|
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
|
|
|
PIPERACILLIN-TAZOBACTAM 4.5 GRAM/100 ML DEXTROSE(ISO-OSM) IV PIGGYBACK [108121]
|
Facility
IP
|
$0.31
|
|
|
Service Code
|
CPT J2543
|
| Hospital Charge Code |
NDG108121
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.07 |
| Max. Negotiated Rate |
$0.26 |
| Rate for Payer: Blue Shield of California Commercial |
$0.22
|
| Rate for Payer: Blue Shield of California EPN |
$0.16
|
| Rate for Payer: Cash Price |
$0.14
|
| Rate for Payer: Cigna of CA HMO |
$0.22
|
| Rate for Payer: Cigna of CA PPO |
$0.22
|
| 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 |
$0.19
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.21
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.12
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.07
|
| Rate for Payer: Multiplan Commercial |
$0.25
|
| Rate for Payer: Networks By Design Commercial |
$0.16
|
| Rate for Payer: Prime Health Services Commercial |
$0.26
|
|
|
PIPERACILLIN-TAZOBACTAM 4.5 GRAM/100 ML DEXTROSE(ISO-OSM) IV PIGGYBACK [108121]
|
Facility
OP
|
$0.31
|
|
|
Service Code
|
CPT J2543
|
| Hospital Charge Code |
NDG108121
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.07 |
| Max. Negotiated Rate |
$10.78 |
| Rate for Payer: Aetna of CA HMO/PPO |
$7.41
|
| 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 |
$10.78
|
| Rate for Payer: BCBS Transplant Transplant |
$0.19
|
| Rate for Payer: Blue Shield of California Commercial |
$0.23
|
| Rate for Payer: Blue Shield of California EPN |
$4.01
|
| Rate for Payer: Cash Price |
$0.14
|
| Rate for Payer: Cash Price |
$0.14
|
| Rate for Payer: Cigna of CA HMO |
$0.22
|
| Rate for Payer: Cigna of CA PPO |
$0.22
|
| 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 |
$0.19
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$0.23
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.21
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.12
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.07
|
| Rate for Payer: Multiplan Commercial |
$0.25
|
| Rate for Payer: Networks By Design Commercial |
$0.16
|
| Rate for Payer: Prime Health Services Commercial |
$0.26
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.19
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.19
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.16
|
| Rate for Payer: United Healthcare All Other HMO |
$0.16
|
| Rate for Payer: United Healthcare HMO Rider |
$0.16
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.16
|
| 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
|
|
|
PIPERACILLIN-TAZOBACTAM 4.5 GRAM INTRAVENOUS SOLUTION [18302]
|
Facility
IP
|
$16.80
|
|
|
Service Code
|
CPT J2543
|
| Hospital Charge Code |
1721132
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$4.03 |
| Max. Negotiated Rate |
$14.28 |
| Rate for Payer: Blue Shield of California EPN |
$8.97
|
| Rate for Payer: Blue Shield of California EPN |
$4.18
|
| Rate for Payer: Blue Shield of California EPN |
$4.22
|
| Rate for Payer: Blue Shield of California EPN |
$8.57
|
| Rate for Payer: Blue Shield of California EPN |
$8.60
|
| Rate for Payer: Cash Price |
$7.53
|
| Rate for Payer: Cash Price |
$7.88
|
| Rate for Payer: Cash Price |
$7.56
|
| Rate for Payer: Cash Price |
$3.71
|
| Rate for Payer: Cash Price |
$3.67
|
| Rate for Payer: Cash Price |
$5.99
|
| Rate for Payer: Cigna of CA HMO |
$11.71
|
| Rate for Payer: Cigna of CA HMO |
$5.77
|
| Rate for Payer: Cigna of CA HMO |
$5.71
|
| Rate for Payer: Cigna of CA HMO |
$11.76
|
| Rate for Payer: Cigna of CA HMO |
$12.26
|
| Rate for Payer: Cigna of CA HMO |
$9.32
|
| Rate for Payer: Cigna of CA PPO |
$11.76
|
| Rate for Payer: Cigna of CA PPO |
$11.71
|
| Rate for Payer: Cigna of CA PPO |
$5.77
|
| Rate for Payer: Cigna of CA PPO |
$5.71
|
| Rate for Payer: Cigna of CA PPO |
$12.26
|
| Rate for Payer: Cigna of CA PPO |
$9.32
|
| Rate for Payer: EPIC Health Plan Commercial |
$5.33
|
| Rate for Payer: EPIC Health Plan Commercial |
$6.69
|
| Rate for Payer: EPIC Health Plan Commercial |
$6.72
|
| Rate for Payer: EPIC Health Plan Commercial |
$7.01
|
| Rate for Payer: EPIC Health Plan Commercial |
$3.26
|
| Rate for Payer: EPIC Health Plan Commercial |
$3.30
|
| Rate for Payer: EPIC Health Plan Transplant |
$6.72
|
| Rate for Payer: EPIC Health Plan Transplant |
$3.26
|
| Rate for Payer: EPIC Health Plan Transplant |
$5.33
|
| Rate for Payer: EPIC Health Plan Transplant |
$3.30
|
| Rate for Payer: EPIC Health Plan Transplant |
$6.69
|
| Rate for Payer: EPIC Health Plan Transplant |
$7.01
|
| Rate for Payer: Galaxy Health WC |
$14.28
|
| Rate for Payer: Galaxy Health WC |
$11.32
|
| Rate for Payer: Galaxy Health WC |
$14.89
|
| Rate for Payer: Galaxy Health WC |
$7.00
|
| Rate for Payer: Galaxy Health WC |
$6.94
|
| Rate for Payer: Galaxy Health WC |
$14.22
|
| Rate for Payer: Blue Shield of California Commercial |
$11.96
|
| Rate for Payer: Blue Shield of California Commercial |
$5.87
|
| Rate for Payer: Blue Shield of California Commercial |
$11.91
|
| Rate for Payer: Blue Shield of California Commercial |
$5.81
|
| Rate for Payer: Blue Shield of California Commercial |
$12.47
|
| Rate for Payer: Blue Shield of California Commercial |
$9.48
|
| Rate for Payer: Blue Shield of California EPN |
$6.82
|
| Rate for Payer: Global Benefits Group Commercial |
$10.04
|
| Rate for Payer: Global Benefits Group Commercial |
$10.08
|
| Rate for Payer: Global Benefits Group Commercial |
$4.90
|
| Rate for Payer: Global Benefits Group Commercial |
$10.51
|
| Rate for Payer: Global Benefits Group Commercial |
$4.94
|
| Rate for Payer: Global Benefits Group Commercial |
$7.99
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$11.69
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$8.88
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$11.16
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$5.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$11.21
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$5.44
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$6.37
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3.14
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3.11
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$6.40
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$5.07
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$6.68
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.03
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.02
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.96
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.20
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.20
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.98
|
| Rate for Payer: Multiplan Commercial |
$6.53
|
| Rate for Payer: Multiplan Commercial |
$13.44
|
| Rate for Payer: Multiplan Commercial |
$14.02
|
| Rate for Payer: Multiplan Commercial |
$10.66
|
| Rate for Payer: Multiplan Commercial |
$6.59
|
| Rate for Payer: Multiplan Commercial |
$13.38
|
| Rate for Payer: Networks By Design Commercial |
$8.36
|
| Rate for Payer: Networks By Design Commercial |
$6.66
|
| Rate for Payer: Networks By Design Commercial |
$8.40
|
| Rate for Payer: Networks By Design Commercial |
$4.08
|
| Rate for Payer: Networks By Design Commercial |
$4.12
|
| Rate for Payer: Networks By Design Commercial |
$8.76
|
| Rate for Payer: Prime Health Services Commercial |
$7.00
|
| Rate for Payer: Prime Health Services Commercial |
$14.22
|
| Rate for Payer: Prime Health Services Commercial |
$14.89
|
| Rate for Payer: Prime Health Services Commercial |
$6.94
|
| Rate for Payer: Prime Health Services Commercial |
$14.28
|
| Rate for Payer: Prime Health Services Commercial |
$11.32
|
|
|
PIPERACILLIN-TAZOBACTAM 4.5 GRAM INTRAVENOUS SOLUTION [18302]
|
Facility
OP
|
$17.52
|
|
|
Service Code
|
CPT J2543
|
| Hospital Charge Code |
1721132
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$4.01 |
| Max. Negotiated Rate |
$14.89 |
| Rate for Payer: BCBS Transplant Transplant |
$10.08
|
| Rate for Payer: BCBS Transplant Transplant |
$10.04
|
| Rate for Payer: BCBS Transplant Transplant |
$7.99
|
| 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: Aetna of CA HMO/PPO |
$7.41
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$14.22
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$11.32
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$7.00
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$6.94
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$14.89
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$14.28
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$4.53
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$4.49
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$9.64
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$9.20
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$7.33
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$9.24
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$9.24
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$9.64
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$4.53
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$7.33
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$4.49
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$9.20
|
| 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: Anthem Blue Cross of CA HMO/PPO |
$10.78
|
| Rate for Payer: BCBS Transplant Transplant |
$4.90
|
| Rate for Payer: BCBS Transplant Transplant |
$10.51
|
| Rate for Payer: BCBS Transplant Transplant |
$4.94
|
| Rate for Payer: Blue Shield of California Commercial |
$6.07
|
| Rate for Payer: Blue Shield of California Commercial |
$6.01
|
| Rate for Payer: Blue Shield of California Commercial |
$9.82
|
| Rate for Payer: Blue Shield of California Commercial |
$12.91
|
| Rate for Payer: Blue Shield of California Commercial |
$12.38
|
| Rate for Payer: Blue Shield of California Commercial |
$12.33
|
| 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: Blue Shield of California EPN |
$4.01
|
| Rate for Payer: Cash Price |
$7.88
|
| Rate for Payer: Cash Price |
$5.99
|
| Rate for Payer: Cash Price |
$3.67
|
| Rate for Payer: Cash Price |
$7.53
|
| Rate for Payer: Cash Price |
$3.71
|
| Rate for Payer: Cash Price |
$5.99
|
| Rate for Payer: Cash Price |
$7.56
|
| Rate for Payer: Cash Price |
$7.53
|
| Rate for Payer: Cash Price |
$3.71
|
| Rate for Payer: Cash Price |
$7.88
|
| Rate for Payer: Cash Price |
$7.56
|
| Rate for Payer: Cash Price |
$3.67
|
| Rate for Payer: Cigna of CA HMO |
$5.71
|
| Rate for Payer: Cigna of CA HMO |
$5.77
|
| Rate for Payer: Cigna of CA HMO |
$12.26
|
| Rate for Payer: Cigna of CA HMO |
$11.71
|
| Rate for Payer: Cigna of CA HMO |
$9.32
|
| Rate for Payer: Cigna of CA HMO |
$11.76
|
| Rate for Payer: Cigna of CA PPO |
$12.26
|
| Rate for Payer: Cigna of CA PPO |
$9.32
|
| Rate for Payer: Cigna of CA PPO |
$5.71
|
| Rate for Payer: Cigna of CA PPO |
$5.77
|
| Rate for Payer: Cigna of CA PPO |
$11.76
|
| Rate for Payer: Cigna of CA PPO |
$11.71
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$14.22
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$6.94
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$7.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$14.89
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$11.32
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$14.28
|
| Rate for Payer: Dignity Health Media |
$11.32
|
| Rate for Payer: Dignity Health Media |
$6.94
|
| Rate for Payer: Dignity Health Media |
$14.89
|
| Rate for Payer: Dignity Health Media |
$14.28
|
| Rate for Payer: Dignity Health Media |
$14.22
|
| Rate for Payer: Dignity Health Media |
$7.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$14.89
|
| Rate for Payer: Dignity Health Medi-Cal |
$14.22
|
| Rate for Payer: Dignity Health Medi-Cal |
$7.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$14.28
|
| Rate for Payer: Dignity Health Medi-Cal |
$11.32
|
| Rate for Payer: Dignity Health Medi-Cal |
$6.94
|
| Rate for Payer: EPIC Health Plan Commercial |
$6.72
|
| Rate for Payer: EPIC Health Plan Commercial |
$3.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$3.26
|
| Rate for Payer: EPIC Health Plan Commercial |
$7.01
|
| Rate for Payer: EPIC Health Plan Commercial |
$6.69
|
| Rate for Payer: EPIC Health Plan Commercial |
$5.33
|
| Rate for Payer: EPIC Health Plan Transplant |
$6.69
|
| Rate for Payer: EPIC Health Plan Transplant |
$3.26
|
| Rate for Payer: EPIC Health Plan Transplant |
$5.33
|
| Rate for Payer: EPIC Health Plan Transplant |
$6.72
|
| Rate for Payer: EPIC Health Plan Transplant |
$3.30
|
| Rate for Payer: EPIC Health Plan Transplant |
$7.01
|
| Rate for Payer: Galaxy Health WC |
$14.89
|
| Rate for Payer: Galaxy Health WC |
$11.32
|
| Rate for Payer: Galaxy Health WC |
$14.28
|
| Rate for Payer: Galaxy Health WC |
$7.00
|
| Rate for Payer: Galaxy Health WC |
$14.22
|
| Rate for Payer: Galaxy Health WC |
$6.94
|
| Rate for Payer: Global Benefits Group Commercial |
$7.99
|
| Rate for Payer: Global Benefits Group Commercial |
$4.90
|
| Rate for Payer: Global Benefits Group Commercial |
$10.08
|
| Rate for Payer: Global Benefits Group Commercial |
$10.51
|
| Rate for Payer: Global Benefits Group Commercial |
$4.94
|
| Rate for Payer: Global Benefits Group Commercial |
$10.04
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$6.12
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$6.18
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$13.14
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$9.99
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$12.55
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$12.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$5.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$8.88
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$11.69
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$11.16
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$5.44
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$11.21
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$6.68
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3.14
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$5.07
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$6.40
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3.11
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$6.37
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.96
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.20
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.20
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.98
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.03
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.02
|
| Rate for Payer: Multiplan Commercial |
$13.44
|
| Rate for Payer: Multiplan Commercial |
$10.66
|
| Rate for Payer: Multiplan Commercial |
$6.59
|
| Rate for Payer: Multiplan Commercial |
$14.02
|
| Rate for Payer: Multiplan Commercial |
$6.53
|
| Rate for Payer: Multiplan Commercial |
$13.38
|
| Rate for Payer: Networks By Design Commercial |
$8.40
|
| Rate for Payer: Networks By Design Commercial |
$8.36
|
| Rate for Payer: Networks By Design Commercial |
$6.66
|
| Rate for Payer: Networks By Design Commercial |
$8.76
|
| Rate for Payer: Networks By Design Commercial |
$4.08
|
| Rate for Payer: Networks By Design Commercial |
$4.12
|
| Rate for Payer: Prime Health Services Commercial |
$14.28
|
| Rate for Payer: Prime Health Services Commercial |
$6.94
|
| Rate for Payer: Prime Health Services Commercial |
$14.89
|
| Rate for Payer: Prime Health Services Commercial |
$11.32
|
| Rate for Payer: Prime Health Services Commercial |
$14.22
|
| Rate for Payer: Prime Health Services Commercial |
$7.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$10.08
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$4.90
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$10.04
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$10.51
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$7.99
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$4.94
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$10.08
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$10.04
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$10.51
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$7.99
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$4.90
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$4.94
|
| Rate for Payer: United Healthcare All Other Commercial |
$8.36
|
| Rate for Payer: United Healthcare All Other Commercial |
$4.12
|
| Rate for Payer: United Healthcare All Other Commercial |
$8.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$8.76
|
| Rate for Payer: United Healthcare All Other Commercial |
$6.66
|
| Rate for Payer: United Healthcare All Other Commercial |
$4.08
|
| Rate for Payer: United Healthcare All Other HMO |
$8.40
|
| Rate for Payer: United Healthcare All Other HMO |
$4.08
|
| Rate for Payer: United Healthcare All Other HMO |
$4.12
|
| Rate for Payer: United Healthcare All Other HMO |
$6.66
|
| Rate for Payer: United Healthcare All Other HMO |
$8.76
|
| Rate for Payer: United Healthcare All Other HMO |
$8.36
|
| Rate for Payer: United Healthcare HMO Rider |
$4.08
|
| Rate for Payer: United Healthcare HMO Rider |
$8.76
|
| Rate for Payer: United Healthcare HMO Rider |
$8.40
|
| Rate for Payer: United Healthcare HMO Rider |
$6.66
|
| Rate for Payer: United Healthcare HMO Rider |
$8.36
|
| Rate for Payer: United Healthcare HMO Rider |
$4.12
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$8.36
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$8.76
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$4.08
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$6.66
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$4.12
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$8.40
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$11.32
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$14.28
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$14.22
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$14.89
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$6.94
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$7.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$14.89
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$11.32
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$14.28
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$14.22
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$6.94
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$7.00
|
| Rate for Payer: Vantage Medical Group Senior |
$14.28
|
| Rate for Payer: Vantage Medical Group Senior |
$14.89
|
| Rate for Payer: Vantage Medical Group Senior |
$14.22
|
| Rate for Payer: Vantage Medical Group Senior |
$11.32
|
| Rate for Payer: Vantage Medical Group Senior |
$7.00
|
| Rate for Payer: Vantage Medical Group Senior |
$6.94
|
|
|
PNEUMOCOCCAL 13-VAL CONJ VACCINE-DIP CRM (PF) 0.5 ML IM SYRINGE [103895]
|
Facility
IP
|
$541.63
|
|
|
Service Code
|
CPT 90670
|
| Hospital Charge Code |
1721197
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$129.99 |
| Max. Negotiated Rate |
$460.39 |
| Rate for Payer: Blue Shield of California Commercial |
$385.64
|
| Rate for Payer: Blue Shield of California EPN |
$277.31
|
| Rate for Payer: Cash Price |
$243.73
|
| Rate for Payer: Cigna of CA HMO |
$379.14
|
| Rate for Payer: Cigna of CA PPO |
$379.14
|
| Rate for Payer: EPIC Health Plan Commercial |
$216.65
|
| Rate for Payer: EPIC Health Plan Transplant |
$216.65
|
| Rate for Payer: Galaxy Health WC |
$460.39
|
| Rate for Payer: Global Benefits Group Commercial |
$324.98
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$361.27
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$206.36
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$129.99
|
| Rate for Payer: Multiplan Commercial |
$433.30
|
| Rate for Payer: Networks By Design Commercial |
$270.82
|
| Rate for Payer: Prime Health Services Commercial |
$460.39
|
|
|
PNEUMOCOCCAL 13-VAL CONJ VACCINE-DIP CRM (PF) 0.5 ML IM SYRINGE [103895]
|
Facility
OP
|
$541.63
|
|
|
Service Code
|
CPT 90670
|
| Hospital Charge Code |
1721197
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$129.99 |
| Max. Negotiated Rate |
$1,793.60 |
| Rate for Payer: Aetna of CA HMO/PPO |
$1,793.60
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$460.39
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$297.90
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$297.90
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$249.29
|
| Rate for Payer: BCBS Transplant Transplant |
$324.98
|
| Rate for Payer: Blue Shield of California Commercial |
$399.18
|
| Rate for Payer: Blue Shield of California EPN |
$241.50
|
| Rate for Payer: Cash Price |
$243.73
|
| Rate for Payer: Cash Price |
$243.73
|
| Rate for Payer: Cigna of CA HMO |
$379.14
|
| Rate for Payer: Cigna of CA PPO |
$379.14
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$460.39
|
| Rate for Payer: Dignity Health Media |
$460.39
|
| Rate for Payer: Dignity Health Medi-Cal |
$460.39
|
| Rate for Payer: EPIC Health Plan Commercial |
$216.65
|
| Rate for Payer: EPIC Health Plan Transplant |
$216.65
|
| Rate for Payer: Galaxy Health WC |
$460.39
|
| Rate for Payer: Global Benefits Group Commercial |
$324.98
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$406.22
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$361.27
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$498.66
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$129.99
|
| Rate for Payer: Multiplan Commercial |
$433.30
|
| Rate for Payer: Networks By Design Commercial |
$270.82
|
| Rate for Payer: Prime Health Services Commercial |
$460.39
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$324.98
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$324.98
|
| Rate for Payer: United Healthcare All Other Commercial |
$270.82
|
| Rate for Payer: United Healthcare All Other HMO |
$270.82
|
| Rate for Payer: United Healthcare HMO Rider |
$270.82
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$270.82
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$460.39
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$460.39
|
| Rate for Payer: Vantage Medical Group Senior |
$460.39
|
|
|
PNEUMOCOCCAL 20-VALENT CONJ VACCINE-DIP CRM (PF) 0.5 ML IM SYRINGE [231988]
|
Facility
OP
|
$607.71
|
|
|
Service Code
|
CPT 90677
|
| Hospital Charge Code |
NDG231988A
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$145.85 |
| Max. Negotiated Rate |
$2,006.82 |
| Rate for Payer: Aetna of CA HMO/PPO |
$2,006.82
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,006.82
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$532.79
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$516.55
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$334.24
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$344.75
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$344.75
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$334.24
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$506.31
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$506.31
|
| Rate for Payer: BCBS Transplant Transplant |
$364.63
|
| Rate for Payer: BCBS Transplant Transplant |
$376.09
|
| Rate for Payer: Blue Shield of California Commercial |
$461.96
|
| Rate for Payer: Blue Shield of California Commercial |
$447.88
|
| Rate for Payer: Blue Shield of California EPN |
$354.90
|
| Rate for Payer: Blue Shield of California EPN |
$366.06
|
| Rate for Payer: Cash Price |
$282.06
|
| Rate for Payer: Cash Price |
$273.47
|
| Rate for Payer: Cash Price |
$282.06
|
| Rate for Payer: Cash Price |
$273.47
|
| Rate for Payer: Cigna of CA HMO |
$425.40
|
| Rate for Payer: Cigna of CA HMO |
$438.77
|
| Rate for Payer: Cigna of CA PPO |
$425.40
|
| Rate for Payer: Cigna of CA PPO |
$438.77
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$532.79
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$516.55
|
| Rate for Payer: Dignity Health Media |
$532.79
|
| Rate for Payer: Dignity Health Media |
$516.55
|
| Rate for Payer: Dignity Health Medi-Cal |
$516.55
|
| Rate for Payer: Dignity Health Medi-Cal |
$532.79
|
| Rate for Payer: EPIC Health Plan Commercial |
$243.08
|
| Rate for Payer: EPIC Health Plan Commercial |
$250.72
|
| Rate for Payer: EPIC Health Plan Transplant |
$243.08
|
| Rate for Payer: EPIC Health Plan Transplant |
$250.72
|
| Rate for Payer: Galaxy Health WC |
$516.55
|
| Rate for Payer: Galaxy Health WC |
$532.79
|
| Rate for Payer: Global Benefits Group Commercial |
$376.09
|
| Rate for Payer: Global Benefits Group Commercial |
$364.63
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$455.78
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$470.11
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$405.34
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$418.08
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$556.93
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$556.93
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$145.85
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$150.43
|
| Rate for Payer: Multiplan Commercial |
$501.45
|
| Rate for Payer: Multiplan Commercial |
$486.17
|
| Rate for Payer: Networks By Design Commercial |
$303.86
|
| Rate for Payer: Networks By Design Commercial |
$313.40
|
| Rate for Payer: Prime Health Services Commercial |
$532.79
|
| Rate for Payer: Prime Health Services Commercial |
$516.55
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$364.63
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$376.09
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$376.09
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$364.63
|
| Rate for Payer: United Healthcare All Other Commercial |
$313.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$303.86
|
| Rate for Payer: United Healthcare All Other HMO |
$303.86
|
| Rate for Payer: United Healthcare All Other HMO |
$313.40
|
| Rate for Payer: United Healthcare HMO Rider |
$313.40
|
| Rate for Payer: United Healthcare HMO Rider |
$303.86
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$303.86
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$313.40
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$532.79
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$516.55
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$516.55
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$532.79
|
| Rate for Payer: Vantage Medical Group Senior |
$516.55
|
| Rate for Payer: Vantage Medical Group Senior |
$532.79
|
|
|
PNEUMOCOCCAL 20-VALENT CONJ VACCINE-DIP CRM (PF) 0.5 ML IM SYRINGE [231988]
|
Facility
IP
|
$626.81
|
|
|
Service Code
|
CPT 90677
|
| Hospital Charge Code |
NDG231988A
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$150.43 |
| Max. Negotiated Rate |
$532.79 |
| Rate for Payer: Blue Shield of California Commercial |
$446.29
|
| Rate for Payer: Blue Shield of California Commercial |
$432.69
|
| Rate for Payer: Blue Shield of California EPN |
$311.15
|
| Rate for Payer: Blue Shield of California EPN |
$320.93
|
| Rate for Payer: Cash Price |
$273.47
|
| Rate for Payer: Cash Price |
$282.06
|
| Rate for Payer: Cigna of CA HMO |
$438.77
|
| Rate for Payer: Cigna of CA HMO |
$425.40
|
| Rate for Payer: Cigna of CA PPO |
$438.77
|
| Rate for Payer: Cigna of CA PPO |
$425.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$250.72
|
| Rate for Payer: EPIC Health Plan Commercial |
$243.08
|
| Rate for Payer: EPIC Health Plan Transplant |
$243.08
|
| Rate for Payer: EPIC Health Plan Transplant |
$250.72
|
| Rate for Payer: Galaxy Health WC |
$532.79
|
| Rate for Payer: Galaxy Health WC |
$516.55
|
| Rate for Payer: Global Benefits Group Commercial |
$364.63
|
| Rate for Payer: Global Benefits Group Commercial |
$376.09
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$405.34
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$418.08
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$238.81
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$231.54
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$145.85
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$150.43
|
| Rate for Payer: Multiplan Commercial |
$486.17
|
| Rate for Payer: Multiplan Commercial |
$501.45
|
| Rate for Payer: Networks By Design Commercial |
$303.86
|
| Rate for Payer: Networks By Design Commercial |
$313.40
|
| Rate for Payer: Prime Health Services Commercial |
$532.79
|
| Rate for Payer: Prime Health Services Commercial |
$516.55
|
|
|
PNEUMOCOCCAL 23 POLYVALENT VACCINE 25 MCG/0.5 ML INJECTION SOLUTION [11037]
|
Facility
IP
|
$280.99
|
|
|
Service Code
|
CPT 90732
|
| Hospital Charge Code |
NDG11037
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$67.44 |
| Max. Negotiated Rate |
$238.84 |
| Rate for Payer: Blue Shield of California Commercial |
$200.06
|
| Rate for Payer: Blue Shield of California EPN |
$143.87
|
| Rate for Payer: Cash Price |
$126.45
|
| Rate for Payer: Cigna of CA HMO |
$196.69
|
| Rate for Payer: Cigna of CA PPO |
$196.69
|
| Rate for Payer: EPIC Health Plan Commercial |
$112.40
|
| Rate for Payer: EPIC Health Plan Transplant |
$112.40
|
| Rate for Payer: Galaxy Health WC |
$238.84
|
| Rate for Payer: Global Benefits Group Commercial |
$168.59
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$187.42
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$107.06
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$67.44
|
| Rate for Payer: Multiplan Commercial |
$224.79
|
| Rate for Payer: Networks By Design Commercial |
$140.50
|
| Rate for Payer: Prime Health Services Commercial |
$238.84
|
|
|
PNEUMOCOCCAL 23 POLYVALENT VACCINE 25 MCG/0.5 ML INJECTION SOLUTION [11037]
|
Facility
OP
|
$280.99
|
|
|
Service Code
|
CPT 90732
|
| Hospital Charge Code |
NDG11037
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$37.06 |
| Max. Negotiated Rate |
$927.91 |
| Rate for Payer: Aetna of CA HMO/PPO |
$927.91
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$238.84
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$154.54
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$154.54
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$37.06
|
| Rate for Payer: BCBS Transplant Transplant |
$168.59
|
| Rate for Payer: Blue Shield of California Commercial |
$207.09
|
| Rate for Payer: Blue Shield of California EPN |
$132.55
|
| Rate for Payer: Cash Price |
$126.45
|
| Rate for Payer: Cash Price |
$126.45
|
| Rate for Payer: Cigna of CA HMO |
$196.69
|
| Rate for Payer: Cigna of CA PPO |
$196.69
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$238.84
|
| Rate for Payer: Dignity Health Media |
$238.84
|
| Rate for Payer: Dignity Health Medi-Cal |
$238.84
|
| Rate for Payer: EPIC Health Plan Commercial |
$112.40
|
| Rate for Payer: EPIC Health Plan Transplant |
$112.40
|
| Rate for Payer: Galaxy Health WC |
$238.84
|
| Rate for Payer: Global Benefits Group Commercial |
$168.59
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$210.74
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$187.42
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$262.07
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$67.44
|
| Rate for Payer: Multiplan Commercial |
$224.79
|
| Rate for Payer: Networks By Design Commercial |
$140.50
|
| Rate for Payer: Prime Health Services Commercial |
$238.84
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$168.59
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$168.59
|
| Rate for Payer: United Healthcare All Other Commercial |
$140.50
|
| Rate for Payer: United Healthcare All Other HMO |
$140.50
|
| Rate for Payer: United Healthcare HMO Rider |
$140.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$140.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$238.84
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$238.84
|
| Rate for Payer: Vantage Medical Group Senior |
$238.84
|
|
|
PNEUMOCOCCAL 23 POLYVALENT VACCINE 25 MCG/0.5 ML INJECTION SYRINGE [113995]
|
Facility
OP
|
$280.99
|
|
|
Service Code
|
CPT 90732
|
| Hospital Charge Code |
1720337
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$37.06 |
| Max. Negotiated Rate |
$927.91 |
| Rate for Payer: Networks By Design Commercial |
$140.50
|
| Rate for Payer: Aetna of CA HMO/PPO |
$927.91
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$238.84
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$154.54
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$154.54
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$37.06
|
| Rate for Payer: BCBS Transplant Transplant |
$168.59
|
| Rate for Payer: Blue Shield of California Commercial |
$207.09
|
| Rate for Payer: Blue Shield of California EPN |
$132.55
|
| Rate for Payer: Cash Price |
$126.45
|
| Rate for Payer: Cash Price |
$126.45
|
| Rate for Payer: Cigna of CA HMO |
$196.69
|
| Rate for Payer: Cigna of CA PPO |
$196.69
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$238.84
|
| Rate for Payer: Dignity Health Media |
$238.84
|
| Rate for Payer: Dignity Health Medi-Cal |
$238.84
|
| Rate for Payer: EPIC Health Plan Commercial |
$112.40
|
| Rate for Payer: EPIC Health Plan Transplant |
$112.40
|
| Rate for Payer: Galaxy Health WC |
$238.84
|
| Rate for Payer: Global Benefits Group Commercial |
$168.59
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$210.74
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$187.42
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$262.07
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$67.44
|
| Rate for Payer: Multiplan Commercial |
$224.79
|
| Rate for Payer: Prime Health Services Commercial |
$238.84
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$168.59
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$168.59
|
| Rate for Payer: United Healthcare All Other Commercial |
$140.50
|
| Rate for Payer: United Healthcare All Other HMO |
$140.50
|
| Rate for Payer: United Healthcare HMO Rider |
$140.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$140.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$238.84
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$238.84
|
| Rate for Payer: Vantage Medical Group Senior |
$238.84
|
|
|
PNEUMOCOCCAL 23 POLYVALENT VACCINE 25 MCG/0.5 ML INJECTION SYRINGE [113995]
|
Facility
IP
|
$280.99
|
|
|
Service Code
|
CPT 90732
|
| Hospital Charge Code |
1720337
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$67.44 |
| Max. Negotiated Rate |
$238.84 |
| Rate for Payer: Blue Shield of California Commercial |
$200.06
|
| Rate for Payer: Blue Shield of California EPN |
$143.87
|
| Rate for Payer: Cash Price |
$126.45
|
| Rate for Payer: Cigna of CA HMO |
$196.69
|
| Rate for Payer: Cigna of CA PPO |
$196.69
|
| Rate for Payer: EPIC Health Plan Commercial |
$112.40
|
| Rate for Payer: EPIC Health Plan Transplant |
$112.40
|
| Rate for Payer: Galaxy Health WC |
$238.84
|
| Rate for Payer: Global Benefits Group Commercial |
$168.59
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$187.42
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$107.06
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$67.44
|
| Rate for Payer: Multiplan Commercial |
$224.79
|
| Rate for Payer: Networks By Design Commercial |
$140.50
|
| Rate for Payer: Prime Health Services Commercial |
$238.84
|
|
|
PNEUMOCOCCAL 23 POLYVALENT VACCINE 25 MCG/0.5 ML INJECTION WRAP. [408113995]
|
Facility
OP
|
$280.99
|
|
|
Service Code
|
CPT 90732
|
| Hospital Charge Code |
1720337
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$37.06 |
| Max. Negotiated Rate |
$927.91 |
| Rate for Payer: Aetna of CA HMO/PPO |
$927.91
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$238.84
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$154.54
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$154.54
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$37.06
|
| Rate for Payer: BCBS Transplant Transplant |
$168.59
|
| Rate for Payer: Blue Shield of California Commercial |
$207.09
|
| Rate for Payer: Blue Shield of California EPN |
$132.55
|
| Rate for Payer: Cash Price |
$126.45
|
| Rate for Payer: Cash Price |
$126.45
|
| Rate for Payer: Cigna of CA HMO |
$196.69
|
| Rate for Payer: Cigna of CA PPO |
$196.69
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$238.84
|
| Rate for Payer: Dignity Health Media |
$238.84
|
| Rate for Payer: Dignity Health Medi-Cal |
$238.84
|
| Rate for Payer: EPIC Health Plan Commercial |
$112.40
|
| Rate for Payer: EPIC Health Plan Transplant |
$112.40
|
| Rate for Payer: Galaxy Health WC |
$238.84
|
| Rate for Payer: Global Benefits Group Commercial |
$168.59
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$210.74
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$187.42
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$262.07
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$67.44
|
| Rate for Payer: Multiplan Commercial |
$224.79
|
| Rate for Payer: Networks By Design Commercial |
$140.50
|
| Rate for Payer: Prime Health Services Commercial |
$238.84
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$168.59
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$168.59
|
| Rate for Payer: United Healthcare All Other Commercial |
$140.50
|
| Rate for Payer: United Healthcare All Other HMO |
$140.50
|
| Rate for Payer: United Healthcare HMO Rider |
$140.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$140.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$238.84
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$238.84
|
| Rate for Payer: Vantage Medical Group Senior |
$238.84
|
|
|
PNEUMOCOCCAL 23 POLYVALENT VACCINE 25 MCG/0.5 ML INJECTION WRAP. [408113995]
|
Facility
IP
|
$280.99
|
|
|
Service Code
|
CPT 90732
|
| Hospital Charge Code |
1720337
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$67.44 |
| Max. Negotiated Rate |
$238.84 |
| Rate for Payer: Blue Shield of California Commercial |
$200.06
|
| Rate for Payer: Blue Shield of California EPN |
$143.87
|
| Rate for Payer: Cash Price |
$126.45
|
| Rate for Payer: Cigna of CA HMO |
$196.69
|
| Rate for Payer: Cigna of CA PPO |
$196.69
|
| Rate for Payer: EPIC Health Plan Commercial |
$112.40
|
| Rate for Payer: EPIC Health Plan Transplant |
$112.40
|
| Rate for Payer: Galaxy Health WC |
$238.84
|
| Rate for Payer: Global Benefits Group Commercial |
$168.59
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$187.42
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$107.06
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$67.44
|
| Rate for Payer: Multiplan Commercial |
$224.79
|
| Rate for Payer: Networks By Design Commercial |
$140.50
|
| Rate for Payer: Prime Health Services Commercial |
$238.84
|
|
|
PNEUMOCOCCAL 23 POLYVALENT VACCINE 25 MCG/0.5 ML INJECTION WRAP. [408113995]
|
Facility
IP
|
$280.99
|
|
|
Service Code
|
CPT 90732
|
| Hospital Charge Code |
NDG11037
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$67.44 |
| Max. Negotiated Rate |
$238.84 |
| Rate for Payer: Blue Shield of California Commercial |
$200.06
|
| Rate for Payer: Blue Shield of California EPN |
$143.87
|
| Rate for Payer: Cash Price |
$126.45
|
| Rate for Payer: Cigna of CA HMO |
$196.69
|
| Rate for Payer: Cigna of CA PPO |
$196.69
|
| Rate for Payer: EPIC Health Plan Commercial |
$112.40
|
| Rate for Payer: EPIC Health Plan Transplant |
$112.40
|
| Rate for Payer: Galaxy Health WC |
$238.84
|
| Rate for Payer: Global Benefits Group Commercial |
$168.59
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$187.42
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$107.06
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$67.44
|
| Rate for Payer: Multiplan Commercial |
$224.79
|
| Rate for Payer: Networks By Design Commercial |
$140.50
|
| Rate for Payer: Prime Health Services Commercial |
$238.84
|
|
|
PNEUMOCOCCAL 23 POLYVALENT VACCINE 25 MCG/0.5 ML INJECTION WRAP. [408113995]
|
Facility
OP
|
$280.99
|
|
|
Service Code
|
CPT 90732
|
| Hospital Charge Code |
NDG11037
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$37.06 |
| Max. Negotiated Rate |
$927.91 |
| Rate for Payer: Aetna of CA HMO/PPO |
$927.91
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$238.84
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$154.54
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$154.54
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$37.06
|
| Rate for Payer: BCBS Transplant Transplant |
$168.59
|
| Rate for Payer: Blue Shield of California Commercial |
$207.09
|
| Rate for Payer: Blue Shield of California EPN |
$132.55
|
| Rate for Payer: Cash Price |
$126.45
|
| Rate for Payer: Cash Price |
$126.45
|
| Rate for Payer: Cigna of CA HMO |
$196.69
|
| Rate for Payer: Cigna of CA PPO |
$196.69
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$238.84
|
| Rate for Payer: Dignity Health Media |
$238.84
|
| Rate for Payer: Dignity Health Medi-Cal |
$238.84
|
| Rate for Payer: EPIC Health Plan Commercial |
$112.40
|
| Rate for Payer: EPIC Health Plan Transplant |
$112.40
|
| Rate for Payer: Galaxy Health WC |
$238.84
|
| Rate for Payer: Global Benefits Group Commercial |
$168.59
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$210.74
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$187.42
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$262.07
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$67.44
|
| Rate for Payer: Multiplan Commercial |
$224.79
|
| Rate for Payer: Networks By Design Commercial |
$140.50
|
| Rate for Payer: Prime Health Services Commercial |
$238.84
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$168.59
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$168.59
|
| Rate for Payer: United Healthcare All Other Commercial |
$140.50
|
| Rate for Payer: United Healthcare All Other HMO |
$140.50
|
| Rate for Payer: United Healthcare HMO Rider |
$140.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$140.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$238.84
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$238.84
|
| Rate for Payer: Vantage Medical Group Senior |
$238.84
|
|
|
POISONING OF MEDICINAL AGENTS
|
Facility
IP
|
$7,932.69
|
|
|
Service Code
|
APR-DRG 8122
|
| Min. Negotiated Rate |
$6,085.21 |
| Max. Negotiated Rate |
$7,932.69 |
| Rate for Payer: IEHP Medi-Cal |
$6,085.21
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$7,932.69
|
|
|
POISONING OF MEDICINAL AGENTS
|
Facility
IP
|
$5,559.80
|
|
|
Service Code
|
APR-DRG 8121
|
| Min. Negotiated Rate |
$4,264.95 |
| Max. Negotiated Rate |
$5,559.80 |
| Rate for Payer: IEHP Medi-Cal |
$4,264.95
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$5,559.80
|
|
|
POISONING OF MEDICINAL AGENTS
|
Facility
IP
|
$11,621.48
|
|
|
Service Code
|
APR-DRG 8123
|
| Min. Negotiated Rate |
$8,914.90 |
| Max. Negotiated Rate |
$11,621.48 |
| Rate for Payer: IEHP Medi-Cal |
$8,914.90
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$11,621.48
|
|
|
POISONING OF MEDICINAL AGENTS
|
Facility
IP
|
$20,675.00
|
|
|
Service Code
|
APR-DRG 8124
|
| Min. Negotiated Rate |
$15,859.90 |
| Max. Negotiated Rate |
$20,675.00 |
| Rate for Payer: IEHP Medi-Cal |
$15,859.90
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$20,675.00
|
|
|
POLATUZUMAB VEDOTIN-PIIQ 140 MG INTRAVENOUS SOLUTION [225066]
|
Facility
OP
|
$19,860.05
|
|
|
Service Code
|
NDC 50242-105-01
|
| Hospital Charge Code |
ERX225066
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$4,766.41 |
| Max. Negotiated Rate |
$16,881.04 |
| Rate for Payer: Aetna of CA HMO/PPO |
$13,026.21
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$16,881.04
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$10,923.03
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$10,923.03
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$11,832.62
|
| Rate for Payer: BCBS Transplant Transplant |
$11,916.03
|
| Rate for Payer: Blue Shield of California Commercial |
$14,636.86
|
| Rate for Payer: Blue Shield of California EPN |
$11,598.27
|
| Rate for Payer: Cash Price |
$8,937.02
|
| Rate for Payer: Cash Price |
$8,937.02
|
| Rate for Payer: Cigna of CA HMO |
$13,902.04
|
| Rate for Payer: Cigna of CA PPO |
$13,902.04
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$16,881.04
|
| Rate for Payer: Dignity Health Media |
$16,881.04
|
| Rate for Payer: Dignity Health Medi-Cal |
$16,881.04
|
| Rate for Payer: EPIC Health Plan Commercial |
$7,944.02
|
| Rate for Payer: EPIC Health Plan Transplant |
$7,944.02
|
| Rate for Payer: Galaxy Health WC |
$16,881.04
|
| Rate for Payer: Global Benefits Group Commercial |
$11,916.03
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$14,895.04
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$13,246.65
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$7,566.68
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4,766.41
|
| Rate for Payer: Multiplan Commercial |
$15,888.04
|
| Rate for Payer: Networks By Design Commercial |
$9,930.02
|
| Rate for Payer: Prime Health Services Commercial |
$16,881.04
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$11,916.03
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$11,916.03
|
| Rate for Payer: United Healthcare All Other Commercial |
$9,930.02
|
| Rate for Payer: United Healthcare All Other HMO |
$9,930.02
|
| Rate for Payer: United Healthcare HMO Rider |
$9,930.02
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$9,930.02
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$16,881.04
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$16,881.04
|
| Rate for Payer: Vantage Medical Group Senior |
$16,881.04
|
|
|
POLATUZUMAB VEDOTIN-PIIQ 140 MG INTRAVENOUS SOLUTION [225066]
|
Facility
IP
|
$19,860.05
|
|
|
Service Code
|
NDC 50242-105-01
|
| Hospital Charge Code |
ERX225066
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$4,766.41 |
| Max. Negotiated Rate |
$16,881.04 |
| Rate for Payer: Blue Shield of California Commercial |
$14,140.36
|
| Rate for Payer: Blue Shield of California EPN |
$10,168.35
|
| Rate for Payer: Cash Price |
$8,937.02
|
| Rate for Payer: Cigna of CA HMO |
$13,902.04
|
| Rate for Payer: Cigna of CA PPO |
$13,902.04
|
| Rate for Payer: EPIC Health Plan Commercial |
$7,944.02
|
| Rate for Payer: EPIC Health Plan Transplant |
$7,944.02
|
| Rate for Payer: Galaxy Health WC |
$16,881.04
|
| Rate for Payer: Global Benefits Group Commercial |
$11,916.03
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$13,246.65
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$7,566.68
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4,766.41
|
| Rate for Payer: Multiplan Commercial |
$15,888.04
|
| Rate for Payer: Networks By Design Commercial |
$9,930.02
|
| Rate for Payer: Prime Health Services Commercial |
$16,881.04
|
|
|
POLIOVIRUS VACCINE 40 UNIT-8 UNIT-32 UNIT/0.5 ML INJECTION SUSPENSION [108127]
|
Facility
OP
|
$95.74
|
|
|
Service Code
|
CPT 90713
|
| Hospital Charge Code |
1780065
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$22.98 |
| Max. Negotiated Rate |
$300.82 |
| Rate for Payer: Aetna of CA HMO/PPO |
$300.82
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$81.38
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$52.66
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$52.66
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$58.75
|
| Rate for Payer: BCBS Transplant Transplant |
$57.44
|
| Rate for Payer: Blue Shield of California Commercial |
$70.56
|
| Rate for Payer: Blue Shield of California EPN |
$42.05
|
| Rate for Payer: Cash Price |
$43.08
|
| Rate for Payer: Cash Price |
$43.08
|
| Rate for Payer: Cigna of CA HMO |
$67.02
|
| Rate for Payer: Cigna of CA PPO |
$67.02
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$81.38
|
| Rate for Payer: Dignity Health Media |
$81.38
|
| Rate for Payer: Dignity Health Medi-Cal |
$81.38
|
| Rate for Payer: EPIC Health Plan Commercial |
$38.30
|
| Rate for Payer: EPIC Health Plan Transplant |
$38.30
|
| Rate for Payer: Galaxy Health WC |
$81.38
|
| Rate for Payer: Global Benefits Group Commercial |
$57.44
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$71.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$63.86
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$88.06
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$22.98
|
| Rate for Payer: Multiplan Commercial |
$76.59
|
| Rate for Payer: Networks By Design Commercial |
$47.87
|
| Rate for Payer: Prime Health Services Commercial |
$81.38
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$57.44
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$57.44
|
| Rate for Payer: United Healthcare All Other Commercial |
$47.87
|
| Rate for Payer: United Healthcare All Other HMO |
$47.87
|
| Rate for Payer: United Healthcare HMO Rider |
$47.87
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$47.87
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$81.38
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$81.38
|
| Rate for Payer: Vantage Medical Group Senior |
$81.38
|
|
|
POLIOVIRUS VACCINE 40 UNIT-8 UNIT-32 UNIT/0.5 ML INJECTION SUSPENSION [108127]
|
Facility
IP
|
$95.74
|
|
|
Service Code
|
CPT 90713
|
| Hospital Charge Code |
1780065
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$22.98 |
| Max. Negotiated Rate |
$81.38 |
| Rate for Payer: Blue Shield of California Commercial |
$68.17
|
| Rate for Payer: Blue Shield of California EPN |
$49.02
|
| Rate for Payer: Cash Price |
$43.08
|
| Rate for Payer: Cigna of CA HMO |
$67.02
|
| Rate for Payer: Cigna of CA PPO |
$67.02
|
| Rate for Payer: EPIC Health Plan Commercial |
$38.30
|
| Rate for Payer: EPIC Health Plan Transplant |
$38.30
|
| Rate for Payer: Galaxy Health WC |
$81.38
|
| Rate for Payer: Global Benefits Group Commercial |
$57.44
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$63.86
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$36.48
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$22.98
|
| Rate for Payer: Multiplan Commercial |
$76.59
|
| Rate for Payer: Networks By Design Commercial |
$47.87
|
| Rate for Payer: Prime Health Services Commercial |
$81.38
|
|
