|
PENTAMIDINE 300 MG SOLUTION FOR INHALATION [28235]
|
Facility
|
IP
|
$173.40
|
|
|
Service Code
|
NDC 0121110255
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$34.68 |
| Max. Negotiated Rate |
$147.39 |
| Rate for Payer: Adventist Health Commercial |
$34.68
|
| Rate for Payer: Blue Shield of California Commercial |
$133.34
|
| Rate for Payer: Blue Shield of California Commercial |
$87.91
|
| Rate for Payer: Cash Price |
$78.03
|
| Rate for Payer: Cigna of CA HMO |
$121.38
|
| Rate for Payer: Cigna of CA PPO |
$121.38
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$121.38
|
| Rate for Payer: EPIC Health Plan Commercial |
$69.36
|
| Rate for Payer: EPIC Health Plan Senior |
$69.36
|
| Rate for Payer: Galaxy Health WC |
$147.39
|
| Rate for Payer: Global Benefits Group Commercial |
$104.04
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$110.11
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$102.31
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$41.62
|
| Rate for Payer: Multiplan Commercial |
$138.72
|
| Rate for Payer: Networks By Design Commercial |
$112.71
|
| Rate for Payer: Prime Health Services Commercial |
$147.39
|
|
|
PENTAMIDINE 300 MG SOLUTION FOR INHALATION [28235]
|
Facility
|
IP
|
$173.40
|
|
|
Service Code
|
NDC 1392552201
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$34.68 |
| Max. Negotiated Rate |
$147.39 |
| Rate for Payer: Adventist Health Commercial |
$34.68
|
| Rate for Payer: Blue Shield of California Commercial |
$133.34
|
| Rate for Payer: Blue Shield of California Commercial |
$87.91
|
| Rate for Payer: Cash Price |
$78.03
|
| Rate for Payer: Cigna of CA HMO |
$121.38
|
| Rate for Payer: Cigna of CA PPO |
$121.38
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$121.38
|
| Rate for Payer: EPIC Health Plan Commercial |
$69.36
|
| Rate for Payer: EPIC Health Plan Senior |
$69.36
|
| Rate for Payer: Galaxy Health WC |
$147.39
|
| Rate for Payer: Global Benefits Group Commercial |
$104.04
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$110.11
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$102.31
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$41.62
|
| Rate for Payer: Multiplan Commercial |
$138.72
|
| Rate for Payer: Networks By Design Commercial |
$112.71
|
| Rate for Payer: Prime Health Services Commercial |
$147.39
|
|
|
PENTAMIDINE 300 MG SOLUTION FOR INHALATION [28235]
|
Facility
|
OP
|
$108.00
|
|
|
Service Code
|
NDC 3982230302
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$21.60 |
| Max. Negotiated Rate |
$91.80 |
| Rate for Payer: Adventist Health Commercial |
$21.60
|
| Rate for Payer: Aetna of CA HMO/PPO |
$70.84
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$91.80
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$59.40
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$81.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$69.30
|
| Rate for Payer: Cash Price |
$48.60
|
| Rate for Payer: Cigna of CA HMO |
$75.60
|
| Rate for Payer: Cigna of CA PPO |
$75.60
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$91.80
|
| Rate for Payer: Dignity Health Medi-Cal |
$91.80
|
| Rate for Payer: Dignity Health Medicare Advantage |
$91.80
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$75.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$43.20
|
| Rate for Payer: EPIC Health Plan Senior |
$43.20
|
| Rate for Payer: Galaxy Health WC |
$91.80
|
| Rate for Payer: Global Benefits Group Commercial |
$64.80
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$68.58
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$39.20
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$63.72
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$25.92
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$75.60
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$75.60
|
| Rate for Payer: Multiplan Commercial |
$86.40
|
| Rate for Payer: Networks By Design Commercial |
$70.20
|
| Rate for Payer: Prime Health Services Commercial |
$91.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$64.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$64.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$54.00
|
| Rate for Payer: United Healthcare All Other HMO |
$54.00
|
| Rate for Payer: United Healthcare HMO Rider |
$54.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$54.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$91.80
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$91.80
|
| Rate for Payer: Vantage Medical Group Senior |
$91.80
|
|
|
PENTAMIDINE 300 MG SOLUTION FOR INJECTION [27430]
|
Facility
|
OP
|
$200.27
|
|
|
Service Code
|
HCPCS J2516
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.16 |
| Max. Negotiated Rate |
$170.23 |
| Rate for Payer: Adventist Health Commercial |
$40.05
|
| Rate for Payer: Aetna of CA HMO/PPO |
$131.36
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$170.23
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$110.15
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$150.20
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.83
|
| Rate for Payer: Cash Price |
$90.12
|
| Rate for Payer: Cash Price |
$90.12
|
| Rate for Payer: Cigna of CA HMO |
$140.19
|
| Rate for Payer: Cigna of CA PPO |
$140.19
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$170.23
|
| Rate for Payer: Dignity Health Medi-Cal |
$170.23
|
| Rate for Payer: Dignity Health Medicare Advantage |
$170.23
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$140.19
|
| Rate for Payer: EPIC Health Plan Commercial |
$80.11
|
| Rate for Payer: EPIC Health Plan Senior |
$80.11
|
| Rate for Payer: Galaxy Health WC |
$170.23
|
| Rate for Payer: Global Benefits Group Commercial |
$120.16
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$0.16
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$127.17
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$8.93
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$118.16
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$48.06
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$140.19
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$140.19
|
| Rate for Payer: Multiplan Commercial |
$160.22
|
| Rate for Payer: Networks By Design Commercial |
$100.14
|
| Rate for Payer: Prime Health Services Commercial |
$170.23
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$120.16
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$120.16
|
| Rate for Payer: United Healthcare All Other Commercial |
$75.16
|
| Rate for Payer: United Healthcare All Other HMO |
$73.16
|
| Rate for Payer: United Healthcare HMO Rider |
$71.58
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$65.59
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$170.23
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$170.23
|
| Rate for Payer: Vantage Medical Group Senior |
$170.23
|
|
|
PENTAMIDINE 300 MG SOLUTION FOR INJECTION [27430]
|
Facility
|
IP
|
$200.27
|
|
|
Service Code
|
HCPCS J2516
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$40.05 |
| Max. Negotiated Rate |
$170.23 |
| Rate for Payer: Adventist Health Commercial |
$40.05
|
| Rate for Payer: Blue Shield of California Commercial |
$101.54
|
| Rate for Payer: Blue Shield of California Commercial |
$154.01
|
| Rate for Payer: Cash Price |
$90.12
|
| Rate for Payer: Cigna of CA HMO |
$140.19
|
| Rate for Payer: Cigna of CA PPO |
$140.19
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$140.19
|
| Rate for Payer: EPIC Health Plan Commercial |
$80.11
|
| Rate for Payer: EPIC Health Plan Senior |
$80.11
|
| Rate for Payer: Galaxy Health WC |
$170.23
|
| Rate for Payer: Global Benefits Group Commercial |
$120.16
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$127.17
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$118.16
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$48.06
|
| Rate for Payer: Multiplan Commercial |
$160.22
|
| Rate for Payer: Networks By Design Commercial |
$100.14
|
| Rate for Payer: Prime Health Services Commercial |
$170.23
|
| Rate for Payer: United Healthcare All Other Commercial |
$75.16
|
| Rate for Payer: United Healthcare All Other HMO |
$73.16
|
| Rate for Payer: United Healthcare HMO Rider |
$71.58
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$65.59
|
|
|
PENTETATE INDIUM DISODIUM IN-111 1.5 MCI/1.5 ML INTRATHECAL SOLUTION [154582]
|
Facility
|
IP
|
$3,187.81
|
|
|
Service Code
|
HCPCS A9548
|
| Hospital Charge Code |
901700057
|
|
Hospital Revenue Code
|
343
|
| Min. Negotiated Rate |
$637.56 |
| Max. Negotiated Rate |
$2,709.64 |
| Rate for Payer: Adventist Health Commercial |
$637.56
|
| Rate for Payer: Blue Shield of California Commercial |
$1,616.22
|
| Rate for Payer: Blue Shield of California Commercial |
$2,451.43
|
| Rate for Payer: Cash Price |
$1,434.51
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$2,231.47
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,275.12
|
| Rate for Payer: EPIC Health Plan Senior |
$1,275.12
|
| Rate for Payer: Galaxy Health WC |
$2,709.64
|
| Rate for Payer: Global Benefits Group Commercial |
$1,912.69
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$2,024.26
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,880.81
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$765.07
|
| Rate for Payer: Multiplan Commercial |
$2,550.25
|
| Rate for Payer: Networks By Design Commercial |
$2,072.08
|
| Rate for Payer: Prime Health Services Commercial |
$2,709.64
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,196.39
|
| Rate for Payer: United Healthcare All Other HMO |
$1,164.51
|
| Rate for Payer: United Healthcare HMO Rider |
$1,139.32
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,044.01
|
|
|
PENTETATE INDIUM DISODIUM IN-111 1.5 MCI/1.5 ML INTRATHECAL SOLUTION [154582]
|
Facility
|
OP
|
$3,187.81
|
|
|
Service Code
|
HCPCS A9548
|
| Hospital Charge Code |
901700057
|
|
Hospital Revenue Code
|
343
|
| Min. Negotiated Rate |
$637.56 |
| Max. Negotiated Rate |
$2,709.64 |
| Rate for Payer: EPIC Health Plan Commercial |
$1,230.27
|
| Rate for Payer: Adventist Health Commercial |
$637.56
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$932.02
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$820.18
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$820.18
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$643.94
|
| Rate for Payer: Blue Shield of California Commercial |
$1,342.07
|
| Rate for Payer: Blue Shield of California Commercial |
$2,033.82
|
| Rate for Payer: Cash Price |
$1,434.51
|
| Rate for Payer: Cash Price |
$1,434.51
|
| Rate for Payer: Cigna of CA HMO |
$2,040.20
|
| Rate for Payer: Cigna of CA PPO |
$2,358.98
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$932.02
|
| Rate for Payer: Dignity Health Medi-Cal |
$820.18
|
| Rate for Payer: Dignity Health Medicare Advantage |
$820.18
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$2,231.47
|
| Rate for Payer: EPIC Health Plan Senior |
$820.18
|
| Rate for Payer: Galaxy Health WC |
$2,709.64
|
| Rate for Payer: Global Benefits Group Commercial |
$1,912.69
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$1,222.82
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$1,311.86
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$745.62
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$2,024.26
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1,483.65
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,043.87
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$765.07
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$939.48
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$999.13
|
| Rate for Payer: Multiplan Commercial |
$2,550.25
|
| Rate for Payer: Networks By Design Commercial |
$2,072.08
|
| Rate for Payer: Prime Health Services Commercial |
$2,709.64
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,912.69
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,912.69
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,196.39
|
| Rate for Payer: United Healthcare All Other HMO |
$1,164.51
|
| Rate for Payer: United Healthcare HMO Rider |
$1,139.32
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,044.01
|
| Rate for Payer: Upland Medical Group Pediatric |
$745.62
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$932.02
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$820.18
|
| Rate for Payer: Vantage Medical Group Senior |
$820.18
|
|
|
PENTOBARBITAL SODIUM 50 MG/ML INJECTION SOLUTION [6097]
|
Facility
|
OP
|
$50.40
|
|
|
Service Code
|
HCPCS J2515
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$5.30 |
| Max. Negotiated Rate |
$327.61 |
| Rate for Payer: Adventist Health Commercial |
$10.08
|
| Rate for Payer: Adventist Health Commercial |
$7.30
|
| Rate for Payer: Adventist Health Commercial |
$14.52
|
| Rate for Payer: Aetna of CA HMO/PPO |
$327.61
|
| Rate for Payer: Aetna of CA HMO/PPO |
$327.61
|
| Rate for Payer: Aetna of CA HMO/PPO |
$327.61
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$28.95
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$28.95
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$28.95
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$21.23
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$21.23
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$21.23
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$19.30
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$19.30
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$19.30
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5.30
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5.30
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5.30
|
| Rate for Payer: Blue Shield of California Commercial |
$63.39
|
| Rate for Payer: Blue Shield of California Commercial |
$63.39
|
| Rate for Payer: Blue Shield of California Commercial |
$63.39
|
| Rate for Payer: Cash Price |
$32.67
|
| Rate for Payer: Cash Price |
$22.68
|
| Rate for Payer: Cash Price |
$22.68
|
| Rate for Payer: Cash Price |
$32.67
|
| Rate for Payer: Cash Price |
$16.42
|
| Rate for Payer: Cash Price |
$16.42
|
| Rate for Payer: Cigna of CA HMO |
$25.54
|
| Rate for Payer: Cigna of CA HMO |
$35.28
|
| Rate for Payer: Cigna of CA HMO |
$50.82
|
| Rate for Payer: Cigna of CA PPO |
$25.54
|
| Rate for Payer: Cigna of CA PPO |
$50.82
|
| Rate for Payer: Cigna of CA PPO |
$35.28
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$28.95
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$28.95
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$28.95
|
| Rate for Payer: Dignity Health Medi-Cal |
$21.23
|
| Rate for Payer: Dignity Health Medi-Cal |
$21.23
|
| Rate for Payer: Dignity Health Medi-Cal |
$21.23
|
| Rate for Payer: Dignity Health Medicare Advantage |
$19.30
|
| Rate for Payer: Dignity Health Medicare Advantage |
$19.30
|
| Rate for Payer: Dignity Health Medicare Advantage |
$19.30
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$35.28
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$25.54
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$50.82
|
| Rate for Payer: EPIC Health Plan Commercial |
$31.84
|
| Rate for Payer: EPIC Health Plan Commercial |
$31.84
|
| Rate for Payer: EPIC Health Plan Commercial |
$31.84
|
| Rate for Payer: EPIC Health Plan Senior |
$21.23
|
| Rate for Payer: EPIC Health Plan Senior |
$21.23
|
| Rate for Payer: EPIC Health Plan Senior |
$21.23
|
| Rate for Payer: Galaxy Health WC |
$61.71
|
| Rate for Payer: Galaxy Health WC |
$31.01
|
| Rate for Payer: Galaxy Health WC |
$42.84
|
| Rate for Payer: Global Benefits Group Commercial |
$43.56
|
| Rate for Payer: Global Benefits Group Commercial |
$30.24
|
| Rate for Payer: Global Benefits Group Commercial |
$21.89
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$31.65
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$31.65
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$31.65
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$81.16
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$81.16
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$81.16
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$19.30
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$19.30
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$19.30
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$32.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$46.10
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$23.16
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$91.79
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$91.79
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$91.79
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$27.02
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$27.02
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$27.02
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$12.10
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$8.76
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$17.42
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$24.32
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$24.32
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$24.32
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$25.86
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$25.86
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$25.86
|
| Rate for Payer: Multiplan Commercial |
$29.18
|
| Rate for Payer: Multiplan Commercial |
$40.32
|
| Rate for Payer: Multiplan Commercial |
$58.08
|
| Rate for Payer: Networks By Design Commercial |
$18.24
|
| Rate for Payer: Networks By Design Commercial |
$25.20
|
| Rate for Payer: Networks By Design Commercial |
$36.30
|
| Rate for Payer: Prime Health Services Commercial |
$42.84
|
| Rate for Payer: Prime Health Services Commercial |
$61.71
|
| Rate for Payer: Prime Health Services Commercial |
$31.01
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$30.24
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$43.56
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$21.89
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$43.56
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$30.24
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$21.89
|
| Rate for Payer: United Healthcare All Other Commercial |
$18.92
|
| Rate for Payer: United Healthcare All Other Commercial |
$13.69
|
| Rate for Payer: United Healthcare All Other Commercial |
$27.25
|
| Rate for Payer: United Healthcare All Other HMO |
$13.33
|
| Rate for Payer: United Healthcare All Other HMO |
$26.52
|
| Rate for Payer: United Healthcare All Other HMO |
$18.41
|
| Rate for Payer: United Healthcare HMO Rider |
$18.01
|
| Rate for Payer: United Healthcare HMO Rider |
$13.04
|
| Rate for Payer: United Healthcare HMO Rider |
$25.95
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$16.51
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$11.95
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$23.78
|
| Rate for Payer: Upland Medical Group Pediatric |
$19.30
|
| Rate for Payer: Upland Medical Group Pediatric |
$19.30
|
| Rate for Payer: Upland Medical Group Pediatric |
$19.30
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$28.95
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$28.95
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$28.95
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$21.23
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$21.23
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$21.23
|
| Rate for Payer: Vantage Medical Group Senior |
$19.30
|
| Rate for Payer: Vantage Medical Group Senior |
$19.30
|
| Rate for Payer: Vantage Medical Group Senior |
$19.30
|
|
|
PENTOBARBITAL SODIUM 50 MG/ML INJECTION SOLUTION [6097]
|
Facility
|
IP
|
$36.48
|
|
|
Service Code
|
HCPCS J2515
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$7.30 |
| Max. Negotiated Rate |
$31.01 |
| Rate for Payer: Adventist Health Commercial |
$7.30
|
| Rate for Payer: Adventist Health Commercial |
$10.08
|
| Rate for Payer: Adventist Health Commercial |
$14.52
|
| Rate for Payer: Blue Shield of California Commercial |
$38.76
|
| Rate for Payer: Blue Shield of California Commercial |
$18.50
|
| Rate for Payer: Blue Shield of California Commercial |
$28.05
|
| Rate for Payer: Blue Shield of California Commercial |
$55.83
|
| Rate for Payer: Blue Shield of California Commercial |
$36.81
|
| Rate for Payer: Blue Shield of California Commercial |
$25.55
|
| Rate for Payer: Cash Price |
$32.67
|
| Rate for Payer: Cash Price |
$22.68
|
| Rate for Payer: Cash Price |
$16.42
|
| Rate for Payer: Cigna of CA HMO |
$50.82
|
| Rate for Payer: Cigna of CA HMO |
$35.28
|
| Rate for Payer: Cigna of CA HMO |
$25.54
|
| Rate for Payer: Cigna of CA PPO |
$25.54
|
| Rate for Payer: Cigna of CA PPO |
$50.82
|
| Rate for Payer: Cigna of CA PPO |
$35.28
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$50.82
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$35.28
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$25.54
|
| Rate for Payer: EPIC Health Plan Commercial |
$20.16
|
| Rate for Payer: EPIC Health Plan Commercial |
$29.04
|
| Rate for Payer: EPIC Health Plan Commercial |
$14.59
|
| Rate for Payer: EPIC Health Plan Senior |
$20.16
|
| Rate for Payer: EPIC Health Plan Senior |
$14.59
|
| Rate for Payer: EPIC Health Plan Senior |
$29.04
|
| Rate for Payer: Galaxy Health WC |
$61.71
|
| Rate for Payer: Galaxy Health WC |
$31.01
|
| Rate for Payer: Galaxy Health WC |
$42.84
|
| Rate for Payer: Global Benefits Group Commercial |
$30.24
|
| Rate for Payer: Global Benefits Group Commercial |
$21.89
|
| Rate for Payer: Global Benefits Group Commercial |
$43.56
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$23.16
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$32.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$46.10
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$29.74
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$21.52
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$42.83
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$8.76
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$12.10
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$17.42
|
| Rate for Payer: Multiplan Commercial |
$29.18
|
| Rate for Payer: Multiplan Commercial |
$40.32
|
| Rate for Payer: Multiplan Commercial |
$58.08
|
| Rate for Payer: Networks By Design Commercial |
$25.20
|
| Rate for Payer: Networks By Design Commercial |
$36.30
|
| Rate for Payer: Networks By Design Commercial |
$18.24
|
| Rate for Payer: Prime Health Services Commercial |
$31.01
|
| Rate for Payer: Prime Health Services Commercial |
$42.84
|
| Rate for Payer: Prime Health Services Commercial |
$61.71
|
| Rate for Payer: United Healthcare All Other Commercial |
$18.92
|
| Rate for Payer: United Healthcare All Other Commercial |
$13.69
|
| Rate for Payer: United Healthcare All Other Commercial |
$27.25
|
| Rate for Payer: United Healthcare All Other HMO |
$26.52
|
| Rate for Payer: United Healthcare All Other HMO |
$13.33
|
| Rate for Payer: United Healthcare All Other HMO |
$18.41
|
| Rate for Payer: United Healthcare HMO Rider |
$18.01
|
| Rate for Payer: United Healthcare HMO Rider |
$25.95
|
| Rate for Payer: United Healthcare HMO Rider |
$13.04
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$23.78
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$11.95
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$16.51
|
|
|
PENTOSAN POLYSULFATE SODIUM 100 MG CAPSULE [12912]
|
Facility
|
OP
|
$15.16
|
|
|
Service Code
|
NDC 5045809801
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$3.03 |
| Max. Negotiated Rate |
$12.89 |
| Rate for Payer: Adventist Health Commercial |
$3.03
|
| Rate for Payer: Aetna of CA HMO/PPO |
$9.94
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$12.89
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$8.34
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$11.37
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$9.73
|
| Rate for Payer: Cash Price |
$6.82
|
| Rate for Payer: Cigna of CA HMO |
$10.61
|
| Rate for Payer: Cigna of CA PPO |
$10.61
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$12.89
|
| Rate for Payer: Dignity Health Medi-Cal |
$12.89
|
| Rate for Payer: Dignity Health Medicare Advantage |
$12.89
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$10.61
|
| Rate for Payer: EPIC Health Plan Commercial |
$6.06
|
| Rate for Payer: EPIC Health Plan Senior |
$6.06
|
| Rate for Payer: Galaxy Health WC |
$12.89
|
| Rate for Payer: Global Benefits Group Commercial |
$9.10
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$9.63
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$5.50
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$8.94
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.64
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$10.61
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$10.61
|
| Rate for Payer: Multiplan Commercial |
$12.13
|
| Rate for Payer: Networks By Design Commercial |
$9.85
|
| Rate for Payer: Prime Health Services Commercial |
$12.89
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$9.10
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$9.10
|
| Rate for Payer: United Healthcare All Other Commercial |
$7.58
|
| Rate for Payer: United Healthcare All Other HMO |
$7.58
|
| Rate for Payer: United Healthcare HMO Rider |
$7.58
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$7.58
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$12.89
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$12.89
|
| Rate for Payer: Vantage Medical Group Senior |
$12.89
|
|
|
PENTOSAN POLYSULFATE SODIUM 100 MG CAPSULE [12912]
|
Facility
|
IP
|
$15.16
|
|
|
Service Code
|
NDC 5045809801
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$3.03 |
| Max. Negotiated Rate |
$12.89 |
| Rate for Payer: Adventist Health Commercial |
$3.03
|
| Rate for Payer: Blue Shield of California Commercial |
$11.66
|
| Rate for Payer: Blue Shield of California Commercial |
$7.69
|
| Rate for Payer: Cash Price |
$6.82
|
| Rate for Payer: Cigna of CA HMO |
$10.61
|
| Rate for Payer: Cigna of CA PPO |
$10.61
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$10.61
|
| Rate for Payer: EPIC Health Plan Commercial |
$6.06
|
| Rate for Payer: EPIC Health Plan Senior |
$6.06
|
| Rate for Payer: Galaxy Health WC |
$12.89
|
| Rate for Payer: Global Benefits Group Commercial |
$9.10
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$9.63
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$8.94
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.64
|
| Rate for Payer: Multiplan Commercial |
$12.13
|
| Rate for Payer: Networks By Design Commercial |
$9.85
|
| Rate for Payer: Prime Health Services Commercial |
$12.89
|
|
|
PENTOSTATIN 10 MG INTRAVENOUS SOLUTION [10910]
|
Facility
|
OP
|
$3,665.48
|
|
|
Service Code
|
HCPCS J9268
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$733.10 |
| Max. Negotiated Rate |
$5,265.33 |
| Rate for Payer: Adventist Health Commercial |
$733.10
|
| Rate for Payer: Aetna of CA HMO/PPO |
$5,265.33
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$4,046.99
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,967.79
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,697.99
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,118.44
|
| Rate for Payer: Blue Shield of California Commercial |
$3,541.54
|
| Rate for Payer: Cash Price |
$1,649.47
|
| Rate for Payer: Cash Price |
$1,649.47
|
| Rate for Payer: Cigna of CA HMO |
$2,565.84
|
| Rate for Payer: Cigna of CA PPO |
$2,565.84
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,372.49
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,967.79
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2,967.79
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$2,565.84
|
| Rate for Payer: EPIC Health Plan Commercial |
$4,451.68
|
| Rate for Payer: EPIC Health Plan Senior |
$2,967.79
|
| Rate for Payer: Galaxy Health WC |
$3,115.66
|
| Rate for Payer: Global Benefits Group Commercial |
$2,199.29
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$4,424.70
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$2,697.99
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$2,697.99
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$2,327.58
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1,330.57
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$3,777.19
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$879.72
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$3,399.47
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$3,615.31
|
| Rate for Payer: Multiplan Commercial |
$2,932.38
|
| Rate for Payer: Networks By Design Commercial |
$1,832.74
|
| Rate for Payer: Prime Health Services Commercial |
$3,115.66
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,199.29
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2,199.29
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,375.65
|
| Rate for Payer: United Healthcare All Other HMO |
$1,339.00
|
| Rate for Payer: United Healthcare HMO Rider |
$1,310.04
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,200.44
|
| Rate for Payer: Upland Medical Group Pediatric |
$2,697.99
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,372.49
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,967.79
|
| Rate for Payer: Vantage Medical Group Senior |
$2,967.79
|
|
|
PENTOSTATIN 10 MG INTRAVENOUS SOLUTION [10910]
|
Facility
|
IP
|
$3,665.48
|
|
|
Service Code
|
HCPCS J9268
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$733.10 |
| Max. Negotiated Rate |
$3,115.66 |
| Rate for Payer: Adventist Health Commercial |
$733.10
|
| Rate for Payer: Blue Shield of California Commercial |
$1,858.40
|
| Rate for Payer: Blue Shield of California Commercial |
$2,818.75
|
| Rate for Payer: Cash Price |
$1,649.47
|
| Rate for Payer: Cigna of CA HMO |
$2,565.84
|
| Rate for Payer: Cigna of CA PPO |
$2,565.84
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$2,565.84
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,466.19
|
| Rate for Payer: EPIC Health Plan Senior |
$1,466.19
|
| Rate for Payer: Galaxy Health WC |
$3,115.66
|
| Rate for Payer: Global Benefits Group Commercial |
$2,199.29
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$2,327.58
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2,162.63
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$879.72
|
| Rate for Payer: Multiplan Commercial |
$2,932.38
|
| Rate for Payer: Networks By Design Commercial |
$1,832.74
|
| Rate for Payer: Prime Health Services Commercial |
$3,115.66
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,375.65
|
| Rate for Payer: United Healthcare All Other HMO |
$1,339.00
|
| Rate for Payer: United Healthcare HMO Rider |
$1,310.04
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,200.44
|
|
|
PENTOXIFYLLINE ER 400 MG TABLET,EXTENDED RELEASE [10911]
|
Facility
|
IP
|
$0.37
|
|
|
Service Code
|
NDC 0904544861
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| 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 |
$0.19
|
| Rate for Payer: Blue Shield of California Commercial |
$0.28
|
| Rate for Payer: Cash Price |
$0.17
|
| Rate for Payer: Cigna of CA HMO |
$0.26
|
| Rate for Payer: Cigna of CA PPO |
$0.26
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$0.26
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.15
|
| Rate for Payer: EPIC Health Plan Senior |
$0.15
|
| Rate for Payer: Galaxy Health WC |
$0.31
|
| Rate for Payer: Global Benefits Group Commercial |
$0.22
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$0.23
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$0.22
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.09
|
| Rate for Payer: Multiplan Commercial |
$0.30
|
| Rate for Payer: Networks By Design Commercial |
$0.24
|
| Rate for Payer: Prime Health Services Commercial |
$0.31
|
|
|
PENTOXIFYLLINE ER 400 MG TABLET,EXTENDED RELEASE [10911]
|
Facility
|
OP
|
$0.51
|
|
|
Service Code
|
NDC 6050500336
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.10 |
| Max. Negotiated Rate |
$0.43 |
| Rate for Payer: Adventist Health Commercial |
$0.10
|
| Rate for Payer: Aetna of CA HMO/PPO |
$0.33
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.43
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.28
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.38
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.33
|
| Rate for Payer: Cash Price |
$0.23
|
| Rate for Payer: Cigna of CA HMO |
$0.36
|
| Rate for Payer: Cigna of CA PPO |
$0.36
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.43
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.43
|
| Rate for Payer: Dignity Health Medicare Advantage |
$0.43
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$0.36
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.20
|
| Rate for Payer: EPIC Health Plan Senior |
$0.20
|
| Rate for Payer: Galaxy Health WC |
$0.43
|
| Rate for Payer: Global Benefits Group Commercial |
$0.31
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$0.32
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.19
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$0.30
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.12
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$0.36
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$0.36
|
| Rate for Payer: Multiplan Commercial |
$0.41
|
| Rate for Payer: Networks By Design Commercial |
$0.33
|
| Rate for Payer: Prime Health Services Commercial |
$0.43
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.31
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.31
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.26
|
| Rate for Payer: United Healthcare All Other HMO |
$0.26
|
| Rate for Payer: United Healthcare HMO Rider |
$0.26
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.26
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.43
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.43
|
| Rate for Payer: Vantage Medical Group Senior |
$0.43
|
|
|
PENTOXIFYLLINE ER 400 MG TABLET,EXTENDED RELEASE [10911]
|
Facility
|
IP
|
$0.51
|
|
|
Service Code
|
NDC 6050500336
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.10 |
| Max. Negotiated Rate |
$0.43 |
| Rate for Payer: Adventist Health Commercial |
$0.10
|
| Rate for Payer: Blue Shield of California Commercial |
$0.26
|
| Rate for Payer: Blue Shield of California Commercial |
$0.39
|
| Rate for Payer: Cash Price |
$0.23
|
| Rate for Payer: Cigna of CA HMO |
$0.36
|
| Rate for Payer: Cigna of CA PPO |
$0.36
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$0.36
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.20
|
| Rate for Payer: EPIC Health Plan Senior |
$0.20
|
| Rate for Payer: Galaxy Health WC |
$0.43
|
| Rate for Payer: Global Benefits Group Commercial |
$0.31
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$0.32
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$0.30
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.12
|
| Rate for Payer: Multiplan Commercial |
$0.41
|
| Rate for Payer: Networks By Design Commercial |
$0.33
|
| Rate for Payer: Prime Health Services Commercial |
$0.43
|
|
|
PENTOXIFYLLINE ER 400 MG TABLET,EXTENDED RELEASE [10911]
|
Facility
|
OP
|
$0.37
|
|
|
Service Code
|
NDC 0904544861
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.07 |
| Max. Negotiated Rate |
$0.31 |
| 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 |
$0.28
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.24
|
| Rate for Payer: Cash Price |
$0.17
|
| Rate for Payer: Cigna of CA HMO |
$0.26
|
| Rate for Payer: Cigna of CA PPO |
$0.26
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.31
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.31
|
| Rate for Payer: Dignity Health Medicare Advantage |
$0.31
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$0.26
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.15
|
| Rate for Payer: EPIC Health Plan Senior |
$0.15
|
| Rate for Payer: Galaxy Health WC |
$0.31
|
| Rate for Payer: Global Benefits Group Commercial |
$0.22
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$0.23
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.13
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$0.22
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.09
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$0.26
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$0.26
|
| Rate for Payer: Multiplan Commercial |
$0.30
|
| Rate for Payer: Networks By Design Commercial |
$0.24
|
| Rate for Payer: Prime Health Services Commercial |
$0.31
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.22
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.22
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.19
|
| Rate for Payer: United Healthcare All Other HMO |
$0.19
|
| Rate for Payer: United Healthcare HMO Rider |
$0.19
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.19
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.31
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.31
|
| Rate for Payer: Vantage Medical Group Senior |
$0.31
|
|
|
PENTOXIFYLLINE ORAL SUSPENSION COMPOUND 20 MG/ML [4080317]
|
Facility
|
OP
|
$0.03
|
|
|
Service Code
|
NDC 9994080317
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.01 |
| Max. Negotiated Rate |
$0.03 |
| Rate for Payer: Adventist Health Commercial |
$0.01
|
| Rate for Payer: Aetna of CA HMO/PPO |
$0.02
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.03
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.02
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.02
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.02
|
| Rate for Payer: Cash Price |
$0.01
|
| Rate for Payer: Cigna of CA HMO |
$0.02
|
| Rate for Payer: Cigna of CA PPO |
$0.02
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.03
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.03
|
| Rate for Payer: Dignity Health Medicare Advantage |
$0.03
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$0.02
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.01
|
| Rate for Payer: EPIC Health Plan Senior |
$0.01
|
| Rate for Payer: Galaxy Health WC |
$0.03
|
| Rate for Payer: Global Benefits Group Commercial |
$0.02
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$0.02
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.01
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$0.02
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.01
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$0.02
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$0.02
|
| Rate for Payer: Multiplan Commercial |
$0.02
|
| Rate for Payer: Networks By Design Commercial |
$0.02
|
| Rate for Payer: Prime Health Services Commercial |
$0.03
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.02
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.02
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.02
|
| Rate for Payer: United Healthcare All Other HMO |
$0.02
|
| Rate for Payer: United Healthcare HMO Rider |
$0.02
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.02
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.03
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.03
|
| Rate for Payer: Vantage Medical Group Senior |
$0.03
|
|
|
PENTOXIFYLLINE ORAL SUSPENSION COMPOUND 20 MG/ML [4080317]
|
Facility
|
IP
|
$0.03
|
|
|
Service Code
|
NDC 9994080317
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.01 |
| Max. Negotiated Rate |
$0.03 |
| Rate for Payer: Adventist Health Commercial |
$0.01
|
| Rate for Payer: Blue Shield of California Commercial |
$0.02
|
| Rate for Payer: Blue Shield of California Commercial |
$0.02
|
| Rate for Payer: Cash Price |
$0.01
|
| Rate for Payer: Cigna of CA HMO |
$0.02
|
| Rate for Payer: Cigna of CA PPO |
$0.02
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$0.02
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.01
|
| Rate for Payer: EPIC Health Plan Senior |
$0.01
|
| Rate for Payer: Galaxy Health WC |
$0.03
|
| Rate for Payer: Global Benefits Group Commercial |
$0.02
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$0.02
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$0.02
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.01
|
| Rate for Payer: Multiplan Commercial |
$0.02
|
| Rate for Payer: Networks By Design Commercial |
$0.02
|
| Rate for Payer: Prime Health Services Commercial |
$0.03
|
|
|
PEPPERMINT OIL [6116]
|
Facility
|
OP
|
$0.94
|
|
|
Service Code
|
NDC 0395201591
|
| Hospital Charge Code |
901700003
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.19 |
| Max. Negotiated Rate |
$0.80 |
| Rate for Payer: Adventist Health Commercial |
$0.19
|
| Rate for Payer: Aetna of CA HMO/PPO |
$0.62
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.80
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.52
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.71
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.60
|
| Rate for Payer: Cash Price |
$0.42
|
| Rate for Payer: Cigna of CA HMO |
$0.60
|
| Rate for Payer: Cigna of CA PPO |
$0.70
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.80
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.80
|
| Rate for Payer: Dignity Health Medicare Advantage |
$0.80
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$0.66
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.38
|
| Rate for Payer: EPIC Health Plan Senior |
$0.38
|
| Rate for Payer: Galaxy Health WC |
$0.80
|
| Rate for Payer: Global Benefits Group Commercial |
$0.56
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$0.60
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.34
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$0.55
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.23
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$0.66
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$0.66
|
| Rate for Payer: Multiplan Commercial |
$0.75
|
| Rate for Payer: Networks By Design Commercial |
$0.61
|
| Rate for Payer: Prime Health Services Commercial |
$0.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.56
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.56
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.47
|
| Rate for Payer: United Healthcare All Other HMO |
$0.47
|
| Rate for Payer: United Healthcare HMO Rider |
$0.47
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.47
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.80
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.80
|
| Rate for Payer: Vantage Medical Group Senior |
$0.80
|
|
|
PEPPERMINT OIL [6116]
|
Facility
|
IP
|
$0.94
|
|
|
Service Code
|
NDC 0395201591
|
| Hospital Charge Code |
901700003
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.19 |
| Max. Negotiated Rate |
$0.80 |
| Rate for Payer: Adventist Health Commercial |
$0.19
|
| Rate for Payer: Blue Shield of California Commercial |
$0.48
|
| Rate for Payer: Blue Shield of California Commercial |
$0.72
|
| Rate for Payer: Cash Price |
$0.42
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$0.66
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.38
|
| Rate for Payer: EPIC Health Plan Senior |
$0.38
|
| Rate for Payer: Galaxy Health WC |
$0.80
|
| Rate for Payer: Global Benefits Group Commercial |
$0.56
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$0.60
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$0.55
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.23
|
| Rate for Payer: Multiplan Commercial |
$0.75
|
| Rate for Payer: Networks By Design Commercial |
$0.61
|
| Rate for Payer: Prime Health Services Commercial |
$0.80
|
|
|
PEPPERMINT SPIRIT FOR CNR (WRAP) [408114897]
|
Facility
|
OP
|
$0.94
|
|
|
Service Code
|
NDC 0395201591
|
| Hospital Charge Code |
901700003
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.19 |
| Max. Negotiated Rate |
$0.80 |
| Rate for Payer: Adventist Health Commercial |
$0.19
|
| Rate for Payer: Aetna of CA HMO/PPO |
$0.62
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.80
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.52
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.71
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.60
|
| Rate for Payer: Cash Price |
$0.42
|
| Rate for Payer: Cigna of CA HMO |
$0.60
|
| Rate for Payer: Cigna of CA PPO |
$0.70
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.80
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.80
|
| Rate for Payer: Dignity Health Medicare Advantage |
$0.80
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$0.66
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.38
|
| Rate for Payer: EPIC Health Plan Senior |
$0.38
|
| Rate for Payer: Galaxy Health WC |
$0.80
|
| Rate for Payer: Global Benefits Group Commercial |
$0.56
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$0.60
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.34
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$0.55
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.23
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$0.66
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$0.66
|
| Rate for Payer: Multiplan Commercial |
$0.75
|
| Rate for Payer: Networks By Design Commercial |
$0.61
|
| Rate for Payer: Prime Health Services Commercial |
$0.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.56
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.56
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.47
|
| Rate for Payer: United Healthcare All Other HMO |
$0.47
|
| Rate for Payer: United Healthcare HMO Rider |
$0.47
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.47
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.80
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.80
|
| Rate for Payer: Vantage Medical Group Senior |
$0.80
|
|
|
PEPPERMINT SPIRIT FOR CNR (WRAP) [408114897]
|
Facility
|
OP
|
$0.35
|
|
|
Service Code
|
NDC 0395224391
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.07 |
| Max. Negotiated Rate |
$0.30 |
| Rate for Payer: Adventist Health Commercial |
$0.07
|
| Rate for Payer: Aetna of CA HMO/PPO |
$0.23
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.30
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.19
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.26
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.22
|
| Rate for Payer: Cash Price |
$0.16
|
| 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 |
$0.30
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.30
|
| Rate for Payer: Dignity Health Medicare Advantage |
$0.30
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$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 |
$0.30
|
| Rate for Payer: Global Benefits Group Commercial |
$0.21
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$0.22
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.13
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$0.21
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.08
|
| 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 |
$0.28
|
| Rate for Payer: Networks By Design Commercial |
$0.23
|
| Rate for Payer: Prime Health Services Commercial |
$0.30
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.21
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.21
|
| 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 HMO Rider |
$0.18
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.18
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.30
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.30
|
| Rate for Payer: Vantage Medical Group Senior |
$0.30
|
|
|
PEPPERMINT SPIRIT FOR CNR (WRAP) [408114897]
|
Facility
|
IP
|
$0.94
|
|
|
Service Code
|
NDC 0395201591
|
| Hospital Charge Code |
901700003
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.19 |
| Max. Negotiated Rate |
$0.80 |
| Rate for Payer: Adventist Health Commercial |
$0.19
|
| Rate for Payer: Blue Shield of California Commercial |
$0.48
|
| Rate for Payer: Blue Shield of California Commercial |
$0.72
|
| Rate for Payer: Cash Price |
$0.42
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$0.66
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.38
|
| Rate for Payer: EPIC Health Plan Senior |
$0.38
|
| Rate for Payer: Galaxy Health WC |
$0.80
|
| Rate for Payer: Global Benefits Group Commercial |
$0.56
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$0.60
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$0.55
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.23
|
| Rate for Payer: Multiplan Commercial |
$0.75
|
| Rate for Payer: Networks By Design Commercial |
$0.61
|
| Rate for Payer: Prime Health Services Commercial |
$0.80
|
|
|
PEPPERMINT SPIRIT FOR CNR (WRAP) [408114897]
|
Facility
|
IP
|
$0.35
|
|
|
Service Code
|
NDC 0395224391
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.07 |
| Max. Negotiated Rate |
$0.30 |
| Rate for Payer: Adventist Health Commercial |
$0.07
|
| Rate for Payer: Blue Shield of California Commercial |
$0.18
|
| Rate for Payer: Blue Shield of California Commercial |
$0.27
|
| Rate for Payer: Cash Price |
$0.16
|
| Rate for Payer: Cigna of CA HMO |
$0.25
|
| Rate for Payer: Cigna of CA PPO |
$0.25
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$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 |
$0.30
|
| Rate for Payer: Global Benefits Group Commercial |
$0.21
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$0.22
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$0.21
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.08
|
| Rate for Payer: Multiplan Commercial |
$0.28
|
| Rate for Payer: Networks By Design Commercial |
$0.23
|
| Rate for Payer: Prime Health Services Commercial |
$0.30
|
|
