
Rate for Payer: Cigna of CA HMO/PPO |
$0.00
|
Rate for Payer: EPIC Health Plan Commercial |
$0.01
|
Rate for Payer: Heritage Provider Network Commercial |
$0.01
|
Rate for Payer: Heritage Provider Network Senior |
$0.01
|
Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.00
|
Rate for Payer: LLUH Dept of Risk Management WC |
$0.00
|
Rate for Payer: Multiplan Commercial |
$0.01
|
Rate for Payer: United Healthcare All Other HMO/non HMO |
$0.00
|
Rate for Payer: United Healthcare Navigate/Select/Select+ |
$0.00
|
|
POTASSIUM CHLORIDE 20 MEQ/L IN DEXTROSE 5 %-0.2 % SODIUM CHLORIDE IV [9800]
|
Facility
OP
|
$0.01
|
|
Service Code
|
CPT J3480
|
Hospital Charge Code |
1771238
|
Hospital Revenue Code
|
636
|
Max. Negotiated Rate |
$1.39 |
Rate for Payer: Adventist Health Commercial |
$0.00
|
Rate for Payer: Aetna of CA Gatekeeper |
$0.29
|
Rate for Payer: Aetna of CA Non-Gatekeeper |
$0.01
|
Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$0.01
|
Rate for Payer: AlphaCare Medical Group Medi-Cal |
$0.01
|
Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$0.01
|
Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1.39
|
Rate for Payer: Blue Shield of California Commercial |
$0.24
|
Rate for Payer: Blue Shield of California EPN |
$0.24
|
Rate for Payer: Cigna of CA HMO/PPO |
$0.00
|
Rate for Payer: Dignity Health Commercial/Exchange |
$0.01
|
Rate for Payer: Dignity Health Medi-Cal |
$0.01
|
Rate for Payer: Dignity Health Senior |
$0.01
|
Rate for Payer: EPIC Health Plan Commercial |
$0.01
|
Rate for Payer: Heritage Provider Network Commercial |
$0.00
|
Rate for Payer: Heritage Provider Network Senior |
$0.00
|
Rate for Payer: Kaiser Permanente of CA Commercial |
$0.00
|
Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.00
|
Rate for Payer: LLUH Dept of Risk Management WC |
$0.00
|
Rate for Payer: Multiplan Commercial |
$0.01
|
Rate for Payer: United Healthcare All Other HMO/non HMO |
$0.00
|
Rate for Payer: United Healthcare Navigate/Select/Select+ |
$0.00
|
Rate for Payer: Vantage Medical Group Medi-Cal |
$0.01
|
Rate for Payer: Vantage Medical Group Senior |
$0.01
|
|
POTASSIUM CHLORIDE 20 MEQ/L IN DEXTROSE 5 %-0.45 % SODIUM CHLORIDE IV [9801]
|
Facility
IP
|
$0.01
|
|
Service Code
|
CPT J3480
|
Hospital Charge Code |
1771057
|
Hospital Revenue Code
|
636
|
Max. Negotiated Rate |
$0.01 |
Rate for Payer: Adventist Health Commercial |
$0.00
|
Rate for Payer: Aetna of CA Non-Gatekeeper |
$0.01
|
Rate for Payer: Cigna of CA HMO/PPO |
$0.00
|
Rate for Payer: EPIC Health Plan Commercial |
$0.01
|
Rate for Payer: Heritage Provider Network Commercial |
$0.01
|
Rate for Payer: Heritage Provider Network Senior |
$0.01
|
Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.00
|
Rate for Payer: LLUH Dept of Risk Management WC |
$0.00
|
Rate for Payer: Multiplan Commercial |
$0.01
|
Rate for Payer: United Healthcare All Other HMO/non HMO |
$0.00
|
Rate for Payer: United Healthcare Navigate/Select/Select+ |
$0.00
|
|
POTASSIUM CHLORIDE 20 MEQ/L IN DEXTROSE 5 %-0.45 % SODIUM CHLORIDE IV [9801]
|
Facility
OP
|
$0.01
|
|
Service Code
|
CPT J3480
|
Hospital Charge Code |
1771057
|
Hospital Revenue Code
|
636
|
Max. Negotiated Rate |
$1.39 |
Rate for Payer: Adventist Health Commercial |
$0.00
|
Rate for Payer: Aetna of CA Gatekeeper |
$0.29
|
Rate for Payer: Aetna of CA Non-Gatekeeper |
$0.01
|
Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$0.01
|
Rate for Payer: AlphaCare Medical Group Medi-Cal |
$0.01
|
Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$0.01
|
Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1.39
|
Rate for Payer: Blue Shield of California Commercial |
$0.24
|
Rate for Payer: Blue Shield of California EPN |
$0.24
|
Rate for Payer: Cigna of CA HMO/PPO |
$0.00
|
Rate for Payer: Dignity Health Commercial/Exchange |
$0.01
|
Rate for Payer: Dignity Health Medi-Cal |
$0.01
|
Rate for Payer: Dignity Health Senior |
$0.01
|
Rate for Payer: EPIC Health Plan Commercial |
$0.01
|
Rate for Payer: Heritage Provider Network Commercial |
$0.00
|
Rate for Payer: Heritage Provider Network Senior |
$0.00
|
Rate for Payer: Kaiser Permanente of CA Commercial |
$0.00
|
Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.00
|
Rate for Payer: LLUH Dept of Risk Management WC |
$0.00
|
Rate for Payer: Multiplan Commercial |
$0.01
|
Rate for Payer: United Healthcare All Other HMO/non HMO |
$0.00
|
Rate for Payer: United Healthcare Navigate/Select/Select+ |
$0.00
|
Rate for Payer: Vantage Medical Group Medi-Cal |
$0.01
|
Rate for Payer: Vantage Medical Group Senior |
$0.01
|
|
POTASSIUM CHLORIDE 2 MEQ/ML IV FORM FOR ORAL USE [400334]
|
Facility
OP
|
$1.12
|
|
Service Code
|
NDC 9994-0804-38
|
Hospital Charge Code |
1715031
|
Hospital Revenue Code
|
259
|
Min. Negotiated Rate |
$0.20 |
Max. Negotiated Rate |
$0.95 |
Rate for Payer: Adventist Health Commercial |
$0.22
|
Rate for Payer: Aetna of CA Gatekeeper |
$0.60
|
Rate for Payer: Aetna of CA Non-Gatekeeper |
$0.77
|
Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$0.95
|
Rate for Payer: AlphaCare Medical Group Medi-Cal |
$0.62
|
Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$0.84
|
Rate for Payer: Blue Shield of California Commercial |
$0.70
|
Rate for Payer: Blue Shield of California EPN |
$0.66
|
Rate for Payer: Cash Price |
$0.50
|
Rate for Payer: Cigna of CA HMO/PPO |
$0.73
|
Rate for Payer: Dignity Health Commercial/Exchange |
$0.95
|
Rate for Payer: Dignity Health Medi-Cal |
$0.95
|
Rate for Payer: Dignity Health Senior |
$0.95
|
Rate for Payer: EPIC Health Plan Commercial |
$0.72
|
Rate for Payer: Heritage Provider Network Commercial |
$0.69
|
Rate for Payer: Heritage Provider Network Senior |
$0.69
|
Rate for Payer: Kaiser Permanente of CA Commercial |
$0.54
|
Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.20
|
Rate for Payer: LLUH Dept of Risk Management WC |
$0.28
|
Rate for Payer: Multiplan Commercial |
$0.84
|
Rate for Payer: Vantage Medical Group Medi-Cal |
$0.95
|
Rate for Payer: Vantage Medical Group Senior |
$0.95
|
|
POTASSIUM CHLORIDE 2 MEQ/ML IV FORM FOR ORAL USE [400334]
|
Facility
IP
|
$1.12
|
|
Service Code
|
NDC 9994-0804-38
|
Hospital Charge Code |
1715031
|
Hospital Revenue Code
|
259
|
Min. Negotiated Rate |
$0.20 |
Max. Negotiated Rate |
$0.84 |
Rate for Payer: Adventist Health Commercial |
$0.22
|
Rate for Payer: Aetna of CA Non-Gatekeeper |
$0.77
|
Rate for Payer: Cash Price |
$0.50
|
Rate for Payer: EPIC Health Plan Commercial |
$0.60
|
Rate for Payer: Heritage Provider Network Commercial |
$0.76
|
Rate for Payer: Heritage Provider Network Senior |
$0.76
|
Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.20
|
Rate for Payer: LLUH Dept of Risk Management WC |
$0.28
|
Rate for Payer: Multiplan Commercial |
$0.84
|
|
POTASSIUM CHLORIDE 30 MEQ/L IN DEXTROSE 5 %-0.45 % SODIUM CHLORIDE IV [9804]
|
Facility
OP
|
$0.01
|
|
Service Code
|
CPT J3480
|
Hospital Charge Code |
1771298
|
Hospital Revenue Code
|
636
|
Max. Negotiated Rate |
$1.39 |
Rate for Payer: Adventist Health Commercial |
$0.00
|
Rate for Payer: Aetna of CA Gatekeeper |
$0.29
|
Rate for Payer: Aetna of CA Non-Gatekeeper |
$0.01
|
Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$0.01
|
Rate for Payer: AlphaCare Medical Group Medi-Cal |
$0.01
|
Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$0.01
|
Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1.39
|
Rate for Payer: Blue Shield of California Commercial |
$0.24
|
Rate for Payer: Blue Shield of California EPN |
$0.24
|
Rate for Payer: Cigna of CA HMO/PPO |
$0.00
|
Rate for Payer: Dignity Health Commercial/Exchange |
$0.01
|
Rate for Payer: Dignity Health Medi-Cal |
$0.01
|
Rate for Payer: Dignity Health Senior |
$0.01
|
Rate for Payer: EPIC Health Plan Commercial |
$0.01
|
Rate for Payer: Heritage Provider Network Commercial |
$0.00
|
Rate for Payer: Heritage Provider Network Senior |
$0.00
|
Rate for Payer: Kaiser Permanente of CA Commercial |
$0.00
|
Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.00
|
Rate for Payer: LLUH Dept of Risk Management WC |
$0.00
|
Rate for Payer: Multiplan Commercial |
$0.01
|
Rate for Payer: United Healthcare All Other HMO/non HMO |
$0.00
|
Rate for Payer: United Healthcare Navigate/Select/Select+ |
$0.00
|
Rate for Payer: Vantage Medical Group Medi-Cal |
$0.01
|
Rate for Payer: Vantage Medical Group Senior |
$0.01
|
|
POTASSIUM CHLORIDE 30 MEQ/L IN DEXTROSE 5 %-0.45 % SODIUM CHLORIDE IV [9804]
|
Facility
IP
|
$0.01
|
|
Service Code
|
CPT J3480
|
Hospital Charge Code |
1771298
|
Hospital Revenue Code
|
636
|
Max. Negotiated Rate |
$0.01 |
Rate for Payer: Adventist Health Commercial |
$0.00
|
Rate for Payer: Aetna of CA Non-Gatekeeper |
$0.01
|
Rate for Payer: Cigna of CA HMO/PPO |
$0.00
|
Rate for Payer: EPIC Health Plan Commercial |
$0.01
|
Rate for Payer: Heritage Provider Network Commercial |
$0.01
|
Rate for Payer: Heritage Provider Network Senior |
$0.01
|
Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.00
|
Rate for Payer: LLUH Dept of Risk Management WC |
$0.00
|
Rate for Payer: Multiplan Commercial |
$0.01
|
Rate for Payer: United Healthcare All Other HMO/non HMO |
$0.00
|
Rate for Payer: United Healthcare Navigate/Select/Select+ |
$0.00
|
|
POTASSIUM CHLORIDE 40 MEQ/100ML IN STERILE WATER INTRAVENOUS PIGGYBACK [11079]
|
Facility
IP
|
$0.06
|
|
Service Code
|
CPT J3480
|
Hospital Charge Code |
1771236
|
Hospital Revenue Code
|
636
|
Min. Negotiated Rate |
$0.01 |
Max. Negotiated Rate |
$0.05 |
Rate for Payer: Adventist Health Commercial |
$0.01
|
Rate for Payer: Adventist Health Commercial |
$0.01
|
Rate for Payer: Aetna of CA Non-Gatekeeper |
$0.03
|
Rate for Payer: Aetna of CA Non-Gatekeeper |
$0.04
|
Rate for Payer: Cash Price |
$0.02
|
Rate for Payer: Cash Price |
$0.03
|
Rate for Payer: Cigna of CA HMO/PPO |
$0.03
|
Rate for Payer: Cigna of CA HMO/PPO |
$0.02
|
Rate for Payer: EPIC Health Plan Commercial |
$0.03
|
Rate for Payer: EPIC Health Plan Commercial |
$0.03
|
Rate for Payer: Heritage Provider Network Commercial |
$0.03
|
Rate for Payer: Heritage Provider Network Commercial |
$0.04
|
Rate for Payer: Heritage Provider Network Senior |
$0.03
|
Rate for Payer: Heritage Provider Network Senior |
$0.04
|
Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.01
|
Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.01
|
Rate for Payer: LLUH Dept of Risk Management WC |
$0.02
|
Rate for Payer: LLUH Dept of Risk Management WC |
$0.01
|
Rate for Payer: Multiplan Commercial |
$0.05
|
Rate for Payer: Multiplan Commercial |
$0.04
|
Rate for Payer: United Healthcare All Other HMO/non HMO |
$0.02
|
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: United Healthcare Navigate/Select/Select+ |
$0.02
|
|
POTASSIUM CHLORIDE 40 MEQ/100ML IN STERILE WATER INTRAVENOUS PIGGYBACK [11079]
|
Facility
OP
|
$0.06
|
|
Service Code
|
CPT J3480
|
Hospital Charge Code |
1771236
|
Hospital Revenue Code
|
636
|
Min. Negotiated Rate |
$0.01 |
Max. Negotiated Rate |
$1.39 |
Rate for Payer: Adventist Health Commercial |
$0.01
|
Rate for Payer: Adventist Health Commercial |
$0.01
|
Rate for Payer: Aetna of CA Gatekeeper |
$0.29
|
Rate for Payer: Aetna of CA Gatekeeper |
$0.29
|
Rate for Payer: Aetna of CA Non-Gatekeeper |
$0.03
|
Rate for Payer: Aetna of CA Non-Gatekeeper |
$0.04
|
Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$0.04
|
Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$0.05
|
Rate for Payer: AlphaCare Medical Group Medi-Cal |
$0.03
|
Rate for Payer: AlphaCare Medical Group Medi-Cal |
$0.03
|
Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$0.04
|
Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$0.05
|
Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1.39
|
Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1.39
|
Rate for Payer: Blue Shield of California Commercial |
$0.24
|
Rate for Payer: Blue Shield of California Commercial |
$0.24
|
Rate for Payer: Blue Shield of California EPN |
$0.24
|
Rate for Payer: Blue Shield of California EPN |
$0.24
|
Rate for Payer: Cash Price |
$0.03
|
Rate for Payer: Cash Price |
$0.02
|
Rate for Payer: Cash Price |
$0.03
|
Rate for Payer: Cash Price |
$0.02
|
Rate for Payer: Cigna of CA HMO/PPO |
$0.02
|
Rate for Payer: Cigna of CA HMO/PPO |
$0.03
|
Rate for Payer: Dignity Health Commercial/Exchange |
$0.04
|
Rate for Payer: Dignity Health Commercial/Exchange |
$0.05
|
Rate for Payer: Dignity Health Medi-Cal |
$0.04
|
Rate for Payer: Dignity Health Medi-Cal |
$0.05
|
Rate for Payer: Dignity Health Senior |
$0.05
|
Rate for Payer: Dignity Health Senior |
$0.04
|
Rate for Payer: EPIC Health Plan Commercial |
$0.03
|
Rate for Payer: EPIC Health Plan Commercial |
$0.04
|
Rate for Payer: Heritage Provider Network Commercial |
$0.03
|
Rate for Payer: Heritage Provider Network Commercial |
$0.02
|
Rate for Payer: Heritage Provider Network Senior |
$0.03
|
Rate for Payer: Heritage Provider Network Senior |
$0.02
|
Rate for Payer: Kaiser Permanente of CA Commercial |
$0.03
|
Rate for Payer: Kaiser Permanente of CA Commercial |
$0.02
|
Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$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: LLUH Dept of Risk Management WC |
$0.02
|
Rate for Payer: Multiplan Commercial |
$0.05
|
Rate for Payer: Multiplan Commercial |
$0.04
|
Rate for Payer: United Healthcare All Other HMO/non HMO |
$0.02
|
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: United Healthcare Navigate/Select/Select+ |
$0.02
|
Rate for Payer: Vantage Medical Group Medi-Cal |
$0.04
|
Rate for Payer: Vantage Medical Group Medi-Cal |
$0.05
|
Rate for Payer: Vantage Medical Group Senior |
$0.04
|
Rate for Payer: Vantage Medical Group Senior |
$0.05
|
|
POTASSIUM CHLORIDE 40 MEQ/L IN 0.9 % SODIUM CHLORIDE INTRAVENOUS [11082]
|
Facility
OP
|
$0.01
|
|
Service Code
|
CPT J3480
|
Hospital Charge Code |
NDG11082
|
Hospital Revenue Code
|
636
|
Max. Negotiated Rate |
$1.39 |
Rate for Payer: Adventist Health Commercial |
$0.00
|
Rate for Payer: Aetna of CA Gatekeeper |
$0.29
|
Rate for Payer: Aetna of CA Non-Gatekeeper |
$0.01
|
Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$0.01
|
Rate for Payer: AlphaCare Medical Group Medi-Cal |
$0.01
|
Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$0.01
|
Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1.39
|
Rate for Payer: Blue Shield of California Commercial |
$0.24
|
Rate for Payer: Blue Shield of California EPN |
$0.24
|
Rate for Payer: Cigna of CA HMO/PPO |
$0.00
|
Rate for Payer: Dignity Health Commercial/Exchange |
$0.01
|
Rate for Payer: Dignity Health Medi-Cal |
$0.01
|
Rate for Payer: Dignity Health Senior |
$0.01
|
Rate for Payer: EPIC Health Plan Commercial |
$0.01
|
Rate for Payer: Heritage Provider Network Commercial |
$0.00
|
Rate for Payer: Heritage Provider Network Senior |
$0.00
|
Rate for Payer: Kaiser Permanente of CA Commercial |
$0.00
|
Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.00
|
Rate for Payer: LLUH Dept of Risk Management WC |
$0.00
|
Rate for Payer: Multiplan Commercial |
$0.01
|
Rate for Payer: United Healthcare All Other HMO/non HMO |
$0.00
|
Rate for Payer: United Healthcare Navigate/Select/Select+ |
$0.00
|
Rate for Payer: Vantage Medical Group Medi-Cal |
$0.01
|
Rate for Payer: Vantage Medical Group Senior |
$0.01
|
|
POTASSIUM CHLORIDE 40 MEQ/L IN 0.9 % SODIUM CHLORIDE INTRAVENOUS [11082]
|
Facility
IP
|
$0.01
|
|
Service Code
|
CPT J3480
|
Hospital Charge Code |
NDG11082
|
Hospital Revenue Code
|
636
|
Max. Negotiated Rate |
$0.01 |
Rate for Payer: Adventist Health Commercial |
$0.00
|
Rate for Payer: Aetna of CA Non-Gatekeeper |
$0.01
|
Rate for Payer: Cigna of CA HMO/PPO |
$0.00
|
Rate for Payer: EPIC Health Plan Commercial |
$0.01
|
Rate for Payer: Heritage Provider Network Commercial |
$0.01
|
Rate for Payer: Heritage Provider Network Senior |
$0.01
|
Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.00
|
Rate for Payer: LLUH Dept of Risk Management WC |
$0.00
|
Rate for Payer: Multiplan Commercial |
$0.01
|
Rate for Payer: United Healthcare All Other HMO/non HMO |
$0.00
|
Rate for Payer: United Healthcare Navigate/Select/Select+ |
$0.00
|
|
POTASSIUM CHLORIDE 40 MEQ/L IN DEXTROSE 5 %-0.45 % SODIUM CHLORIDE IV [9807]
|
Facility
IP
|
$0.01
|
|
Service Code
|
CPT J3480
|
Hospital Charge Code |
1771299
|
Hospital Revenue Code
|
636
|
Max. Negotiated Rate |
$0.01 |
Rate for Payer: Adventist Health Commercial |
$0.00
|
Rate for Payer: Aetna of CA Non-Gatekeeper |
$0.01
|
Rate for Payer: Cigna of CA HMO/PPO |
$0.00
|
Rate for Payer: EPIC Health Plan Commercial |
$0.01
|
Rate for Payer: Heritage Provider Network Commercial |
$0.01
|
Rate for Payer: Heritage Provider Network Senior |
$0.01
|
Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.00
|
Rate for Payer: LLUH Dept of Risk Management WC |
$0.00
|
Rate for Payer: Multiplan Commercial |
$0.01
|
Rate for Payer: United Healthcare All Other HMO/non HMO |
$0.00
|
Rate for Payer: United Healthcare Navigate/Select/Select+ |
$0.00
|
|
POTASSIUM CHLORIDE 40 MEQ/L IN DEXTROSE 5 %-0.45 % SODIUM CHLORIDE IV [9807]
|
Facility
OP
|
$0.01
|
|
Service Code
|
CPT J3480
|
Hospital Charge Code |
1771299
|
Hospital Revenue Code
|
636
|
Max. Negotiated Rate |
$1.39 |
Rate for Payer: Adventist Health Commercial |
$0.00
|
Rate for Payer: Aetna of CA Gatekeeper |
$0.29
|
Rate for Payer: Aetna of CA Non-Gatekeeper |
$0.01
|
Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$0.01
|
Rate for Payer: AlphaCare Medical Group Medi-Cal |
$0.01
|
Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$0.01
|
Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1.39
|
Rate for Payer: Blue Shield of California Commercial |
$0.24
|
Rate for Payer: Blue Shield of California EPN |
$0.24
|
Rate for Payer: Cigna of CA HMO/PPO |
$0.00
|
Rate for Payer: Dignity Health Commercial/Exchange |
$0.01
|
Rate for Payer: Dignity Health Medi-Cal |
$0.01
|
Rate for Payer: Dignity Health Senior |
$0.01
|
Rate for Payer: EPIC Health Plan Commercial |
$0.01
|
Rate for Payer: Heritage Provider Network Commercial |
$0.00
|
Rate for Payer: Heritage Provider Network Senior |
$0.00
|
Rate for Payer: Kaiser Permanente of CA Commercial |
$0.00
|
Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.00
|
Rate for Payer: LLUH Dept of Risk Management WC |
$0.00
|
Rate for Payer: Multiplan Commercial |
$0.01
|
Rate for Payer: United Healthcare All Other HMO/non HMO |
$0.00
|
Rate for Payer: United Healthcare Navigate/Select/Select+ |
$0.00
|
Rate for Payer: Vantage Medical Group Medi-Cal |
$0.01
|
Rate for Payer: Vantage Medical Group Senior |
$0.01
|
|