|
SELEXIPAG 400 MCG TABLET [212416]
|
Facility
IP
|
$422.95
|
|
|
Service Code
|
CPT C9399
|
| Hospital Charge Code |
ERX212416
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$76.55 |
| Max. Negotiated Rate |
$317.21 |
| Rate for Payer: Adventist Health Commercial |
$84.59
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$290.57
|
| Rate for Payer: Cash Price |
$190.33
|
| Rate for Payer: EPIC Health Plan Commercial |
$228.39
|
| Rate for Payer: Heritage Provider Network Commercial |
$286.34
|
| Rate for Payer: Heritage Provider Network Senior |
$286.34
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$76.55
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$105.74
|
| Rate for Payer: Multiplan Commercial |
$317.21
|
|
|
SELEXIPAG 400 MCG TABLET [212416]
|
Facility
OP
|
$422.95
|
|
|
Service Code
|
CPT C9399
|
| Hospital Charge Code |
ERX212416
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$76.55 |
| Max. Negotiated Rate |
$359.51 |
| Rate for Payer: Adventist Health Commercial |
$84.59
|
| Rate for Payer: Aetna of CA Gatekeeper |
$226.07
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$290.57
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$359.51
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$232.62
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$317.21
|
| Rate for Payer: Blue Shield of California Commercial |
$262.65
|
| Rate for Payer: Blue Shield of California EPN |
$248.27
|
| Rate for Payer: Cash Price |
$190.33
|
| Rate for Payer: Cigna of CA HMO/PPO |
$274.92
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$359.51
|
| Rate for Payer: Dignity Health Medi-Cal |
$359.51
|
| Rate for Payer: Dignity Health Senior |
$359.51
|
| Rate for Payer: EPIC Health Plan Commercial |
$270.69
|
| Rate for Payer: Heritage Provider Network Commercial |
$261.81
|
| Rate for Payer: Heritage Provider Network Senior |
$261.81
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$203.86
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$76.55
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$105.74
|
| Rate for Payer: Multiplan Commercial |
$317.21
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$359.51
|
| Rate for Payer: Vantage Medical Group Senior |
$359.51
|
|
|
SELPERCATINIB 40 MG CAPSULE [228076]
|
Facility
IP
|
$141.46
|
|
|
Service Code
|
NDC 0002-3977-60
|
| Hospital Charge Code |
ERX228076
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$25.60 |
| Max. Negotiated Rate |
$106.10 |
| Rate for Payer: Adventist Health Commercial |
$28.29
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$97.18
|
| Rate for Payer: Cash Price |
$63.66
|
| Rate for Payer: EPIC Health Plan Commercial |
$76.39
|
| Rate for Payer: Heritage Provider Network Commercial |
$95.77
|
| Rate for Payer: Heritage Provider Network Senior |
$95.77
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$25.60
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$35.36
|
| Rate for Payer: Multiplan Commercial |
$106.10
|
|
|
SELPERCATINIB 40 MG CAPSULE [228076]
|
Facility
OP
|
$141.46
|
|
|
Service Code
|
NDC 0002-3977-60
|
| Hospital Charge Code |
ERX228076
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$25.60 |
| Max. Negotiated Rate |
$120.24 |
| Rate for Payer: Adventist Health Commercial |
$28.29
|
| Rate for Payer: Aetna of CA Gatekeeper |
$75.61
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$97.18
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$120.24
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$77.80
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$106.10
|
| Rate for Payer: Blue Shield of California Commercial |
$87.85
|
| Rate for Payer: Blue Shield of California EPN |
$83.04
|
| Rate for Payer: Cash Price |
$63.66
|
| Rate for Payer: Cigna of CA HMO/PPO |
$91.95
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$120.24
|
| Rate for Payer: Dignity Health Medi-Cal |
$120.24
|
| Rate for Payer: Dignity Health Senior |
$120.24
|
| Rate for Payer: EPIC Health Plan Commercial |
$90.53
|
| Rate for Payer: Heritage Provider Network Commercial |
$87.56
|
| Rate for Payer: Heritage Provider Network Senior |
$87.56
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$68.18
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$25.60
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$35.36
|
| Rate for Payer: Multiplan Commercial |
$106.10
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$120.24
|
| Rate for Payer: Vantage Medical Group Senior |
$120.24
|
|
|
SELPERCATINIB 80 MG CAPSULE [228077]
|
Facility
OP
|
$212.18
|
|
|
Service Code
|
NDC 0002-2980-60
|
| Hospital Charge Code |
ERX228077
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$38.40 |
| Max. Negotiated Rate |
$180.35 |
| Rate for Payer: Adventist Health Commercial |
$42.44
|
| Rate for Payer: Aetna of CA Gatekeeper |
$113.41
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$145.77
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$180.35
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$116.70
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$159.14
|
| Rate for Payer: Blue Shield of California Commercial |
$131.76
|
| Rate for Payer: Blue Shield of California EPN |
$124.55
|
| Rate for Payer: Cash Price |
$95.48
|
| Rate for Payer: Cigna of CA HMO/PPO |
$137.92
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$180.35
|
| Rate for Payer: Dignity Health Medi-Cal |
$180.35
|
| Rate for Payer: Dignity Health Senior |
$180.35
|
| Rate for Payer: EPIC Health Plan Commercial |
$135.80
|
| Rate for Payer: Heritage Provider Network Commercial |
$131.34
|
| Rate for Payer: Heritage Provider Network Senior |
$131.34
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$102.27
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$38.40
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$53.04
|
| Rate for Payer: Multiplan Commercial |
$159.14
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$180.35
|
| Rate for Payer: Vantage Medical Group Senior |
$180.35
|
|
|
SELPERCATINIB 80 MG CAPSULE [228077]
|
Facility
IP
|
$212.18
|
|
|
Service Code
|
NDC 0002-2980-60
|
| Hospital Charge Code |
ERX228077
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$38.40 |
| Max. Negotiated Rate |
$159.14 |
| Rate for Payer: Adventist Health Commercial |
$42.44
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$145.77
|
| Rate for Payer: Cash Price |
$95.48
|
| Rate for Payer: EPIC Health Plan Commercial |
$114.58
|
| Rate for Payer: Heritage Provider Network Commercial |
$143.65
|
| Rate for Payer: Heritage Provider Network Senior |
$143.65
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$38.40
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$53.04
|
| Rate for Payer: Multiplan Commercial |
$159.14
|
|
|
SELPERCATINIB 80 MG CAPSULE [228077]
|
Facility
IP
|
$212.18
|
|
|
Service Code
|
NDC 0002-2980-26
|
| Hospital Charge Code |
ERX228077
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$38.40 |
| Max. Negotiated Rate |
$159.14 |
| Rate for Payer: Adventist Health Commercial |
$42.44
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$145.77
|
| Rate for Payer: Cash Price |
$95.48
|
| Rate for Payer: EPIC Health Plan Commercial |
$114.58
|
| Rate for Payer: Heritage Provider Network Commercial |
$143.65
|
| Rate for Payer: Heritage Provider Network Senior |
$143.65
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$38.40
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$53.04
|
| Rate for Payer: Multiplan Commercial |
$159.14
|
|
|
SELPERCATINIB 80 MG CAPSULE [228077]
|
Facility
OP
|
$212.18
|
|
|
Service Code
|
NDC 0002-2980-26
|
| Hospital Charge Code |
ERX228077
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$38.40 |
| Max. Negotiated Rate |
$180.35 |
| Rate for Payer: Adventist Health Commercial |
$42.44
|
| Rate for Payer: Aetna of CA Gatekeeper |
$113.41
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$145.77
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$180.35
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$116.70
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$159.14
|
| Rate for Payer: Blue Shield of California Commercial |
$131.76
|
| Rate for Payer: Blue Shield of California EPN |
$124.55
|
| Rate for Payer: Cash Price |
$95.48
|
| Rate for Payer: Cigna of CA HMO/PPO |
$137.92
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$180.35
|
| Rate for Payer: Dignity Health Medi-Cal |
$180.35
|
| Rate for Payer: Dignity Health Senior |
$180.35
|
| Rate for Payer: EPIC Health Plan Commercial |
$135.80
|
| Rate for Payer: Heritage Provider Network Commercial |
$131.34
|
| Rate for Payer: Heritage Provider Network Senior |
$131.34
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$102.27
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$38.40
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$53.04
|
| Rate for Payer: Multiplan Commercial |
$159.14
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$180.35
|
| Rate for Payer: Vantage Medical Group Senior |
$180.35
|
|
|
SENNA LEAF EXTRACT 176 MG/5 ML ORAL SYRUP [117388]
|
Facility
OP
|
$0.06
|
|
|
Service Code
|
NDC 121072208
|
| Hospital Charge Code |
NDG117388
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.01 |
| Max. Negotiated Rate |
$0.05 |
| Rate for Payer: Adventist Health Commercial |
$0.01
|
| Rate for Payer: Aetna of CA Gatekeeper |
$0.03
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$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 Medicare Advantage/Dual Product |
$0.05
|
| Rate for Payer: Blue Shield of California Commercial |
$0.04
|
| Rate for Payer: Blue Shield of California EPN |
$0.04
|
| Rate for Payer: Cash Price |
$0.03
|
| Rate for Payer: Cigna of CA HMO/PPO |
$0.04
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.05
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.05
|
| Rate for Payer: Dignity Health Senior |
$0.05
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.04
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.04
|
| Rate for Payer: Heritage Provider Network Senior |
$0.04
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$0.03
|
| 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: Multiplan Commercial |
$0.05
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.05
|
| Rate for Payer: Vantage Medical Group Senior |
$0.05
|
|
|
SENNA LEAF EXTRACT 176 MG/5 ML ORAL SYRUP [117388]
|
Facility
IP
|
$0.06
|
|
|
Service Code
|
NDC 121072208
|
| Hospital Charge Code |
NDG117388
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.01 |
| Max. Negotiated Rate |
$0.05 |
| Rate for Payer: Adventist Health Commercial |
$0.01
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$0.04
|
| Rate for Payer: Cash Price |
$0.03
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.03
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.04
|
| Rate for Payer: Heritage Provider Network Senior |
$0.04
|
| 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: Multiplan Commercial |
$0.05
|
|
|
SENNOSIDES 8.6 MG-DOCUSATE SODIUM 50 MG TABLET [24216]
|
Facility
OP
|
$0.02
|
|
|
Service Code
|
NDC 69618-065-01
|
| Hospital Charge Code |
1710268
|
|
Hospital Revenue Code
|
259
|
| Max. Negotiated Rate |
$0.02 |
| Rate for Payer: Adventist Health Commercial |
$0.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$0.01
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$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 |
$0.02
|
| 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: Cigna of CA HMO/PPO |
$0.01
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.02
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.02
|
| Rate for Payer: Dignity Health Senior |
$0.02
|
| 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 Commercial |
$0.01
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.01
|
| Rate for Payer: Multiplan Commercial |
$0.02
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.02
|
| Rate for Payer: Vantage Medical Group Senior |
$0.02
|
|
|
SENNOSIDES 8.6 MG-DOCUSATE SODIUM 50 MG TABLET [24216]
|
Facility
IP
|
$0.06
|
|
|
Service Code
|
NDC 46122-669-78
|
| Hospital Charge Code |
1710268
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.01 |
| Max. Negotiated Rate |
$0.05 |
| Rate for Payer: Adventist Health Commercial |
$0.01
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$0.04
|
| Rate for Payer: Cash Price |
$0.03
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.03
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.04
|
| Rate for Payer: Heritage Provider Network Senior |
$0.04
|
| 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: Multiplan Commercial |
$0.05
|
|
|
SENNOSIDES 8.6 MG-DOCUSATE SODIUM 50 MG TABLET [24216]
|
Facility
IP
|
$0.02
|
|
|
Service Code
|
NDC 69618-065-01
|
| Hospital Charge Code |
1710268
|
|
Hospital Revenue Code
|
259
|
| Max. Negotiated Rate |
$0.02 |
| Rate for Payer: Adventist Health Commercial |
$0.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$0.01
|
| Rate for Payer: Cash Price |
$0.01
|
| 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 |
$0.01
|
| Rate for Payer: Multiplan Commercial |
$0.02
|
|
|
SENNOSIDES 8.6 MG-DOCUSATE SODIUM 50 MG TABLET [24216]
|
Facility
OP
|
$0.17
|
|
|
Service Code
|
NDC 60687-622-01
|
| Hospital Charge Code |
1710268
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.03 |
| Max. Negotiated Rate |
$0.14 |
| Rate for Payer: Adventist Health Commercial |
$0.03
|
| Rate for Payer: Aetna of CA Gatekeeper |
$0.09
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$0.12
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$0.14
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$0.09
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$0.13
|
| Rate for Payer: Blue Shield of California Commercial |
$0.11
|
| Rate for Payer: Blue Shield of California EPN |
$0.10
|
| Rate for Payer: Cash Price |
$0.08
|
| Rate for Payer: Cigna of CA HMO/PPO |
$0.11
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.14
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.14
|
| Rate for Payer: Dignity Health Senior |
$0.14
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.11
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.11
|
| Rate for Payer: Heritage Provider Network Senior |
$0.11
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$0.08
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.03
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.04
|
| Rate for Payer: Multiplan Commercial |
$0.13
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.14
|
| Rate for Payer: Vantage Medical Group Senior |
$0.14
|
|
|
SENNOSIDES 8.6 MG-DOCUSATE SODIUM 50 MG TABLET [24216]
|
Facility
IP
|
$0.17
|
|
|
Service Code
|
NDC 60687-622-11
|
| Hospital Charge Code |
1710268
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.03 |
| Max. Negotiated Rate |
$0.13 |
| Rate for Payer: Adventist Health Commercial |
$0.03
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$0.12
|
| Rate for Payer: Cash Price |
$0.08
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.09
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.12
|
| Rate for Payer: Heritage Provider Network Senior |
$0.12
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.03
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.04
|
| Rate for Payer: Multiplan Commercial |
$0.13
|
|
|
SENNOSIDES 8.6 MG-DOCUSATE SODIUM 50 MG TABLET [24216]
|
Facility
OP
|
$0.03
|
|
|
Service Code
|
NDC 57896-555-01
|
| Hospital Charge Code |
1710268
|
|
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: 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: Blue Shield of California Commercial |
$0.02
|
| Rate for Payer: Blue Shield of California EPN |
$0.02
|
| Rate for Payer: Cash Price |
$0.01
|
| 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: Multiplan Commercial |
$0.02
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.03
|
| Rate for Payer: Vantage Medical Group Senior |
$0.03
|
|
|
SENNOSIDES 8.6 MG-DOCUSATE SODIUM 50 MG TABLET [24216]
|
Facility
OP
|
$0.06
|
|
|
Service Code
|
NDC 46122-669-78
|
| Hospital Charge Code |
1710268
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.01 |
| Max. Negotiated Rate |
$0.05 |
| Rate for Payer: Adventist Health Commercial |
$0.01
|
| Rate for Payer: Aetna of CA Gatekeeper |
$0.03
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$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 Medicare Advantage/Dual Product |
$0.05
|
| Rate for Payer: Blue Shield of California Commercial |
$0.04
|
| Rate for Payer: Blue Shield of California EPN |
$0.04
|
| Rate for Payer: Cash Price |
$0.03
|
| Rate for Payer: Cigna of CA HMO/PPO |
$0.04
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.05
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.05
|
| Rate for Payer: Dignity Health Senior |
$0.05
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.04
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.04
|
| Rate for Payer: Heritage Provider Network Senior |
$0.04
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$0.03
|
| 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: Multiplan Commercial |
$0.05
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.05
|
| Rate for Payer: Vantage Medical Group Senior |
$0.05
|
|
|
SENNOSIDES 8.6 MG-DOCUSATE SODIUM 50 MG TABLET [24216]
|
Facility
OP
|
$0.17
|
|
|
Service Code
|
NDC 60687-622-11
|
| Hospital Charge Code |
1710268
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.03 |
| Max. Negotiated Rate |
$0.14 |
| Rate for Payer: Adventist Health Commercial |
$0.03
|
| Rate for Payer: Aetna of CA Gatekeeper |
$0.09
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$0.12
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$0.14
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$0.09
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$0.13
|
| Rate for Payer: Blue Shield of California Commercial |
$0.11
|
| Rate for Payer: Blue Shield of California EPN |
$0.10
|
| Rate for Payer: Cash Price |
$0.08
|
| Rate for Payer: Cigna of CA HMO/PPO |
$0.11
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.14
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.14
|
| Rate for Payer: Dignity Health Senior |
$0.14
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.11
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.11
|
| Rate for Payer: Heritage Provider Network Senior |
$0.11
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$0.08
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.03
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.04
|
| Rate for Payer: Multiplan Commercial |
$0.13
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.14
|
| Rate for Payer: Vantage Medical Group Senior |
$0.14
|
|
|
SENNOSIDES 8.6 MG-DOCUSATE SODIUM 50 MG TABLET [24216]
|
Facility
IP
|
$0.03
|
|
|
Service Code
|
NDC 0536-1248-01
|
| Hospital Charge Code |
1710268
|
|
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: Aetna of CA Non-Gatekeeper |
$0.02
|
| Rate for Payer: Cash Price |
$0.01
|
| 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
|
|
|
SENNOSIDES 8.6 MG-DOCUSATE SODIUM 50 MG TABLET [24216]
|
Facility
IP
|
$0.03
|
|
|
Service Code
|
NDC 57896-555-01
|
| Hospital Charge Code |
1710268
|
|
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: Aetna of CA Non-Gatekeeper |
$0.02
|
| Rate for Payer: Cash Price |
$0.01
|
| 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
|
|
|
SENNOSIDES 8.6 MG-DOCUSATE SODIUM 50 MG TABLET [24216]
|
Facility
OP
|
$0.34
|
|
|
Service Code
|
NDC 67618-110-60
|
| Hospital Charge Code |
1710268
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.06 |
| Max. Negotiated Rate |
$0.29 |
| Rate for Payer: Adventist Health Commercial |
$0.07
|
| Rate for Payer: Aetna of CA Gatekeeper |
$0.18
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$0.23
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$0.29
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$0.19
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$0.26
|
| Rate for Payer: Blue Shield of California Commercial |
$0.21
|
| Rate for Payer: Blue Shield of California EPN |
$0.20
|
| Rate for Payer: Cash Price |
$0.15
|
| Rate for Payer: Cigna of CA HMO/PPO |
$0.22
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.29
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.29
|
| Rate for Payer: Dignity Health Senior |
$0.29
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.22
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.21
|
| Rate for Payer: Heritage Provider Network Senior |
$0.21
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$0.16
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.06
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.09
|
| Rate for Payer: Multiplan Commercial |
$0.26
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.29
|
| Rate for Payer: Vantage Medical Group Senior |
$0.29
|
|
|
SENNOSIDES 8.6 MG-DOCUSATE SODIUM 50 MG TABLET [24216]
|
Facility
IP
|
$0.34
|
|
|
Service Code
|
NDC 67618-110-60
|
| Hospital Charge Code |
1710268
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.06 |
| Max. Negotiated Rate |
$0.26 |
| Rate for Payer: Adventist Health Commercial |
$0.07
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$0.23
|
| Rate for Payer: Cash Price |
$0.15
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.18
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.23
|
| Rate for Payer: Heritage Provider Network Senior |
$0.23
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.06
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.09
|
| Rate for Payer: Multiplan Commercial |
$0.26
|
|
|
SENNOSIDES 8.6 MG-DOCUSATE SODIUM 50 MG TABLET [24216]
|
Facility
IP
|
$0.17
|
|
|
Service Code
|
NDC 60687-622-01
|
| Hospital Charge Code |
1710268
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.03 |
| Max. Negotiated Rate |
$0.13 |
| Rate for Payer: Adventist Health Commercial |
$0.03
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$0.12
|
| Rate for Payer: Cash Price |
$0.08
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.09
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.12
|
| Rate for Payer: Heritage Provider Network Senior |
$0.12
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.03
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.04
|
| Rate for Payer: Multiplan Commercial |
$0.13
|
|
|
SENNOSIDES 8.6 MG-DOCUSATE SODIUM 50 MG TABLET [24216]
|
Facility
OP
|
$0.03
|
|
|
Service Code
|
NDC 0536-1248-01
|
| Hospital Charge Code |
1710268
|
|
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: 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: Blue Shield of California Commercial |
$0.02
|
| Rate for Payer: Blue Shield of California EPN |
$0.02
|
| Rate for Payer: Cash Price |
$0.01
|
| 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: Multiplan Commercial |
$0.02
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.03
|
| Rate for Payer: Vantage Medical Group Senior |
$0.03
|
|
|
SENNOSIDES 8.6 MG TABLET [11349]
|
Facility
OP
|
$0.01
|
|
|
Service Code
|
NDC 0904-7252-80
|
| Hospital Charge Code |
1710631
|
|
Hospital Revenue Code
|
259
|
| Max. Negotiated Rate |
$0.01 |
| Rate for Payer: Adventist Health Commercial |
$0.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$0.01
|
| 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: Blue Shield of California Commercial |
$0.01
|
| Rate for Payer: Blue Shield of California EPN |
$0.01
|
| Rate for Payer: Cigna of CA HMO/PPO |
$0.01
|
| 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 |
$0.01
|
| Rate for Payer: Heritage Provider Network Senior |
$0.01
|
| 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: Vantage Medical Group Medi-Cal |
$0.01
|
| Rate for Payer: Vantage Medical Group Senior |
$0.01
|
|
