|
PALATOPLASTY FOR CLEFT PALATE, SOFT AND/OR HARD PALATE ONLY
|
Facility
|
OP
|
$32,312.00
|
|
|
Service Code
|
CPT 42200
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$226.41 |
| Max. Negotiated Rate |
$32,312.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$32,312.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$11,420.83
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$8,375.28
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$7,613.89
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$9,323.00
|
| Rate for Payer: Blue Shield of California Commercial |
$6,262.29
|
| Rate for Payer: Blue Shield of California Commercial |
$4,136.63
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$11,420.83
|
| Rate for Payer: Dignity Health Medi-Cal |
$8,375.28
|
| Rate for Payer: Dignity Health Medicare Advantage |
$7,613.89
|
| Rate for Payer: EPIC Health Plan Commercial |
$12,562.92
|
| Rate for Payer: EPIC Health Plan Senior |
$8,375.28
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$12,486.78
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$226.41
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$7,613.89
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$256.06
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$10,659.45
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$9,593.50
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$10,202.61
|
| Rate for Payer: Multiplan WC |
$11,976.10
|
| Rate for Payer: Prime Health Services WC |
$11,853.89
|
| Rate for Payer: United Healthcare All Other HMO |
$26,788.00
|
| Rate for Payer: United Healthcare HMO Rider |
$16,872.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$15,456.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$7,613.89
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$11,420.83
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$8,375.28
|
| Rate for Payer: Vantage Medical Group Senior |
$7,613.89
|
|
|
PALIFERMIN 5.16 MG INTRAVENOUS SOLUTION [239790]
|
Facility
|
IP
|
$4,601.84
|
|
|
Service Code
|
HCPCS J2425
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$920.37 |
| Max. Negotiated Rate |
$3,911.56 |
| Rate for Payer: Adventist Health Commercial |
$920.37
|
| Rate for Payer: Blue Shield of California Commercial |
$2,333.13
|
| Rate for Payer: Blue Shield of California Commercial |
$3,538.81
|
| Rate for Payer: Cash Price |
$2,070.83
|
| Rate for Payer: Cigna of CA HMO |
$3,221.29
|
| Rate for Payer: Cigna of CA PPO |
$3,221.29
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$3,221.29
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,840.74
|
| Rate for Payer: EPIC Health Plan Senior |
$1,840.74
|
| Rate for Payer: Galaxy Health WC |
$3,911.56
|
| Rate for Payer: Global Benefits Group Commercial |
$2,761.10
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$2,922.17
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2,715.09
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,104.44
|
| Rate for Payer: Multiplan Commercial |
$3,681.47
|
| Rate for Payer: Networks By Design Commercial |
$2,300.92
|
| Rate for Payer: Prime Health Services Commercial |
$3,911.56
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,727.07
|
| Rate for Payer: United Healthcare All Other HMO |
$1,681.05
|
| Rate for Payer: United Healthcare HMO Rider |
$1,644.70
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,507.10
|
|
|
PALIFERMIN 5.16 MG INTRAVENOUS SOLUTION [239790]
|
Facility
|
OP
|
$4,601.84
|
|
|
Service Code
|
HCPCS J2425
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$29.31 |
| Max. Negotiated Rate |
$3,911.56 |
| Rate for Payer: Adventist Health Commercial |
$920.37
|
| Rate for Payer: Aetna of CA HMO/PPO |
$213.78
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$48.36
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$42.56
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$42.56
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$29.31
|
| Rate for Payer: Blue Shield of California Commercial |
$38.53
|
| Rate for Payer: Cash Price |
$2,070.83
|
| Rate for Payer: Cash Price |
$2,070.83
|
| Rate for Payer: Cigna of CA HMO |
$3,221.29
|
| Rate for Payer: Cigna of CA PPO |
$3,221.29
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$48.36
|
| Rate for Payer: Dignity Health Medi-Cal |
$42.56
|
| Rate for Payer: Dignity Health Medicare Advantage |
$42.56
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$3,221.29
|
| Rate for Payer: EPIC Health Plan Commercial |
$63.84
|
| Rate for Payer: EPIC Health Plan Senior |
$42.56
|
| Rate for Payer: Galaxy Health WC |
$3,911.56
|
| Rate for Payer: Global Benefits Group Commercial |
$2,761.10
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$63.45
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$38.69
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$38.69
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$2,922.17
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$69.60
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$54.17
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,104.44
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$48.75
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$51.84
|
| Rate for Payer: Multiplan Commercial |
$3,681.47
|
| Rate for Payer: Networks By Design Commercial |
$2,300.92
|
| Rate for Payer: Prime Health Services Commercial |
$3,911.56
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,761.10
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2,761.10
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,727.07
|
| Rate for Payer: United Healthcare All Other HMO |
$1,681.05
|
| Rate for Payer: United Healthcare HMO Rider |
$1,644.70
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,507.10
|
| Rate for Payer: Upland Medical Group Pediatric |
$38.69
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$48.36
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$42.56
|
| Rate for Payer: Vantage Medical Group Senior |
$42.56
|
|
|
PALIPERIDONE PALMITATE 156 MG/ML INTRAMUSCULAR SYRINGE [99702]
|
Facility
|
OP
|
$2,923.92
|
|
|
Service Code
|
HCPCS J2426
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$15.43 |
| Max. Negotiated Rate |
$2,485.33 |
| Rate for Payer: Adventist Health Commercial |
$584.78
|
| Rate for Payer: Aetna of CA HMO/PPO |
$92.72
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$19.29
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$16.97
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$16.97
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$16.23
|
| Rate for Payer: Blue Shield of California Commercial |
$17.84
|
| Rate for Payer: Cash Price |
$1,315.76
|
| Rate for Payer: Cash Price |
$1,315.76
|
| Rate for Payer: Cigna of CA HMO |
$2,046.74
|
| Rate for Payer: Cigna of CA PPO |
$2,046.74
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$19.29
|
| Rate for Payer: Dignity Health Medi-Cal |
$16.97
|
| Rate for Payer: Dignity Health Medicare Advantage |
$16.97
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$2,046.74
|
| Rate for Payer: EPIC Health Plan Commercial |
$25.46
|
| Rate for Payer: EPIC Health Plan Senior |
$16.97
|
| Rate for Payer: Galaxy Health WC |
$2,485.33
|
| Rate for Payer: Global Benefits Group Commercial |
$1,754.35
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$25.31
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$15.43
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$15.43
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,856.69
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$37.18
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$21.60
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$701.74
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$19.44
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$20.68
|
| Rate for Payer: Multiplan Commercial |
$2,339.14
|
| Rate for Payer: Networks By Design Commercial |
$1,461.96
|
| Rate for Payer: Prime Health Services Commercial |
$2,485.33
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,754.35
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,754.35
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,097.35
|
| Rate for Payer: United Healthcare All Other HMO |
$1,068.11
|
| Rate for Payer: United Healthcare HMO Rider |
$1,045.01
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$957.58
|
| Rate for Payer: Upland Medical Group Pediatric |
$15.43
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$19.29
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$16.97
|
| Rate for Payer: Vantage Medical Group Senior |
$16.97
|
|
|
PALIPERIDONE PALMITATE 156 MG/ML INTRAMUSCULAR SYRINGE [99702]
|
Facility
|
IP
|
$2,923.92
|
|
|
Service Code
|
HCPCS J2426
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$584.78 |
| Max. Negotiated Rate |
$2,485.33 |
| Rate for Payer: Adventist Health Commercial |
$584.78
|
| Rate for Payer: Blue Shield of California Commercial |
$1,482.43
|
| Rate for Payer: Blue Shield of California Commercial |
$2,248.49
|
| Rate for Payer: Cash Price |
$1,315.76
|
| Rate for Payer: Cigna of CA HMO |
$2,046.74
|
| Rate for Payer: Cigna of CA PPO |
$2,046.74
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$2,046.74
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,169.57
|
| Rate for Payer: EPIC Health Plan Senior |
$1,169.57
|
| Rate for Payer: Galaxy Health WC |
$2,485.33
|
| Rate for Payer: Global Benefits Group Commercial |
$1,754.35
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,856.69
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,725.11
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$701.74
|
| Rate for Payer: Multiplan Commercial |
$2,339.14
|
| Rate for Payer: Networks By Design Commercial |
$1,461.96
|
| Rate for Payer: Prime Health Services Commercial |
$2,485.33
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,097.35
|
| Rate for Payer: United Healthcare All Other HMO |
$1,068.11
|
| Rate for Payer: United Healthcare HMO Rider |
$1,045.01
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$957.58
|
|
|
PALIPERIDONE PALMITATE 234 MG/1.5 ML INTRAMUSCULAR SYRINGE [108109]
|
Facility
|
IP
|
$2,923.85
|
|
|
Service Code
|
HCPCS J2426
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$584.77 |
| Max. Negotiated Rate |
$2,485.27 |
| Rate for Payer: Adventist Health Commercial |
$584.77
|
| Rate for Payer: Blue Shield of California Commercial |
$1,482.39
|
| Rate for Payer: Blue Shield of California Commercial |
$2,248.44
|
| Rate for Payer: Cash Price |
$1,315.73
|
| Rate for Payer: Cigna of CA HMO |
$2,046.69
|
| Rate for Payer: Cigna of CA PPO |
$2,046.69
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$2,046.69
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,169.54
|
| Rate for Payer: EPIC Health Plan Senior |
$1,169.54
|
| Rate for Payer: Galaxy Health WC |
$2,485.27
|
| Rate for Payer: Global Benefits Group Commercial |
$1,754.31
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,856.64
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,725.07
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$701.72
|
| Rate for Payer: Multiplan Commercial |
$2,339.08
|
| Rate for Payer: Networks By Design Commercial |
$1,461.92
|
| Rate for Payer: Prime Health Services Commercial |
$2,485.27
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,097.32
|
| Rate for Payer: United Healthcare All Other HMO |
$1,068.08
|
| Rate for Payer: United Healthcare HMO Rider |
$1,044.98
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$957.56
|
|
|
PALIPERIDONE PALMITATE 234 MG/1.5 ML INTRAMUSCULAR SYRINGE [108109]
|
Facility
|
OP
|
$2,923.85
|
|
|
Service Code
|
HCPCS J2426
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$15.43 |
| Max. Negotiated Rate |
$2,485.27 |
| Rate for Payer: Adventist Health Commercial |
$584.77
|
| Rate for Payer: Aetna of CA HMO/PPO |
$92.72
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$19.29
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$16.97
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$16.97
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$16.23
|
| Rate for Payer: Blue Shield of California Commercial |
$17.84
|
| Rate for Payer: Cash Price |
$1,315.73
|
| Rate for Payer: Cash Price |
$1,315.73
|
| Rate for Payer: Cigna of CA HMO |
$2,046.69
|
| Rate for Payer: Cigna of CA PPO |
$2,046.69
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$19.29
|
| Rate for Payer: Dignity Health Medi-Cal |
$16.97
|
| Rate for Payer: Dignity Health Medicare Advantage |
$16.97
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$2,046.69
|
| Rate for Payer: EPIC Health Plan Commercial |
$25.46
|
| Rate for Payer: EPIC Health Plan Senior |
$16.97
|
| Rate for Payer: Galaxy Health WC |
$2,485.27
|
| Rate for Payer: Global Benefits Group Commercial |
$1,754.31
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$25.31
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$15.43
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$15.43
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,856.64
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$37.18
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$21.60
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$701.72
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$19.44
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$20.68
|
| Rate for Payer: Multiplan Commercial |
$2,339.08
|
| Rate for Payer: Networks By Design Commercial |
$1,461.92
|
| Rate for Payer: Prime Health Services Commercial |
$2,485.27
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,754.31
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,754.31
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,097.32
|
| Rate for Payer: United Healthcare All Other HMO |
$1,068.08
|
| Rate for Payer: United Healthcare HMO Rider |
$1,044.98
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$957.56
|
| Rate for Payer: Upland Medical Group Pediatric |
$15.43
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$19.29
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$16.97
|
| Rate for Payer: Vantage Medical Group Senior |
$16.97
|
|
|
PALONOSETRON 0.25 MG/5 ML INTRAVENOUS SOLUTION [36591]
|
Facility
|
IP
|
$4.32
|
|
|
Service Code
|
HCPCS J2469
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.86 |
| Max. Negotiated Rate |
$3.67 |
| Rate for Payer: Adventist Health Commercial |
$0.86
|
| Rate for Payer: Blue Shield of California Commercial |
$2.19
|
| Rate for Payer: Blue Shield of California Commercial |
$3.32
|
| Rate for Payer: Cash Price |
$1.94
|
| Rate for Payer: Cigna of CA HMO |
$3.02
|
| Rate for Payer: Cigna of CA PPO |
$3.02
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$3.02
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.73
|
| Rate for Payer: EPIC Health Plan Senior |
$1.73
|
| Rate for Payer: Galaxy Health WC |
$3.67
|
| Rate for Payer: Global Benefits Group Commercial |
$2.59
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$2.74
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2.55
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.04
|
| Rate for Payer: Multiplan Commercial |
$3.46
|
| Rate for Payer: Networks By Design Commercial |
$2.16
|
| Rate for Payer: Prime Health Services Commercial |
$3.67
|
| Rate for Payer: United Healthcare All Other Commercial |
$1.62
|
| Rate for Payer: United Healthcare All Other HMO |
$1.58
|
| Rate for Payer: United Healthcare HMO Rider |
$1.54
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1.41
|
|
|
PALONOSETRON 0.25 MG/5 ML INTRAVENOUS SOLUTION [36591]
|
Facility
|
OP
|
$4.32
|
|
|
Service Code
|
HCPCS J2469
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.57 |
| Max. Negotiated Rate |
$72.53 |
| Rate for Payer: Adventist Health Commercial |
$0.86
|
| Rate for Payer: Aetna of CA HMO/PPO |
$3.11
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3.67
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2.38
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$3.24
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$72.53
|
| Rate for Payer: Blue Shield of California Commercial |
$3.67
|
| Rate for Payer: Cash Price |
$1.94
|
| Rate for Payer: Cash Price |
$1.94
|
| Rate for Payer: Cigna of CA HMO |
$3.02
|
| Rate for Payer: Cigna of CA PPO |
$3.02
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3.67
|
| Rate for Payer: Dignity Health Medi-Cal |
$3.67
|
| Rate for Payer: Dignity Health Medicare Advantage |
$3.67
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$3.02
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.73
|
| Rate for Payer: EPIC Health Plan Senior |
$1.73
|
| Rate for Payer: Galaxy Health WC |
$3.67
|
| Rate for Payer: Global Benefits Group Commercial |
$2.59
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$0.57
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$2.74
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.67
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2.55
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.04
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$3.02
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$3.02
|
| Rate for Payer: Multiplan Commercial |
$3.46
|
| Rate for Payer: Networks By Design Commercial |
$2.16
|
| Rate for Payer: Prime Health Services Commercial |
$3.67
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2.59
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2.59
|
| Rate for Payer: United Healthcare All Other Commercial |
$1.62
|
| Rate for Payer: United Healthcare All Other HMO |
$1.58
|
| Rate for Payer: United Healthcare HMO Rider |
$1.54
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1.41
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3.67
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$3.67
|
| Rate for Payer: Vantage Medical Group Senior |
$3.67
|
|
|
PALONOSETRON 0.25 MG/5 ML INTRAVENOUS SOLUTION. [40836591]
|
Facility
|
OP
|
$12.00
|
|
|
Service Code
|
HCPCS J2469
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.57 |
| Max. Negotiated Rate |
$72.53 |
| Rate for Payer: Adventist Health Commercial |
$2.40
|
| Rate for Payer: Aetna of CA HMO/PPO |
$3.11
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$10.20
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$6.60
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$9.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$72.53
|
| Rate for Payer: Blue Shield of California Commercial |
$3.67
|
| Rate for Payer: Cash Price |
$5.40
|
| Rate for Payer: Cash Price |
$5.40
|
| Rate for Payer: Cigna of CA HMO |
$8.40
|
| Rate for Payer: Cigna of CA PPO |
$8.40
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$10.20
|
| Rate for Payer: Dignity Health Medi-Cal |
$10.20
|
| Rate for Payer: Dignity Health Medicare Advantage |
$10.20
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$8.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$4.80
|
| Rate for Payer: EPIC Health Plan Senior |
$4.80
|
| Rate for Payer: Galaxy Health WC |
$10.20
|
| Rate for Payer: Global Benefits Group Commercial |
$7.20
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$0.57
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$7.62
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.67
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$7.08
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.88
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$8.40
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$8.40
|
| Rate for Payer: Multiplan Commercial |
$9.60
|
| Rate for Payer: Networks By Design Commercial |
$6.00
|
| Rate for Payer: Prime Health Services Commercial |
$10.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$7.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$7.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$4.50
|
| Rate for Payer: United Healthcare All Other HMO |
$4.38
|
| Rate for Payer: United Healthcare HMO Rider |
$4.29
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3.93
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$10.20
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$10.20
|
| Rate for Payer: Vantage Medical Group Senior |
$10.20
|
|
|
PALONOSETRON 0.25 MG/5 ML INTRAVENOUS SOLUTION. [40836591]
|
Facility
|
IP
|
$12.00
|
|
|
Service Code
|
HCPCS J2469
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$2.40 |
| Max. Negotiated Rate |
$10.20 |
| Rate for Payer: Adventist Health Commercial |
$2.40
|
| Rate for Payer: Blue Shield of California Commercial |
$6.08
|
| Rate for Payer: Blue Shield of California Commercial |
$9.23
|
| Rate for Payer: Cash Price |
$5.40
|
| Rate for Payer: Cigna of CA HMO |
$8.40
|
| Rate for Payer: Cigna of CA PPO |
$8.40
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$8.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$4.80
|
| Rate for Payer: EPIC Health Plan Senior |
$4.80
|
| Rate for Payer: Galaxy Health WC |
$10.20
|
| Rate for Payer: Global Benefits Group Commercial |
$7.20
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$7.62
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$7.08
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.88
|
| Rate for Payer: Multiplan Commercial |
$9.60
|
| Rate for Payer: Networks By Design Commercial |
$6.00
|
| Rate for Payer: Prime Health Services Commercial |
$10.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$4.50
|
| Rate for Payer: United Healthcare All Other HMO |
$4.38
|
| Rate for Payer: United Healthcare HMO Rider |
$4.29
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3.93
|
|
|
PALONOSETRON 0.25 MG/5 ML INTRAVENOUS SYRINGE [222773]
|
Facility
|
OP
|
$12.00
|
|
|
Service Code
|
HCPCS J2469
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.57 |
| Max. Negotiated Rate |
$72.53 |
| Rate for Payer: Adventist Health Commercial |
$2.40
|
| Rate for Payer: Aetna of CA HMO/PPO |
$3.11
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$10.20
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$6.60
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$9.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$72.53
|
| Rate for Payer: Blue Shield of California Commercial |
$3.67
|
| Rate for Payer: Cash Price |
$5.40
|
| Rate for Payer: Cash Price |
$5.40
|
| Rate for Payer: Cigna of CA HMO |
$8.40
|
| Rate for Payer: Cigna of CA PPO |
$8.40
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$10.20
|
| Rate for Payer: Dignity Health Medi-Cal |
$10.20
|
| Rate for Payer: Dignity Health Medicare Advantage |
$10.20
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$8.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$4.80
|
| Rate for Payer: EPIC Health Plan Senior |
$4.80
|
| Rate for Payer: Galaxy Health WC |
$10.20
|
| Rate for Payer: Global Benefits Group Commercial |
$7.20
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$0.57
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$7.62
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.67
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$7.08
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.88
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$8.40
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$8.40
|
| Rate for Payer: Multiplan Commercial |
$9.60
|
| Rate for Payer: Networks By Design Commercial |
$6.00
|
| Rate for Payer: Prime Health Services Commercial |
$10.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$7.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$7.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$4.50
|
| Rate for Payer: United Healthcare All Other HMO |
$4.38
|
| Rate for Payer: United Healthcare HMO Rider |
$4.29
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3.93
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$10.20
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$10.20
|
| Rate for Payer: Vantage Medical Group Senior |
$10.20
|
|
|
PALONOSETRON 0.25 MG/5 ML INTRAVENOUS SYRINGE [222773]
|
Facility
|
IP
|
$12.00
|
|
|
Service Code
|
HCPCS J2469
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$2.40 |
| Max. Negotiated Rate |
$10.20 |
| Rate for Payer: Adventist Health Commercial |
$2.40
|
| Rate for Payer: Blue Shield of California Commercial |
$6.08
|
| Rate for Payer: Blue Shield of California Commercial |
$9.23
|
| Rate for Payer: Cash Price |
$5.40
|
| Rate for Payer: Cigna of CA HMO |
$8.40
|
| Rate for Payer: Cigna of CA PPO |
$8.40
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$8.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$4.80
|
| Rate for Payer: EPIC Health Plan Senior |
$4.80
|
| Rate for Payer: Galaxy Health WC |
$10.20
|
| Rate for Payer: Global Benefits Group Commercial |
$7.20
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$7.62
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$7.08
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.88
|
| Rate for Payer: Multiplan Commercial |
$9.60
|
| Rate for Payer: Networks By Design Commercial |
$6.00
|
| Rate for Payer: Prime Health Services Commercial |
$10.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$4.50
|
| Rate for Payer: United Healthcare All Other HMO |
$4.38
|
| Rate for Payer: United Healthcare HMO Rider |
$4.29
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3.93
|
|
|
PAMIDRONATE 30 MG/10 ML (3 MG/ML) INTRAVENOUS SOLUTION [32589]
|
Facility
|
IP
|
$3.24
|
|
|
Service Code
|
HCPCS J2430
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.65 |
| Max. Negotiated Rate |
$2.75 |
| Rate for Payer: Adventist Health Commercial |
$0.65
|
| Rate for Payer: Adventist Health Commercial |
$0.35
|
| Rate for Payer: Blue Shield of California Commercial |
$1.33
|
| Rate for Payer: Blue Shield of California Commercial |
$1.64
|
| Rate for Payer: Blue Shield of California Commercial |
$2.49
|
| Rate for Payer: Blue Shield of California Commercial |
$0.88
|
| Rate for Payer: Cash Price |
$0.78
|
| Rate for Payer: Cash Price |
$1.46
|
| Rate for Payer: Cigna of CA HMO |
$2.27
|
| Rate for Payer: Cigna of CA HMO |
$1.21
|
| Rate for Payer: Cigna of CA PPO |
$1.21
|
| Rate for Payer: Cigna of CA PPO |
$2.27
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1.21
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$2.27
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.69
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.30
|
| Rate for Payer: EPIC Health Plan Senior |
$0.69
|
| Rate for Payer: EPIC Health Plan Senior |
$1.30
|
| Rate for Payer: Galaxy Health WC |
$1.47
|
| Rate for Payer: Galaxy Health WC |
$2.75
|
| Rate for Payer: Global Benefits Group Commercial |
$1.94
|
| Rate for Payer: Global Benefits Group Commercial |
$1.04
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1.10
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$2.06
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1.02
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1.91
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.42
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.78
|
| Rate for Payer: Multiplan Commercial |
$1.38
|
| Rate for Payer: Multiplan Commercial |
$2.59
|
| Rate for Payer: Networks By Design Commercial |
$1.62
|
| Rate for Payer: Networks By Design Commercial |
$0.87
|
| Rate for Payer: Prime Health Services Commercial |
$2.75
|
| Rate for Payer: Prime Health Services Commercial |
$1.47
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.65
|
| Rate for Payer: United Healthcare All Other Commercial |
$1.22
|
| Rate for Payer: United Healthcare All Other HMO |
$1.18
|
| Rate for Payer: United Healthcare All Other HMO |
$0.63
|
| Rate for Payer: United Healthcare HMO Rider |
$0.62
|
| Rate for Payer: United Healthcare HMO Rider |
$1.16
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.57
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1.06
|
|
|
PAMIDRONATE 30 MG/10 ML (3 MG/ML) INTRAVENOUS SOLUTION [32589]
|
Facility
|
OP
|
$1.73
|
|
|
Service Code
|
HCPCS J2430
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.35 |
| Max. Negotiated Rate |
$630.57 |
| Rate for Payer: Adventist Health Commercial |
$0.35
|
| Rate for Payer: Adventist Health Commercial |
$0.65
|
| Rate for Payer: Aetna of CA HMO/PPO |
$27.32
|
| Rate for Payer: Aetna of CA HMO/PPO |
$27.32
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2.75
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1.47
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1.78
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.95
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2.43
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1.30
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$630.57
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$630.57
|
| Rate for Payer: Blue Shield of California Commercial |
$24.61
|
| Rate for Payer: Blue Shield of California Commercial |
$24.61
|
| Rate for Payer: Cash Price |
$0.78
|
| Rate for Payer: Cash Price |
$1.46
|
| Rate for Payer: Cash Price |
$0.78
|
| Rate for Payer: Cash Price |
$1.46
|
| Rate for Payer: Cigna of CA HMO |
$2.27
|
| Rate for Payer: Cigna of CA HMO |
$1.21
|
| Rate for Payer: Cigna of CA PPO |
$2.27
|
| Rate for Payer: Cigna of CA PPO |
$1.21
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2.75
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1.47
|
| Rate for Payer: Dignity Health Medi-Cal |
$1.47
|
| Rate for Payer: Dignity Health Medi-Cal |
$2.75
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2.75
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1.47
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1.21
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$2.27
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.69
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.30
|
| Rate for Payer: EPIC Health Plan Senior |
$1.30
|
| Rate for Payer: EPIC Health Plan Senior |
$0.69
|
| Rate for Payer: Galaxy Health WC |
$2.75
|
| Rate for Payer: Galaxy Health WC |
$1.47
|
| Rate for Payer: Global Benefits Group Commercial |
$1.94
|
| Rate for Payer: Global Benefits Group Commercial |
$1.04
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$12.03
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$12.03
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1.10
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$2.06
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$21.45
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$21.45
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1.91
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1.02
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.78
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.42
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1.21
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2.27
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1.21
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2.27
|
| Rate for Payer: Multiplan Commercial |
$2.59
|
| Rate for Payer: Multiplan Commercial |
$1.38
|
| Rate for Payer: Networks By Design Commercial |
$1.62
|
| Rate for Payer: Networks By Design Commercial |
$0.87
|
| Rate for Payer: Prime Health Services Commercial |
$1.47
|
| Rate for Payer: Prime Health Services Commercial |
$2.75
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1.04
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1.94
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1.04
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1.94
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.65
|
| Rate for Payer: United Healthcare All Other Commercial |
$1.22
|
| Rate for Payer: United Healthcare All Other HMO |
$0.63
|
| Rate for Payer: United Healthcare All Other HMO |
$1.18
|
| Rate for Payer: United Healthcare HMO Rider |
$1.16
|
| Rate for Payer: United Healthcare HMO Rider |
$0.62
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.57
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1.06
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2.75
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1.47
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1.47
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2.75
|
| Rate for Payer: Vantage Medical Group Senior |
$1.47
|
| Rate for Payer: Vantage Medical Group Senior |
$2.75
|
|
|
PAMIDRONATE 30 MG INTRAVENOUS SOLUTION [10845]
|
Facility
|
OP
|
$22.55
|
|
|
Service Code
|
HCPCS J2430
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$4.51 |
| Max. Negotiated Rate |
$630.57 |
| Rate for Payer: Adventist Health Commercial |
$4.51
|
| Rate for Payer: Aetna of CA HMO/PPO |
$27.32
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$19.17
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$12.40
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$16.91
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$630.57
|
| Rate for Payer: Blue Shield of California Commercial |
$24.61
|
| Rate for Payer: Cash Price |
$10.15
|
| Rate for Payer: Cash Price |
$10.15
|
| Rate for Payer: Cigna of CA HMO |
$15.79
|
| Rate for Payer: Cigna of CA PPO |
$15.79
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$19.17
|
| Rate for Payer: Dignity Health Medi-Cal |
$19.17
|
| Rate for Payer: Dignity Health Medicare Advantage |
$19.17
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$15.79
|
| Rate for Payer: EPIC Health Plan Commercial |
$9.02
|
| Rate for Payer: EPIC Health Plan Senior |
$9.02
|
| Rate for Payer: Galaxy Health WC |
$19.17
|
| Rate for Payer: Global Benefits Group Commercial |
$13.53
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$12.03
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$14.32
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$21.45
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$13.30
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5.41
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$15.79
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$15.79
|
| Rate for Payer: Multiplan Commercial |
$18.04
|
| Rate for Payer: Networks By Design Commercial |
$11.28
|
| Rate for Payer: Prime Health Services Commercial |
$19.17
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$13.53
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$13.53
|
| Rate for Payer: United Healthcare All Other Commercial |
$8.46
|
| Rate for Payer: United Healthcare All Other HMO |
$8.24
|
| Rate for Payer: United Healthcare HMO Rider |
$8.06
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$7.39
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$19.17
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$19.17
|
| Rate for Payer: Vantage Medical Group Senior |
$19.17
|
|
|
PAMIDRONATE 30 MG INTRAVENOUS SOLUTION [10845]
|
Facility
|
IP
|
$22.55
|
|
|
Service Code
|
HCPCS J2430
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$4.51 |
| Max. Negotiated Rate |
$19.17 |
| Rate for Payer: Adventist Health Commercial |
$4.51
|
| Rate for Payer: Blue Shield of California Commercial |
$11.43
|
| Rate for Payer: Blue Shield of California Commercial |
$17.34
|
| Rate for Payer: Cash Price |
$10.15
|
| Rate for Payer: Cigna of CA HMO |
$15.79
|
| Rate for Payer: Cigna of CA PPO |
$15.79
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$15.79
|
| Rate for Payer: EPIC Health Plan Commercial |
$9.02
|
| Rate for Payer: EPIC Health Plan Senior |
$9.02
|
| Rate for Payer: Galaxy Health WC |
$19.17
|
| Rate for Payer: Global Benefits Group Commercial |
$13.53
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$14.32
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$13.30
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5.41
|
| Rate for Payer: Multiplan Commercial |
$18.04
|
| Rate for Payer: Networks By Design Commercial |
$11.28
|
| Rate for Payer: Prime Health Services Commercial |
$19.17
|
| Rate for Payer: United Healthcare All Other Commercial |
$8.46
|
| Rate for Payer: United Healthcare All Other HMO |
$8.24
|
| Rate for Payer: United Healthcare HMO Rider |
$8.06
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$7.39
|
|
|
PAMIDRONATE 60 MG/10 ML (6 MG/ML) INTRAVENOUS SOLUTION [33886]
|
Facility
|
IP
|
$5.45
|
|
|
Service Code
|
HCPCS J2430
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.09 |
| Max. Negotiated Rate |
$4.63 |
| Rate for Payer: Adventist Health Commercial |
$1.09
|
| Rate for Payer: Blue Shield of California Commercial |
$2.76
|
| Rate for Payer: Blue Shield of California Commercial |
$4.19
|
| Rate for Payer: Cash Price |
$2.45
|
| Rate for Payer: Cigna of CA HMO |
$3.81
|
| Rate for Payer: Cigna of CA PPO |
$3.81
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$3.81
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.18
|
| Rate for Payer: EPIC Health Plan Senior |
$2.18
|
| Rate for Payer: Galaxy Health WC |
$4.63
|
| Rate for Payer: Global Benefits Group Commercial |
$3.27
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$3.46
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$3.22
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.31
|
| Rate for Payer: Multiplan Commercial |
$4.36
|
| Rate for Payer: Networks By Design Commercial |
$2.73
|
| Rate for Payer: Prime Health Services Commercial |
$4.63
|
| Rate for Payer: United Healthcare All Other Commercial |
$2.05
|
| Rate for Payer: United Healthcare All Other HMO |
$1.99
|
| Rate for Payer: United Healthcare HMO Rider |
$1.95
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1.78
|
|
|
PAMIDRONATE 60 MG/10 ML (6 MG/ML) INTRAVENOUS SOLUTION [33886]
|
Facility
|
OP
|
$5.45
|
|
|
Service Code
|
HCPCS J2430
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.09 |
| Max. Negotiated Rate |
$630.57 |
| Rate for Payer: Adventist Health Commercial |
$1.09
|
| Rate for Payer: Aetna of CA HMO/PPO |
$27.32
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$4.63
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$3.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4.09
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$630.57
|
| Rate for Payer: Blue Shield of California Commercial |
$24.61
|
| Rate for Payer: Cash Price |
$2.45
|
| Rate for Payer: Cash Price |
$2.45
|
| Rate for Payer: Cigna of CA HMO |
$3.81
|
| Rate for Payer: Cigna of CA PPO |
$3.81
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$4.63
|
| Rate for Payer: Dignity Health Medi-Cal |
$4.63
|
| Rate for Payer: Dignity Health Medicare Advantage |
$4.63
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$3.81
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.18
|
| Rate for Payer: EPIC Health Plan Senior |
$2.18
|
| Rate for Payer: Galaxy Health WC |
$4.63
|
| Rate for Payer: Global Benefits Group Commercial |
$3.27
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$12.03
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$3.46
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$21.45
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$3.22
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.31
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$3.81
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$3.81
|
| Rate for Payer: Multiplan Commercial |
$4.36
|
| Rate for Payer: Networks By Design Commercial |
$2.73
|
| Rate for Payer: Prime Health Services Commercial |
$4.63
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3.27
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$3.27
|
| Rate for Payer: United Healthcare All Other Commercial |
$2.05
|
| Rate for Payer: United Healthcare All Other HMO |
$1.99
|
| Rate for Payer: United Healthcare HMO Rider |
$1.95
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1.78
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$4.63
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4.63
|
| Rate for Payer: Vantage Medical Group Senior |
$4.63
|
|
|
PAMIDRONATE 90 MG/10 ML (9 MG/ML) INTRAVENOUS SOLUTION [32855]
|
Facility
|
OP
|
$11.23
|
|
|
Service Code
|
HCPCS J2430
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$2.25 |
| Max. Negotiated Rate |
$630.57 |
| Rate for Payer: Adventist Health Commercial |
$2.25
|
| Rate for Payer: Adventist Health Commercial |
$2.53
|
| Rate for Payer: Aetna of CA HMO/PPO |
$27.32
|
| Rate for Payer: Aetna of CA HMO/PPO |
$27.32
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$10.77
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$9.55
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$6.97
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$6.18
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$9.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$8.42
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$630.57
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$630.57
|
| Rate for Payer: Blue Shield of California Commercial |
$24.61
|
| Rate for Payer: Blue Shield of California Commercial |
$24.61
|
| Rate for Payer: Cash Price |
$5.05
|
| Rate for Payer: Cash Price |
$5.70
|
| Rate for Payer: Cash Price |
$5.05
|
| Rate for Payer: Cash Price |
$5.70
|
| Rate for Payer: Cigna of CA HMO |
$8.87
|
| Rate for Payer: Cigna of CA HMO |
$7.86
|
| Rate for Payer: Cigna of CA PPO |
$8.87
|
| Rate for Payer: Cigna of CA PPO |
$7.86
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$10.77
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$9.55
|
| Rate for Payer: Dignity Health Medi-Cal |
$9.55
|
| Rate for Payer: Dignity Health Medi-Cal |
$10.77
|
| Rate for Payer: Dignity Health Medicare Advantage |
$10.77
|
| Rate for Payer: Dignity Health Medicare Advantage |
$9.55
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$7.86
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$8.87
|
| Rate for Payer: EPIC Health Plan Commercial |
$4.49
|
| Rate for Payer: EPIC Health Plan Commercial |
$5.07
|
| Rate for Payer: EPIC Health Plan Senior |
$5.07
|
| Rate for Payer: EPIC Health Plan Senior |
$4.49
|
| Rate for Payer: Galaxy Health WC |
$10.77
|
| Rate for Payer: Galaxy Health WC |
$9.55
|
| Rate for Payer: Global Benefits Group Commercial |
$7.60
|
| Rate for Payer: Global Benefits Group Commercial |
$6.74
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$12.03
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$12.03
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$7.13
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$8.05
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$21.45
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$21.45
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$7.48
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$6.63
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.04
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.70
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$7.86
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$8.87
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$7.86
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$8.87
|
| Rate for Payer: Multiplan Commercial |
$10.14
|
| Rate for Payer: Multiplan Commercial |
$8.98
|
| Rate for Payer: Networks By Design Commercial |
$6.33
|
| Rate for Payer: Networks By Design Commercial |
$5.62
|
| Rate for Payer: Prime Health Services Commercial |
$9.55
|
| Rate for Payer: Prime Health Services Commercial |
$10.77
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$6.74
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$7.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$6.74
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$7.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$4.21
|
| Rate for Payer: United Healthcare All Other Commercial |
$4.76
|
| Rate for Payer: United Healthcare All Other HMO |
$4.10
|
| Rate for Payer: United Healthcare All Other HMO |
$4.63
|
| Rate for Payer: United Healthcare HMO Rider |
$4.53
|
| Rate for Payer: United Healthcare HMO Rider |
$4.01
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3.68
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$4.15
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$10.77
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$9.55
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$9.55
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$10.77
|
| Rate for Payer: Vantage Medical Group Senior |
$9.55
|
| Rate for Payer: Vantage Medical Group Senior |
$10.77
|
|
|
PAMIDRONATE 90 MG/10 ML (9 MG/ML) INTRAVENOUS SOLUTION [32855]
|
Facility
|
IP
|
$12.67
|
|
|
Service Code
|
HCPCS J2430
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$2.53 |
| Max. Negotiated Rate |
$10.77 |
| Rate for Payer: Adventist Health Commercial |
$2.53
|
| Rate for Payer: Adventist Health Commercial |
$2.25
|
| Rate for Payer: Blue Shield of California Commercial |
$8.64
|
| Rate for Payer: Blue Shield of California Commercial |
$6.42
|
| Rate for Payer: Blue Shield of California Commercial |
$9.74
|
| Rate for Payer: Blue Shield of California Commercial |
$5.69
|
| Rate for Payer: Cash Price |
$5.05
|
| Rate for Payer: Cash Price |
$5.70
|
| Rate for Payer: Cigna of CA HMO |
$8.87
|
| Rate for Payer: Cigna of CA HMO |
$7.86
|
| Rate for Payer: Cigna of CA PPO |
$7.86
|
| Rate for Payer: Cigna of CA PPO |
$8.87
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$7.86
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$8.87
|
| Rate for Payer: EPIC Health Plan Commercial |
$4.49
|
| Rate for Payer: EPIC Health Plan Commercial |
$5.07
|
| Rate for Payer: EPIC Health Plan Senior |
$4.49
|
| Rate for Payer: EPIC Health Plan Senior |
$5.07
|
| Rate for Payer: Galaxy Health WC |
$9.55
|
| Rate for Payer: Galaxy Health WC |
$10.77
|
| Rate for Payer: Global Benefits Group Commercial |
$7.60
|
| Rate for Payer: Global Benefits Group Commercial |
$6.74
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$7.13
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$8.05
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$6.63
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$7.48
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.70
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.04
|
| Rate for Payer: Multiplan Commercial |
$8.98
|
| Rate for Payer: Multiplan Commercial |
$10.14
|
| Rate for Payer: Networks By Design Commercial |
$6.33
|
| Rate for Payer: Networks By Design Commercial |
$5.62
|
| Rate for Payer: Prime Health Services Commercial |
$10.77
|
| Rate for Payer: Prime Health Services Commercial |
$9.55
|
| Rate for Payer: United Healthcare All Other Commercial |
$4.21
|
| Rate for Payer: United Healthcare All Other Commercial |
$4.76
|
| Rate for Payer: United Healthcare All Other HMO |
$4.63
|
| Rate for Payer: United Healthcare All Other HMO |
$4.10
|
| Rate for Payer: United Healthcare HMO Rider |
$4.01
|
| Rate for Payer: United Healthcare HMO Rider |
$4.53
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3.68
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$4.15
|
|
|
PANCREAS, LIVER AND SHUNT PROCEDURES WITH CC
|
Facility
|
IP
|
$130,713.16
|
|
|
Service Code
|
MSDRG 406
|
| Min. Negotiated Rate |
$7,611.00 |
| Max. Negotiated Rate |
$130,713.16 |
| Rate for Payer: Aetna of CA HMO/PPO |
$87,922.46
|
| Rate for Payer: EPIC Health Plan Commercial |
$130,713.16
|
| Rate for Payer: EPIC Health Plan Senior |
$87,142.11
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$79,220.10
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$110,908.14
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$106,154.93
|
| Rate for Payer: United Healthcare All Other Commercial |
$12,844.00
|
| Rate for Payer: United Healthcare All Other HMO |
$10,823.00
|
| Rate for Payer: United Healthcare HMO Rider |
$8,307.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$7,611.00
|
|
|
PANCREAS, LIVER AND SHUNT PROCEDURES WITH MCC
|
Facility
|
IP
|
$176,322.68
|
|
|
Service Code
|
MSDRG 405
|
| Min. Negotiated Rate |
$7,611.00 |
| Max. Negotiated Rate |
$176,322.68 |
| Rate for Payer: Aetna of CA HMO/PPO |
$165,843.68
|
| Rate for Payer: EPIC Health Plan Commercial |
$176,322.68
|
| Rate for Payer: EPIC Health Plan Senior |
$117,548.45
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$106,862.23
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$149,607.12
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$143,195.39
|
| Rate for Payer: United Healthcare All Other Commercial |
$12,844.00
|
| Rate for Payer: United Healthcare All Other HMO |
$10,823.00
|
| Rate for Payer: United Healthcare HMO Rider |
$8,307.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$7,611.00
|
|
|
PANCREAS, LIVER AND SHUNT PROCEDURES WITHOUT CC/MCC
|
Facility
|
IP
|
$118,636.02
|
|
|
Service Code
|
MSDRG 407
|
| Min. Negotiated Rate |
$7,611.00 |
| Max. Negotiated Rate |
$118,636.02 |
| Rate for Payer: Aetna of CA HMO/PPO |
$67,289.39
|
| Rate for Payer: EPIC Health Plan Commercial |
$118,636.02
|
| Rate for Payer: EPIC Health Plan Senior |
$79,090.68
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$71,900.62
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$100,660.87
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$96,346.83
|
| Rate for Payer: United Healthcare All Other Commercial |
$12,844.00
|
| Rate for Payer: United Healthcare All Other HMO |
$10,823.00
|
| Rate for Payer: United Healthcare HMO Rider |
$8,307.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$7,611.00
|
|
|
PANCREAS TRANSPLANT
|
Facility
|
IP
|
$206,581.15
|
|
|
Service Code
|
MSDRG 010
|
| Min. Negotiated Rate |
$60,000.00 |
| Max. Negotiated Rate |
$206,581.15 |
| Rate for Payer: Aetna of CA HMO/PPO |
$93,067.09
|
| Rate for Payer: EPIC Health Plan Commercial |
$206,581.15
|
| Rate for Payer: EPIC Health Plan Senior |
$137,720.77
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$125,200.70
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$175,280.98
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$167,768.94
|
|
