|
PILOCARPINE 5 MG TABLET [12803]
|
Facility
|
IP
|
$2.57
|
|
|
Service Code
|
NDC 50268-652-12
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.51 |
| Max. Negotiated Rate |
$2.18 |
| Rate for Payer: Adventist Health Commercial |
$0.51
|
| Rate for Payer: Blue Shield of California Commercial |
$1.90
|
| Rate for Payer: Blue Shield of California EPN |
$1.25
|
| Rate for Payer: Cash Price |
$1.41
|
| Rate for Payer: Cigna of CA HMO |
$1.80
|
| Rate for Payer: Cigna of CA PPO |
$1.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.03
|
| Rate for Payer: EPIC Health Plan Senior |
$1.03
|
| Rate for Payer: Galaxy Health WC |
$2.18
|
| Rate for Payer: Global Benefits Group Commercial |
$1.54
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1.71
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.98
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1.59
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.62
|
| Rate for Payer: Multiplan Commercial |
$2.06
|
| Rate for Payer: Networks By Design Commercial |
$1.67
|
| Rate for Payer: Prime Health Services Commercial |
$2.18
|
|
|
PILOCARPINE 5 MG TABLET [12803]
|
Facility
|
IP
|
$0.49
|
|
|
Service Code
|
NDC 0527-1313-01
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.10 |
| Max. Negotiated Rate |
$0.42 |
| Rate for Payer: Adventist Health Commercial |
$0.10
|
| Rate for Payer: Blue Shield of California Commercial |
$0.36
|
| Rate for Payer: Blue Shield of California EPN |
$0.24
|
| Rate for Payer: Cash Price |
$0.27
|
| 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 Senior |
$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: Kaiser Permanente of CA Medicare Advantage |
$0.30
|
| 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
|
|
|
PIMECROLIMUS 1 % TOPICAL CREAM [32052]
|
Facility
|
OP
|
$11.96
|
|
|
Service Code
|
NDC 0187-5100-01
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$2.39 |
| Max. Negotiated Rate |
$10.17 |
| Rate for Payer: Adventist Health Commercial |
$2.39
|
| Rate for Payer: Aetna of CA HMO/PPO |
$7.84
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$10.17
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$6.58
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$8.97
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$7.34
|
| Rate for Payer: Cash Price |
$6.58
|
| 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 Medi-Cal |
$10.17
|
| Rate for Payer: Dignity Health Medicare Advantage |
$10.17
|
| Rate for Payer: EPIC Health Plan Commercial |
$4.78
|
| Rate for Payer: EPIC Health Plan Senior |
$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: Kaiser Permanente of CA Medicare Advantage |
$7.40
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.87
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$8.37
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$8.37
|
| 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: 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 |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$2.39 |
| Max. Negotiated Rate |
$10.17 |
| Rate for Payer: Adventist Health Commercial |
$2.39
|
| Rate for Payer: Blue Shield of California Commercial |
$8.83
|
| Rate for Payer: Blue Shield of California EPN |
$5.81
|
| Rate for Payer: Cash Price |
$6.58
|
| 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: EPIC Health Plan Senior |
$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: Kaiser Permanente of CA Medicare Advantage |
$7.40
|
| 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 30 MG TABLET [25529]
|
Facility
|
IP
|
$0.22
|
|
|
Service Code
|
NDC 33342-055-07
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.04 |
| Max. Negotiated Rate |
$0.19 |
| Rate for Payer: Adventist Health Commercial |
$0.04
|
| 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 |
$0.12
|
| 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: EPIC Health Plan Senior |
$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: Kaiser Permanente of CA Medicare Advantage |
$0.14
|
| 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
|
|
|
PIOGLITAZONE 30 MG TABLET [25529]
|
Facility
|
OP
|
$0.22
|
|
|
Service Code
|
NDC 33342-055-07
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.04 |
| Max. Negotiated Rate |
$0.19 |
| Rate for Payer: Adventist Health Commercial |
$0.04
|
| Rate for Payer: Aetna of CA HMO/PPO |
$0.14
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.19
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.12
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.17
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.14
|
| Rate for Payer: Cash Price |
$0.12
|
| 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 Medi-Cal |
$0.19
|
| Rate for Payer: Dignity Health Medicare Advantage |
$0.19
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.09
|
| Rate for Payer: EPIC Health Plan Senior |
$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: Kaiser Permanente of CA Medicare Advantage |
$0.14
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.05
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$0.15
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$0.15
|
| 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
|
| 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
|
|
|
PIPERACILLIN-TAZOBACTAM 2.25 GRAM/50 ML IN DEXTROSE(ISO) IV PIGGYBACK [34523]
|
Facility
|
IP
|
$0.36
|
|
|
Service Code
|
HCPCS J2543
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.07 |
| Max. Negotiated Rate |
$0.31 |
| Rate for Payer: Adventist Health Commercial |
$0.07
|
| Rate for Payer: Blue Shield of California Commercial |
$0.27
|
| Rate for Payer: Blue Shield of California EPN |
$0.17
|
| Rate for Payer: Cash Price |
$0.20
|
| Rate for Payer: Cigna of CA HMO |
$0.25
|
| Rate for Payer: Cigna of CA PPO |
$0.25
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.14
|
| Rate for Payer: EPIC Health Plan Senior |
$0.14
|
| 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 |
$0.24
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.14
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$0.22
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.09
|
| Rate for Payer: Multiplan Commercial |
$0.29
|
| Rate for Payer: Networks By Design Commercial |
$0.18
|
| Rate for Payer: Prime Health Services Commercial |
$0.31
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.14
|
| Rate for Payer: United Healthcare All Other HMO |
$0.13
|
| Rate for Payer: United Healthcare HMO Rider |
$0.13
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.12
|
|
|
PIPERACILLIN-TAZOBACTAM 2.25 GRAM/50 ML IN DEXTROSE(ISO) IV PIGGYBACK [34523]
|
Facility
|
OP
|
$0.36
|
|
|
Service Code
|
HCPCS J2543
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.07 |
| Max. Negotiated Rate |
$4.69 |
| Rate for Payer: Adventist Health Commercial |
$0.07
|
| Rate for Payer: Aetna of CA HMO/PPO |
$0.24
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.31
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.20
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.27
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4.69
|
| Rate for Payer: Blue Shield of California Commercial |
$2.10
|
| Rate for Payer: Blue Shield of California EPN |
$2.10
|
| Rate for Payer: Cash Price |
$0.20
|
| Rate for Payer: Cash Price |
$0.20
|
| Rate for Payer: Cigna of CA HMO |
$0.25
|
| Rate for Payer: Cigna of CA PPO |
$0.25
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.31
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.31
|
| Rate for Payer: Dignity Health Medicare Advantage |
$0.31
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.14
|
| Rate for Payer: EPIC Health Plan Senior |
$0.14
|
| Rate for Payer: Galaxy Health WC |
$0.31
|
| Rate for Payer: Global Benefits Group Commercial |
$0.22
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$1.12
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.24
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.14
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$0.22
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.09
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$0.25
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$0.25
|
| Rate for Payer: Multiplan Commercial |
$0.29
|
| Rate for Payer: Networks By Design Commercial |
$0.18
|
| 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 |
$0.14
|
| Rate for Payer: United Healthcare All Other HMO |
$0.13
|
| Rate for Payer: United Healthcare HMO Rider |
$0.13
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.12
|
| 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
|
IP
|
$4.12
|
|
|
Service Code
|
HCPCS J2543
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.82 |
| Max. Negotiated Rate |
$3.50 |
| Rate for Payer: Adventist Health Commercial |
$0.82
|
| Rate for Payer: Adventist Health Commercial |
$0.72
|
| Rate for Payer: Adventist Health Commercial |
$0.79
|
| Rate for Payer: Adventist Health Commercial |
$2.22
|
| Rate for Payer: Adventist Health Commercial |
$0.72
|
| Rate for Payer: Blue Shield of California Commercial |
$3.04
|
| Rate for Payer: Blue Shield of California Commercial |
$2.66
|
| Rate for Payer: Blue Shield of California Commercial |
$8.19
|
| Rate for Payer: Blue Shield of California Commercial |
$2.92
|
| Rate for Payer: Blue Shield of California Commercial |
$2.65
|
| Rate for Payer: Blue Shield of California EPN |
$5.39
|
| Rate for Payer: Blue Shield of California EPN |
$1.75
|
| Rate for Payer: Blue Shield of California EPN |
$1.74
|
| Rate for Payer: Blue Shield of California EPN |
$1.92
|
| Rate for Payer: Blue Shield of California EPN |
$2.00
|
| Rate for Payer: Cash Price |
$2.27
|
| Rate for Payer: Cash Price |
$1.97
|
| Rate for Payer: Cash Price |
$1.98
|
| Rate for Payer: Cash Price |
$6.11
|
| Rate for Payer: Cash Price |
$2.18
|
| Rate for Payer: Cigna of CA HMO |
$2.77
|
| Rate for Payer: Cigna of CA HMO |
$7.77
|
| Rate for Payer: Cigna of CA HMO |
$2.51
|
| Rate for Payer: Cigna of CA HMO |
$2.52
|
| Rate for Payer: Cigna of CA HMO |
$2.88
|
| Rate for Payer: Cigna of CA PPO |
$2.77
|
| Rate for Payer: Cigna of CA PPO |
$2.52
|
| Rate for Payer: Cigna of CA PPO |
$7.77
|
| Rate for Payer: Cigna of CA PPO |
$2.51
|
| Rate for Payer: Cigna of CA PPO |
$2.88
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.44
|
| Rate for Payer: EPIC Health Plan Commercial |
$4.44
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.44
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.65
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.58
|
| Rate for Payer: EPIC Health Plan Senior |
$1.65
|
| Rate for Payer: EPIC Health Plan Senior |
$1.58
|
| Rate for Payer: EPIC Health Plan Senior |
$1.44
|
| Rate for Payer: EPIC Health Plan Senior |
$1.44
|
| Rate for Payer: EPIC Health Plan Senior |
$4.44
|
| Rate for Payer: Galaxy Health WC |
$9.44
|
| Rate for Payer: Galaxy Health WC |
$3.37
|
| Rate for Payer: Galaxy Health WC |
$3.50
|
| Rate for Payer: Galaxy Health WC |
$3.06
|
| Rate for Payer: Galaxy Health WC |
$3.05
|
| Rate for Payer: Global Benefits Group Commercial |
$2.15
|
| Rate for Payer: Global Benefits Group Commercial |
$2.16
|
| Rate for Payer: Global Benefits Group Commercial |
$2.47
|
| Rate for Payer: Global Benefits Group Commercial |
$2.38
|
| Rate for Payer: Global Benefits Group Commercial |
$6.66
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2.39
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$7.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2.75
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2.64
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1.57
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1.37
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4.23
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1.51
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1.37
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2.22
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2.23
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$6.87
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2.45
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2.55
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.86
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.86
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.95
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.99
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.66
|
| Rate for Payer: Multiplan Commercial |
$2.87
|
| Rate for Payer: Multiplan Commercial |
$3.17
|
| Rate for Payer: Multiplan Commercial |
$8.88
|
| Rate for Payer: Multiplan Commercial |
$2.88
|
| Rate for Payer: Multiplan Commercial |
$3.30
|
| Rate for Payer: Networks By Design Commercial |
$2.06
|
| Rate for Payer: Networks By Design Commercial |
$1.80
|
| Rate for Payer: Networks By Design Commercial |
$1.79
|
| Rate for Payer: Networks By Design Commercial |
$1.98
|
| Rate for Payer: Networks By Design Commercial |
$5.55
|
| Rate for Payer: Prime Health Services Commercial |
$3.50
|
| Rate for Payer: Prime Health Services Commercial |
$3.37
|
| Rate for Payer: Prime Health Services Commercial |
$3.06
|
| Rate for Payer: Prime Health Services Commercial |
$3.05
|
| Rate for Payer: Prime Health Services Commercial |
$9.44
|
| Rate for Payer: United Healthcare All Other Commercial |
$4.17
|
| Rate for Payer: United Healthcare All Other Commercial |
$1.35
|
| Rate for Payer: United Healthcare All Other Commercial |
$1.55
|
| Rate for Payer: United Healthcare All Other Commercial |
$1.49
|
| Rate for Payer: United Healthcare All Other Commercial |
$1.35
|
| Rate for Payer: United Healthcare All Other HMO |
$1.51
|
| Rate for Payer: United Healthcare All Other HMO |
$1.45
|
| Rate for Payer: United Healthcare All Other HMO |
$1.31
|
| Rate for Payer: United Healthcare All Other HMO |
$4.05
|
| Rate for Payer: United Healthcare All Other HMO |
$1.32
|
| Rate for Payer: United Healthcare HMO Rider |
$3.97
|
| Rate for Payer: United Healthcare HMO Rider |
$1.29
|
| Rate for Payer: United Healthcare HMO Rider |
$1.47
|
| Rate for Payer: United Healthcare HMO Rider |
$1.42
|
| Rate for Payer: United Healthcare HMO Rider |
$1.28
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1.18
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1.30
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1.35
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1.18
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3.64
|
|
|
PIPERACILLIN-TAZOBACTAM 2.25 GRAM INTRAVENOUS SOLUTION [18304]
|
Facility
|
OP
|
$3.96
|
|
|
Service Code
|
HCPCS J2543
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.79 |
| Max. Negotiated Rate |
$4.69 |
| Rate for Payer: Adventist Health Commercial |
$0.79
|
| Rate for Payer: Adventist Health Commercial |
$0.82
|
| Rate for Payer: Adventist Health Commercial |
$0.72
|
| Rate for Payer: Adventist Health Commercial |
$0.72
|
| Rate for Payer: Adventist Health Commercial |
$2.22
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2.36
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2.35
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2.70
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2.60
|
| Rate for Payer: Aetna of CA HMO/PPO |
$7.28
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$9.44
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3.06
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3.05
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3.50
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3.37
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2.18
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1.97
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2.27
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$6.11
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1.98
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$8.32
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$3.09
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2.97
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2.70
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2.69
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4.69
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4.69
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4.69
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4.69
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4.69
|
| Rate for Payer: Blue Shield of California Commercial |
$2.10
|
| Rate for Payer: Blue Shield of California Commercial |
$2.10
|
| Rate for Payer: Blue Shield of California Commercial |
$2.10
|
| Rate for Payer: Blue Shield of California Commercial |
$2.10
|
| Rate for Payer: Blue Shield of California Commercial |
$2.10
|
| Rate for Payer: Blue Shield of California EPN |
$2.10
|
| Rate for Payer: Blue Shield of California EPN |
$2.10
|
| Rate for Payer: Blue Shield of California EPN |
$2.10
|
| Rate for Payer: Blue Shield of California EPN |
$2.10
|
| Rate for Payer: Blue Shield of California EPN |
$2.10
|
| Rate for Payer: Cash Price |
$2.27
|
| Rate for Payer: Cash Price |
$2.27
|
| Rate for Payer: Cash Price |
$1.97
|
| Rate for Payer: Cash Price |
$2.18
|
| Rate for Payer: Cash Price |
$1.98
|
| Rate for Payer: Cash Price |
$1.98
|
| Rate for Payer: Cash Price |
$6.11
|
| Rate for Payer: Cash Price |
$1.97
|
| Rate for Payer: Cash Price |
$2.18
|
| Rate for Payer: Cash Price |
$6.11
|
| Rate for Payer: Cigna of CA HMO |
$7.77
|
| Rate for Payer: Cigna of CA HMO |
$2.51
|
| Rate for Payer: Cigna of CA HMO |
$2.77
|
| Rate for Payer: Cigna of CA HMO |
$2.52
|
| 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 |
$2.51
|
| Rate for Payer: Cigna of CA PPO |
$7.77
|
| Rate for Payer: Cigna of CA PPO |
$2.77
|
| Rate for Payer: Cigna of CA PPO |
$2.52
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3.37
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$9.44
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3.05
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3.06
|
| Rate for Payer: Dignity Health Medi-Cal |
$3.05
|
| Rate for Payer: Dignity Health Medi-Cal |
$3.37
|
| Rate for Payer: Dignity Health Medi-Cal |
$3.50
|
| Rate for Payer: Dignity Health Medi-Cal |
$3.06
|
| Rate for Payer: Dignity Health Medi-Cal |
$9.44
|
| Rate for Payer: Dignity Health Medicare Advantage |
$3.50
|
| Rate for Payer: Dignity Health Medicare Advantage |
$3.06
|
| Rate for Payer: Dignity Health Medicare Advantage |
$9.44
|
| Rate for Payer: Dignity Health Medicare Advantage |
$3.37
|
| Rate for Payer: Dignity Health Medicare Advantage |
$3.05
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.44
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.58
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.65
|
| Rate for Payer: EPIC Health Plan Commercial |
$4.44
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.44
|
| Rate for Payer: EPIC Health Plan Senior |
$1.44
|
| Rate for Payer: EPIC Health Plan Senior |
$1.65
|
| Rate for Payer: EPIC Health Plan Senior |
$1.58
|
| Rate for Payer: EPIC Health Plan Senior |
$1.44
|
| Rate for Payer: EPIC Health Plan Senior |
$4.44
|
| Rate for Payer: Galaxy Health WC |
$3.37
|
| Rate for Payer: Galaxy Health WC |
$3.50
|
| Rate for Payer: Galaxy Health WC |
$9.44
|
| Rate for Payer: Galaxy Health WC |
$3.05
|
| Rate for Payer: Galaxy Health WC |
$3.06
|
| Rate for Payer: Global Benefits Group Commercial |
$2.15
|
| Rate for Payer: Global Benefits Group Commercial |
$6.66
|
| Rate for Payer: Global Benefits Group Commercial |
$2.47
|
| Rate for Payer: Global Benefits Group Commercial |
$2.16
|
| Rate for Payer: Global Benefits Group Commercial |
$2.38
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$1.12
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$1.12
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$1.12
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$1.12
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$1.12
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2.75
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2.39
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2.64
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$7.40
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1.37
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1.57
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4.23
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1.37
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1.51
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2.45
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2.23
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2.55
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2.22
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$6.87
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.66
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.95
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.86
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.86
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.99
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2.88
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2.52
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$7.77
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2.77
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2.51
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2.77
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$7.77
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2.52
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2.51
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2.88
|
| Rate for Payer: Multiplan Commercial |
$2.88
|
| Rate for Payer: Multiplan Commercial |
$3.30
|
| Rate for Payer: Multiplan Commercial |
$2.87
|
| Rate for Payer: Multiplan Commercial |
$8.88
|
| Rate for Payer: Multiplan Commercial |
$3.17
|
| Rate for Payer: Networks By Design Commercial |
$5.55
|
| Rate for Payer: Networks By Design Commercial |
$2.06
|
| Rate for Payer: Networks By Design Commercial |
$1.79
|
| Rate for Payer: Networks By Design Commercial |
$1.80
|
| Rate for Payer: Networks By Design Commercial |
$1.98
|
| Rate for Payer: Prime Health Services Commercial |
$3.37
|
| Rate for Payer: Prime Health Services Commercial |
$3.06
|
| Rate for Payer: Prime Health Services Commercial |
$3.50
|
| Rate for Payer: Prime Health Services Commercial |
$3.05
|
| Rate for Payer: Prime Health Services Commercial |
$9.44
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2.15
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2.38
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2.16
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2.47
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$6.66
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2.47
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2.15
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2.38
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2.16
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$6.66
|
| Rate for Payer: United Healthcare All Other Commercial |
$1.49
|
| Rate for Payer: United Healthcare All Other Commercial |
$1.35
|
| Rate for Payer: United Healthcare All Other Commercial |
$1.35
|
| Rate for Payer: United Healthcare All Other Commercial |
$4.17
|
| Rate for Payer: United Healthcare All Other Commercial |
$1.55
|
| Rate for Payer: United Healthcare All Other HMO |
$1.51
|
| Rate for Payer: United Healthcare All Other HMO |
$1.45
|
| Rate for Payer: United Healthcare All Other HMO |
$4.05
|
| Rate for Payer: United Healthcare All Other HMO |
$1.31
|
| Rate for Payer: United Healthcare All Other HMO |
$1.32
|
| Rate for Payer: United Healthcare HMO Rider |
$1.28
|
| Rate for Payer: United Healthcare HMO Rider |
$1.47
|
| Rate for Payer: United Healthcare HMO Rider |
$3.97
|
| Rate for Payer: United Healthcare HMO Rider |
$1.29
|
| Rate for Payer: United Healthcare HMO Rider |
$1.42
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1.18
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3.64
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1.18
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1.30
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1.35
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3.37
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3.06
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$9.44
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3.05
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$3.37
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$3.05
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$9.44
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$3.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$3.06
|
| Rate for Payer: Vantage Medical Group Senior |
$3.50
|
| Rate for Payer: Vantage Medical Group Senior |
$9.44
|
| Rate for Payer: Vantage Medical Group Senior |
$3.05
|
| Rate for Payer: Vantage Medical Group Senior |
$3.06
|
| Rate for Payer: Vantage Medical Group Senior |
$3.37
|
|
|
PIPERACILLIN-TAZOBACTAM 3.375 GRAM/50 ML DEXTROSE(ISO-OS) IV PIGGYBACK [34524]
|
Facility
|
OP
|
$0.49
|
|
|
Service Code
|
HCPCS J2543
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.10 |
| Max. Negotiated Rate |
$4.69 |
| Rate for Payer: Adventist Health Commercial |
$0.10
|
| Rate for Payer: Adventist Health Commercial |
$0.10
|
| Rate for Payer: Aetna of CA HMO/PPO |
$0.31
|
| Rate for Payer: Aetna of CA HMO/PPO |
$0.32
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.42
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.41
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.27
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.26
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.37
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.36
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4.69
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4.69
|
| Rate for Payer: Blue Shield of California Commercial |
$2.10
|
| Rate for Payer: Blue Shield of California Commercial |
$2.10
|
| Rate for Payer: Blue Shield of California EPN |
$2.10
|
| Rate for Payer: Blue Shield of California EPN |
$2.10
|
| Rate for Payer: Cash Price |
$0.27
|
| Rate for Payer: Cash Price |
$0.27
|
| Rate for Payer: Cash Price |
$0.27
|
| Rate for Payer: Cash Price |
$0.27
|
| Rate for Payer: Cigna of CA HMO |
$0.34
|
| Rate for Payer: Cigna of CA HMO |
$0.34
|
| Rate for Payer: Cigna of CA PPO |
$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 Commercial/Exchange |
$0.42
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.42
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.41
|
| Rate for Payer: Dignity Health Medicare Advantage |
$0.41
|
| Rate for Payer: Dignity Health Medicare Advantage |
$0.42
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.19
|
| Rate for Payer: EPIC Health Plan Senior |
$0.19
|
| Rate for Payer: EPIC Health Plan Senior |
$0.20
|
| Rate for Payer: Galaxy Health WC |
$0.42
|
| Rate for Payer: Galaxy Health WC |
$0.41
|
| Rate for Payer: Global Benefits Group Commercial |
$0.29
|
| Rate for Payer: Global Benefits Group Commercial |
$0.29
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$1.12
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$1.12
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.32
|
| 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: Kaiser Permanente of CA Medi-Cal |
$0.18
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$0.30
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$0.30
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.12
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.12
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$0.34
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$0.34
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$0.34
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$0.34
|
| Rate for Payer: Multiplan Commercial |
$0.39
|
| Rate for Payer: Multiplan Commercial |
$0.38
|
| Rate for Payer: Networks By Design Commercial |
$0.25
|
| Rate for Payer: Networks By Design Commercial |
$0.24
|
| Rate for Payer: Prime Health Services Commercial |
$0.41
|
| Rate for Payer: Prime Health Services Commercial |
$0.42
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$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: TriValley Medical Group Commercial/Senior |
$0.29
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.18
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.18
|
| Rate for Payer: United Healthcare All Other HMO |
$0.18
|
| Rate for Payer: United Healthcare All Other HMO |
$0.18
|
| Rate for Payer: United Healthcare HMO Rider |
$0.18
|
| Rate for Payer: United Healthcare HMO Rider |
$0.17
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.16
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.16
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.42
|
| 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 Medi-Cal |
$0.42
|
| Rate for Payer: Vantage Medical Group Senior |
$0.41
|
| Rate for Payer: Vantage Medical Group Senior |
$0.42
|
|
|
PIPERACILLIN-TAZOBACTAM 3.375 GRAM/50 ML DEXTROSE(ISO-OS) IV PIGGYBACK [34524]
|
Facility
|
IP
|
$0.49
|
|
|
Service Code
|
HCPCS J2543
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.10 |
| Max. Negotiated Rate |
$0.42 |
| Rate for Payer: Adventist Health Commercial |
$0.10
|
| Rate for Payer: Adventist Health Commercial |
$0.10
|
| Rate for Payer: Blue Shield of California Commercial |
$0.36
|
| Rate for Payer: Blue Shield of California Commercial |
$0.35
|
| Rate for Payer: Blue Shield of California EPN |
$0.23
|
| Rate for Payer: Blue Shield of California EPN |
$0.24
|
| Rate for Payer: Cash Price |
$0.27
|
| Rate for Payer: Cash Price |
$0.27
|
| Rate for Payer: Cigna of CA HMO |
$0.34
|
| Rate for Payer: Cigna of CA HMO |
$0.34
|
| Rate for Payer: Cigna of CA PPO |
$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 Commercial |
$0.20
|
| Rate for Payer: EPIC Health Plan Senior |
$0.19
|
| Rate for Payer: EPIC Health Plan Senior |
$0.20
|
| Rate for Payer: Galaxy Health WC |
$0.41
|
| Rate for Payer: Galaxy Health WC |
$0.42
|
| Rate for Payer: Global Benefits Group Commercial |
$0.29
|
| 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 Commercial/Self Funded |
$0.32
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.18
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.19
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$0.30
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$0.30
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.12
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.12
|
| Rate for Payer: Multiplan Commercial |
$0.38
|
| Rate for Payer: Multiplan Commercial |
$0.39
|
| Rate for Payer: Networks By Design Commercial |
$0.25
|
| Rate for Payer: Networks By Design Commercial |
$0.24
|
| Rate for Payer: Prime Health Services Commercial |
$0.42
|
| Rate for Payer: Prime Health Services Commercial |
$0.41
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.18
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.18
|
| Rate for Payer: United Healthcare All Other HMO |
$0.18
|
| Rate for Payer: United Healthcare All Other HMO |
$0.18
|
| Rate for Payer: United Healthcare HMO Rider |
$0.17
|
| Rate for Payer: United Healthcare HMO Rider |
$0.18
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.16
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.16
|
|
|
PIPERACILLIN-TAZOBACTAM 3.375 GRAM/50 ML IN D5W INFUSION ADMIXTURE KIT (ADSOK) [504084141]
|
Facility
|
IP
|
$2.69
|
|
|
Service Code
|
NDC 9994-8147-10
|
| Min. Negotiated Rate |
$0.54 |
| Max. Negotiated Rate |
$2.29 |
| Rate for Payer: Adventist Health Commercial |
$0.54
|
| Rate for Payer: Cash Price |
$1.48
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.08
|
| Rate for Payer: EPIC Health Plan Senior |
$1.08
|
| Rate for Payer: Galaxy Health WC |
$2.29
|
| Rate for Payer: Global Benefits Group Commercial |
$1.61
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1.79
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1.02
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1.67
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.65
|
| Rate for Payer: Multiplan Commercial |
$2.15
|
| Rate for Payer: Networks By Design Commercial |
$1.75
|
| Rate for Payer: Prime Health Services Commercial |
$2.29
|
|
|
PIPERACILLIN-TAZOBACTAM 3.375 GRAM/50 ML IN D5W INFUSION ADMIXTURE KIT (ADSOK) [504084141]
|
Facility
|
OP
|
$2.69
|
|
|
Service Code
|
NDC 9994-8147-10
|
| Min. Negotiated Rate |
$0.54 |
| Max. Negotiated Rate |
$2.29 |
| Rate for Payer: Adventist Health Commercial |
$0.54
|
| Rate for Payer: Aetna of CA HMO/PPO |
$1.76
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2.29
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1.48
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2.02
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1.65
|
| Rate for Payer: Cash Price |
$1.48
|
| Rate for Payer: Cigna of CA HMO |
$1.72
|
| Rate for Payer: Cigna of CA PPO |
$1.99
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2.29
|
| Rate for Payer: Dignity Health Medi-Cal |
$2.29
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2.29
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.08
|
| Rate for Payer: EPIC Health Plan Senior |
$1.08
|
| Rate for Payer: Galaxy Health WC |
$2.29
|
| Rate for Payer: Global Benefits Group Commercial |
$1.61
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1.79
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1.02
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1.67
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.65
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1.88
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1.88
|
| Rate for Payer: Multiplan Commercial |
$2.15
|
| Rate for Payer: Networks By Design Commercial |
$1.75
|
| Rate for Payer: Prime Health Services Commercial |
$2.29
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1.61
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1.61
|
| Rate for Payer: United Healthcare All Other Commercial |
$1.34
|
| Rate for Payer: United Healthcare All Other HMO |
$1.34
|
| Rate for Payer: United Healthcare HMO Rider |
$1.34
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1.34
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2.29
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2.29
|
| Rate for Payer: Vantage Medical Group Senior |
$2.29
|
|
|
PIPERACILLIN-TAZOBACTAM 3.375 GRAM INTRAVENOUS SOLUTION [18303]
|
Facility
|
OP
|
$6.60
|
|
|
Service Code
|
HCPCS J2543
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.12 |
| Max. Negotiated Rate |
$5.61 |
| Rate for Payer: Adventist Health Commercial |
$1.32
|
| Rate for Payer: Adventist Health Commercial |
$0.84
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2.75
|
| Rate for Payer: Aetna of CA HMO/PPO |
$4.33
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$5.61
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3.57
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$3.63
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2.31
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4.95
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$3.15
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4.69
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4.69
|
| Rate for Payer: Blue Shield of California Commercial |
$2.10
|
| Rate for Payer: Blue Shield of California Commercial |
$2.10
|
| Rate for Payer: Blue Shield of California EPN |
$2.10
|
| Rate for Payer: Blue Shield of California EPN |
$2.10
|
| Rate for Payer: Cash Price |
$3.63
|
| Rate for Payer: Cash Price |
$2.31
|
| Rate for Payer: Cash Price |
$3.63
|
| Rate for Payer: Cash Price |
$2.31
|
| Rate for Payer: Cigna of CA HMO |
$4.62
|
| Rate for Payer: Cigna of CA HMO |
$2.94
|
| Rate for Payer: Cigna of CA PPO |
$4.62
|
| Rate for Payer: Cigna of CA PPO |
$2.94
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3.57
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$5.61
|
| Rate for Payer: Dignity Health Medi-Cal |
$5.61
|
| Rate for Payer: Dignity Health Medi-Cal |
$3.57
|
| Rate for Payer: Dignity Health Medicare Advantage |
$3.57
|
| Rate for Payer: Dignity Health Medicare Advantage |
$5.61
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.64
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.68
|
| Rate for Payer: EPIC Health Plan Senior |
$1.68
|
| Rate for Payer: EPIC Health Plan Senior |
$2.64
|
| Rate for Payer: Galaxy Health WC |
$5.61
|
| Rate for Payer: Galaxy Health WC |
$3.57
|
| Rate for Payer: Global Benefits Group Commercial |
$3.96
|
| Rate for Payer: Global Benefits Group Commercial |
$2.52
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$1.12
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$1.12
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4.40
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2.51
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1.60
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2.60
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4.09
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.58
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.01
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$4.62
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2.94
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$4.62
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2.94
|
| Rate for Payer: Multiplan Commercial |
$5.28
|
| Rate for Payer: Multiplan Commercial |
$3.36
|
| Rate for Payer: Networks By Design Commercial |
$3.30
|
| Rate for Payer: Networks By Design Commercial |
$2.10
|
| Rate for Payer: Prime Health Services Commercial |
$3.57
|
| Rate for Payer: Prime Health Services Commercial |
$5.61
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2.52
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3.96
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2.52
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$3.96
|
| Rate for Payer: United Healthcare All Other Commercial |
$1.58
|
| Rate for Payer: United Healthcare All Other Commercial |
$2.48
|
| Rate for Payer: United Healthcare All Other HMO |
$1.53
|
| Rate for Payer: United Healthcare All Other HMO |
$2.41
|
| Rate for Payer: United Healthcare HMO Rider |
$2.36
|
| Rate for Payer: United Healthcare HMO Rider |
$1.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1.38
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2.16
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$5.61
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3.57
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$3.57
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$5.61
|
| Rate for Payer: Vantage Medical Group Senior |
$3.57
|
| Rate for Payer: Vantage Medical Group Senior |
$5.61
|
|
|
PIPERACILLIN-TAZOBACTAM 3.375 GRAM INTRAVENOUS SOLUTION [18303]
|
Facility
|
IP
|
$6.60
|
|
|
Service Code
|
HCPCS J2543
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.32 |
| Max. Negotiated Rate |
$5.61 |
| Rate for Payer: Adventist Health Commercial |
$1.32
|
| Rate for Payer: Adventist Health Commercial |
$0.84
|
| Rate for Payer: Blue Shield of California Commercial |
$4.87
|
| Rate for Payer: Blue Shield of California Commercial |
$3.10
|
| Rate for Payer: Blue Shield of California EPN |
$2.04
|
| Rate for Payer: Blue Shield of California EPN |
$3.21
|
| Rate for Payer: Cash Price |
$3.63
|
| Rate for Payer: Cash Price |
$2.31
|
| Rate for Payer: Cigna of CA HMO |
$4.62
|
| Rate for Payer: Cigna of CA HMO |
$2.94
|
| Rate for Payer: Cigna of CA PPO |
$2.94
|
| Rate for Payer: Cigna of CA PPO |
$4.62
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.68
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.64
|
| Rate for Payer: EPIC Health Plan Senior |
$1.68
|
| Rate for Payer: EPIC Health Plan Senior |
$2.64
|
| Rate for Payer: Galaxy Health WC |
$3.57
|
| Rate for Payer: Galaxy Health WC |
$5.61
|
| Rate for Payer: Global Benefits Group Commercial |
$2.52
|
| Rate for Payer: Global Benefits Group Commercial |
$3.96
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2.80
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1.60
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2.51
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2.60
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4.09
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.01
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.58
|
| Rate for Payer: Multiplan Commercial |
$3.36
|
| Rate for Payer: Multiplan Commercial |
$5.28
|
| Rate for Payer: Networks By Design Commercial |
$3.30
|
| Rate for Payer: Networks By Design Commercial |
$2.10
|
| Rate for Payer: Prime Health Services Commercial |
$5.61
|
| Rate for Payer: Prime Health Services Commercial |
$3.57
|
| Rate for Payer: United Healthcare All Other Commercial |
$1.58
|
| Rate for Payer: United Healthcare All Other Commercial |
$2.48
|
| Rate for Payer: United Healthcare All Other HMO |
$2.41
|
| Rate for Payer: United Healthcare All Other HMO |
$1.53
|
| Rate for Payer: United Healthcare HMO Rider |
$1.50
|
| Rate for Payer: United Healthcare HMO Rider |
$2.36
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1.38
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2.16
|
|
|
PIPERACILLIN-TAZOBACTAM 40.5 GRAM INTRAVENOUS SOLUTION [12587]
|
Facility
|
IP
|
$176.12
|
|
|
Service Code
|
HCPCS J2543
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$35.22 |
| Max. Negotiated Rate |
$149.70 |
| Rate for Payer: Adventist Health Commercial |
$35.22
|
| Rate for Payer: Adventist Health Commercial |
$16.56
|
| Rate for Payer: Adventist Health Commercial |
$17.50
|
| Rate for Payer: Blue Shield of California Commercial |
$61.11
|
| Rate for Payer: Blue Shield of California Commercial |
$64.56
|
| Rate for Payer: Blue Shield of California Commercial |
$129.98
|
| Rate for Payer: Blue Shield of California EPN |
$40.24
|
| Rate for Payer: Blue Shield of California EPN |
$85.59
|
| Rate for Payer: Blue Shield of California EPN |
$42.52
|
| Rate for Payer: Cash Price |
$45.54
|
| Rate for Payer: Cash Price |
$96.87
|
| Rate for Payer: Cash Price |
$48.11
|
| Rate for Payer: Cigna of CA HMO |
$57.96
|
| Rate for Payer: Cigna of CA HMO |
$123.28
|
| Rate for Payer: Cigna of CA HMO |
$61.24
|
| Rate for Payer: Cigna of CA PPO |
$57.96
|
| Rate for Payer: Cigna of CA PPO |
$123.28
|
| Rate for Payer: Cigna of CA PPO |
$61.24
|
| Rate for Payer: EPIC Health Plan Commercial |
$70.45
|
| Rate for Payer: EPIC Health Plan Commercial |
$33.12
|
| Rate for Payer: EPIC Health Plan Commercial |
$34.99
|
| Rate for Payer: EPIC Health Plan Senior |
$34.99
|
| Rate for Payer: EPIC Health Plan Senior |
$70.45
|
| Rate for Payer: EPIC Health Plan Senior |
$33.12
|
| Rate for Payer: Galaxy Health WC |
$70.38
|
| Rate for Payer: Galaxy Health WC |
$149.70
|
| Rate for Payer: Galaxy Health WC |
$74.36
|
| Rate for Payer: Global Benefits Group Commercial |
$52.49
|
| Rate for Payer: Global Benefits Group Commercial |
$105.67
|
| Rate for Payer: Global Benefits Group Commercial |
$49.68
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$55.23
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$117.47
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$58.35
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$67.10
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$31.55
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$33.33
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$51.25
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$109.02
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$54.15
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$42.27
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$19.87
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$21.00
|
| Rate for Payer: Multiplan Commercial |
$140.90
|
| Rate for Payer: Multiplan Commercial |
$66.24
|
| Rate for Payer: Multiplan Commercial |
$69.98
|
| Rate for Payer: Networks By Design Commercial |
$41.40
|
| Rate for Payer: Networks By Design Commercial |
$43.74
|
| Rate for Payer: Networks By Design Commercial |
$88.06
|
| Rate for Payer: Prime Health Services Commercial |
$149.70
|
| Rate for Payer: Prime Health Services Commercial |
$70.38
|
| Rate for Payer: Prime Health Services Commercial |
$74.36
|
| Rate for Payer: United Healthcare All Other Commercial |
$31.07
|
| Rate for Payer: United Healthcare All Other Commercial |
$66.10
|
| Rate for Payer: United Healthcare All Other Commercial |
$32.83
|
| Rate for Payer: United Healthcare All Other HMO |
$31.96
|
| Rate for Payer: United Healthcare All Other HMO |
$64.34
|
| Rate for Payer: United Healthcare All Other HMO |
$30.25
|
| Rate for Payer: United Healthcare HMO Rider |
$29.59
|
| Rate for Payer: United Healthcare HMO Rider |
$31.27
|
| Rate for Payer: United Healthcare HMO Rider |
$62.95
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$28.65
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$57.68
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$27.12
|
|
|
PIPERACILLIN-TAZOBACTAM 40.5 GRAM INTRAVENOUS SOLUTION [12587]
|
Facility
|
OP
|
$82.80
|
|
|
Service Code
|
HCPCS J2543
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.12 |
| Max. Negotiated Rate |
$70.38 |
| Rate for Payer: Adventist Health Commercial |
$16.56
|
| Rate for Payer: Adventist Health Commercial |
$17.50
|
| Rate for Payer: Adventist Health Commercial |
$35.22
|
| Rate for Payer: Aetna of CA HMO/PPO |
$115.52
|
| Rate for Payer: Aetna of CA HMO/PPO |
$54.31
|
| Rate for Payer: Aetna of CA HMO/PPO |
$57.38
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$74.36
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$70.38
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$149.70
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$45.54
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$96.87
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$48.11
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$132.09
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$62.10
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$65.61
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4.69
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4.69
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4.69
|
| Rate for Payer: Blue Shield of California Commercial |
$2.10
|
| Rate for Payer: Blue Shield of California Commercial |
$2.10
|
| Rate for Payer: Blue Shield of California Commercial |
$2.10
|
| Rate for Payer: Blue Shield of California EPN |
$2.10
|
| Rate for Payer: Blue Shield of California EPN |
$2.10
|
| Rate for Payer: Blue Shield of California EPN |
$2.10
|
| Rate for Payer: Cash Price |
$48.11
|
| Rate for Payer: Cash Price |
$96.87
|
| Rate for Payer: Cash Price |
$45.54
|
| Rate for Payer: Cash Price |
$96.87
|
| Rate for Payer: Cash Price |
$48.11
|
| Rate for Payer: Cash Price |
$45.54
|
| Rate for Payer: Cigna of CA HMO |
$61.24
|
| Rate for Payer: Cigna of CA HMO |
$57.96
|
| Rate for Payer: Cigna of CA HMO |
$123.28
|
| Rate for Payer: Cigna of CA PPO |
$123.28
|
| Rate for Payer: Cigna of CA PPO |
$61.24
|
| Rate for Payer: Cigna of CA PPO |
$57.96
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$74.36
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$149.70
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$70.38
|
| Rate for Payer: Dignity Health Medi-Cal |
$74.36
|
| Rate for Payer: Dignity Health Medi-Cal |
$70.38
|
| Rate for Payer: Dignity Health Medi-Cal |
$149.70
|
| Rate for Payer: Dignity Health Medicare Advantage |
$70.38
|
| Rate for Payer: Dignity Health Medicare Advantage |
$149.70
|
| Rate for Payer: Dignity Health Medicare Advantage |
$74.36
|
| Rate for Payer: EPIC Health Plan Commercial |
$70.45
|
| Rate for Payer: EPIC Health Plan Commercial |
$34.99
|
| Rate for Payer: EPIC Health Plan Commercial |
$33.12
|
| Rate for Payer: EPIC Health Plan Senior |
$33.12
|
| Rate for Payer: EPIC Health Plan Senior |
$70.45
|
| Rate for Payer: EPIC Health Plan Senior |
$34.99
|
| Rate for Payer: Galaxy Health WC |
$70.38
|
| Rate for Payer: Galaxy Health WC |
$74.36
|
| Rate for Payer: Galaxy Health WC |
$149.70
|
| Rate for Payer: Global Benefits Group Commercial |
$49.68
|
| Rate for Payer: Global Benefits Group Commercial |
$105.67
|
| Rate for Payer: Global Benefits Group Commercial |
$52.49
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$1.12
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$1.12
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$1.12
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$58.35
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$117.47
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$55.23
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$31.55
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$67.10
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$33.33
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$109.02
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$51.25
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$54.15
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$21.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$19.87
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$42.27
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$123.28
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$57.96
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$61.24
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$61.24
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$57.96
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$123.28
|
| Rate for Payer: Multiplan Commercial |
$66.24
|
| Rate for Payer: Multiplan Commercial |
$69.98
|
| Rate for Payer: Multiplan Commercial |
$140.90
|
| Rate for Payer: Networks By Design Commercial |
$43.74
|
| Rate for Payer: Networks By Design Commercial |
$41.40
|
| Rate for Payer: Networks By Design Commercial |
$88.06
|
| Rate for Payer: Prime Health Services Commercial |
$74.36
|
| Rate for Payer: Prime Health Services Commercial |
$149.70
|
| Rate for Payer: Prime Health Services Commercial |
$70.38
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$49.68
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$52.49
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$105.67
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$105.67
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$52.49
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$49.68
|
| Rate for Payer: United Healthcare All Other Commercial |
$31.07
|
| Rate for Payer: United Healthcare All Other Commercial |
$32.83
|
| Rate for Payer: United Healthcare All Other Commercial |
$66.10
|
| Rate for Payer: United Healthcare All Other HMO |
$31.96
|
| Rate for Payer: United Healthcare All Other HMO |
$30.25
|
| Rate for Payer: United Healthcare All Other HMO |
$64.34
|
| Rate for Payer: United Healthcare HMO Rider |
$62.95
|
| Rate for Payer: United Healthcare HMO Rider |
$31.27
|
| Rate for Payer: United Healthcare HMO Rider |
$29.59
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$28.65
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$27.12
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$57.68
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$70.38
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$149.70
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$74.36
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$70.38
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$149.70
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$74.36
|
| Rate for Payer: Vantage Medical Group Senior |
$149.70
|
| Rate for Payer: Vantage Medical Group Senior |
$74.36
|
| Rate for Payer: Vantage Medical Group Senior |
$70.38
|
|
|
PIPERACILLIN-TAZOBACTAM 4.5 GRAM/100 ML DEXTROSE(ISO-OSM) IV PIGGYBACK [108121]
|
Facility
|
IP
|
$0.30
|
|
|
Service Code
|
HCPCS J2543
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.06 |
| Max. Negotiated Rate |
$0.26 |
| Rate for Payer: Adventist Health Commercial |
$0.06
|
| Rate for Payer: Blue Shield of California Commercial |
$0.22
|
| Rate for Payer: Blue Shield of California EPN |
$0.15
|
| Rate for Payer: Cash Price |
$0.17
|
| Rate for Payer: Cigna of CA HMO |
$0.21
|
| Rate for Payer: Cigna of CA PPO |
$0.21
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.12
|
| Rate for Payer: EPIC Health Plan Senior |
$0.12
|
| Rate for Payer: Galaxy Health WC |
$0.26
|
| Rate for Payer: Global Benefits Group Commercial |
$0.18
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.20
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.11
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$0.19
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.07
|
| Rate for Payer: Multiplan Commercial |
$0.24
|
| Rate for Payer: Networks By Design Commercial |
$0.15
|
| Rate for Payer: Prime Health Services Commercial |
$0.26
|
| 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 |
$0.10
|
|
|
PIPERACILLIN-TAZOBACTAM 4.5 GRAM/100 ML DEXTROSE(ISO-OSM) IV PIGGYBACK [108121]
|
Facility
|
OP
|
$0.30
|
|
|
Service Code
|
HCPCS J2543
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.06 |
| Max. Negotiated Rate |
$4.69 |
| Rate for Payer: Adventist Health Commercial |
$0.06
|
| Rate for Payer: Aetna of CA HMO/PPO |
$0.20
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.26
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.17
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.23
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4.69
|
| Rate for Payer: Blue Shield of California Commercial |
$2.10
|
| Rate for Payer: Blue Shield of California EPN |
$2.10
|
| Rate for Payer: Cash Price |
$0.17
|
| Rate for Payer: Cash Price |
$0.17
|
| Rate for Payer: Cigna of CA HMO |
$0.21
|
| Rate for Payer: Cigna of CA PPO |
$0.21
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.26
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.26
|
| Rate for Payer: Dignity Health Medicare Advantage |
$0.26
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.12
|
| Rate for Payer: EPIC Health Plan Senior |
$0.12
|
| Rate for Payer: Galaxy Health WC |
$0.26
|
| Rate for Payer: Global Benefits Group Commercial |
$0.18
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$1.12
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.20
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.11
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$0.19
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.07
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$0.21
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$0.21
|
| Rate for Payer: Multiplan Commercial |
$0.24
|
| Rate for Payer: Networks By Design Commercial |
$0.15
|
| Rate for Payer: Prime Health Services Commercial |
$0.26
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.18
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.18
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.11
|
| 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 |
$0.10
|
| 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
|
$6.73
|
|
|
Service Code
|
HCPCS J2543
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.35 |
| Max. Negotiated Rate |
$5.72 |
| Rate for Payer: Networks By Design Commercial |
$3.37
|
| Rate for Payer: Adventist Health Commercial |
$1.35
|
| Rate for Payer: Adventist Health Commercial |
$1.63
|
| Rate for Payer: Adventist Health Commercial |
$2.54
|
| Rate for Payer: Adventist Health Commercial |
$1.56
|
| Rate for Payer: Blue Shield of California Commercial |
$9.37
|
| Rate for Payer: Blue Shield of California Commercial |
$6.02
|
| Rate for Payer: Blue Shield of California Commercial |
$5.76
|
| Rate for Payer: Blue Shield of California Commercial |
$4.97
|
| Rate for Payer: Blue Shield of California EPN |
$6.17
|
| Rate for Payer: Blue Shield of California EPN |
$3.27
|
| Rate for Payer: Blue Shield of California EPN |
$3.79
|
| Rate for Payer: Blue Shield of California EPN |
$3.97
|
| Rate for Payer: Cash Price |
$4.29
|
| Rate for Payer: Cash Price |
$6.98
|
| Rate for Payer: Cash Price |
$4.49
|
| Rate for Payer: Cash Price |
$3.70
|
| Rate for Payer: Cigna of CA HMO |
$8.89
|
| Rate for Payer: Cigna of CA HMO |
$5.46
|
| Rate for Payer: Cigna of CA HMO |
$4.71
|
| Rate for Payer: Cigna of CA HMO |
$5.71
|
| Rate for Payer: Cigna of CA PPO |
$5.71
|
| Rate for Payer: Cigna of CA PPO |
$5.46
|
| Rate for Payer: Cigna of CA PPO |
$8.89
|
| Rate for Payer: Cigna of CA PPO |
$4.71
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.69
|
| Rate for Payer: EPIC Health Plan Commercial |
$3.12
|
| Rate for Payer: EPIC Health Plan Commercial |
$5.08
|
| Rate for Payer: EPIC Health Plan Commercial |
$3.26
|
| Rate for Payer: EPIC Health Plan Senior |
$5.08
|
| Rate for Payer: EPIC Health Plan Senior |
$3.12
|
| Rate for Payer: EPIC Health Plan Senior |
$2.69
|
| Rate for Payer: EPIC Health Plan Senior |
$3.26
|
| Rate for Payer: Galaxy Health WC |
$10.79
|
| Rate for Payer: Galaxy Health WC |
$5.72
|
| Rate for Payer: Galaxy Health WC |
$6.63
|
| Rate for Payer: Galaxy Health WC |
$6.94
|
| Rate for Payer: Global Benefits Group Commercial |
$4.90
|
| Rate for Payer: Global Benefits Group Commercial |
$7.62
|
| Rate for Payer: Global Benefits Group Commercial |
$4.68
|
| Rate for Payer: Global Benefits Group Commercial |
$4.04
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$5.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4.49
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$5.44
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$8.47
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2.97
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2.56
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3.11
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4.84
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$7.86
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4.17
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4.83
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$5.05
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.62
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.05
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.87
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.96
|
| Rate for Payer: Multiplan Commercial |
$10.16
|
| Rate for Payer: Multiplan Commercial |
$6.24
|
| Rate for Payer: Multiplan Commercial |
$5.38
|
| Rate for Payer: Multiplan Commercial |
$6.53
|
| Rate for Payer: Networks By Design Commercial |
$3.90
|
| Rate for Payer: Networks By Design Commercial |
$4.08
|
| Rate for Payer: Networks By Design Commercial |
$6.35
|
| Rate for Payer: Prime Health Services Commercial |
$6.63
|
| Rate for Payer: Prime Health Services Commercial |
$10.79
|
| Rate for Payer: Prime Health Services Commercial |
$6.94
|
| Rate for Payer: Prime Health Services Commercial |
$5.72
|
| Rate for Payer: United Healthcare All Other Commercial |
$2.93
|
| Rate for Payer: United Healthcare All Other Commercial |
$2.53
|
| Rate for Payer: United Healthcare All Other Commercial |
$4.77
|
| Rate for Payer: United Healthcare All Other Commercial |
$3.06
|
| Rate for Payer: United Healthcare All Other HMO |
$2.46
|
| Rate for Payer: United Healthcare All Other HMO |
$2.98
|
| Rate for Payer: United Healthcare All Other HMO |
$2.85
|
| Rate for Payer: United Healthcare All Other HMO |
$4.64
|
| Rate for Payer: United Healthcare HMO Rider |
$2.41
|
| Rate for Payer: United Healthcare HMO Rider |
$4.54
|
| Rate for Payer: United Healthcare HMO Rider |
$2.92
|
| Rate for Payer: United Healthcare HMO Rider |
$2.79
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2.20
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$4.16
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2.67
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2.55
|
|
|
PIPERACILLIN-TAZOBACTAM 4.5 GRAM INTRAVENOUS SOLUTION [18302]
|
Facility
|
OP
|
$7.80
|
|
|
Service Code
|
HCPCS J2543
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.12 |
| Max. Negotiated Rate |
$6.63 |
| Rate for Payer: Adventist Health Commercial |
$1.56
|
| Rate for Payer: Adventist Health Commercial |
$1.63
|
| Rate for Payer: Adventist Health Commercial |
$2.54
|
| Rate for Payer: Adventist Health Commercial |
$1.35
|
| Rate for Payer: Aetna of CA HMO/PPO |
$5.12
|
| Rate for Payer: Aetna of CA HMO/PPO |
$4.41
|
| Rate for Payer: Aetna of CA HMO/PPO |
$5.35
|
| Rate for Payer: Aetna of CA HMO/PPO |
$8.33
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$6.94
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$10.79
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$5.72
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$6.63
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$6.99
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4.29
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4.49
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$3.70
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$9.53
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$5.05
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$5.85
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$6.12
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4.69
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4.69
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4.69
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4.69
|
| Rate for Payer: Blue Shield of California Commercial |
$2.10
|
| Rate for Payer: Blue Shield of California Commercial |
$2.10
|
| Rate for Payer: Blue Shield of California Commercial |
$2.10
|
| Rate for Payer: Blue Shield of California Commercial |
$2.10
|
| Rate for Payer: Blue Shield of California EPN |
$2.10
|
| Rate for Payer: Blue Shield of California EPN |
$2.10
|
| Rate for Payer: Blue Shield of California EPN |
$2.10
|
| Rate for Payer: Blue Shield of California EPN |
$2.10
|
| Rate for Payer: Cash Price |
$4.29
|
| Rate for Payer: Cash Price |
$3.70
|
| Rate for Payer: Cash Price |
$6.98
|
| Rate for Payer: Cash Price |
$3.70
|
| Rate for Payer: Cash Price |
$6.98
|
| Rate for Payer: Cash Price |
$4.49
|
| Rate for Payer: Cash Price |
$4.49
|
| Rate for Payer: Cash Price |
$4.29
|
| Rate for Payer: Cigna of CA HMO |
$8.89
|
| Rate for Payer: Cigna of CA HMO |
$5.71
|
| Rate for Payer: Cigna of CA HMO |
$4.71
|
| Rate for Payer: Cigna of CA HMO |
$5.46
|
| Rate for Payer: Cigna of CA PPO |
$4.71
|
| Rate for Payer: Cigna of CA PPO |
$8.89
|
| Rate for Payer: Cigna of CA PPO |
$5.46
|
| Rate for Payer: Cigna of CA PPO |
$5.71
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$6.94
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$5.72
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$10.79
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$6.63
|
| Rate for Payer: Dignity Health Medi-Cal |
$10.79
|
| Rate for Payer: Dignity Health Medi-Cal |
$6.63
|
| Rate for Payer: Dignity Health Medi-Cal |
$6.94
|
| Rate for Payer: Dignity Health Medi-Cal |
$5.72
|
| Rate for Payer: Dignity Health Medicare Advantage |
$6.94
|
| Rate for Payer: Dignity Health Medicare Advantage |
$6.63
|
| Rate for Payer: Dignity Health Medicare Advantage |
$5.72
|
| Rate for Payer: Dignity Health Medicare Advantage |
$10.79
|
| Rate for Payer: EPIC Health Plan Commercial |
$3.26
|
| Rate for Payer: EPIC Health Plan Commercial |
$5.08
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.69
|
| Rate for Payer: EPIC Health Plan Commercial |
$3.12
|
| Rate for Payer: EPIC Health Plan Senior |
$3.12
|
| Rate for Payer: EPIC Health Plan Senior |
$5.08
|
| Rate for Payer: EPIC Health Plan Senior |
$2.69
|
| Rate for Payer: EPIC Health Plan Senior |
$3.26
|
| Rate for Payer: Galaxy Health WC |
$5.72
|
| Rate for Payer: Galaxy Health WC |
$6.63
|
| Rate for Payer: Galaxy Health WC |
$10.79
|
| Rate for Payer: Galaxy Health WC |
$6.94
|
| Rate for Payer: Global Benefits Group Commercial |
$4.68
|
| Rate for Payer: Global Benefits Group Commercial |
$4.04
|
| Rate for Payer: Global Benefits Group Commercial |
$7.62
|
| Rate for Payer: Global Benefits Group Commercial |
$4.90
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$1.12
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$1.12
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$1.12
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$1.12
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$5.44
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4.49
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$8.47
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$5.20
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4.84
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2.56
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2.97
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3.11
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4.83
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$7.86
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4.17
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$5.05
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.87
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.05
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.62
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.96
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$5.71
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$8.89
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$4.71
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$5.46
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$8.89
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$5.71
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$5.46
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$4.71
|
| Rate for Payer: Multiplan Commercial |
$10.16
|
| Rate for Payer: Multiplan Commercial |
$6.53
|
| Rate for Payer: Multiplan Commercial |
$6.24
|
| Rate for Payer: Multiplan Commercial |
$5.38
|
| Rate for Payer: Networks By Design Commercial |
$4.08
|
| Rate for Payer: Networks By Design Commercial |
$3.37
|
| Rate for Payer: Networks By Design Commercial |
$3.90
|
| Rate for Payer: Networks By Design Commercial |
$6.35
|
| Rate for Payer: Prime Health Services Commercial |
$6.63
|
| Rate for Payer: Prime Health Services Commercial |
$6.94
|
| Rate for Payer: Prime Health Services Commercial |
$5.72
|
| Rate for Payer: Prime Health Services Commercial |
$10.79
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$4.90
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$4.04
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$7.62
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$4.68
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$7.62
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$4.04
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$4.68
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$4.90
|
| Rate for Payer: United Healthcare All Other Commercial |
$3.06
|
| Rate for Payer: United Healthcare All Other Commercial |
$2.93
|
| Rate for Payer: United Healthcare All Other Commercial |
$2.53
|
| Rate for Payer: United Healthcare All Other Commercial |
$4.77
|
| Rate for Payer: United Healthcare All Other HMO |
$2.85
|
| Rate for Payer: United Healthcare All Other HMO |
$2.98
|
| Rate for Payer: United Healthcare All Other HMO |
$2.46
|
| Rate for Payer: United Healthcare All Other HMO |
$4.64
|
| Rate for Payer: United Healthcare HMO Rider |
$2.92
|
| Rate for Payer: United Healthcare HMO Rider |
$2.79
|
| Rate for Payer: United Healthcare HMO Rider |
$2.41
|
| Rate for Payer: United Healthcare HMO Rider |
$4.54
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2.67
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$4.16
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2.55
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2.20
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$10.79
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$6.63
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$6.94
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$5.72
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$5.72
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$6.63
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$6.94
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$10.79
|
| Rate for Payer: Vantage Medical Group Senior |
$6.63
|
| Rate for Payer: Vantage Medical Group Senior |
$6.94
|
| Rate for Payer: Vantage Medical Group Senior |
$10.79
|
| Rate for Payer: Vantage Medical Group Senior |
$5.72
|
|
|
PLERIXAFOR 24 MG/1.2 ML (20 MG/ML) SUBCUTANEOUS SOLUTION [95849]
|
Facility
|
IP
|
$500.00
|
|
|
Service Code
|
HCPCS J2562
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$100.00 |
| Max. Negotiated Rate |
$425.00 |
| Rate for Payer: Adventist Health Commercial |
$100.00
|
| Rate for Payer: Blue Shield of California Commercial |
$369.00
|
| Rate for Payer: Blue Shield of California EPN |
$243.00
|
| Rate for Payer: Cash Price |
$275.00
|
| Rate for Payer: Cigna of CA HMO |
$350.00
|
| Rate for Payer: Cigna of CA PPO |
$350.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$200.00
|
| Rate for Payer: EPIC Health Plan Senior |
$200.00
|
| Rate for Payer: Galaxy Health WC |
$425.00
|
| Rate for Payer: Global Benefits Group Commercial |
$300.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$333.50
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$190.50
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$309.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$120.00
|
| Rate for Payer: Multiplan Commercial |
$400.00
|
| Rate for Payer: Networks By Design Commercial |
$250.00
|
| Rate for Payer: Prime Health Services Commercial |
$425.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$187.65
|
| Rate for Payer: United Healthcare All Other HMO |
$182.65
|
| Rate for Payer: United Healthcare HMO Rider |
$178.70
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$163.75
|
|
|
PLERIXAFOR 24 MG/1.2 ML (20 MG/ML) SUBCUTANEOUS SOLUTION [95849]
|
Facility
|
OP
|
$500.00
|
|
|
Service Code
|
HCPCS J2562
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$24.98 |
| Max. Negotiated Rate |
$425.00 |
| Rate for Payer: Adventist Health Commercial |
$100.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$327.95
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$149.34
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$131.42
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$131.42
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$88.13
|
| Rate for Payer: Blue Shield of California Commercial |
$43.07
|
| Rate for Payer: Blue Shield of California EPN |
$43.07
|
| Rate for Payer: Cash Price |
$275.00
|
| Rate for Payer: Cash Price |
$275.00
|
| Rate for Payer: Cigna of CA HMO |
$350.00
|
| Rate for Payer: Cigna of CA PPO |
$350.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$149.34
|
| Rate for Payer: Dignity Health Medi-Cal |
$131.42
|
| Rate for Payer: Dignity Health Medicare Advantage |
$131.42
|
| Rate for Payer: EPIC Health Plan Commercial |
$161.28
|
| Rate for Payer: EPIC Health Plan Senior |
$119.47
|
| Rate for Payer: Galaxy Health WC |
$425.00
|
| Rate for Payer: Global Benefits Group Commercial |
$300.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$195.93
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$24.98
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$119.47
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$333.50
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$78.93
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$119.47
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$120.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$150.53
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$160.09
|
| Rate for Payer: Multiplan Commercial |
$400.00
|
| Rate for Payer: Networks By Design Commercial |
$250.00
|
| Rate for Payer: Prime Health Services Commercial |
$425.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$300.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$300.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$187.65
|
| Rate for Payer: United Healthcare All Other HMO |
$182.65
|
| Rate for Payer: United Healthcare HMO Rider |
$178.70
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$163.75
|
| Rate for Payer: Upland Medical Group Pediatric |
$119.47
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$149.34
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$131.42
|
| Rate for Payer: Vantage Medical Group Senior |
$131.42
|
|
|
PNEUMOCOCCAL 20-VALENT CONJ VACCINE-DIP CRM (PF) 0.5 ML IM SYRINGE [231988]
|
Facility
|
OP
|
$657.24
|
|
|
Service Code
|
HCPCS 90677
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$131.45 |
| Max. Negotiated Rate |
$745.59 |
| Rate for Payer: EPIC Health Plan Senior |
$271.16
|
| Rate for Payer: Adventist Health Commercial |
$131.45
|
| Rate for Payer: Adventist Health Commercial |
$135.58
|
| Rate for Payer: Aetna of CA HMO/PPO |
$444.63
|
| Rate for Payer: Aetna of CA HMO/PPO |
$431.08
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$576.22
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$558.65
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$372.85
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$361.48
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$508.43
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$492.93
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$745.59
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$745.59
|
| Rate for Payer: Blue Shield of California Commercial |
$313.77
|
| Rate for Payer: Blue Shield of California Commercial |
$313.77
|
| Rate for Payer: Blue Shield of California EPN |
$313.77
|
| Rate for Payer: Blue Shield of California EPN |
$313.77
|
| Rate for Payer: Cash Price |
$361.48
|
| Rate for Payer: Cash Price |
$372.85
|
| Rate for Payer: Cash Price |
$361.48
|
| Rate for Payer: Cash Price |
$372.85
|
| Rate for Payer: Cigna of CA HMO |
$474.53
|
| Rate for Payer: Cigna of CA HMO |
$460.07
|
| Rate for Payer: Cigna of CA PPO |
$460.07
|
| Rate for Payer: Cigna of CA PPO |
$474.53
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$576.22
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$558.65
|
| Rate for Payer: Dignity Health Medi-Cal |
$576.22
|
| Rate for Payer: Dignity Health Medi-Cal |
$558.65
|
| Rate for Payer: Dignity Health Medicare Advantage |
$558.65
|
| Rate for Payer: Dignity Health Medicare Advantage |
$576.22
|
| Rate for Payer: EPIC Health Plan Commercial |
$262.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$271.16
|
| Rate for Payer: EPIC Health Plan Senior |
$262.90
|
| Rate for Payer: Galaxy Health WC |
$576.22
|
| Rate for Payer: Galaxy Health WC |
$558.65
|
| Rate for Payer: Global Benefits Group Commercial |
$406.74
|
| Rate for Payer: Global Benefits Group Commercial |
$394.34
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$312.90
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$312.90
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$438.38
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$452.16
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$574.75
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$574.75
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$419.62
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$406.83
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$162.70
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$157.74
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$460.07
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$474.53
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$460.07
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$474.53
|
| Rate for Payer: Multiplan Commercial |
$542.32
|
| Rate for Payer: Multiplan Commercial |
$525.79
|
| Rate for Payer: Networks By Design Commercial |
$338.95
|
| Rate for Payer: Networks By Design Commercial |
$328.62
|
| Rate for Payer: Prime Health Services Commercial |
$558.65
|
| Rate for Payer: Prime Health Services Commercial |
$576.22
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$394.34
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$406.74
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$394.34
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$406.74
|
| Rate for Payer: United Healthcare All Other Commercial |
$246.66
|
| Rate for Payer: United Healthcare All Other Commercial |
$254.42
|
| Rate for Payer: United Healthcare All Other HMO |
$240.09
|
| Rate for Payer: United Healthcare All Other HMO |
$247.64
|
| Rate for Payer: United Healthcare HMO Rider |
$242.28
|
| Rate for Payer: United Healthcare HMO Rider |
$234.90
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$215.25
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$222.01
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$576.22
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$558.65
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$558.65
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$576.22
|
| Rate for Payer: Vantage Medical Group Senior |
$558.65
|
| Rate for Payer: Vantage Medical Group Senior |
$576.22
|
|
