PILOCARPINE 2 % EYE DROPS [6280]
|
Facility
IP
|
$6.07
|
|
Service Code
|
NDC 70069-191-01
|
Hospital Charge Code |
1740090
|
Hospital Revenue Code
|
259
|
Min. Negotiated Rate |
$1.46 |
Max. Negotiated Rate |
$5.16 |
Rate for Payer: Blue Shield of California Commercial |
$4.32
|
Rate for Payer: Blue Shield of California EPN |
$3.11
|
Rate for Payer: Cash Price |
$2.73
|
Rate for Payer: Cigna of CA HMO |
$4.25
|
Rate for Payer: Cigna of CA PPO |
$4.25
|
Rate for Payer: EPIC Health Plan Commercial |
$2.43
|
Rate for Payer: Galaxy Health WC |
$5.16
|
Rate for Payer: Global Benefits Group Commercial |
$3.64
|
Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4.05
|
Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2.31
|
Rate for Payer: LLUH Dept of Risk Management WC |
$1.46
|
Rate for Payer: Multiplan Commercial |
$4.86
|
Rate for Payer: Networks By Design Commercial |
$3.95
|
Rate for Payer: Prime Health Services Commercial |
$5.16
|
|
PILOCARPINE 2 % EYE DROPS [6280]
|
Facility
OP
|
$7.61
|
|
Service Code
|
NDC 0998-0204-15
|
Hospital Charge Code |
1740090
|
Hospital Revenue Code
|
259
|
Min. Negotiated Rate |
$1.83 |
Max. Negotiated Rate |
$6.47 |
Rate for Payer: Aetna of CA HMO/PPO |
$4.99
|
Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$6.47
|
Rate for Payer: AlphaCare Medical Group Medi-Cal |
$4.19
|
Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$4.19
|
Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4.53
|
Rate for Payer: BCBS Transplant Transplant |
$4.57
|
Rate for Payer: Blue Shield of California Commercial |
$5.61
|
Rate for Payer: Blue Shield of California EPN |
$4.44
|
Rate for Payer: Cash Price |
$3.42
|
Rate for Payer: Cigna of CA HMO |
$5.33
|
Rate for Payer: Cigna of CA PPO |
$5.33
|
Rate for Payer: Dignity Health Commercial/Exchange |
$6.47
|
Rate for Payer: Dignity Health Media |
$6.47
|
Rate for Payer: Dignity Health Medi-Cal |
$6.47
|
Rate for Payer: EPIC Health Plan Commercial |
$3.04
|
Rate for Payer: EPIC Health Plan Transplant |
$3.04
|
Rate for Payer: Galaxy Health WC |
$6.47
|
Rate for Payer: Global Benefits Group Commercial |
$4.57
|
Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$5.71
|
Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$5.08
|
Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2.90
|
Rate for Payer: LLUH Dept of Risk Management WC |
$1.83
|
Rate for Payer: Multiplan Commercial |
$6.09
|
Rate for Payer: Networks By Design Commercial |
$4.95
|
Rate for Payer: Prime Health Services Commercial |
$6.47
|
Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$4.57
|
Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$4.57
|
Rate for Payer: TriValley Medical Group Commercial/Senior |
$4.57
|
Rate for Payer: United Healthcare All Other Commercial |
$3.80
|
Rate for Payer: United Healthcare All Other HMO |
$3.80
|
Rate for Payer: United Healthcare HMO Rider |
$3.80
|
Rate for Payer: United Healthcare Select/Navigate/Core |
$3.80
|
Rate for Payer: Vantage Medical Group Commercial/Exchange |
$6.47
|
Rate for Payer: Vantage Medical Group Medi-Cal |
$6.47
|
Rate for Payer: Vantage Medical Group Senior |
$6.47
|
|
PILOCARPINE 4 % EYE DROPS [6282]
|
Facility
OP
|
$6.36
|
|
Service Code
|
NDC 70069-201-01
|
Hospital Charge Code |
1740061
|
Hospital Revenue Code
|
259
|
Min. Negotiated Rate |
$1.53 |
Max. Negotiated Rate |
$5.41 |
Rate for Payer: Aetna of CA HMO/PPO |
$4.17
|
Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$5.41
|
Rate for Payer: AlphaCare Medical Group Medi-Cal |
$3.50
|
Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$3.50
|
Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3.79
|
Rate for Payer: BCBS Transplant Transplant |
$3.82
|
Rate for Payer: Blue Shield of California Commercial |
$4.69
|
Rate for Payer: Blue Shield of California EPN |
$3.71
|
Rate for Payer: Cash Price |
$2.86
|
Rate for Payer: Cigna of CA HMO |
$4.45
|
Rate for Payer: Cigna of CA PPO |
$4.45
|
Rate for Payer: Dignity Health Commercial/Exchange |
$5.41
|
Rate for Payer: Dignity Health Media |
$5.41
|
Rate for Payer: Dignity Health Medi-Cal |
$5.41
|
Rate for Payer: EPIC Health Plan Commercial |
$2.54
|
Rate for Payer: EPIC Health Plan Transplant |
$2.54
|
Rate for Payer: Galaxy Health WC |
$5.41
|
Rate for Payer: Global Benefits Group Commercial |
$3.82
|
Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$4.77
|
Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4.24
|
Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2.42
|
Rate for Payer: LLUH Dept of Risk Management WC |
$1.53
|
Rate for Payer: Multiplan Commercial |
$5.09
|
Rate for Payer: Networks By Design Commercial |
$4.13
|
Rate for Payer: Prime Health Services Commercial |
$5.41
|
Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$3.82
|
Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3.82
|
Rate for Payer: TriValley Medical Group Commercial/Senior |
$3.82
|
Rate for Payer: United Healthcare All Other Commercial |
$3.18
|
Rate for Payer: United Healthcare All Other HMO |
$3.18
|
Rate for Payer: United Healthcare HMO Rider |
$3.18
|
Rate for Payer: United Healthcare Select/Navigate/Core |
$3.18
|
Rate for Payer: Vantage Medical Group Commercial/Exchange |
$5.41
|
Rate for Payer: Vantage Medical Group Medi-Cal |
$5.41
|
Rate for Payer: Vantage Medical Group Senior |
$5.41
|
|
PILOCARPINE 4 % EYE DROPS [6282]
|
Facility
IP
|
$6.36
|
|
Service Code
|
NDC 70069-201-01
|
Hospital Charge Code |
1740061
|
Hospital Revenue Code
|
259
|
Min. Negotiated Rate |
$1.53 |
Max. Negotiated Rate |
$5.41 |
Rate for Payer: Blue Shield of California Commercial |
$4.53
|
Rate for Payer: Blue Shield of California EPN |
$3.26
|
Rate for Payer: Cash Price |
$2.86
|
Rate for Payer: Cigna of CA HMO |
$4.45
|
Rate for Payer: Cigna of CA PPO |
$4.45
|
Rate for Payer: EPIC Health Plan Commercial |
$2.54
|
Rate for Payer: Galaxy Health WC |
$5.41
|
Rate for Payer: Global Benefits Group Commercial |
$3.82
|
Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4.24
|
Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2.42
|
Rate for Payer: LLUH Dept of Risk Management WC |
$1.53
|
Rate for Payer: Multiplan Commercial |
$5.09
|
Rate for Payer: Networks By Design Commercial |
$4.13
|
Rate for Payer: Prime Health Services Commercial |
$5.41
|
|
PILOCARPINE 5 MG TABLET [12803]
|
Facility
OP
|
$2.73
|
|
Service Code
|
NDC 68084-928-95
|
Hospital Charge Code |
1711692
|
Hospital Revenue Code
|
259
|
Min. Negotiated Rate |
$0.66 |
Max. Negotiated Rate |
$2.32 |
Rate for Payer: BCBS Transplant Transplant |
$1.64
|
Rate for Payer: Aetna of CA HMO/PPO |
$1.79
|
Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$2.32
|
Rate for Payer: AlphaCare Medical Group Medi-Cal |
$1.50
|
Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$1.50
|
Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1.63
|
Rate for Payer: Blue Shield of California Commercial |
$2.01
|
Rate for Payer: Blue Shield of California EPN |
$1.59
|
Rate for Payer: Cash Price |
$1.23
|
Rate for Payer: Cigna of CA HMO |
$1.91
|
Rate for Payer: Cigna of CA PPO |
$1.91
|
Rate for Payer: Dignity Health Commercial/Exchange |
$2.32
|
Rate for Payer: Dignity Health Media |
$2.32
|
Rate for Payer: Dignity Health Medi-Cal |
$2.32
|
Rate for Payer: EPIC Health Plan Commercial |
$1.09
|
Rate for Payer: EPIC Health Plan Transplant |
$1.09
|
Rate for Payer: Galaxy Health WC |
$2.32
|
Rate for Payer: Global Benefits Group Commercial |
$1.64
|
Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$2.05
|
Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1.82
|
Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1.04
|
Rate for Payer: LLUH Dept of Risk Management WC |
$0.66
|
Rate for Payer: Multiplan Commercial |
$2.18
|
Rate for Payer: Networks By Design Commercial |
$1.77
|
Rate for Payer: Prime Health Services Commercial |
$2.32
|
Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$1.64
|
Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1.64
|
Rate for Payer: TriValley Medical Group Commercial/Senior |
$1.64
|
Rate for Payer: United Healthcare All Other Commercial |
$1.36
|
Rate for Payer: United Healthcare All Other HMO |
$1.36
|
Rate for Payer: United Healthcare HMO Rider |
$1.36
|
Rate for Payer: United Healthcare Select/Navigate/Core |
$1.36
|
Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2.32
|
Rate for Payer: Vantage Medical Group Medi-Cal |
$2.32
|
Rate for Payer: Vantage Medical Group Senior |
$2.32
|
|
PILOCARPINE 5 MG TABLET [12803]
|
Facility
IP
|
$0.49
|
|
Service Code
|
NDC 0527-1313-01
|
Hospital Charge Code |
1711692
|
Hospital Revenue Code
|
259
|
Min. Negotiated Rate |
$0.12 |
Max. Negotiated Rate |
$0.42 |
Rate for Payer: Blue Shield of California Commercial |
$0.35
|
Rate for Payer: Blue Shield of California EPN |
$0.25
|
Rate for Payer: Cash Price |
$0.22
|
Rate for Payer: Cigna of CA HMO |
$0.34
|
Rate for Payer: Cigna of CA PPO |
$0.34
|
Rate for Payer: EPIC Health Plan Commercial |
$0.20
|
Rate for Payer: Galaxy Health WC |
$0.42
|
Rate for Payer: Global Benefits Group Commercial |
$0.29
|
Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.33
|
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 |
$0.39
|
Rate for Payer: Networks By Design Commercial |
$0.32
|
Rate for Payer: Prime Health Services Commercial |
$0.42
|
|
PILOCARPINE 5 MG TABLET [12803]
|
Facility
IP
|
$2.73
|
|
Service Code
|
NDC 68084-928-25
|
Hospital Charge Code |
1711692
|
Hospital Revenue Code
|
259
|
Min. Negotiated Rate |
$0.66 |
Max. Negotiated Rate |
$2.32 |
Rate for Payer: Blue Shield of California Commercial |
$1.94
|
Rate for Payer: Blue Shield of California EPN |
$1.40
|
Rate for Payer: Cash Price |
$1.23
|
Rate for Payer: Cigna of CA HMO |
$1.91
|
Rate for Payer: Cigna of CA PPO |
$1.91
|
Rate for Payer: EPIC Health Plan Commercial |
$1.09
|
Rate for Payer: Galaxy Health WC |
$2.32
|
Rate for Payer: Global Benefits Group Commercial |
$1.64
|
Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1.82
|
Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1.04
|
Rate for Payer: LLUH Dept of Risk Management WC |
$0.66
|
Rate for Payer: Multiplan Commercial |
$2.18
|
Rate for Payer: Networks By Design Commercial |
$1.77
|
Rate for Payer: Prime Health Services Commercial |
$2.32
|
|
PILOCARPINE 5 MG TABLET [12803]
|
Facility
OP
|
$2.73
|
|
Service Code
|
NDC 68084-928-25
|
Hospital Charge Code |
1711692
|
Hospital Revenue Code
|
259
|
Min. Negotiated Rate |
$0.66 |
Max. Negotiated Rate |
$2.32 |
Rate for Payer: Aetna of CA HMO/PPO |
$1.79
|
Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$2.32
|
Rate for Payer: AlphaCare Medical Group Medi-Cal |
$1.50
|
Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$1.50
|
Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1.63
|
Rate for Payer: BCBS Transplant Transplant |
$1.64
|
Rate for Payer: Blue Shield of California Commercial |
$2.01
|
Rate for Payer: Blue Shield of California EPN |
$1.59
|
Rate for Payer: Cash Price |
$1.23
|
Rate for Payer: Cigna of CA HMO |
$1.91
|
Rate for Payer: Cigna of CA PPO |
$1.91
|
Rate for Payer: Dignity Health Commercial/Exchange |
$2.32
|
Rate for Payer: Dignity Health Media |
$2.32
|
Rate for Payer: Dignity Health Medi-Cal |
$2.32
|
Rate for Payer: EPIC Health Plan Commercial |
$1.09
|
Rate for Payer: EPIC Health Plan Transplant |
$1.09
|
Rate for Payer: Galaxy Health WC |
$2.32
|
Rate for Payer: Global Benefits Group Commercial |
$1.64
|
Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$2.05
|
Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1.82
|
Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1.04
|
Rate for Payer: LLUH Dept of Risk Management WC |
$0.66
|
Rate for Payer: Multiplan Commercial |
$2.18
|
Rate for Payer: Networks By Design Commercial |
$1.77
|
Rate for Payer: Prime Health Services Commercial |
$2.32
|
Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$1.64
|
Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1.64
|
Rate for Payer: TriValley Medical Group Commercial/Senior |
$1.64
|
Rate for Payer: United Healthcare All Other Commercial |
$1.36
|
Rate for Payer: United Healthcare All Other HMO |
$1.36
|
Rate for Payer: United Healthcare HMO Rider |
$1.36
|
Rate for Payer: United Healthcare Select/Navigate/Core |
$1.36
|
Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2.32
|
Rate for Payer: Vantage Medical Group Medi-Cal |
$2.32
|
Rate for Payer: Vantage Medical Group Senior |
$2.32
|
|
PILOCARPINE 5 MG TABLET [12803]
|
Facility
IP
|
$2.73
|
|
Service Code
|
NDC 68084-928-95
|
Hospital Charge Code |
1711692
|
Hospital Revenue Code
|
259
|
Min. Negotiated Rate |
$0.66 |
Max. Negotiated Rate |
$2.32 |
Rate for Payer: Blue Shield of California Commercial |
$1.94
|
Rate for Payer: Blue Shield of California EPN |
$1.40
|
Rate for Payer: Cash Price |
$1.23
|
Rate for Payer: Cigna of CA HMO |
$1.91
|
Rate for Payer: Cigna of CA PPO |
$1.91
|
Rate for Payer: EPIC Health Plan Commercial |
$1.09
|
Rate for Payer: Galaxy Health WC |
$2.32
|
Rate for Payer: Global Benefits Group Commercial |
$1.64
|
Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1.82
|
Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1.04
|
Rate for Payer: LLUH Dept of Risk Management WC |
$0.66
|
Rate for Payer: Multiplan Commercial |
$2.18
|
Rate for Payer: Networks By Design Commercial |
$1.77
|
Rate for Payer: Prime Health Services Commercial |
$2.32
|
|
PILOCARPINE 5 MG TABLET [12803]
|
Facility
OP
|
$0.49
|
|
Service Code
|
NDC 0527-1313-01
|
Hospital Charge Code |
1711692
|
Hospital Revenue Code
|
259
|
Min. Negotiated Rate |
$0.12 |
Max. Negotiated Rate |
$0.42 |
Rate for Payer: Aetna of CA HMO/PPO |
$0.32
|
Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$0.42
|
Rate for Payer: AlphaCare Medical Group Medi-Cal |
$0.27
|
Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$0.27
|
Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.29
|
Rate for Payer: BCBS Transplant Transplant |
$0.29
|
Rate for Payer: Blue Shield of California Commercial |
$0.36
|
Rate for Payer: Blue Shield of California EPN |
$0.29
|
Rate for Payer: Cash Price |
$0.22
|
Rate for Payer: Cigna of CA HMO |
$0.34
|
Rate for Payer: Cigna of CA PPO |
$0.34
|
Rate for Payer: Dignity Health Commercial/Exchange |
$0.42
|
Rate for Payer: Dignity Health Media |
$0.42
|
Rate for Payer: Dignity Health Medi-Cal |
$0.42
|
Rate for Payer: EPIC Health Plan Commercial |
$0.20
|
Rate for Payer: EPIC Health Plan Transplant |
$0.20
|
Rate for Payer: Galaxy Health WC |
$0.42
|
Rate for Payer: Global Benefits Group Commercial |
$0.29
|
Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$0.37
|
Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.33
|
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 |
$0.39
|
Rate for Payer: Networks By Design Commercial |
$0.32
|
Rate for Payer: Prime Health Services Commercial |
$0.42
|
Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$0.29
|
Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.29
|
Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.29
|
Rate for Payer: United Healthcare All Other Commercial |
$0.25
|
Rate for Payer: United Healthcare All Other HMO |
$0.25
|
Rate for Payer: United Healthcare HMO Rider |
$0.25
|
Rate for Payer: United Healthcare Select/Navigate/Core |
$0.25
|
Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.42
|
Rate for Payer: Vantage Medical Group Medi-Cal |
$0.42
|
Rate for Payer: Vantage Medical Group Senior |
$0.42
|
|
PIMECROLIMUS 1 % TOPICAL CREAM [32052]
|
Facility
OP
|
$11.96
|
|
Service Code
|
NDC 0187-5100-01
|
Hospital Charge Code |
1743701
|
Hospital Revenue Code
|
259
|
Min. Negotiated Rate |
$2.87 |
Max. Negotiated Rate |
$10.17 |
Rate for Payer: Aetna of CA HMO/PPO |
$7.84
|
Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$10.17
|
Rate for Payer: AlphaCare Medical Group Medi-Cal |
$6.58
|
Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$6.58
|
Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$7.13
|
Rate for Payer: BCBS Transplant Transplant |
$7.18
|
Rate for Payer: Blue Shield of California Commercial |
$8.81
|
Rate for Payer: Blue Shield of California EPN |
$6.98
|
Rate for Payer: Cash Price |
$5.38
|
Rate for Payer: Cigna of CA HMO |
$8.37
|
Rate for Payer: Cigna of CA PPO |
$8.37
|
Rate for Payer: Dignity Health Commercial/Exchange |
$10.17
|
Rate for Payer: Dignity Health Media |
$10.17
|
Rate for Payer: Dignity Health Medi-Cal |
$10.17
|
Rate for Payer: EPIC Health Plan Commercial |
$4.78
|
Rate for Payer: EPIC Health Plan Transplant |
$4.78
|
Rate for Payer: Galaxy Health WC |
$10.17
|
Rate for Payer: Global Benefits Group Commercial |
$7.18
|
Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$8.97
|
Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$7.98
|
Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4.56
|
Rate for Payer: LLUH Dept of Risk Management WC |
$2.87
|
Rate for Payer: Multiplan Commercial |
$9.57
|
Rate for Payer: Networks By Design Commercial |
$7.77
|
Rate for Payer: Prime Health Services Commercial |
$10.17
|
Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$7.18
|
Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$7.18
|
Rate for Payer: TriValley Medical Group Commercial/Senior |
$7.18
|
Rate for Payer: United Healthcare All Other Commercial |
$5.98
|
Rate for Payer: United Healthcare All Other HMO |
$5.98
|
Rate for Payer: United Healthcare HMO Rider |
$5.98
|
Rate for Payer: United Healthcare Select/Navigate/Core |
$5.98
|
Rate for Payer: Vantage Medical Group Commercial/Exchange |
$10.17
|
Rate for Payer: Vantage Medical Group Medi-Cal |
$10.17
|
Rate for Payer: Vantage Medical Group Senior |
$10.17
|
|
PIMECROLIMUS 1 % TOPICAL CREAM [32052]
|
Facility
IP
|
$11.96
|
|
Service Code
|
NDC 0187-5100-01
|
Hospital Charge Code |
1743701
|
Hospital Revenue Code
|
259
|
Min. Negotiated Rate |
$2.87 |
Max. Negotiated Rate |
$10.17 |
Rate for Payer: Blue Shield of California Commercial |
$8.52
|
Rate for Payer: Blue Shield of California EPN |
$6.12
|
Rate for Payer: Cash Price |
$5.38
|
Rate for Payer: Cigna of CA HMO |
$8.37
|
Rate for Payer: Cigna of CA PPO |
$8.37
|
Rate for Payer: EPIC Health Plan Commercial |
$4.78
|
Rate for Payer: Galaxy Health WC |
$10.17
|
Rate for Payer: Global Benefits Group Commercial |
$7.18
|
Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$7.98
|
Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4.56
|
Rate for Payer: LLUH Dept of Risk Management WC |
$2.87
|
Rate for Payer: Multiplan Commercial |
$9.57
|
Rate for Payer: Networks By Design Commercial |
$7.77
|
Rate for Payer: Prime Health Services Commercial |
$10.17
|
|
PIOGLITAZONE 15 MG TABLET [25528]
|
Facility
IP
|
$0.44
|
|
Service Code
|
NDC 0781-5420-92
|
Hospital Charge Code |
1710878
|
Hospital Revenue Code
|
259
|
Min. Negotiated Rate |
$0.11 |
Max. Negotiated Rate |
$0.37 |
Rate for Payer: Blue Shield of California Commercial |
$0.31
|
Rate for Payer: Blue Shield of California EPN |
$0.23
|
Rate for Payer: Cash Price |
$0.20
|
Rate for Payer: Cigna of CA HMO |
$0.31
|
Rate for Payer: Cigna of CA PPO |
$0.31
|
Rate for Payer: EPIC Health Plan Commercial |
$0.18
|
Rate for Payer: Galaxy Health WC |
$0.37
|
Rate for Payer: Global Benefits Group Commercial |
$0.26
|
Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.29
|
Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.17
|
Rate for Payer: LLUH Dept of Risk Management WC |
$0.11
|
Rate for Payer: Multiplan Commercial |
$0.35
|
Rate for Payer: Networks By Design Commercial |
$0.29
|
Rate for Payer: Prime Health Services Commercial |
$0.37
|
|
PIOGLITAZONE 15 MG TABLET [25528]
|
Facility
OP
|
$0.44
|
|
Service Code
|
NDC 0781-5420-92
|
Hospital Charge Code |
1710878
|
Hospital Revenue Code
|
259
|
Min. Negotiated Rate |
$0.11 |
Max. Negotiated Rate |
$0.37 |
Rate for Payer: Aetna of CA HMO/PPO |
$0.29
|
Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$0.37
|
Rate for Payer: AlphaCare Medical Group Medi-Cal |
$0.24
|
Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$0.24
|
Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.26
|
Rate for Payer: BCBS Transplant Transplant |
$0.26
|
Rate for Payer: Blue Shield of California Commercial |
$0.32
|
Rate for Payer: Blue Shield of California EPN |
$0.26
|
Rate for Payer: Cash Price |
$0.20
|
Rate for Payer: Cigna of CA HMO |
$0.31
|
Rate for Payer: Cigna of CA PPO |
$0.31
|
Rate for Payer: Dignity Health Commercial/Exchange |
$0.37
|
Rate for Payer: Dignity Health Media |
$0.37
|
Rate for Payer: Dignity Health Medi-Cal |
$0.37
|
Rate for Payer: EPIC Health Plan Commercial |
$0.18
|
Rate for Payer: EPIC Health Plan Transplant |
$0.18
|
Rate for Payer: Galaxy Health WC |
$0.37
|
Rate for Payer: Global Benefits Group Commercial |
$0.26
|
Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$0.33
|
Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.29
|
Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.17
|
Rate for Payer: LLUH Dept of Risk Management WC |
$0.11
|
Rate for Payer: Multiplan Commercial |
$0.35
|
Rate for Payer: Networks By Design Commercial |
$0.29
|
Rate for Payer: Prime Health Services Commercial |
$0.37
|
Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$0.26
|
Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.26
|
Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.26
|
Rate for Payer: United Healthcare All Other Commercial |
$0.22
|
Rate for Payer: United Healthcare All Other HMO |
$0.22
|
Rate for Payer: United Healthcare HMO Rider |
$0.22
|
Rate for Payer: United Healthcare Select/Navigate/Core |
$0.22
|
Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.37
|
Rate for Payer: Vantage Medical Group Medi-Cal |
$0.37
|
Rate for Payer: Vantage Medical Group Senior |
$0.37
|
|
PIOGLITAZONE 30 MG TABLET [25529]
|
Facility
OP
|
$0.22
|
|
Service Code
|
NDC 33342-055-07
|
Hospital Charge Code |
1712291
|
Hospital Revenue Code
|
259
|
Min. Negotiated Rate |
$0.05 |
Max. Negotiated Rate |
$0.19 |
Rate for Payer: Multiplan Commercial |
$0.18
|
Rate for Payer: Networks By Design Commercial |
$0.14
|
Rate for Payer: Aetna of CA HMO/PPO |
$0.14
|
Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$0.19
|
Rate for Payer: AlphaCare Medical Group Medi-Cal |
$0.12
|
Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$0.12
|
Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.13
|
Rate for Payer: BCBS Transplant Transplant |
$0.13
|
Rate for Payer: Blue Shield of California Commercial |
$0.16
|
Rate for Payer: Blue Shield of California EPN |
$0.13
|
Rate for Payer: Cash Price |
$0.10
|
Rate for Payer: Cigna of CA HMO |
$0.15
|
Rate for Payer: Cigna of CA PPO |
$0.15
|
Rate for Payer: Dignity Health Commercial/Exchange |
$0.19
|
Rate for Payer: Dignity Health Media |
$0.19
|
Rate for Payer: Dignity Health Medi-Cal |
$0.19
|
Rate for Payer: EPIC Health Plan Commercial |
$0.09
|
Rate for Payer: EPIC Health Plan Transplant |
$0.09
|
Rate for Payer: Galaxy Health WC |
$0.19
|
Rate for Payer: Global Benefits Group Commercial |
$0.13
|
Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$0.17
|
Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.15
|
Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.08
|
Rate for Payer: LLUH Dept of Risk Management WC |
$0.05
|
Rate for Payer: Prime Health Services Commercial |
$0.19
|
Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$0.13
|
Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.13
|
Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.13
|
Rate for Payer: United Healthcare All Other Commercial |
$0.11
|
Rate for Payer: United Healthcare All Other HMO |
$0.11
|
Rate for Payer: United Healthcare HMO Rider |
$0.11
|
Rate for Payer: United Healthcare Select/Navigate/Core |
$0.11
|
Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.19
|
Rate for Payer: Vantage Medical Group Medi-Cal |
$0.19
|
Rate for Payer: Vantage Medical Group Senior |
$0.19
|
|
PIOGLITAZONE 30 MG TABLET [25529]
|
Facility
IP
|
$0.22
|
|
Service Code
|
NDC 33342-055-07
|
Hospital Charge Code |
1712291
|
Hospital Revenue Code
|
259
|
Min. Negotiated Rate |
$0.05 |
Max. Negotiated Rate |
$0.19 |
Rate for Payer: Blue Shield of California Commercial |
$0.16
|
Rate for Payer: Blue Shield of California EPN |
$0.11
|
Rate for Payer: Cash Price |
$0.10
|
Rate for Payer: Cigna of CA HMO |
$0.15
|
Rate for Payer: Cigna of CA PPO |
$0.15
|
Rate for Payer: EPIC Health Plan Commercial |
$0.09
|
Rate for Payer: Galaxy Health WC |
$0.19
|
Rate for Payer: Global Benefits Group Commercial |
$0.13
|
Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.15
|
Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.08
|
Rate for Payer: LLUH Dept of Risk Management WC |
$0.05
|
Rate for Payer: Multiplan Commercial |
$0.18
|
Rate for Payer: Networks By Design Commercial |
$0.14
|
Rate for Payer: Prime Health Services Commercial |
$0.19
|
|
PIPERACILLIN-TAZOBACTAM 2.25 GRAM/50 ML IN DEXTROSE(ISO) IV PIGGYBACK [34523]
|
Facility
IP
|
$0.37
|
|
Service Code
|
CPT J2543
|
Hospital Charge Code |
NDG34523
|
Hospital Revenue Code
|
636
|
Min. Negotiated Rate |
$0.09 |
Max. Negotiated Rate |
$0.31 |
Rate for Payer: Blue Shield of California Commercial |
$0.26
|
Rate for Payer: Blue Shield of California EPN |
$0.19
|
Rate for Payer: Cash Price |
$0.17
|
Rate for Payer: Cigna of CA HMO |
$0.26
|
Rate for Payer: Cigna of CA PPO |
$0.26
|
Rate for Payer: EPIC Health Plan Commercial |
$0.15
|
Rate for Payer: EPIC Health Plan Transplant |
$0.15
|
Rate for Payer: Galaxy Health WC |
$0.31
|
Rate for Payer: Global Benefits Group Commercial |
$0.22
|
Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.25
|
Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.14
|
Rate for Payer: LLUH Dept of Risk Management WC |
$0.09
|
Rate for Payer: Multiplan Commercial |
$0.30
|
Rate for Payer: Networks By Design Commercial |
$0.19
|
Rate for Payer: Prime Health Services Commercial |
$0.31
|
|
PIPERACILLIN-TAZOBACTAM 2.25 GRAM/50 ML IN DEXTROSE(ISO) IV PIGGYBACK [34523]
|
Facility
OP
|
$0.37
|
|
Service Code
|
CPT J2543
|
Hospital Charge Code |
NDG34523
|
Hospital Revenue Code
|
636
|
Min. Negotiated Rate |
$0.09 |
Max. Negotiated Rate |
$10.78 |
Rate for Payer: Aetna of CA HMO/PPO |
$7.41
|
Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$0.31
|
Rate for Payer: AlphaCare Medical Group Medi-Cal |
$0.20
|
Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$0.20
|
Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$10.78
|
Rate for Payer: BCBS Transplant Transplant |
$0.22
|
Rate for Payer: Blue Shield of California Commercial |
$0.27
|
Rate for Payer: Blue Shield of California EPN |
$4.01
|
Rate for Payer: Cash Price |
$0.17
|
Rate for Payer: Cash Price |
$0.17
|
Rate for Payer: Cigna of CA HMO |
$0.26
|
Rate for Payer: Cigna of CA PPO |
$0.26
|
Rate for Payer: Dignity Health Commercial/Exchange |
$0.31
|
Rate for Payer: Dignity Health Media |
$0.31
|
Rate for Payer: Dignity Health Medi-Cal |
$0.31
|
Rate for Payer: EPIC Health Plan Commercial |
$0.15
|
Rate for Payer: EPIC Health Plan Transplant |
$0.15
|
Rate for Payer: Galaxy Health WC |
$0.31
|
Rate for Payer: Global Benefits Group Commercial |
$0.22
|
Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$0.28
|
Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.25
|
Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.14
|
Rate for Payer: LLUH Dept of Risk Management WC |
$0.09
|
Rate for Payer: Multiplan Commercial |
$0.30
|
Rate for Payer: Networks By Design Commercial |
$0.19
|
Rate for Payer: Prime Health Services Commercial |
$0.31
|
Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.22
|
Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.22
|
Rate for Payer: United Healthcare All Other Commercial |
$0.19
|
Rate for Payer: United Healthcare All Other HMO |
$0.19
|
Rate for Payer: United Healthcare HMO Rider |
$0.19
|
Rate for Payer: United Healthcare Select/Navigate/Core |
$0.19
|
Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.31
|
Rate for Payer: Vantage Medical Group Medi-Cal |
$0.31
|
Rate for Payer: Vantage Medical Group Senior |
$0.31
|
|
PIPERACILLIN-TAZOBACTAM 2.25 GRAM INTRAVENOUS SOLUTION [18304]
|
Facility
OP
|
$11.10
|
|
Service Code
|
CPT J2543
|
Hospital Charge Code |
ERX18304
|
Hospital Revenue Code
|
636
|
Min. Negotiated Rate |
$2.66 |
Max. Negotiated Rate |
$10.78 |
Rate for Payer: Aetna of CA HMO/PPO |
$7.41
|
Rate for Payer: Aetna of CA HMO/PPO |
$7.41
|
Rate for Payer: Aetna of CA HMO/PPO |
$7.41
|
Rate for Payer: Aetna of CA HMO/PPO |
$7.41
|
Rate for Payer: Aetna of CA HMO/PPO |
$7.41
|
Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$3.50
|
Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$9.44
|
Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$7.14
|
Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$5.61
|
Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$7.84
|
Rate for Payer: AlphaCare Medical Group Medi-Cal |
$5.07
|
Rate for Payer: AlphaCare Medical Group Medi-Cal |
$2.27
|
Rate for Payer: AlphaCare Medical Group Medi-Cal |
$6.10
|
Rate for Payer: AlphaCare Medical Group Medi-Cal |
$4.62
|
Rate for Payer: AlphaCare Medical Group Medi-Cal |
$3.63
|
Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$5.07
|
Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$2.27
|
Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$3.63
|
Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$4.62
|
Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$6.10
|
Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$10.78
|
Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$10.78
|
Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$10.78
|
Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$10.78
|
Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$10.78
|
Rate for Payer: BCBS Transplant Transplant |
$5.53
|
Rate for Payer: BCBS Transplant Transplant |
$6.66
|
Rate for Payer: BCBS Transplant Transplant |
$5.04
|
Rate for Payer: BCBS Transplant Transplant |
$3.96
|
Rate for Payer: BCBS Transplant Transplant |
$2.47
|
Rate for Payer: Blue Shield of California Commercial |
$6.19
|
Rate for Payer: Blue Shield of California Commercial |
$3.04
|
Rate for Payer: Blue Shield of California Commercial |
$8.18
|
Rate for Payer: Blue Shield of California Commercial |
$6.80
|
Rate for Payer: Blue Shield of California Commercial |
$4.86
|
Rate for Payer: Blue Shield of California EPN |
$4.01
|
Rate for Payer: Blue Shield of California EPN |
$4.01
|
Rate for Payer: Blue Shield of California EPN |
$4.01
|
Rate for Payer: Blue Shield of California EPN |
$4.01
|
Rate for Payer: Blue Shield of California EPN |
$4.01
|
Rate for Payer: Cash Price |
$3.78
|
Rate for Payer: Cash Price |
$3.78
|
Rate for Payer: Cash Price |
$2.97
|
Rate for Payer: Cash Price |
$2.97
|
Rate for Payer: Cash Price |
$4.15
|
Rate for Payer: Cash Price |
$1.85
|
Rate for Payer: Cash Price |
$4.15
|
Rate for Payer: Cash Price |
$5.00
|
Rate for Payer: Cash Price |
$1.85
|
Rate for Payer: Cash Price |
$5.00
|
Rate for Payer: Cigna of CA HMO |
$4.62
|
Rate for Payer: Cigna of CA HMO |
$7.77
|
Rate for Payer: Cigna of CA HMO |
$2.88
|
Rate for Payer: Cigna of CA HMO |
$5.88
|
Rate for Payer: Cigna of CA HMO |
$6.45
|
Rate for Payer: Cigna of CA PPO |
$6.45
|
Rate for Payer: Cigna of CA PPO |
$5.88
|
Rate for Payer: Cigna of CA PPO |
$4.62
|
Rate for Payer: Cigna of CA PPO |
$2.88
|
Rate for Payer: Cigna of CA PPO |
$7.77
|
Rate for Payer: Dignity Health Commercial/Exchange |
$7.14
|
Rate for Payer: Dignity Health Commercial/Exchange |
$7.84
|
Rate for Payer: Dignity Health Commercial/Exchange |
$9.44
|
Rate for Payer: Dignity Health Commercial/Exchange |
$3.50
|
Rate for Payer: Dignity Health Commercial/Exchange |
$5.61
|
Rate for Payer: Dignity Health Media |
$7.14
|
Rate for Payer: Dignity Health Media |
$7.84
|
Rate for Payer: Dignity Health Media |
$9.44
|
Rate for Payer: Dignity Health Media |
$5.61
|
Rate for Payer: Dignity Health Media |
$3.50
|
Rate for Payer: Dignity Health Medi-Cal |
$7.84
|
Rate for Payer: Dignity Health Medi-Cal |
$5.61
|
Rate for Payer: Dignity Health Medi-Cal |
$9.44
|
Rate for Payer: Dignity Health Medi-Cal |
$7.14
|
Rate for Payer: Dignity Health Medi-Cal |
$3.50
|
Rate for Payer: EPIC Health Plan Commercial |
$3.36
|
Rate for Payer: EPIC Health Plan Commercial |
$3.69
|
Rate for Payer: EPIC Health Plan Commercial |
$4.44
|
Rate for Payer: EPIC Health Plan Commercial |
$1.65
|
Rate for Payer: EPIC Health Plan Commercial |
$2.64
|
Rate for Payer: EPIC Health Plan Transplant |
$3.36
|
Rate for Payer: EPIC Health Plan Transplant |
$2.64
|
Rate for Payer: EPIC Health Plan Transplant |
$1.65
|
Rate for Payer: EPIC Health Plan Transplant |
$4.44
|
Rate for Payer: EPIC Health Plan Transplant |
$3.69
|
Rate for Payer: Galaxy Health WC |
$9.44
|
Rate for Payer: Galaxy Health WC |
$3.50
|
Rate for Payer: Galaxy Health WC |
$7.84
|
Rate for Payer: Galaxy Health WC |
$7.14
|
Rate for Payer: Galaxy Health WC |
$5.61
|
Rate for Payer: Global Benefits Group Commercial |
$6.66
|
Rate for Payer: Global Benefits Group Commercial |
$5.53
|
Rate for Payer: Global Benefits Group Commercial |
$2.47
|
Rate for Payer: Global Benefits Group Commercial |
$3.96
|
Rate for Payer: Global Benefits Group Commercial |
$5.04
|
Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$3.09
|
Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$4.95
|
Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$6.30
|
Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$8.32
|
Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$6.92
|
Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$6.15
|
Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2.75
|
Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4.40
|
Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$5.60
|
Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$7.40
|
Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4.23
|
Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2.51
|
Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3.51
|
Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3.20
|
Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1.57
|
Rate for Payer: LLUH Dept of Risk Management WC |
$1.58
|
Rate for Payer: LLUH Dept of Risk Management WC |
$0.99
|
Rate for Payer: LLUH Dept of Risk Management WC |
$2.02
|
Rate for Payer: LLUH Dept of Risk Management WC |
$2.21
|
Rate for Payer: LLUH Dept of Risk Management WC |
$2.66
|
Rate for Payer: Multiplan Commercial |
$6.72
|
Rate for Payer: Multiplan Commercial |
$3.30
|
Rate for Payer: Multiplan Commercial |
$8.88
|
Rate for Payer: Multiplan Commercial |
$7.38
|
Rate for Payer: Multiplan Commercial |
$5.28
|
Rate for Payer: Networks By Design Commercial |
$3.30
|
Rate for Payer: Networks By Design Commercial |
$2.06
|
Rate for Payer: Networks By Design Commercial |
$4.20
|
Rate for Payer: Networks By Design Commercial |
$5.55
|
Rate for Payer: Networks By Design Commercial |
$4.61
|
Rate for Payer: Prime Health Services Commercial |
$7.84
|
Rate for Payer: Prime Health Services Commercial |
$9.44
|
Rate for Payer: Prime Health Services Commercial |
$5.61
|
Rate for Payer: Prime Health Services Commercial |
$7.14
|
Rate for Payer: Prime Health Services Commercial |
$3.50
|
Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$5.04
|
Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$6.66
|
Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2.47
|
Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3.96
|
Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$5.53
|
Rate for Payer: TriValley Medical Group Commercial/Senior |
$6.66
|
Rate for Payer: TriValley Medical Group Commercial/Senior |
$5.04
|
Rate for Payer: TriValley Medical Group Commercial/Senior |
$3.96
|
Rate for Payer: TriValley Medical Group Commercial/Senior |
$2.47
|
Rate for Payer: TriValley Medical Group Commercial/Senior |
$5.53
|
Rate for Payer: United Healthcare All Other Commercial |
$2.06
|
Rate for Payer: United Healthcare All Other Commercial |
$4.61
|
Rate for Payer: United Healthcare All Other Commercial |
$4.20
|
Rate for Payer: United Healthcare All Other Commercial |
$5.55
|
Rate for Payer: United Healthcare All Other Commercial |
$3.30
|
Rate for Payer: United Healthcare All Other HMO |
$3.30
|
Rate for Payer: United Healthcare All Other HMO |
$5.55
|
Rate for Payer: United Healthcare All Other HMO |
$4.20
|
Rate for Payer: United Healthcare All Other HMO |
$4.61
|
Rate for Payer: United Healthcare All Other HMO |
$2.06
|
Rate for Payer: United Healthcare HMO Rider |
$2.06
|
Rate for Payer: United Healthcare HMO Rider |
$4.61
|
Rate for Payer: United Healthcare HMO Rider |
$4.20
|
Rate for Payer: United Healthcare HMO Rider |
$5.55
|
Rate for Payer: United Healthcare HMO Rider |
$3.30
|
Rate for Payer: United Healthcare Select/Navigate/Core |
$3.30
|
Rate for Payer: United Healthcare Select/Navigate/Core |
$2.06
|
Rate for Payer: United Healthcare Select/Navigate/Core |
$5.55
|
Rate for Payer: United Healthcare Select/Navigate/Core |
$4.20
|
Rate for Payer: United Healthcare Select/Navigate/Core |
$4.61
|
Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3.50
|
Rate for Payer: Vantage Medical Group Commercial/Exchange |
$5.61
|
Rate for Payer: Vantage Medical Group Commercial/Exchange |
$9.44
|
Rate for Payer: Vantage Medical Group Commercial/Exchange |
$7.84
|
Rate for Payer: Vantage Medical Group Commercial/Exchange |
$7.14
|
Rate for Payer: Vantage Medical Group Medi-Cal |
$5.61
|
Rate for Payer: Vantage Medical Group Medi-Cal |
$7.84
|
Rate for Payer: Vantage Medical Group Medi-Cal |
$7.14
|
Rate for Payer: Vantage Medical Group Medi-Cal |
$3.50
|
Rate for Payer: Vantage Medical Group Medi-Cal |
$9.44
|
Rate for Payer: Vantage Medical Group Senior |
$7.14
|
Rate for Payer: Vantage Medical Group Senior |
$5.61
|
Rate for Payer: Vantage Medical Group Senior |
$9.44
|
Rate for Payer: Vantage Medical Group Senior |
$3.50
|
Rate for Payer: Vantage Medical Group Senior |
$7.84
|
|
PIPERACILLIN-TAZOBACTAM 2.25 GRAM INTRAVENOUS SOLUTION [18304]
|
Facility
IP
|
$4.12
|
|
Service Code
|
CPT J2543
|
Hospital Charge Code |
ERX18304
|
Hospital Revenue Code
|
636
|
Min. Negotiated Rate |
$0.99 |
Max. Negotiated Rate |
$3.50 |
Rate for Payer: Blue Shield of California Commercial |
$2.93
|
Rate for Payer: Blue Shield of California Commercial |
$7.90
|
Rate for Payer: Blue Shield of California Commercial |
$4.70
|
Rate for Payer: Blue Shield of California Commercial |
$5.98
|
Rate for Payer: Blue Shield of California Commercial |
$6.56
|
Rate for Payer: Blue Shield of California EPN |
$3.38
|
Rate for Payer: Blue Shield of California EPN |
$4.30
|
Rate for Payer: Blue Shield of California EPN |
$2.11
|
Rate for Payer: Blue Shield of California EPN |
$4.72
|
Rate for Payer: Blue Shield of California EPN |
$5.68
|
Rate for Payer: Cash Price |
$2.97
|
Rate for Payer: Cash Price |
$3.78
|
Rate for Payer: Cash Price |
$5.00
|
Rate for Payer: Cash Price |
$1.85
|
Rate for Payer: Cash Price |
$4.15
|
Rate for Payer: Cigna of CA HMO |
$4.62
|
Rate for Payer: Cigna of CA HMO |
$7.77
|
Rate for Payer: Cigna of CA HMO |
$6.45
|
Rate for Payer: Cigna of CA HMO |
$5.88
|
Rate for Payer: Cigna of CA HMO |
$2.88
|
Rate for Payer: Cigna of CA PPO |
$2.88
|
Rate for Payer: Cigna of CA PPO |
$5.88
|
Rate for Payer: Cigna of CA PPO |
$6.45
|
Rate for Payer: Cigna of CA PPO |
$4.62
|
Rate for Payer: Cigna of CA PPO |
$7.77
|
Rate for Payer: EPIC Health Plan Commercial |
$2.64
|
Rate for Payer: EPIC Health Plan Commercial |
$4.44
|
Rate for Payer: EPIC Health Plan Commercial |
$1.65
|
Rate for Payer: EPIC Health Plan Commercial |
$3.36
|
Rate for Payer: EPIC Health Plan Commercial |
$3.69
|
Rate for Payer: EPIC Health Plan Transplant |
$3.36
|
Rate for Payer: EPIC Health Plan Transplant |
$1.65
|
Rate for Payer: EPIC Health Plan Transplant |
$3.69
|
Rate for Payer: EPIC Health Plan Transplant |
$4.44
|
Rate for Payer: EPIC Health Plan Transplant |
$2.64
|
Rate for Payer: Galaxy Health WC |
$7.84
|
Rate for Payer: Galaxy Health WC |
$7.14
|
Rate for Payer: Galaxy Health WC |
$3.50
|
Rate for Payer: Galaxy Health WC |
$5.61
|
Rate for Payer: Galaxy Health WC |
$9.44
|
Rate for Payer: Global Benefits Group Commercial |
$2.47
|
Rate for Payer: Global Benefits Group Commercial |
$5.53
|
Rate for Payer: Global Benefits Group Commercial |
$3.96
|
Rate for Payer: Global Benefits Group Commercial |
$5.04
|
Rate for Payer: Global Benefits Group Commercial |
$6.66
|
Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2.75
|
Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$7.40
|
Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4.40
|
Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$6.15
|
Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$5.60
|
Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1.57
|
Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3.51
|
Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4.23
|
Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3.20
|
Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2.51
|
Rate for Payer: LLUH Dept of Risk Management WC |
$0.99
|
Rate for Payer: LLUH Dept of Risk Management WC |
$1.58
|
Rate for Payer: LLUH Dept of Risk Management WC |
$2.21
|
Rate for Payer: LLUH Dept of Risk Management WC |
$2.02
|
Rate for Payer: LLUH Dept of Risk Management WC |
$2.66
|
Rate for Payer: Multiplan Commercial |
$5.28
|
Rate for Payer: Multiplan Commercial |
$8.88
|
Rate for Payer: Multiplan Commercial |
$3.30
|
Rate for Payer: Multiplan Commercial |
$7.38
|
Rate for Payer: Multiplan Commercial |
$6.72
|
Rate for Payer: Networks By Design Commercial |
$4.61
|
Rate for Payer: Networks By Design Commercial |
$3.30
|
Rate for Payer: Networks By Design Commercial |
$5.55
|
Rate for Payer: Networks By Design Commercial |
$4.20
|
Rate for Payer: Networks By Design Commercial |
$2.06
|
Rate for Payer: Prime Health Services Commercial |
$7.14
|
Rate for Payer: Prime Health Services Commercial |
$9.44
|
Rate for Payer: Prime Health Services Commercial |
$7.84
|
Rate for Payer: Prime Health Services Commercial |
$5.61
|
Rate for Payer: Prime Health Services Commercial |
$3.50
|
|
PIPERACILLIN-TAZOBACTAM 3.375 GRAM/50 ML DEXTROSE(ISO-OS) IV PIGGYBACK [34524]
|
Facility
IP
|
$0.48
|
|
Service Code
|
CPT J2543
|
Hospital Charge Code |
NDG34524
|
Hospital Revenue Code
|
636
|
Min. Negotiated Rate |
$0.12 |
Max. Negotiated Rate |
$0.41 |
Rate for Payer: Blue Shield of California Commercial |
$0.34
|
Rate for Payer: Blue Shield of California EPN |
$0.25
|
Rate for Payer: Cash Price |
$0.22
|
Rate for Payer: Cigna of CA HMO |
$0.34
|
Rate for Payer: Cigna of CA PPO |
$0.34
|
Rate for Payer: EPIC Health Plan Commercial |
$0.19
|
Rate for Payer: EPIC Health Plan Transplant |
$0.19
|
Rate for Payer: Galaxy Health WC |
$0.41
|
Rate for Payer: Global Benefits Group Commercial |
$0.29
|
Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.32
|
Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.18
|
Rate for Payer: LLUH Dept of Risk Management WC |
$0.12
|
Rate for Payer: Multiplan Commercial |
$0.38
|
Rate for Payer: Networks By Design Commercial |
$0.24
|
Rate for Payer: Prime Health Services Commercial |
$0.41
|
|
PIPERACILLIN-TAZOBACTAM 3.375 GRAM/50 ML DEXTROSE(ISO-OS) IV PIGGYBACK [34524]
|
Facility
IP
|
$0.49
|
|
Service Code
|
CPT J2543
|
Hospital Charge Code |
1753480
|
Hospital Revenue Code
|
636
|
Min. Negotiated Rate |
$0.12 |
Max. Negotiated Rate |
$0.42 |
Rate for Payer: Blue Shield of California Commercial |
$0.35
|
Rate for Payer: Blue Shield of California EPN |
$0.25
|
Rate for Payer: Cash Price |
$0.22
|
Rate for Payer: Cigna of CA HMO |
$0.34
|
Rate for Payer: Cigna of CA PPO |
$0.34
|
Rate for Payer: EPIC Health Plan Commercial |
$0.20
|
Rate for Payer: EPIC Health Plan Transplant |
$0.20
|
Rate for Payer: Galaxy Health WC |
$0.42
|
Rate for Payer: Global Benefits Group Commercial |
$0.29
|
Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.33
|
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 |
$0.39
|
Rate for Payer: Networks By Design Commercial |
$0.25
|
Rate for Payer: Prime Health Services Commercial |
$0.42
|
|
PIPERACILLIN-TAZOBACTAM 3.375 GRAM/50 ML DEXTROSE(ISO-OS) IV PIGGYBACK [34524]
|
Facility
OP
|
$0.49
|
|
Service Code
|
CPT J2543
|
Hospital Charge Code |
1753480
|
Hospital Revenue Code
|
636
|
Min. Negotiated Rate |
$0.12 |
Max. Negotiated Rate |
$10.78 |
Rate for Payer: Aetna of CA HMO/PPO |
$7.41
|
Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$0.42
|
Rate for Payer: AlphaCare Medical Group Medi-Cal |
$0.27
|
Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$0.27
|
Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$10.78
|
Rate for Payer: BCBS Transplant Transplant |
$0.29
|
Rate for Payer: Blue Shield of California Commercial |
$0.36
|
Rate for Payer: Blue Shield of California EPN |
$4.01
|
Rate for Payer: Cash Price |
$0.22
|
Rate for Payer: Cash Price |
$0.22
|
Rate for Payer: Cigna of CA HMO |
$0.34
|
Rate for Payer: Cigna of CA PPO |
$0.34
|
Rate for Payer: Dignity Health Commercial/Exchange |
$0.42
|
Rate for Payer: Dignity Health Media |
$0.42
|
Rate for Payer: Dignity Health Medi-Cal |
$0.42
|
Rate for Payer: EPIC Health Plan Commercial |
$0.20
|
Rate for Payer: EPIC Health Plan Transplant |
$0.20
|
Rate for Payer: Galaxy Health WC |
$0.42
|
Rate for Payer: Global Benefits Group Commercial |
$0.29
|
Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$0.37
|
Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.33
|
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 |
$0.39
|
Rate for Payer: Networks By Design Commercial |
$0.25
|
Rate for Payer: Prime Health Services Commercial |
$0.42
|
Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.29
|
Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.29
|
Rate for Payer: United Healthcare All Other Commercial |
$0.25
|
Rate for Payer: United Healthcare All Other HMO |
$0.25
|
Rate for Payer: United Healthcare HMO Rider |
$0.25
|
Rate for Payer: United Healthcare Select/Navigate/Core |
$0.25
|
Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.42
|
Rate for Payer: Vantage Medical Group Medi-Cal |
$0.42
|
Rate for Payer: Vantage Medical Group Senior |
$0.42
|
|
PIPERACILLIN-TAZOBACTAM 3.375 GRAM/50 ML DEXTROSE(ISO-OS) IV PIGGYBACK [34524]
|
Facility
OP
|
$0.48
|
|
Service Code
|
CPT J2543
|
Hospital Charge Code |
NDG34524
|
Hospital Revenue Code
|
636
|
Min. Negotiated Rate |
$0.12 |
Max. Negotiated Rate |
$10.78 |
Rate for Payer: Aetna of CA HMO/PPO |
$7.41
|
Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$0.41
|
Rate for Payer: AlphaCare Medical Group Medi-Cal |
$0.26
|
Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$0.26
|
Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$10.78
|
Rate for Payer: BCBS Transplant Transplant |
$0.29
|
Rate for Payer: Blue Shield of California Commercial |
$0.35
|
Rate for Payer: Blue Shield of California EPN |
$4.01
|
Rate for Payer: Cash Price |
$0.22
|
Rate for Payer: Cash Price |
$0.22
|
Rate for Payer: Cigna of CA HMO |
$0.34
|
Rate for Payer: Cigna of CA PPO |
$0.34
|
Rate for Payer: Dignity Health Commercial/Exchange |
$0.41
|
Rate for Payer: Dignity Health Media |
$0.41
|
Rate for Payer: Dignity Health Medi-Cal |
$0.41
|
Rate for Payer: EPIC Health Plan Commercial |
$0.19
|
Rate for Payer: EPIC Health Plan Transplant |
$0.19
|
Rate for Payer: Galaxy Health WC |
$0.41
|
Rate for Payer: Global Benefits Group Commercial |
$0.29
|
Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$0.36
|
Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.32
|
Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.18
|
Rate for Payer: LLUH Dept of Risk Management WC |
$0.12
|
Rate for Payer: Multiplan Commercial |
$0.38
|
Rate for Payer: Networks By Design Commercial |
$0.24
|
Rate for Payer: Prime Health Services Commercial |
$0.41
|
Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.29
|
Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.29
|
Rate for Payer: United Healthcare All Other Commercial |
$0.24
|
Rate for Payer: United Healthcare All Other HMO |
$0.24
|
Rate for Payer: United Healthcare HMO Rider |
$0.24
|
Rate for Payer: United Healthcare Select/Navigate/Core |
$0.24
|
Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.41
|
Rate for Payer: Vantage Medical Group Medi-Cal |
$0.41
|
Rate for Payer: Vantage Medical Group Senior |
$0.41
|
|
PIPERACILLIN-TAZOBACTAM 3.375 GRAM INTRAVENOUS SOLUTION [18303]
|
Facility
IP
|
$11.74
|
|
Service Code
|
CPT J2543
|
Hospital Charge Code |
1721150
|
Hospital Revenue Code
|
636
|
Min. Negotiated Rate |
$2.82 |
Max. Negotiated Rate |
$9.98 |
Rate for Payer: Blue Shield of California Commercial |
$8.36
|
Rate for Payer: Blue Shield of California Commercial |
$7.52
|
Rate for Payer: Blue Shield of California EPN |
$5.41
|
Rate for Payer: Blue Shield of California EPN |
$6.01
|
Rate for Payer: Cash Price |
$4.75
|
Rate for Payer: Cash Price |
$5.28
|
Rate for Payer: Cigna of CA HMO |
$7.39
|
Rate for Payer: Cigna of CA HMO |
$8.22
|
Rate for Payer: Cigna of CA PPO |
$8.22
|
Rate for Payer: Cigna of CA PPO |
$7.39
|
Rate for Payer: EPIC Health Plan Commercial |
$4.70
|
Rate for Payer: EPIC Health Plan Commercial |
$4.22
|
Rate for Payer: EPIC Health Plan Transplant |
$4.22
|
Rate for Payer: EPIC Health Plan Transplant |
$4.70
|
Rate for Payer: Galaxy Health WC |
$8.98
|
Rate for Payer: Galaxy Health WC |
$9.98
|
Rate for Payer: Global Benefits Group Commercial |
$7.04
|
Rate for Payer: Global Benefits Group Commercial |
$6.34
|
Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$7.83
|
Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$7.04
|
Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4.47
|
Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4.02
|
Rate for Payer: LLUH Dept of Risk Management WC |
$2.53
|
Rate for Payer: LLUH Dept of Risk Management WC |
$2.82
|
Rate for Payer: Multiplan Commercial |
$9.39
|
Rate for Payer: Multiplan Commercial |
$8.45
|
Rate for Payer: Networks By Design Commercial |
$5.28
|
Rate for Payer: Networks By Design Commercial |
$5.87
|
Rate for Payer: Prime Health Services Commercial |
$8.98
|
Rate for Payer: Prime Health Services Commercial |
$9.98
|
|