|
PENICILLIN V POTASSIUM 6.25 MG/ML (10,000 UNITS/ML) ORAL SOLN [4081500]
|
Facility
IP
|
$0.08
|
|
|
Service Code
|
NDC 9994-0815-00
|
| Hospital Charge Code |
NDC4081500
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.02 |
| Max. Negotiated Rate |
$0.07 |
| Rate for Payer: Blue Shield of California Commercial |
$0.06
|
| Rate for Payer: Blue Shield of California EPN |
$0.04
|
| Rate for Payer: Cash Price |
$0.04
|
| Rate for Payer: Cigna of CA HMO |
$0.06
|
| Rate for Payer: Cigna of CA PPO |
$0.06
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.03
|
| Rate for Payer: Galaxy Health WC |
$0.07
|
| Rate for Payer: Global Benefits Group Commercial |
$0.05
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.05
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.03
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.02
|
| Rate for Payer: Multiplan Commercial |
$0.06
|
| Rate for Payer: Networks By Design Commercial |
$0.05
|
| Rate for Payer: Prime Health Services Commercial |
$0.07
|
|
|
PENIS, TESTES AND SCROTAL PROCEDURES
|
Facility
IP
|
$14,565.42
|
|
|
Service Code
|
APR-DRG 4831
|
| Min. Negotiated Rate |
$11,173.21 |
| Max. Negotiated Rate |
$14,565.42 |
| Rate for Payer: IEHP Medi-Cal |
$11,173.21
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$14,565.42
|
|
|
PENIS, TESTES AND SCROTAL PROCEDURES
|
Facility
IP
|
$52,767.52
|
|
|
Service Code
|
APR-DRG 4834
|
| Min. Negotiated Rate |
$40,478.24 |
| Max. Negotiated Rate |
$52,767.52 |
| Rate for Payer: IEHP Medi-Cal |
$40,478.24
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$52,767.52
|
|
|
PENIS, TESTES AND SCROTAL PROCEDURES
|
Facility
IP
|
$19,454.86
|
|
|
Service Code
|
APR-DRG 4832
|
| Min. Negotiated Rate |
$14,923.93 |
| Max. Negotiated Rate |
$19,454.86 |
| Rate for Payer: IEHP Medi-Cal |
$14,923.93
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$19,454.86
|
|
|
PENIS, TESTES AND SCROTAL PROCEDURES
|
Facility
IP
|
$29,239.04
|
|
|
Service Code
|
APR-DRG 4833
|
| Min. Negotiated Rate |
$22,429.42 |
| Max. Negotiated Rate |
$29,239.04 |
| Rate for Payer: IEHP Medi-Cal |
$22,429.42
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$29,239.04
|
|
|
PENTAMIDINE 300 MG SOLUTION FOR INHALATION [28235]
|
Facility
OP
|
$173.40
|
|
|
Service Code
|
NDC 13925-522-01
|
| Hospital Charge Code |
1744057
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$41.62 |
| Max. Negotiated Rate |
$147.39 |
| Rate for Payer: Aetna of CA HMO/PPO |
$113.73
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$147.39
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$95.37
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$95.37
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$103.31
|
| Rate for Payer: BCBS Transplant Transplant |
$104.04
|
| Rate for Payer: Blue Shield of California Commercial |
$127.80
|
| Rate for Payer: Blue Shield of California EPN |
$101.27
|
| Rate for Payer: Cash Price |
$78.03
|
| Rate for Payer: Cigna of CA HMO |
$121.38
|
| Rate for Payer: Cigna of CA PPO |
$121.38
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$147.39
|
| Rate for Payer: Dignity Health Media |
$147.39
|
| Rate for Payer: Dignity Health Medi-Cal |
$147.39
|
| Rate for Payer: EPIC Health Plan Commercial |
$69.36
|
| Rate for Payer: EPIC Health Plan Transplant |
$69.36
|
| Rate for Payer: Galaxy Health WC |
$147.39
|
| Rate for Payer: Global Benefits Group Commercial |
$104.04
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$130.05
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$115.66
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$66.07
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$41.62
|
| Rate for Payer: Multiplan Commercial |
$138.72
|
| Rate for Payer: Networks By Design Commercial |
$112.71
|
| Rate for Payer: Prime Health Services Commercial |
$147.39
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$104.04
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$104.04
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$104.04
|
| Rate for Payer: United Healthcare All Other Commercial |
$86.70
|
| Rate for Payer: United Healthcare All Other HMO |
$86.70
|
| Rate for Payer: United Healthcare HMO Rider |
$86.70
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$86.70
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$147.39
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$147.39
|
| Rate for Payer: Vantage Medical Group Senior |
$147.39
|
|
|
PENTAMIDINE 300 MG SOLUTION FOR INHALATION [28235]
|
Facility
IP
|
$173.40
|
|
|
Service Code
|
NDC 13925-522-01
|
| Hospital Charge Code |
1744057
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$41.62 |
| Max. Negotiated Rate |
$147.39 |
| Rate for Payer: Blue Shield of California Commercial |
$123.46
|
| Rate for Payer: Blue Shield of California EPN |
$88.78
|
| Rate for Payer: Cash Price |
$78.03
|
| Rate for Payer: Cigna of CA HMO |
$121.38
|
| Rate for Payer: Cigna of CA PPO |
$121.38
|
| Rate for Payer: EPIC Health Plan Commercial |
$69.36
|
| Rate for Payer: Galaxy Health WC |
$147.39
|
| Rate for Payer: Global Benefits Group Commercial |
$104.04
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$115.66
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$66.07
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$41.62
|
| Rate for Payer: Multiplan Commercial |
$138.72
|
| Rate for Payer: Networks By Design Commercial |
$112.71
|
| Rate for Payer: Prime Health Services Commercial |
$147.39
|
|
|
PENTAMIDINE 300 MG SOLUTION FOR INHALATION [28235]
|
Facility
IP
|
$200.27
|
|
|
Service Code
|
NDC 63323-877-15
|
| Hospital Charge Code |
1744057
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$48.06 |
| Max. Negotiated Rate |
$170.23 |
| Rate for Payer: Blue Shield of California Commercial |
$142.59
|
| Rate for Payer: Blue Shield of California EPN |
$102.54
|
| Rate for Payer: Cash Price |
$90.12
|
| Rate for Payer: Cigna of CA HMO |
$140.19
|
| Rate for Payer: Cigna of CA PPO |
$140.19
|
| Rate for Payer: EPIC Health Plan Commercial |
$80.11
|
| Rate for Payer: Galaxy Health WC |
$170.23
|
| Rate for Payer: Global Benefits Group Commercial |
$120.16
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$133.58
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$76.30
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$48.06
|
| Rate for Payer: Multiplan Commercial |
$160.22
|
| Rate for Payer: Networks By Design Commercial |
$130.18
|
| Rate for Payer: Prime Health Services Commercial |
$170.23
|
|
|
PENTAMIDINE 300 MG SOLUTION FOR INHALATION [28235]
|
Facility
OP
|
$200.27
|
|
|
Service Code
|
NDC 63323-877-15
|
| Hospital Charge Code |
1744057
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$48.06 |
| Max. Negotiated Rate |
$170.23 |
| Rate for Payer: Aetna of CA HMO/PPO |
$131.36
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$170.23
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$110.15
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$110.15
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$119.32
|
| Rate for Payer: BCBS Transplant Transplant |
$120.16
|
| Rate for Payer: Blue Shield of California Commercial |
$147.60
|
| Rate for Payer: Blue Shield of California EPN |
$116.96
|
| Rate for Payer: Cash Price |
$90.12
|
| Rate for Payer: Cigna of CA HMO |
$140.19
|
| Rate for Payer: Cigna of CA PPO |
$140.19
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$170.23
|
| Rate for Payer: Dignity Health Media |
$170.23
|
| Rate for Payer: Dignity Health Medi-Cal |
$170.23
|
| Rate for Payer: EPIC Health Plan Commercial |
$80.11
|
| Rate for Payer: EPIC Health Plan Transplant |
$80.11
|
| Rate for Payer: Galaxy Health WC |
$170.23
|
| Rate for Payer: Global Benefits Group Commercial |
$120.16
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$150.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$133.58
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$76.30
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$48.06
|
| Rate for Payer: Multiplan Commercial |
$160.22
|
| Rate for Payer: Networks By Design Commercial |
$130.18
|
| Rate for Payer: Prime Health Services Commercial |
$170.23
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$120.16
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$120.16
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$120.16
|
| Rate for Payer: United Healthcare All Other Commercial |
$100.14
|
| Rate for Payer: United Healthcare All Other HMO |
$100.14
|
| Rate for Payer: United Healthcare HMO Rider |
$100.14
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$100.14
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$170.23
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$170.23
|
| Rate for Payer: Vantage Medical Group Senior |
$170.23
|
|
|
PENTAMIDINE 300 MG SOLUTION FOR INJECTION [27430]
|
Facility
IP
|
$117.24
|
|
|
Service Code
|
CPT J3490
|
| Hospital Charge Code |
1720550
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$28.14 |
| Max. Negotiated Rate |
$99.65 |
| Rate for Payer: Blue Shield of California Commercial |
$83.47
|
| Rate for Payer: Blue Shield of California Commercial |
$123.46
|
| Rate for Payer: Blue Shield of California EPN |
$88.78
|
| Rate for Payer: Blue Shield of California EPN |
$60.03
|
| Rate for Payer: Cash Price |
$52.76
|
| Rate for Payer: Cash Price |
$78.03
|
| Rate for Payer: Cigna of CA HMO |
$82.07
|
| Rate for Payer: Cigna of CA HMO |
$121.38
|
| Rate for Payer: Cigna of CA PPO |
$82.07
|
| Rate for Payer: Cigna of CA PPO |
$121.38
|
| Rate for Payer: EPIC Health Plan Commercial |
$69.36
|
| Rate for Payer: EPIC Health Plan Commercial |
$46.90
|
| Rate for Payer: EPIC Health Plan Transplant |
$46.90
|
| Rate for Payer: EPIC Health Plan Transplant |
$69.36
|
| Rate for Payer: Galaxy Health WC |
$147.39
|
| Rate for Payer: Galaxy Health WC |
$99.65
|
| Rate for Payer: Global Benefits Group Commercial |
$70.34
|
| Rate for Payer: Global Benefits Group Commercial |
$104.04
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$115.66
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$78.20
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$44.67
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$66.07
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$41.62
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$28.14
|
| Rate for Payer: Multiplan Commercial |
$138.72
|
| Rate for Payer: Multiplan Commercial |
$93.79
|
| Rate for Payer: Networks By Design Commercial |
$58.62
|
| Rate for Payer: Networks By Design Commercial |
$86.70
|
| Rate for Payer: Prime Health Services Commercial |
$147.39
|
| Rate for Payer: Prime Health Services Commercial |
$99.65
|
|
|
PENTAMIDINE 300 MG SOLUTION FOR INJECTION [27430]
|
Facility
OP
|
$173.40
|
|
|
Service Code
|
CPT J3490
|
| Hospital Charge Code |
1720550
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$41.62 |
| Max. Negotiated Rate |
$147.39 |
| Rate for Payer: Aetna of CA HMO/PPO |
$113.73
|
| Rate for Payer: Aetna of CA HMO/PPO |
$76.90
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$147.39
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$99.65
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$95.37
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$64.48
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$95.37
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$64.48
|
| Rate for Payer: BCBS Transplant Transplant |
$70.34
|
| Rate for Payer: BCBS Transplant Transplant |
$104.04
|
| Rate for Payer: Blue Shield of California Commercial |
$86.41
|
| Rate for Payer: Blue Shield of California Commercial |
$127.80
|
| Rate for Payer: Blue Shield of California EPN |
$101.27
|
| Rate for Payer: Blue Shield of California EPN |
$68.47
|
| Rate for Payer: Cash Price |
$78.03
|
| Rate for Payer: Cash Price |
$52.76
|
| Rate for Payer: Cash Price |
$52.76
|
| Rate for Payer: Cash Price |
$78.03
|
| Rate for Payer: Cigna of CA HMO |
$121.38
|
| Rate for Payer: Cigna of CA HMO |
$82.07
|
| Rate for Payer: Cigna of CA PPO |
$121.38
|
| Rate for Payer: Cigna of CA PPO |
$82.07
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$99.65
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$147.39
|
| Rate for Payer: Dignity Health Media |
$147.39
|
| Rate for Payer: Dignity Health Media |
$99.65
|
| Rate for Payer: Dignity Health Medi-Cal |
$147.39
|
| Rate for Payer: Dignity Health Medi-Cal |
$99.65
|
| Rate for Payer: EPIC Health Plan Commercial |
$46.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$69.36
|
| Rate for Payer: EPIC Health Plan Transplant |
$46.90
|
| Rate for Payer: EPIC Health Plan Transplant |
$69.36
|
| Rate for Payer: Galaxy Health WC |
$147.39
|
| Rate for Payer: Galaxy Health WC |
$99.65
|
| Rate for Payer: Global Benefits Group Commercial |
$104.04
|
| Rate for Payer: Global Benefits Group Commercial |
$70.34
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$87.93
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$130.05
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$78.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$115.66
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$28.14
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$41.62
|
| Rate for Payer: Multiplan Commercial |
$93.79
|
| Rate for Payer: Multiplan Commercial |
$138.72
|
| Rate for Payer: Networks By Design Commercial |
$86.70
|
| Rate for Payer: Networks By Design Commercial |
$58.62
|
| Rate for Payer: Prime Health Services Commercial |
$99.65
|
| Rate for Payer: Prime Health Services Commercial |
$147.39
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$70.34
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$104.04
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$70.34
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$104.04
|
| Rate for Payer: United Healthcare All Other Commercial |
$86.70
|
| Rate for Payer: United Healthcare All Other Commercial |
$58.62
|
| Rate for Payer: United Healthcare All Other HMO |
$86.70
|
| Rate for Payer: United Healthcare All Other HMO |
$58.62
|
| Rate for Payer: United Healthcare HMO Rider |
$86.70
|
| Rate for Payer: United Healthcare HMO Rider |
$58.62
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$86.70
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$58.62
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$99.65
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$147.39
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$99.65
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$147.39
|
| Rate for Payer: Vantage Medical Group Senior |
$147.39
|
| Rate for Payer: Vantage Medical Group Senior |
$99.65
|
|
|
PENTOSAN POLYSULFATE SODIUM 100 MG CAPSULE [12912]
|
Facility
OP
|
$13.10
|
|
|
Service Code
|
NDC 50458-098-01
|
| Hospital Charge Code |
1710932
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$3.14 |
| Max. Negotiated Rate |
$11.14 |
| Rate for Payer: Aetna of CA HMO/PPO |
$8.59
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$11.14
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$7.20
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$7.20
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$7.80
|
| Rate for Payer: BCBS Transplant Transplant |
$7.86
|
| Rate for Payer: Blue Shield of California Commercial |
$9.65
|
| Rate for Payer: Blue Shield of California EPN |
$7.65
|
| Rate for Payer: Cash Price |
$5.90
|
| Rate for Payer: Cigna of CA HMO |
$9.17
|
| Rate for Payer: Cigna of CA PPO |
$9.17
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$11.14
|
| Rate for Payer: Dignity Health Media |
$11.14
|
| Rate for Payer: Dignity Health Medi-Cal |
$11.14
|
| Rate for Payer: EPIC Health Plan Commercial |
$5.24
|
| Rate for Payer: EPIC Health Plan Transplant |
$5.24
|
| Rate for Payer: Galaxy Health WC |
$11.14
|
| Rate for Payer: Global Benefits Group Commercial |
$7.86
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$9.82
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$8.74
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4.99
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.14
|
| Rate for Payer: Multiplan Commercial |
$10.48
|
| Rate for Payer: Networks By Design Commercial |
$8.52
|
| Rate for Payer: Prime Health Services Commercial |
$11.14
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$7.86
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$7.86
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$7.86
|
| Rate for Payer: United Healthcare All Other Commercial |
$6.55
|
| Rate for Payer: United Healthcare All Other HMO |
$6.55
|
| Rate for Payer: United Healthcare HMO Rider |
$6.55
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$6.55
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$11.14
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$11.14
|
| Rate for Payer: Vantage Medical Group Senior |
$11.14
|
|
|
PENTOSAN POLYSULFATE SODIUM 100 MG CAPSULE [12912]
|
Facility
IP
|
$13.10
|
|
|
Service Code
|
NDC 50458-098-01
|
| Hospital Charge Code |
1710932
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$3.14 |
| Max. Negotiated Rate |
$11.14 |
| Rate for Payer: Blue Shield of California Commercial |
$9.33
|
| Rate for Payer: Blue Shield of California EPN |
$6.71
|
| Rate for Payer: Cash Price |
$5.90
|
| Rate for Payer: Cigna of CA HMO |
$9.17
|
| Rate for Payer: Cigna of CA PPO |
$9.17
|
| Rate for Payer: EPIC Health Plan Commercial |
$5.24
|
| Rate for Payer: Galaxy Health WC |
$11.14
|
| Rate for Payer: Global Benefits Group Commercial |
$7.86
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$8.74
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4.99
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.14
|
| Rate for Payer: Multiplan Commercial |
$10.48
|
| Rate for Payer: Networks By Design Commercial |
$8.52
|
| Rate for Payer: Prime Health Services Commercial |
$11.14
|
|
|
PENTOSTATIN 10 MG INTRAVENOUS SOLUTION [10910]
|
Facility
OP
|
$2,926.88
|
|
|
Service Code
|
CPT J9268
|
| Hospital Charge Code |
1755684
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$702.45 |
| Max. Negotiated Rate |
$4,476.97 |
| Rate for Payer: Aetna of CA HMO/PPO |
$4,476.97
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$2,841.44
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$2,500.47
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$2,500.47
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,435.98
|
| Rate for Payer: BCBS Transplant Transplant |
$1,756.13
|
| Rate for Payer: Blue Shield of California Commercial |
$2,157.11
|
| Rate for Payer: Blue Shield of California EPN |
$2,647.57
|
| Rate for Payer: Cash Price |
$1,317.10
|
| Rate for Payer: Cash Price |
$1,317.10
|
| Rate for Payer: Cigna of CA HMO |
$2,048.82
|
| Rate for Payer: Cigna of CA PPO |
$2,048.82
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,409.73
|
| Rate for Payer: Dignity Health Media |
$2,273.15
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,500.47
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,068.76
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$2,273.15
|
| Rate for Payer: EPIC Health Plan Transplant |
$2,273.15
|
| Rate for Payer: Galaxy Health WC |
$2,487.85
|
| Rate for Payer: Global Benefits Group Commercial |
$1,756.13
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$2,195.16
|
| Rate for Payer: Heritage Provider Network Commercial |
$3,727.97
|
| Rate for Payer: Heritage Provider Network Transplant |
$3,727.97
|
| Rate for Payer: IEHP Medi-Cal |
$3,682.51
|
| Rate for Payer: IEHP Medi-Cal Transplant |
$3,682.51
|
| Rate for Payer: IEHP Medicare Advantage |
$2,273.15
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,952.23
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,115.14
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,273.15
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$702.45
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,864.17
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$3,046.03
|
| Rate for Payer: Multiplan Commercial |
$2,341.50
|
| Rate for Payer: Networks By Design Commercial |
$1,463.44
|
| Rate for Payer: Prime Health Services Commercial |
$2,487.85
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,756.13
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,756.13
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,463.44
|
| Rate for Payer: United Healthcare All Other HMO |
$1,463.44
|
| Rate for Payer: United Healthcare HMO Rider |
$1,463.44
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,463.44
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,409.73
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,500.47
|
| Rate for Payer: Vantage Medical Group Senior |
$2,273.15
|
|
|
PENTOSTATIN 10 MG INTRAVENOUS SOLUTION [10910]
|
Facility
IP
|
$2,926.88
|
|
|
Service Code
|
CPT J9268
|
| Hospital Charge Code |
1755684
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$702.45 |
| Max. Negotiated Rate |
$2,487.85 |
| Rate for Payer: Blue Shield of California Commercial |
$2,083.94
|
| Rate for Payer: Blue Shield of California EPN |
$1,498.56
|
| Rate for Payer: Cash Price |
$1,317.10
|
| Rate for Payer: Cigna of CA HMO |
$2,048.82
|
| Rate for Payer: Cigna of CA PPO |
$2,048.82
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,170.75
|
| Rate for Payer: EPIC Health Plan Transplant |
$1,170.75
|
| Rate for Payer: Galaxy Health WC |
$2,487.85
|
| Rate for Payer: Global Benefits Group Commercial |
$1,756.13
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,952.23
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,115.14
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$702.45
|
| Rate for Payer: Multiplan Commercial |
$2,341.50
|
| Rate for Payer: Networks By Design Commercial |
$1,463.44
|
| Rate for Payer: Prime Health Services Commercial |
$2,487.85
|
|
|
PENTOXIFYLLINE ER 400 MG TABLET,EXTENDED RELEASE [10911]
|
Facility
OP
|
$0.30
|
|
|
Service Code
|
NDC 0904-5448-61
|
| Hospital Charge Code |
1711410
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.07 |
| Max. Negotiated Rate |
$0.26 |
| Rate for Payer: Aetna of CA HMO/PPO |
$0.20
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$0.26
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$0.17
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$0.17
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.18
|
| Rate for Payer: BCBS Transplant Transplant |
$0.18
|
| Rate for Payer: Blue Shield of California Commercial |
$0.22
|
| Rate for Payer: Blue Shield of California EPN |
$0.18
|
| Rate for Payer: Cash Price |
$0.14
|
| Rate for Payer: Cigna of CA HMO |
$0.21
|
| Rate for Payer: Cigna of CA PPO |
$0.21
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.26
|
| Rate for Payer: Dignity Health Media |
$0.26
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.26
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.12
|
| Rate for Payer: EPIC Health Plan Transplant |
$0.12
|
| Rate for Payer: Galaxy Health WC |
$0.26
|
| Rate for Payer: Global Benefits Group Commercial |
$0.18
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$0.23
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.20
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.11
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.07
|
| Rate for Payer: Multiplan Commercial |
$0.24
|
| Rate for Payer: Networks By Design Commercial |
$0.20
|
| Rate for Payer: Prime Health Services Commercial |
$0.26
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$0.18
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.18
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.18
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.15
|
| Rate for Payer: United Healthcare All Other HMO |
$0.15
|
| Rate for Payer: United Healthcare HMO Rider |
$0.15
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.15
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.26
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.26
|
| Rate for Payer: Vantage Medical Group Senior |
$0.26
|
|
|
PENTOXIFYLLINE ER 400 MG TABLET,EXTENDED RELEASE [10911]
|
Facility
IP
|
$0.30
|
|
|
Service Code
|
NDC 0904-5448-61
|
| Hospital Charge Code |
1711410
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.07 |
| Max. Negotiated Rate |
$0.26 |
| Rate for Payer: Blue Shield of California Commercial |
$0.21
|
| Rate for Payer: Blue Shield of California EPN |
$0.15
|
| Rate for Payer: Cash Price |
$0.14
|
| Rate for Payer: Cigna of CA HMO |
$0.21
|
| Rate for Payer: Cigna of CA PPO |
$0.21
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.12
|
| Rate for Payer: Galaxy Health WC |
$0.26
|
| Rate for Payer: Global Benefits Group Commercial |
$0.18
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.20
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.11
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.07
|
| Rate for Payer: Multiplan Commercial |
$0.24
|
| Rate for Payer: Networks By Design Commercial |
$0.20
|
| Rate for Payer: Prime Health Services Commercial |
$0.26
|
|
|
PENTOXIFYLLINE ER 400 MG TABLET,EXTENDED RELEASE [10911]
|
Facility
IP
|
$0.51
|
|
|
Service Code
|
NDC 60505-0033-6
|
| Hospital Charge Code |
1711410
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.12 |
| Max. Negotiated Rate |
$0.43 |
| Rate for Payer: Blue Shield of California Commercial |
$0.36
|
| Rate for Payer: Blue Shield of California EPN |
$0.26
|
| Rate for Payer: Cash Price |
$0.23
|
| Rate for Payer: Cigna of CA HMO |
$0.36
|
| Rate for Payer: Cigna of CA PPO |
$0.36
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.20
|
| Rate for Payer: Galaxy Health WC |
$0.43
|
| Rate for Payer: Global Benefits Group Commercial |
$0.31
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.34
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.19
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.12
|
| Rate for Payer: Multiplan Commercial |
$0.41
|
| Rate for Payer: Networks By Design Commercial |
$0.33
|
| Rate for Payer: Prime Health Services Commercial |
$0.43
|
|
|
PENTOXIFYLLINE ER 400 MG TABLET,EXTENDED RELEASE [10911]
|
Facility
OP
|
$0.51
|
|
|
Service Code
|
NDC 60505-0033-6
|
| Hospital Charge Code |
1711410
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.12 |
| Max. Negotiated Rate |
$0.43 |
| Rate for Payer: Aetna of CA HMO/PPO |
$0.33
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$0.43
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$0.28
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$0.28
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.30
|
| Rate for Payer: BCBS Transplant Transplant |
$0.31
|
| Rate for Payer: Blue Shield of California Commercial |
$0.38
|
| Rate for Payer: Blue Shield of California EPN |
$0.30
|
| Rate for Payer: Cash Price |
$0.23
|
| Rate for Payer: Cigna of CA HMO |
$0.36
|
| Rate for Payer: Cigna of CA PPO |
$0.36
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.43
|
| Rate for Payer: Dignity Health Media |
$0.43
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.43
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.20
|
| Rate for Payer: EPIC Health Plan Transplant |
$0.20
|
| Rate for Payer: Galaxy Health WC |
$0.43
|
| Rate for Payer: Global Benefits Group Commercial |
$0.31
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$0.38
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.34
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.19
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.12
|
| Rate for Payer: Multiplan Commercial |
$0.41
|
| Rate for Payer: Networks By Design Commercial |
$0.33
|
| Rate for Payer: Prime Health Services Commercial |
$0.43
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$0.31
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.31
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.31
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.26
|
| Rate for Payer: United Healthcare All Other HMO |
$0.26
|
| Rate for Payer: United Healthcare HMO Rider |
$0.26
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.26
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.43
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.43
|
| Rate for Payer: Vantage Medical Group Senior |
$0.43
|
|
|
PENTOXIFYLLINE ORAL SUSPENSION COMPOUND 20 MG/ML [4080317]
|
Facility
OP
|
$0.03
|
|
|
Service Code
|
NDC 9994-0803-17
|
| Hospital Charge Code |
ERX4080317
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.01 |
| Max. Negotiated Rate |
$0.03 |
| Rate for Payer: Aetna of CA HMO/PPO |
$0.02
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$0.03
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$0.02
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$0.02
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.02
|
| Rate for Payer: BCBS Transplant Transplant |
$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 |
$0.02
|
| Rate for Payer: Cigna of CA PPO |
$0.02
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.03
|
| Rate for Payer: Dignity Health Media |
$0.03
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.03
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.01
|
| Rate for Payer: EPIC Health Plan Transplant |
$0.01
|
| Rate for Payer: Galaxy Health WC |
$0.03
|
| Rate for Payer: Global Benefits Group Commercial |
$0.02
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$0.02
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$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
|
| Rate for Payer: Networks By Design Commercial |
$0.02
|
| Rate for Payer: Prime Health Services Commercial |
$0.03
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$0.02
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.02
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.02
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.02
|
| Rate for Payer: United Healthcare All Other HMO |
$0.02
|
| Rate for Payer: United Healthcare HMO Rider |
$0.02
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.02
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.03
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.03
|
| Rate for Payer: Vantage Medical Group Senior |
$0.03
|
|
|
PENTOXIFYLLINE ORAL SUSPENSION COMPOUND 20 MG/ML [4080317]
|
Facility
IP
|
$0.03
|
|
|
Service Code
|
NDC 9994-0803-17
|
| Hospital Charge Code |
ERX4080317
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.01 |
| Max. Negotiated Rate |
$0.03 |
| 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 |
$0.02
|
| Rate for Payer: Cigna of CA PPO |
$0.02
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.01
|
| Rate for Payer: Galaxy Health WC |
$0.03
|
| Rate for Payer: Global Benefits Group Commercial |
$0.02
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$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
|
| Rate for Payer: Networks By Design Commercial |
$0.02
|
| Rate for Payer: Prime Health Services Commercial |
$0.03
|
|
|
PEPPERMINT OIL [6116]
|
Facility
OP
|
$0.87
|
|
|
Service Code
|
NDC 395201591
|
| Hospital Charge Code |
1743585
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.21 |
| Max. Negotiated Rate |
$0.74 |
| Rate for Payer: Multiplan Commercial |
$0.70
|
| Rate for Payer: Networks By Design Commercial |
$0.57
|
| Rate for Payer: Aetna of CA HMO/PPO |
$0.57
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$0.74
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$0.48
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$0.48
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.52
|
| Rate for Payer: BCBS Transplant Transplant |
$0.52
|
| Rate for Payer: Blue Shield of California Commercial |
$0.64
|
| Rate for Payer: Blue Shield of California EPN |
$0.51
|
| Rate for Payer: Cash Price |
$0.39
|
| Rate for Payer: Cigna of CA HMO |
$0.61
|
| Rate for Payer: Cigna of CA PPO |
$0.61
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.74
|
| Rate for Payer: Dignity Health Media |
$0.74
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.74
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.35
|
| Rate for Payer: EPIC Health Plan Transplant |
$0.35
|
| Rate for Payer: Galaxy Health WC |
$0.74
|
| Rate for Payer: Global Benefits Group Commercial |
$0.52
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$0.65
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.58
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.33
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.21
|
| Rate for Payer: Prime Health Services Commercial |
$0.74
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$0.52
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.52
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.52
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.44
|
| Rate for Payer: United Healthcare All Other HMO |
$0.44
|
| Rate for Payer: United Healthcare HMO Rider |
$0.44
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.44
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.74
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.74
|
| Rate for Payer: Vantage Medical Group Senior |
$0.74
|
|
|
PEPPERMINT OIL [6116]
|
Facility
IP
|
$0.87
|
|
|
Service Code
|
NDC 395201591
|
| Hospital Charge Code |
1743585
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.21 |
| Max. Negotiated Rate |
$0.74 |
| Rate for Payer: Blue Shield of California Commercial |
$0.62
|
| Rate for Payer: Blue Shield of California EPN |
$0.45
|
| Rate for Payer: Cash Price |
$0.39
|
| Rate for Payer: Cigna of CA HMO |
$0.61
|
| Rate for Payer: Cigna of CA PPO |
$0.61
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.35
|
| Rate for Payer: Galaxy Health WC |
$0.74
|
| Rate for Payer: Global Benefits Group Commercial |
$0.52
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.58
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.33
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.21
|
| Rate for Payer: Multiplan Commercial |
$0.70
|
| Rate for Payer: Networks By Design Commercial |
$0.57
|
| Rate for Payer: Prime Health Services Commercial |
$0.74
|
|
|
PEPPERMINT SPIRIT FOR CNR (WRAP) [408114897]
|
Facility
IP
|
$0.87
|
|
|
Service Code
|
NDC 395201591
|
| Hospital Charge Code |
1743585
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.21 |
| Max. Negotiated Rate |
$0.74 |
| Rate for Payer: Blue Shield of California Commercial |
$0.62
|
| Rate for Payer: Blue Shield of California EPN |
$0.45
|
| Rate for Payer: Cash Price |
$0.39
|
| Rate for Payer: Cigna of CA HMO |
$0.61
|
| Rate for Payer: Cigna of CA PPO |
$0.61
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.35
|
| Rate for Payer: Galaxy Health WC |
$0.74
|
| Rate for Payer: Global Benefits Group Commercial |
$0.52
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.58
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.33
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.21
|
| Rate for Payer: Multiplan Commercial |
$0.70
|
| Rate for Payer: Networks By Design Commercial |
$0.57
|
| Rate for Payer: Prime Health Services Commercial |
$0.74
|
|
|
PEPPERMINT SPIRIT FOR CNR (WRAP) [408114897]
|
Facility
OP
|
$0.87
|
|
|
Service Code
|
NDC 395201591
|
| Hospital Charge Code |
1743585
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.21 |
| Max. Negotiated Rate |
$0.74 |
| Rate for Payer: Aetna of CA HMO/PPO |
$0.57
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$0.74
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$0.48
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$0.48
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.52
|
| Rate for Payer: BCBS Transplant Transplant |
$0.52
|
| Rate for Payer: Blue Shield of California Commercial |
$0.64
|
| Rate for Payer: Blue Shield of California EPN |
$0.51
|
| Rate for Payer: Cash Price |
$0.39
|
| Rate for Payer: Cigna of CA HMO |
$0.61
|
| Rate for Payer: Cigna of CA PPO |
$0.61
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.74
|
| Rate for Payer: Dignity Health Media |
$0.74
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.74
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.35
|
| Rate for Payer: EPIC Health Plan Transplant |
$0.35
|
| Rate for Payer: Galaxy Health WC |
$0.74
|
| Rate for Payer: Global Benefits Group Commercial |
$0.52
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$0.65
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.58
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.33
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.21
|
| Rate for Payer: Multiplan Commercial |
$0.70
|
| Rate for Payer: Networks By Design Commercial |
$0.57
|
| Rate for Payer: Prime Health Services Commercial |
$0.74
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$0.52
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.52
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.52
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.44
|
| Rate for Payer: United Healthcare All Other HMO |
$0.44
|
| Rate for Payer: United Healthcare HMO Rider |
$0.44
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.44
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.74
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.74
|
| Rate for Payer: Vantage Medical Group Senior |
$0.74
|
|
