|
PTCA / Angioplasty - #2636
|
Facility
IP
|
$11,541.00
|
|
|
Service Code
|
ICD 047M35Z
|
| Min. Negotiated Rate |
$11,541.00 |
| Max. Negotiated Rate |
$11,541.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$11,541.00
|
|
|
PTCA / Angioplasty - #2636
|
Facility
IP
|
$11,541.00
|
|
|
Service Code
|
ICD 047U06Z
|
| Min. Negotiated Rate |
$11,541.00 |
| Max. Negotiated Rate |
$11,541.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$11,541.00
|
|
|
PTCA / Angioplasty - #2636
|
Facility
IP
|
$11,541.00
|
|
|
Service Code
|
ICD 047F341
|
| Min. Negotiated Rate |
$11,541.00 |
| Max. Negotiated Rate |
$11,541.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$11,541.00
|
|
|
PTCA / Angioplasty - #2636
|
Facility
IP
|
$11,541.00
|
|
|
Service Code
|
ICD 047P45Z
|
| Min. Negotiated Rate |
$11,541.00 |
| Max. Negotiated Rate |
$11,541.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$11,541.00
|
|
|
PTCA / Angioplasty - #2636
|
Facility
IP
|
$11,541.00
|
|
|
Service Code
|
ICD 047W341
|
| Min. Negotiated Rate |
$11,541.00 |
| Max. Negotiated Rate |
$11,541.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$11,541.00
|
|
|
PTCA / Angioplasty - #2636
|
Facility
IP
|
$11,541.00
|
|
|
Service Code
|
ICD 047T34Z
|
| Min. Negotiated Rate |
$11,541.00 |
| Max. Negotiated Rate |
$11,541.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$11,541.00
|
|
|
PTCA / Angioplasty - #2636
|
Facility
IP
|
$11,541.00
|
|
|
Service Code
|
ICD 047W37Z
|
| Min. Negotiated Rate |
$11,541.00 |
| Max. Negotiated Rate |
$11,541.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$11,541.00
|
|
|
PTCA / Angioplasty - #2636
|
Facility
IP
|
$11,541.00
|
|
|
Service Code
|
ICD 047S04Z
|
| Min. Negotiated Rate |
$11,541.00 |
| Max. Negotiated Rate |
$11,541.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$11,541.00
|
|
|
PTCA / Angioplasty - #2636
|
Facility
IP
|
$11,541.00
|
|
|
Service Code
|
ICD 047P06Z
|
| Min. Negotiated Rate |
$11,541.00 |
| Max. Negotiated Rate |
$11,541.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$11,541.00
|
|
|
PTCA / Angioplasty - #2636
|
Facility
IP
|
$11,541.00
|
|
|
Service Code
|
ICD 047W06Z
|
| Min. Negotiated Rate |
$11,541.00 |
| Max. Negotiated Rate |
$11,541.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$11,541.00
|
|
|
PTCA / Angioplasty - #2636
|
Facility
IP
|
$11,541.00
|
|
|
Service Code
|
ICD 047S35Z
|
| Min. Negotiated Rate |
$11,541.00 |
| Max. Negotiated Rate |
$11,541.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$11,541.00
|
|
|
PTCA / Angioplasty - #2636
|
Facility
IP
|
$11,541.00
|
|
|
Service Code
|
ICD 047Y441
|
| Min. Negotiated Rate |
$11,541.00 |
| Max. Negotiated Rate |
$11,541.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$11,541.00
|
|
|
PTCA / Angioplasty - #2636
|
Facility
IP
|
$11,541.00
|
|
|
Service Code
|
ICD 047J44Z
|
| Min. Negotiated Rate |
$11,541.00 |
| Max. Negotiated Rate |
$11,541.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$11,541.00
|
|
|
PTCA / Angioplasty - #2636
|
Facility
IP
|
$11,541.00
|
|
|
Service Code
|
ICD 047R34Z
|
| Min. Negotiated Rate |
$11,541.00 |
| Max. Negotiated Rate |
$11,541.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$11,541.00
|
|
|
PTCA / Angioplasty - #2636
|
Facility
IP
|
$11,541.00
|
|
|
Service Code
|
ICD 047T45Z
|
| Min. Negotiated Rate |
$11,541.00 |
| Max. Negotiated Rate |
$11,541.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$11,541.00
|
|
|
PULMONARY EMBOLISM
|
Facility
IP
|
$9,025.13
|
|
|
Service Code
|
APR-DRG 1341
|
| Min. Negotiated Rate |
$6,923.23 |
| Max. Negotiated Rate |
$9,025.13 |
| Rate for Payer: IEHP Medi-Cal |
$6,923.23
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$9,025.13
|
|
|
PULMONARY EMBOLISM
|
Facility
IP
|
$11,750.95
|
|
|
Service Code
|
APR-DRG 1342
|
| Min. Negotiated Rate |
$9,014.21 |
| Max. Negotiated Rate |
$11,750.95 |
| Rate for Payer: IEHP Medi-Cal |
$9,014.21
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$11,750.95
|
|
|
PULMONARY EMBOLISM
|
Facility
IP
|
$16,954.27
|
|
|
Service Code
|
APR-DRG 1343
|
| Min. Negotiated Rate |
$13,005.71 |
| Max. Negotiated Rate |
$16,954.27 |
| Rate for Payer: IEHP Medi-Cal |
$13,005.71
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$16,954.27
|
|
|
PULMONARY EMBOLISM
|
Facility
IP
|
$25,805.61
|
|
|
Service Code
|
APR-DRG 1344
|
| Min. Negotiated Rate |
$19,795.62 |
| Max. Negotiated Rate |
$25,805.61 |
| Rate for Payer: IEHP Medi-Cal |
$19,795.62
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$25,805.61
|
|
|
PYRAZINAMIDE 500 MG TABLET [6738]
|
Facility
OP
|
$6.06
|
|
|
Service Code
|
NDC 61748-012-06
|
| Hospital Charge Code |
1712086
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$1.45 |
| Max. Negotiated Rate |
$5.15 |
| Rate for Payer: BCBS Transplant Transplant |
$3.64
|
| Rate for Payer: Aetna of CA HMO/PPO |
$3.97
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$5.15
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$3.33
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$3.33
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3.61
|
| Rate for Payer: Blue Shield of California Commercial |
$4.47
|
| Rate for Payer: Blue Shield of California EPN |
$3.54
|
| Rate for Payer: Cash Price |
$2.73
|
| Rate for Payer: Cigna of CA HMO |
$4.24
|
| Rate for Payer: Cigna of CA PPO |
$4.24
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$5.15
|
| Rate for Payer: Dignity Health Media |
$5.15
|
| Rate for Payer: Dignity Health Medi-Cal |
$5.15
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.42
|
| Rate for Payer: EPIC Health Plan Transplant |
$2.42
|
| Rate for Payer: Galaxy Health WC |
$5.15
|
| Rate for Payer: Global Benefits Group Commercial |
$3.64
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$4.54
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4.04
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2.31
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.45
|
| Rate for Payer: Multiplan Commercial |
$4.85
|
| Rate for Payer: Networks By Design Commercial |
$3.94
|
| Rate for Payer: Prime Health Services Commercial |
$5.15
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$3.64
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3.64
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$3.64
|
| Rate for Payer: United Healthcare All Other Commercial |
$3.03
|
| Rate for Payer: United Healthcare All Other HMO |
$3.03
|
| Rate for Payer: United Healthcare HMO Rider |
$3.03
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3.03
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$5.15
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$5.15
|
| Rate for Payer: Vantage Medical Group Senior |
$5.15
|
|
|
PYRAZINAMIDE 500 MG TABLET [6738]
|
Facility
IP
|
$6.06
|
|
|
Service Code
|
NDC 61748-012-06
|
| Hospital Charge Code |
1712086
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$1.45 |
| Max. Negotiated Rate |
$5.15 |
| Rate for Payer: Blue Shield of California Commercial |
$4.31
|
| Rate for Payer: Blue Shield of California EPN |
$3.10
|
| Rate for Payer: Cash Price |
$2.73
|
| Rate for Payer: Cigna of CA HMO |
$4.24
|
| Rate for Payer: Cigna of CA PPO |
$4.24
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.42
|
| Rate for Payer: Galaxy Health WC |
$5.15
|
| Rate for Payer: Global Benefits Group Commercial |
$3.64
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4.04
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2.31
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.45
|
| Rate for Payer: Multiplan Commercial |
$4.85
|
| Rate for Payer: Networks By Design Commercial |
$3.94
|
| Rate for Payer: Prime Health Services Commercial |
$5.15
|
|
|
PYRAZINAMIDE 500 MG TABLET [6738]
|
Facility
IP
|
$5.46
|
|
|
Service Code
|
NDC 70954-484-10
|
| Hospital Charge Code |
1712086
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$1.31 |
| Max. Negotiated Rate |
$4.64 |
| Rate for Payer: Blue Shield of California Commercial |
$3.89
|
| Rate for Payer: Blue Shield of California EPN |
$2.80
|
| Rate for Payer: Cash Price |
$2.46
|
| Rate for Payer: Cigna of CA HMO |
$3.82
|
| Rate for Payer: Cigna of CA PPO |
$3.82
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.18
|
| Rate for Payer: Galaxy Health WC |
$4.64
|
| Rate for Payer: Global Benefits Group Commercial |
$3.28
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3.64
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2.08
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.31
|
| Rate for Payer: Multiplan Commercial |
$4.37
|
| Rate for Payer: Networks By Design Commercial |
$3.55
|
| Rate for Payer: Prime Health Services Commercial |
$4.64
|
|
|
PYRAZINAMIDE 500 MG TABLET [6738]
|
Facility
IP
|
$6.03
|
|
|
Service Code
|
NDC 61748-012-09
|
| Hospital Charge Code |
1712086
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$1.45 |
| Max. Negotiated Rate |
$5.13 |
| Rate for Payer: Blue Shield of California Commercial |
$4.29
|
| Rate for Payer: Blue Shield of California EPN |
$3.09
|
| Rate for Payer: Cash Price |
$2.71
|
| Rate for Payer: Cigna of CA HMO |
$4.22
|
| Rate for Payer: Cigna of CA PPO |
$4.22
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.41
|
| Rate for Payer: Galaxy Health WC |
$5.13
|
| Rate for Payer: Global Benefits Group Commercial |
$3.62
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4.02
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2.30
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.45
|
| Rate for Payer: Multiplan Commercial |
$4.82
|
| Rate for Payer: Networks By Design Commercial |
$3.92
|
| Rate for Payer: Prime Health Services Commercial |
$5.13
|
|
|
PYRAZINAMIDE 500 MG TABLET [6738]
|
Facility
OP
|
$5.46
|
|
|
Service Code
|
NDC 70954-484-10
|
| Hospital Charge Code |
1712086
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$1.31 |
| Max. Negotiated Rate |
$4.64 |
| Rate for Payer: Aetna of CA HMO/PPO |
$3.58
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$4.64
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$3.00
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$3.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3.25
|
| Rate for Payer: BCBS Transplant Transplant |
$3.28
|
| Rate for Payer: Blue Shield of California Commercial |
$4.02
|
| Rate for Payer: Blue Shield of California EPN |
$3.19
|
| Rate for Payer: Cash Price |
$2.46
|
| Rate for Payer: Cigna of CA HMO |
$3.82
|
| Rate for Payer: Cigna of CA PPO |
$3.82
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$4.64
|
| Rate for Payer: Dignity Health Media |
$4.64
|
| Rate for Payer: Dignity Health Medi-Cal |
$4.64
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.18
|
| Rate for Payer: EPIC Health Plan Transplant |
$2.18
|
| Rate for Payer: Galaxy Health WC |
$4.64
|
| Rate for Payer: Global Benefits Group Commercial |
$3.28
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$4.10
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3.64
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2.08
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.31
|
| Rate for Payer: Multiplan Commercial |
$4.37
|
| Rate for Payer: Networks By Design Commercial |
$3.55
|
| Rate for Payer: Prime Health Services Commercial |
$4.64
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$3.28
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3.28
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$3.28
|
| Rate for Payer: United Healthcare All Other Commercial |
$2.73
|
| Rate for Payer: United Healthcare All Other HMO |
$2.73
|
| Rate for Payer: United Healthcare HMO Rider |
$2.73
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2.73
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$4.64
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4.64
|
| Rate for Payer: Vantage Medical Group Senior |
$4.64
|
|
|
PYRAZINAMIDE 500 MG TABLET [6738]
|
Facility
OP
|
$5.32
|
|
|
Service Code
|
NDC 33342-447-11
|
| Hospital Charge Code |
1712086
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$1.28 |
| Max. Negotiated Rate |
$4.52 |
| Rate for Payer: Aetna of CA HMO/PPO |
$3.49
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$4.52
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$2.93
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$2.93
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3.17
|
| Rate for Payer: BCBS Transplant Transplant |
$3.19
|
| Rate for Payer: Blue Shield of California Commercial |
$3.92
|
| Rate for Payer: Blue Shield of California EPN |
$3.11
|
| Rate for Payer: Cash Price |
$2.39
|
| Rate for Payer: Cigna of CA HMO |
$3.72
|
| Rate for Payer: Cigna of CA PPO |
$3.72
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$4.52
|
| Rate for Payer: Dignity Health Media |
$4.52
|
| Rate for Payer: Dignity Health Medi-Cal |
$4.52
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.13
|
| Rate for Payer: EPIC Health Plan Transplant |
$2.13
|
| Rate for Payer: Galaxy Health WC |
$4.52
|
| Rate for Payer: Global Benefits Group Commercial |
$3.19
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$3.99
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3.55
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2.03
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.28
|
| Rate for Payer: Multiplan Commercial |
$4.26
|
| Rate for Payer: Networks By Design Commercial |
$3.46
|
| Rate for Payer: Prime Health Services Commercial |
$4.52
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$3.19
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3.19
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$3.19
|
| Rate for Payer: United Healthcare All Other Commercial |
$2.66
|
| Rate for Payer: United Healthcare All Other HMO |
$2.66
|
| Rate for Payer: United Healthcare HMO Rider |
$2.66
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2.66
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$4.52
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4.52
|
| Rate for Payer: Vantage Medical Group Senior |
$4.52
|
|
