|
OXYTOCIN (ML/HR) CONTINUOUS INFUSION 30 UNITS/500 ML LR PREMIX [4081759]
|
Facility
|
IP
|
$0.40
|
|
|
Service Code
|
CPT J2590
|
| Hospital Charge Code |
ERX4081759
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.10 |
| Max. Negotiated Rate |
$0.34 |
| Rate for Payer: Blue Shield of California Commercial |
$0.28
|
| Rate for Payer: Blue Shield of California EPN |
$0.20
|
| Rate for Payer: Cash Price |
$0.18
|
| Rate for Payer: Cigna of CA HMO |
$0.28
|
| Rate for Payer: Cigna of CA PPO |
$0.28
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.16
|
| Rate for Payer: EPIC Health Plan Transplant |
$0.16
|
| Rate for Payer: Galaxy Health WC |
$0.34
|
| Rate for Payer: Global Benefits Group Commercial |
$0.24
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.27
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.15
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.10
|
| Rate for Payer: Multiplan Commercial |
$0.32
|
| Rate for Payer: Networks By Design Commercial |
$0.20
|
| Rate for Payer: Prime Health Services Commercial |
$0.34
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.15
|
| Rate for Payer: United Healthcare All Other HMO |
$0.15
|
| Rate for Payer: United Healthcare HMO Rider |
$0.14
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.13
|
|
|
OXYTOCIN (ML/HR) CONTINUOUS INFUSION 30 UNITS/500 ML LR PREMIX [4081759]
|
Facility
|
OP
|
$0.40
|
|
|
Service Code
|
CPT J2590
|
| Hospital Charge Code |
ERX4081759
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.10 |
| Max. Negotiated Rate |
$14.44 |
| Rate for Payer: Aetna of CA HMO/PPO |
$8.66
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.34
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.22
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.22
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1.93
|
| Rate for Payer: Blue Distinction Transplant |
$0.24
|
| Rate for Payer: Blue Shield of California Commercial |
$0.29
|
| Rate for Payer: Blue Shield of California EPN |
$1.04
|
| Rate for Payer: Cash Price |
$0.18
|
| Rate for Payer: Cash Price |
$0.18
|
| Rate for Payer: Cigna of CA HMO |
$0.28
|
| Rate for Payer: Cigna of CA PPO |
$0.28
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.34
|
| Rate for Payer: Dignity Health Media |
$0.34
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.34
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.16
|
| Rate for Payer: EPIC Health Plan Transplant |
$0.16
|
| Rate for Payer: Galaxy Health WC |
$0.34
|
| Rate for Payer: Global Benefits Group Commercial |
$0.24
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$0.30
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.27
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$14.44
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.10
|
| Rate for Payer: Multiplan Commercial |
$0.32
|
| Rate for Payer: Networks By Design Commercial |
$0.20
|
| Rate for Payer: Prime Health Services Commercial |
$0.34
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.24
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.24
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.20
|
| Rate for Payer: United Healthcare All Other HMO |
$0.20
|
| Rate for Payer: United Healthcare HMO Rider |
$0.20
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.20
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.34
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.34
|
| Rate for Payer: Vantage Medical Group Senior |
$0.34
|
|
|
PACLITAXEL 6 MG/ML CONCENTRATE,INTRAVENOUS [10843]
|
Facility
|
IP
|
$2.84
|
|
|
Service Code
|
CPT J9267
|
| Hospital Charge Code |
1755742
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.68 |
| Max. Negotiated Rate |
$2.41 |
| Rate for Payer: Blue Shield of California Commercial |
$2.02
|
| Rate for Payer: Blue Shield of California EPN |
$1.45
|
| Rate for Payer: Cash Price |
$1.28
|
| Rate for Payer: Cigna of CA HMO |
$1.99
|
| Rate for Payer: Cigna of CA PPO |
$1.99
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.14
|
| Rate for Payer: EPIC Health Plan Transplant |
$1.14
|
| Rate for Payer: Galaxy Health WC |
$2.41
|
| Rate for Payer: Global Benefits Group Commercial |
$1.70
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1.89
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1.08
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.68
|
| Rate for Payer: Multiplan Commercial |
$2.27
|
| Rate for Payer: Networks By Design Commercial |
$1.42
|
| Rate for Payer: Prime Health Services Commercial |
$2.41
|
| Rate for Payer: United Healthcare All Other Commercial |
$1.07
|
| Rate for Payer: United Healthcare All Other HMO |
$1.05
|
| Rate for Payer: United Healthcare HMO Rider |
$1.02
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.94
|
|
|
PACLITAXEL 6 MG/ML CONCENTRATE,INTRAVENOUS [10843]
|
Facility
|
IP
|
$1.71
|
|
|
Service Code
|
CPT J9267
|
| Hospital Charge Code |
1755743
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.41 |
| Max. Negotiated Rate |
$1.45 |
| Rate for Payer: Blue Shield of California Commercial |
$1.22
|
| Rate for Payer: Blue Shield of California Commercial |
$1.71
|
| Rate for Payer: Blue Shield of California EPN |
$0.88
|
| Rate for Payer: Blue Shield of California EPN |
$1.23
|
| Rate for Payer: Cash Price |
$0.77
|
| Rate for Payer: Cash Price |
$1.08
|
| Rate for Payer: Cigna of CA HMO |
$1.20
|
| Rate for Payer: Cigna of CA HMO |
$1.68
|
| Rate for Payer: Cigna of CA PPO |
$1.68
|
| Rate for Payer: Cigna of CA PPO |
$1.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.96
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.68
|
| Rate for Payer: EPIC Health Plan Transplant |
$0.68
|
| Rate for Payer: EPIC Health Plan Transplant |
$0.96
|
| Rate for Payer: Galaxy Health WC |
$1.45
|
| Rate for Payer: Galaxy Health WC |
$2.04
|
| Rate for Payer: Global Benefits Group Commercial |
$1.44
|
| Rate for Payer: Global Benefits Group Commercial |
$1.03
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1.14
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.65
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.91
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.41
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.58
|
| Rate for Payer: Multiplan Commercial |
$1.37
|
| Rate for Payer: Multiplan Commercial |
$1.92
|
| Rate for Payer: Networks By Design Commercial |
$0.86
|
| Rate for Payer: Networks By Design Commercial |
$1.20
|
| Rate for Payer: Prime Health Services Commercial |
$1.45
|
| Rate for Payer: Prime Health Services Commercial |
$2.04
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.65
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.91
|
| Rate for Payer: United Healthcare All Other HMO |
$0.63
|
| Rate for Payer: United Healthcare All Other HMO |
$0.89
|
| Rate for Payer: United Healthcare HMO Rider |
$0.62
|
| Rate for Payer: United Healthcare HMO Rider |
$0.87
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.56
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.79
|
|
|
PACLITAXEL 6 MG/ML CONCENTRATE,INTRAVENOUS [10843]
|
Facility
|
OP
|
$2.84
|
|
|
Service Code
|
CPT J9267
|
| Hospital Charge Code |
1755742
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.21 |
| Max. Negotiated Rate |
$8.68 |
| Rate for Payer: Aetna of CA HMO/PPO |
$0.21
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2.41
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1.56
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1.56
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.97
|
| Rate for Payer: Blue Distinction Transplant |
$1.70
|
| Rate for Payer: Blue Shield of California Commercial |
$2.09
|
| Rate for Payer: Blue Shield of California EPN |
$0.39
|
| Rate for Payer: Cash Price |
$1.28
|
| Rate for Payer: Cash Price |
$1.28
|
| Rate for Payer: Cigna of CA HMO |
$1.99
|
| Rate for Payer: Cigna of CA PPO |
$1.99
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2.41
|
| Rate for Payer: Dignity Health Media |
$2.41
|
| Rate for Payer: Dignity Health Medi-Cal |
$2.41
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.14
|
| Rate for Payer: EPIC Health Plan Transplant |
$1.14
|
| Rate for Payer: Galaxy Health WC |
$2.41
|
| Rate for Payer: Global Benefits Group Commercial |
$1.70
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$2.13
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1.89
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$8.68
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.68
|
| Rate for Payer: Multiplan Commercial |
$2.27
|
| Rate for Payer: Networks By Design Commercial |
$1.42
|
| Rate for Payer: Prime Health Services Commercial |
$2.41
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1.70
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1.70
|
| Rate for Payer: United Healthcare All Other Commercial |
$1.42
|
| Rate for Payer: United Healthcare All Other HMO |
$1.42
|
| Rate for Payer: United Healthcare HMO Rider |
$1.42
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1.42
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2.41
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2.41
|
| Rate for Payer: Vantage Medical Group Senior |
$2.41
|
|
|
PACLITAXEL 6 MG/ML CONCENTRATE,INTRAVENOUS [10843]
|
Facility
|
OP
|
$2.40
|
|
|
Service Code
|
CPT J9267
|
| Hospital Charge Code |
1759501
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.21 |
| Max. Negotiated Rate |
$8.68 |
| Rate for Payer: Aetna of CA HMO/PPO |
$0.21
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2.04
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1.32
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1.32
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.97
|
| Rate for Payer: Blue Distinction Transplant |
$1.44
|
| Rate for Payer: Blue Shield of California Commercial |
$1.77
|
| Rate for Payer: Blue Shield of California EPN |
$0.39
|
| Rate for Payer: Cash Price |
$1.08
|
| Rate for Payer: Cash Price |
$1.08
|
| Rate for Payer: Cigna of CA HMO |
$1.68
|
| Rate for Payer: Cigna of CA PPO |
$1.68
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2.04
|
| Rate for Payer: Dignity Health Media |
$2.04
|
| Rate for Payer: Dignity Health Medi-Cal |
$2.04
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.96
|
| Rate for Payer: EPIC Health Plan Transplant |
$0.96
|
| Rate for Payer: Galaxy Health WC |
$2.04
|
| Rate for Payer: Global Benefits Group Commercial |
$1.44
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$1.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1.60
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$8.68
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.58
|
| Rate for Payer: Multiplan Commercial |
$1.92
|
| Rate for Payer: Networks By Design Commercial |
$1.20
|
| Rate for Payer: Prime Health Services Commercial |
$2.04
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1.44
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1.44
|
| Rate for Payer: United Healthcare All Other Commercial |
$1.20
|
| Rate for Payer: United Healthcare All Other HMO |
$1.20
|
| Rate for Payer: United Healthcare HMO Rider |
$1.20
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1.20
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2.04
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2.04
|
| Rate for Payer: Vantage Medical Group Senior |
$2.04
|
|
|
PACLITAXEL 6 MG/ML CONCENTRATE,INTRAVENOUS [10843]
|
Facility
|
OP
|
$1.71
|
|
|
Service Code
|
CPT J9267
|
| Hospital Charge Code |
1755743
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.21 |
| Max. Negotiated Rate |
$8.68 |
| Rate for Payer: Aetna of CA HMO/PPO |
$0.21
|
| Rate for Payer: Aetna of CA HMO/PPO |
$0.21
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2.04
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1.45
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.94
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1.32
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1.32
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.94
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.97
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.97
|
| Rate for Payer: Blue Distinction Transplant |
$1.03
|
| Rate for Payer: Blue Distinction Transplant |
$1.44
|
| Rate for Payer: Blue Shield of California Commercial |
$1.26
|
| Rate for Payer: Blue Shield of California Commercial |
$1.77
|
| Rate for Payer: Blue Shield of California EPN |
$0.39
|
| Rate for Payer: Blue Shield of California EPN |
$0.39
|
| Rate for Payer: Cash Price |
$1.08
|
| Rate for Payer: Cash Price |
$1.08
|
| Rate for Payer: Cash Price |
$0.77
|
| Rate for Payer: Cash Price |
$0.77
|
| Rate for Payer: Cigna of CA HMO |
$1.20
|
| Rate for Payer: Cigna of CA HMO |
$1.68
|
| Rate for Payer: Cigna of CA PPO |
$1.20
|
| Rate for Payer: Cigna of CA PPO |
$1.68
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2.04
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1.45
|
| Rate for Payer: Dignity Health Media |
$2.04
|
| Rate for Payer: Dignity Health Media |
$1.45
|
| Rate for Payer: Dignity Health Medi-Cal |
$1.45
|
| Rate for Payer: Dignity Health Medi-Cal |
$2.04
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.96
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.68
|
| Rate for Payer: EPIC Health Plan Transplant |
$0.68
|
| Rate for Payer: EPIC Health Plan Transplant |
$0.96
|
| Rate for Payer: Galaxy Health WC |
$1.45
|
| Rate for Payer: Galaxy Health WC |
$2.04
|
| Rate for Payer: Global Benefits Group Commercial |
$1.44
|
| Rate for Payer: Global Benefits Group Commercial |
$1.03
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$1.80
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$1.28
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1.14
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$8.68
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$8.68
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.58
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.41
|
| Rate for Payer: Multiplan Commercial |
$1.92
|
| Rate for Payer: Multiplan Commercial |
$1.37
|
| Rate for Payer: Networks By Design Commercial |
$0.86
|
| Rate for Payer: Networks By Design Commercial |
$1.20
|
| Rate for Payer: Prime Health Services Commercial |
$2.04
|
| Rate for Payer: Prime Health Services Commercial |
$1.45
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1.44
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1.03
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1.44
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1.03
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.86
|
| Rate for Payer: United Healthcare All Other Commercial |
$1.20
|
| Rate for Payer: United Healthcare All Other HMO |
$1.20
|
| Rate for Payer: United Healthcare All Other HMO |
$0.86
|
| Rate for Payer: United Healthcare HMO Rider |
$1.20
|
| Rate for Payer: United Healthcare HMO Rider |
$0.86
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.86
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1.20
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1.45
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2.04
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1.45
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2.04
|
| Rate for Payer: Vantage Medical Group Senior |
$2.04
|
| Rate for Payer: Vantage Medical Group Senior |
$1.45
|
|
|
PACLITAXEL 6 MG/ML CONCENTRATE,INTRAVENOUS [10843]
|
Facility
|
IP
|
$2.40
|
|
|
Service Code
|
CPT J9267
|
| Hospital Charge Code |
1759501
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.58 |
| Max. Negotiated Rate |
$2.04 |
| Rate for Payer: Blue Shield of California Commercial |
$1.71
|
| Rate for Payer: Blue Shield of California EPN |
$1.23
|
| Rate for Payer: Cash Price |
$1.08
|
| Rate for Payer: Cigna of CA HMO |
$1.68
|
| Rate for Payer: Cigna of CA PPO |
$1.68
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.96
|
| Rate for Payer: EPIC Health Plan Transplant |
$0.96
|
| Rate for Payer: Galaxy Health WC |
$2.04
|
| Rate for Payer: Global Benefits Group Commercial |
$1.44
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1.60
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.91
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.58
|
| Rate for Payer: Multiplan Commercial |
$1.92
|
| Rate for Payer: Networks By Design Commercial |
$1.20
|
| Rate for Payer: Prime Health Services Commercial |
$2.04
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.91
|
| Rate for Payer: United Healthcare All Other HMO |
$0.89
|
| Rate for Payer: United Healthcare HMO Rider |
$0.87
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.79
|
|
|
PACLITAXEL PROTEIN-BOUND 100 MG INTRAVENOUS SUSPENSION [40475]
|
Facility
|
IP
|
$1,896.07
|
|
|
Service Code
|
NDC 68817-134-50
|
| Hospital Charge Code |
1755722
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$455.06 |
| Max. Negotiated Rate |
$1,611.66 |
| Rate for Payer: Blue Shield of California Commercial |
$1,350.00
|
| Rate for Payer: Blue Shield of California EPN |
$970.79
|
| Rate for Payer: Cash Price |
$853.23
|
| Rate for Payer: Cigna of CA HMO |
$1,327.25
|
| Rate for Payer: Cigna of CA PPO |
$1,327.25
|
| Rate for Payer: EPIC Health Plan Commercial |
$758.43
|
| Rate for Payer: EPIC Health Plan Transplant |
$758.43
|
| Rate for Payer: Galaxy Health WC |
$1,611.66
|
| Rate for Payer: Global Benefits Group Commercial |
$1,137.64
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,264.68
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$722.40
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$455.06
|
| Rate for Payer: Multiplan Commercial |
$1,516.86
|
| Rate for Payer: Networks By Design Commercial |
$948.04
|
| Rate for Payer: Prime Health Services Commercial |
$1,611.66
|
| Rate for Payer: United Healthcare All Other Commercial |
$715.96
|
| Rate for Payer: United Healthcare All Other HMO |
$699.27
|
| Rate for Payer: United Healthcare HMO Rider |
$684.10
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$625.70
|
|
|
PACLITAXEL PROTEIN-BOUND 100 MG INTRAVENOUS SUSPENSION [40475]
|
Facility
|
OP
|
$1,896.07
|
|
|
Service Code
|
NDC 68817-134-50
|
| Hospital Charge Code |
1755722
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$455.06 |
| Max. Negotiated Rate |
$1,611.66 |
| Rate for Payer: Aetna of CA HMO/PPO |
$1,243.63
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,611.66
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,042.84
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,042.84
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,129.68
|
| Rate for Payer: Blue Distinction Transplant |
$1,137.64
|
| Rate for Payer: Blue Shield of California Commercial |
$1,397.40
|
| Rate for Payer: Blue Shield of California EPN |
$1,107.30
|
| Rate for Payer: Cash Price |
$853.23
|
| Rate for Payer: Cigna of CA HMO |
$1,327.25
|
| Rate for Payer: Cigna of CA PPO |
$1,327.25
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,611.66
|
| Rate for Payer: Dignity Health Media |
$1,611.66
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,611.66
|
| Rate for Payer: EPIC Health Plan Commercial |
$758.43
|
| Rate for Payer: EPIC Health Plan Transplant |
$758.43
|
| Rate for Payer: Galaxy Health WC |
$1,611.66
|
| Rate for Payer: Global Benefits Group Commercial |
$1,137.64
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$1,422.05
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,264.68
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$722.40
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$455.06
|
| Rate for Payer: Multiplan Commercial |
$1,516.86
|
| Rate for Payer: Networks By Design Commercial |
$948.04
|
| Rate for Payer: Prime Health Services Commercial |
$1,611.66
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,137.64
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,137.64
|
| Rate for Payer: United Healthcare All Other Commercial |
$948.04
|
| Rate for Payer: United Healthcare All Other HMO |
$948.04
|
| Rate for Payer: United Healthcare HMO Rider |
$948.04
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$948.04
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,611.66
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,611.66
|
| Rate for Payer: Vantage Medical Group Senior |
$1,611.66
|
|
|
PALIFERMIN 6.25 MG INTRAVENOUS SOLUTION [40400]
|
Facility
|
IP
|
$3,751.26
|
|
|
Service Code
|
CPT J2425
|
| Hospital Charge Code |
1753463
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$900.30 |
| Max. Negotiated Rate |
$3,188.57 |
| Rate for Payer: Blue Shield of California Commercial |
$2,670.90
|
| Rate for Payer: Blue Shield of California EPN |
$1,920.65
|
| Rate for Payer: Cash Price |
$1,688.07
|
| Rate for Payer: Cigna of CA HMO |
$2,625.88
|
| Rate for Payer: Cigna of CA PPO |
$2,625.88
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,500.50
|
| Rate for Payer: EPIC Health Plan Transplant |
$1,500.50
|
| Rate for Payer: Galaxy Health WC |
$3,188.57
|
| Rate for Payer: Global Benefits Group Commercial |
$2,250.76
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,502.09
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,429.23
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$900.30
|
| Rate for Payer: Multiplan Commercial |
$3,001.01
|
| Rate for Payer: Networks By Design Commercial |
$1,875.63
|
| Rate for Payer: Prime Health Services Commercial |
$3,188.57
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,416.48
|
| Rate for Payer: United Healthcare All Other HMO |
$1,383.46
|
| Rate for Payer: United Healthcare HMO Rider |
$1,353.45
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,237.92
|
|
|
PALIFERMIN 6.25 MG INTRAVENOUS SOLUTION [40400]
|
Facility
|
OP
|
$3,751.26
|
|
|
Service Code
|
CPT J2425
|
| Hospital Charge Code |
1753463
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$24.45 |
| Max. Negotiated Rate |
$3,188.57 |
| Rate for Payer: Aetna of CA HMO/PPO |
$199.15
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$33.14
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$29.16
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$29.16
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$24.45
|
| Rate for Payer: Blue Distinction Transplant |
$2,250.76
|
| Rate for Payer: Blue Shield of California Commercial |
$2,764.68
|
| Rate for Payer: Blue Shield of California EPN |
$25.90
|
| Rate for Payer: Cash Price |
$1,688.07
|
| Rate for Payer: Cash Price |
$1,688.07
|
| Rate for Payer: Cigna of CA HMO |
$2,625.88
|
| Rate for Payer: Cigna of CA PPO |
$2,625.88
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$39.76
|
| Rate for Payer: Dignity Health Media |
$26.51
|
| Rate for Payer: Dignity Health Medi-Cal |
$29.16
|
| Rate for Payer: EPIC Health Plan Commercial |
$35.79
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$26.51
|
| Rate for Payer: EPIC Health Plan Transplant |
$26.51
|
| Rate for Payer: Galaxy Health WC |
$3,188.57
|
| Rate for Payer: Global Benefits Group Commercial |
$2,250.76
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$2,813.44
|
| Rate for Payer: Heritage Provider Network Commercial |
$43.47
|
| Rate for Payer: Heritage Provider Network Transplant |
$43.47
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$42.94
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal Transplant |
$42.94
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$26.51
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,502.09
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$62.74
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$26.51
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$900.30
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$33.40
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$35.52
|
| Rate for Payer: Multiplan Commercial |
$3,001.01
|
| Rate for Payer: Networks By Design Commercial |
$1,875.63
|
| Rate for Payer: Prime Health Services Commercial |
$3,188.57
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,250.76
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2,250.76
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,875.63
|
| Rate for Payer: United Healthcare All Other HMO |
$1,875.63
|
| Rate for Payer: United Healthcare HMO Rider |
$1,875.63
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,875.63
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$39.76
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$29.16
|
| Rate for Payer: Vantage Medical Group Senior |
$26.51
|
|
|
PALIPERIDONE PALMITATE 156 MG/ML INTRAMUSCULAR SYRINGE [99702]
|
Facility
|
IP
|
$2,678.57
|
|
|
Service Code
|
CPT J2426
|
| Hospital Charge Code |
NDG99702
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$642.86 |
| Max. Negotiated Rate |
$2,276.78 |
| Rate for Payer: Blue Shield of California Commercial |
$1,907.14
|
| Rate for Payer: Blue Shield of California EPN |
$1,371.43
|
| Rate for Payer: Cash Price |
$1,205.36
|
| Rate for Payer: Cigna of CA HMO |
$1,875.00
|
| Rate for Payer: Cigna of CA PPO |
$1,875.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,071.43
|
| Rate for Payer: EPIC Health Plan Transplant |
$1,071.43
|
| Rate for Payer: Galaxy Health WC |
$2,276.78
|
| Rate for Payer: Global Benefits Group Commercial |
$1,607.14
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,786.61
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,020.54
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$642.86
|
| Rate for Payer: Multiplan Commercial |
$2,142.86
|
| Rate for Payer: Networks By Design Commercial |
$1,339.28
|
| Rate for Payer: Prime Health Services Commercial |
$2,276.78
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,011.43
|
| Rate for Payer: United Healthcare All Other HMO |
$987.86
|
| Rate for Payer: United Healthcare HMO Rider |
$966.43
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$883.93
|
|
|
PALIPERIDONE PALMITATE 156 MG/ML INTRAMUSCULAR SYRINGE [99702]
|
Facility
|
OP
|
$2,678.57
|
|
|
Service Code
|
CPT J2426
|
| Hospital Charge Code |
NDG99702
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$13.54 |
| Max. Negotiated Rate |
$2,276.78 |
| Rate for Payer: Aetna of CA HMO/PPO |
$90.05
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$17.90
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$15.75
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$15.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13.54
|
| Rate for Payer: Blue Distinction Transplant |
$1,607.14
|
| Rate for Payer: Blue Shield of California Commercial |
$1,974.11
|
| Rate for Payer: Blue Shield of California EPN |
$14.39
|
| Rate for Payer: Cash Price |
$1,205.36
|
| Rate for Payer: Cash Price |
$1,205.36
|
| Rate for Payer: Cigna of CA HMO |
$1,875.00
|
| Rate for Payer: Cigna of CA PPO |
$1,875.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$21.48
|
| Rate for Payer: Dignity Health Media |
$14.32
|
| Rate for Payer: Dignity Health Medi-Cal |
$15.75
|
| Rate for Payer: EPIC Health Plan Commercial |
$19.33
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$14.32
|
| Rate for Payer: EPIC Health Plan Transplant |
$14.32
|
| Rate for Payer: Galaxy Health WC |
$2,276.78
|
| Rate for Payer: Global Benefits Group Commercial |
$1,607.14
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$2,008.93
|
| Rate for Payer: Heritage Provider Network Commercial |
$23.48
|
| Rate for Payer: Heritage Provider Network Transplant |
$23.48
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$23.20
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal Transplant |
$23.20
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$14.32
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,786.61
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$35.68
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$14.32
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$642.86
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$18.04
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$19.19
|
| Rate for Payer: Multiplan Commercial |
$2,142.86
|
| Rate for Payer: Networks By Design Commercial |
$1,339.28
|
| Rate for Payer: Prime Health Services Commercial |
$2,276.78
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,607.14
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,607.14
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,339.28
|
| Rate for Payer: United Healthcare All Other HMO |
$1,339.28
|
| Rate for Payer: United Healthcare HMO Rider |
$1,339.28
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,339.28
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$21.48
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$15.75
|
| Rate for Payer: Vantage Medical Group Senior |
$14.32
|
|
|
PALIPERIDONE PALMITATE 234 MG/1.5 ML INTRAMUSCULAR SYRINGE [108109]
|
Facility
|
OP
|
$2,678.50
|
|
|
Service Code
|
CPT J2426
|
| Hospital Charge Code |
1712607
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$13.54 |
| Max. Negotiated Rate |
$2,276.72 |
| Rate for Payer: Aetna of CA HMO/PPO |
$90.05
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$17.90
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$15.75
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$15.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13.54
|
| Rate for Payer: Blue Distinction Transplant |
$1,607.10
|
| Rate for Payer: Blue Shield of California Commercial |
$1,974.05
|
| Rate for Payer: Blue Shield of California EPN |
$14.39
|
| Rate for Payer: Cash Price |
$1,205.33
|
| Rate for Payer: Cash Price |
$1,205.33
|
| Rate for Payer: Cigna of CA HMO |
$1,874.95
|
| Rate for Payer: Cigna of CA PPO |
$1,874.95
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$21.48
|
| Rate for Payer: Dignity Health Media |
$14.32
|
| Rate for Payer: Dignity Health Medi-Cal |
$15.75
|
| Rate for Payer: EPIC Health Plan Commercial |
$19.33
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$14.32
|
| Rate for Payer: EPIC Health Plan Transplant |
$14.32
|
| Rate for Payer: Galaxy Health WC |
$2,276.72
|
| Rate for Payer: Global Benefits Group Commercial |
$1,607.10
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$2,008.88
|
| Rate for Payer: Heritage Provider Network Commercial |
$23.48
|
| Rate for Payer: Heritage Provider Network Transplant |
$23.48
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$23.20
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal Transplant |
$23.20
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$14.32
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,786.56
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$35.68
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$14.32
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$642.84
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$18.04
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$19.19
|
| Rate for Payer: Multiplan Commercial |
$2,142.80
|
| Rate for Payer: Networks By Design Commercial |
$1,339.25
|
| Rate for Payer: Prime Health Services Commercial |
$2,276.72
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,607.10
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,607.10
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,339.25
|
| Rate for Payer: United Healthcare All Other HMO |
$1,339.25
|
| Rate for Payer: United Healthcare HMO Rider |
$1,339.25
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,339.25
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$21.48
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$15.75
|
| Rate for Payer: Vantage Medical Group Senior |
$14.32
|
|
|
PALIPERIDONE PALMITATE 234 MG/1.5 ML INTRAMUSCULAR SYRINGE [108109]
|
Facility
|
IP
|
$2,678.50
|
|
|
Service Code
|
CPT J2426
|
| Hospital Charge Code |
1712607
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$642.84 |
| Max. Negotiated Rate |
$2,276.72 |
| Rate for Payer: Blue Shield of California Commercial |
$1,907.09
|
| Rate for Payer: Blue Shield of California EPN |
$1,371.39
|
| Rate for Payer: Cash Price |
$1,205.33
|
| Rate for Payer: Cigna of CA HMO |
$1,874.95
|
| Rate for Payer: Cigna of CA PPO |
$1,874.95
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,071.40
|
| Rate for Payer: EPIC Health Plan Transplant |
$1,071.40
|
| Rate for Payer: Galaxy Health WC |
$2,276.72
|
| Rate for Payer: Global Benefits Group Commercial |
$1,607.10
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,786.56
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,020.51
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$642.84
|
| Rate for Payer: Multiplan Commercial |
$2,142.80
|
| Rate for Payer: Networks By Design Commercial |
$1,339.25
|
| Rate for Payer: Prime Health Services Commercial |
$2,276.72
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,011.40
|
| Rate for Payer: United Healthcare All Other HMO |
$987.83
|
| Rate for Payer: United Healthcare HMO Rider |
$966.40
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$883.90
|
|
|
PALIVIZUMAB 100 MG/ML INTRAMUSCULAR SOLUTION [41675]
|
Facility
|
IP
|
$4,125.50
|
|
|
Service Code
|
CPT 90378
|
| Hospital Charge Code |
NDG41675
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$990.12 |
| Max. Negotiated Rate |
$3,506.68 |
| Rate for Payer: Blue Shield of California Commercial |
$2,937.36
|
| Rate for Payer: Blue Shield of California EPN |
$2,112.26
|
| Rate for Payer: Cash Price |
$1,856.48
|
| Rate for Payer: Cigna of CA HMO |
$2,887.85
|
| Rate for Payer: Cigna of CA PPO |
$2,887.85
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,650.20
|
| Rate for Payer: EPIC Health Plan Transplant |
$1,650.20
|
| Rate for Payer: Galaxy Health WC |
$3,506.68
|
| Rate for Payer: Global Benefits Group Commercial |
$2,475.30
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,751.71
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,571.82
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$990.12
|
| Rate for Payer: Multiplan Commercial |
$3,300.40
|
| Rate for Payer: Networks By Design Commercial |
$2,062.75
|
| Rate for Payer: Prime Health Services Commercial |
$3,506.68
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,557.79
|
| Rate for Payer: United Healthcare All Other HMO |
$1,521.48
|
| Rate for Payer: United Healthcare HMO Rider |
$1,488.48
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,361.42
|
|
|
PALIVIZUMAB 100 MG/ML INTRAMUSCULAR SOLUTION [41675]
|
Facility
|
OP
|
$4,125.50
|
|
|
Service Code
|
CPT 90378
|
| Hospital Charge Code |
NDG41675
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$339.68 |
| Max. Negotiated Rate |
$12,910.72 |
| Rate for Payer: Aetna of CA HMO/PPO |
$12,910.72
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$424.60
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$373.65
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$373.65
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,258.51
|
| Rate for Payer: Blue Distinction Transplant |
$2,475.30
|
| Rate for Payer: Blue Shield of California Commercial |
$3,040.49
|
| Rate for Payer: Blue Shield of California EPN |
$1,835.14
|
| Rate for Payer: Cash Price |
$1,856.48
|
| Rate for Payer: Cash Price |
$1,856.48
|
| Rate for Payer: Cigna of CA HMO |
$2,887.85
|
| Rate for Payer: Cigna of CA PPO |
$2,887.85
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$509.52
|
| Rate for Payer: Dignity Health Media |
$339.68
|
| Rate for Payer: Dignity Health Medi-Cal |
$373.65
|
| Rate for Payer: EPIC Health Plan Commercial |
$458.57
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$339.68
|
| Rate for Payer: EPIC Health Plan Transplant |
$339.68
|
| Rate for Payer: Galaxy Health WC |
$3,506.68
|
| Rate for Payer: Global Benefits Group Commercial |
$2,475.30
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$3,094.12
|
| Rate for Payer: Heritage Provider Network Commercial |
$557.08
|
| Rate for Payer: Heritage Provider Network Transplant |
$557.08
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$550.28
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal Transplant |
$550.28
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$339.68
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,751.71
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3,371.11
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$339.68
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$990.12
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$428.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$455.17
|
| Rate for Payer: Multiplan Commercial |
$3,300.40
|
| Rate for Payer: Networks By Design Commercial |
$2,062.75
|
| Rate for Payer: Prime Health Services Commercial |
$3,506.68
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,475.30
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2,475.30
|
| Rate for Payer: United Healthcare All Other Commercial |
$2,062.75
|
| Rate for Payer: United Healthcare All Other HMO |
$2,062.75
|
| Rate for Payer: United Healthcare HMO Rider |
$2,062.75
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,062.75
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$509.52
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$373.65
|
| Rate for Payer: Vantage Medical Group Senior |
$339.68
|
|
|
PALONOSETRON 0.25 MG/5 ML INTRAVENOUS SOLUTION [36591]
|
Facility
|
OP
|
$24.00
|
|
|
Service Code
|
CPT J2469
|
| Hospital Charge Code |
1720944
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$5.29 |
| Max. Negotiated Rate |
$60.51 |
| Rate for Payer: Aetna of CA HMO/PPO |
$5.29
|
| Rate for Payer: Aetna of CA HMO/PPO |
$5.29
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$7.14
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$20.40
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$13.20
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4.62
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4.62
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$13.20
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$60.51
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$60.51
|
| Rate for Payer: Blue Distinction Transplant |
$14.40
|
| Rate for Payer: Blue Distinction Transplant |
$5.04
|
| Rate for Payer: Blue Shield of California Commercial |
$17.69
|
| Rate for Payer: Blue Shield of California Commercial |
$6.19
|
| Rate for Payer: Blue Shield of California EPN |
$16.20
|
| Rate for Payer: Blue Shield of California EPN |
$16.20
|
| Rate for Payer: Cash Price |
$3.78
|
| Rate for Payer: Cash Price |
$3.78
|
| Rate for Payer: Cash Price |
$10.80
|
| Rate for Payer: Cash Price |
$10.80
|
| Rate for Payer: Cigna of CA HMO |
$16.80
|
| Rate for Payer: Cigna of CA HMO |
$5.88
|
| Rate for Payer: Cigna of CA PPO |
$16.80
|
| Rate for Payer: Cigna of CA PPO |
$5.88
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$7.14
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$20.40
|
| Rate for Payer: Dignity Health Media |
$7.14
|
| Rate for Payer: Dignity Health Media |
$20.40
|
| Rate for Payer: Dignity Health Medi-Cal |
$20.40
|
| Rate for Payer: Dignity Health Medi-Cal |
$7.14
|
| Rate for Payer: EPIC Health Plan Commercial |
$3.36
|
| Rate for Payer: EPIC Health Plan Commercial |
$9.60
|
| Rate for Payer: EPIC Health Plan Transplant |
$9.60
|
| Rate for Payer: EPIC Health Plan Transplant |
$3.36
|
| Rate for Payer: Galaxy Health WC |
$20.40
|
| Rate for Payer: Galaxy Health WC |
$7.14
|
| Rate for Payer: Global Benefits Group Commercial |
$5.04
|
| Rate for Payer: Global Benefits Group Commercial |
$14.40
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$6.30
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$18.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$5.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$16.01
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$10.09
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$10.09
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.02
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5.76
|
| Rate for Payer: Multiplan Commercial |
$6.72
|
| Rate for Payer: Multiplan Commercial |
$19.20
|
| Rate for Payer: Networks By Design Commercial |
$12.00
|
| Rate for Payer: Networks By Design Commercial |
$4.20
|
| Rate for Payer: Prime Health Services Commercial |
$7.14
|
| Rate for Payer: Prime Health Services Commercial |
$20.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$5.04
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$14.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$5.04
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$14.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$12.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$4.20
|
| Rate for Payer: United Healthcare All Other HMO |
$4.20
|
| Rate for Payer: United Healthcare All Other HMO |
$12.00
|
| Rate for Payer: United Healthcare HMO Rider |
$4.20
|
| Rate for Payer: United Healthcare HMO Rider |
$12.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$12.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$4.20
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$20.40
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$7.14
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$20.40
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$7.14
|
| Rate for Payer: Vantage Medical Group Senior |
$7.14
|
| Rate for Payer: Vantage Medical Group Senior |
$20.40
|
|
|
PALONOSETRON 0.25 MG/5 ML INTRAVENOUS SOLUTION [36591]
|
Facility
|
IP
|
$24.00
|
|
|
Service Code
|
CPT J2469
|
| Hospital Charge Code |
1720944
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$5.76 |
| Max. Negotiated Rate |
$20.40 |
| Rate for Payer: Blue Shield of California Commercial |
$17.09
|
| Rate for Payer: Blue Shield of California Commercial |
$5.98
|
| Rate for Payer: Blue Shield of California EPN |
$12.29
|
| Rate for Payer: Blue Shield of California EPN |
$4.30
|
| Rate for Payer: Cash Price |
$10.80
|
| Rate for Payer: Cash Price |
$3.78
|
| Rate for Payer: Cigna of CA HMO |
$16.80
|
| Rate for Payer: Cigna of CA HMO |
$5.88
|
| Rate for Payer: Cigna of CA PPO |
$5.88
|
| Rate for Payer: Cigna of CA PPO |
$16.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$3.36
|
| Rate for Payer: EPIC Health Plan Commercial |
$9.60
|
| Rate for Payer: EPIC Health Plan Transplant |
$9.60
|
| Rate for Payer: EPIC Health Plan Transplant |
$3.36
|
| Rate for Payer: Galaxy Health WC |
$20.40
|
| Rate for Payer: Galaxy Health WC |
$7.14
|
| Rate for Payer: Global Benefits Group Commercial |
$5.04
|
| Rate for Payer: Global Benefits Group Commercial |
$14.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$5.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$16.01
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$9.14
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3.20
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5.76
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.02
|
| Rate for Payer: Multiplan Commercial |
$19.20
|
| Rate for Payer: Multiplan Commercial |
$6.72
|
| Rate for Payer: Networks By Design Commercial |
$12.00
|
| Rate for Payer: Networks By Design Commercial |
$4.20
|
| Rate for Payer: Prime Health Services Commercial |
$20.40
|
| Rate for Payer: Prime Health Services Commercial |
$7.14
|
| Rate for Payer: United Healthcare All Other Commercial |
$9.06
|
| Rate for Payer: United Healthcare All Other Commercial |
$3.17
|
| Rate for Payer: United Healthcare All Other HMO |
$8.85
|
| Rate for Payer: United Healthcare All Other HMO |
$3.10
|
| Rate for Payer: United Healthcare HMO Rider |
$8.66
|
| Rate for Payer: United Healthcare HMO Rider |
$3.03
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$7.92
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2.77
|
|
|
PALONOSETRON 0.25 MG/5 ML INTRAVENOUS SOLUTION. [40836591]
|
Facility
|
OP
|
$12.00
|
|
|
Service Code
|
CPT J2469
|
| Hospital Charge Code |
1720944
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$2.88 |
| Max. Negotiated Rate |
$60.51 |
| Rate for Payer: Aetna of CA HMO/PPO |
$5.29
|
| 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 |
$6.60
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$60.51
|
| Rate for Payer: Blue Distinction Transplant |
$7.20
|
| Rate for Payer: Blue Shield of California Commercial |
$8.84
|
| Rate for Payer: Blue Shield of California EPN |
$16.20
|
| 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 Media |
$10.20
|
| Rate for Payer: Dignity Health Medi-Cal |
$10.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$4.80
|
| Rate for Payer: EPIC Health Plan Transplant |
$4.80
|
| Rate for Payer: Galaxy Health WC |
$10.20
|
| Rate for Payer: Global Benefits Group Commercial |
$7.20
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$9.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$8.00
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$10.09
|
| 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: 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 |
$6.00
|
| Rate for Payer: United Healthcare All Other HMO |
$6.00
|
| Rate for Payer: United Healthcare HMO Rider |
$6.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$6.00
|
| 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
|
CPT J2469
|
| Hospital Charge Code |
1720944
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$2.88 |
| Max. Negotiated Rate |
$10.20 |
| Rate for Payer: Blue Shield of California Commercial |
$8.54
|
| Rate for Payer: Blue Shield of California EPN |
$6.14
|
| 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: EPIC Health Plan Commercial |
$4.80
|
| Rate for Payer: EPIC Health Plan Transplant |
$4.80
|
| Rate for Payer: Galaxy Health WC |
$10.20
|
| Rate for Payer: Global Benefits Group Commercial |
$7.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$8.00
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4.57
|
| 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 |
$4.53
|
| Rate for Payer: United Healthcare All Other HMO |
$4.43
|
| Rate for Payer: United Healthcare HMO Rider |
$4.33
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3.96
|
|
|
PALONOSETRON 0.25 MG/5 ML INTRAVENOUS SYRINGE [222773]
|
Facility
|
IP
|
$12.00
|
|
|
Service Code
|
CPT J2469
|
| Hospital Charge Code |
1720944
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$2.88 |
| Max. Negotiated Rate |
$10.20 |
| Rate for Payer: Blue Shield of California Commercial |
$8.54
|
| Rate for Payer: Blue Shield of California EPN |
$6.14
|
| 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: EPIC Health Plan Commercial |
$4.80
|
| Rate for Payer: EPIC Health Plan Transplant |
$4.80
|
| Rate for Payer: Galaxy Health WC |
$10.20
|
| Rate for Payer: Global Benefits Group Commercial |
$7.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$8.00
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4.57
|
| 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 |
$4.53
|
| Rate for Payer: United Healthcare All Other HMO |
$4.43
|
| Rate for Payer: United Healthcare HMO Rider |
$4.33
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3.96
|
|
|
PALONOSETRON 0.25 MG/5 ML INTRAVENOUS SYRINGE [222773]
|
Facility
|
OP
|
$12.00
|
|
|
Service Code
|
CPT J2469
|
| Hospital Charge Code |
1720944
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$2.88 |
| Max. Negotiated Rate |
$60.51 |
| Rate for Payer: Aetna of CA HMO/PPO |
$5.29
|
| 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 |
$6.60
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$60.51
|
| Rate for Payer: Blue Distinction Transplant |
$7.20
|
| Rate for Payer: Blue Shield of California Commercial |
$8.84
|
| Rate for Payer: Blue Shield of California EPN |
$16.20
|
| 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 Media |
$10.20
|
| Rate for Payer: Dignity Health Medi-Cal |
$10.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$4.80
|
| Rate for Payer: EPIC Health Plan Transplant |
$4.80
|
| Rate for Payer: Galaxy Health WC |
$10.20
|
| Rate for Payer: Global Benefits Group Commercial |
$7.20
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$9.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$8.00
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$10.09
|
| 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: 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 |
$6.00
|
| Rate for Payer: United Healthcare All Other HMO |
$6.00
|
| Rate for Payer: United Healthcare HMO Rider |
$6.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$6.00
|
| 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
|
|
|
PAMIDRONATE 30 MG/10 ML (3 MG/ML) INTRAVENOUS SOLUTION [32589]
|
Facility
|
IP
|
$1.68
|
|
|
Service Code
|
CPT J2430
|
| Hospital Charge Code |
NDG32589
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.40 |
| Max. Negotiated Rate |
$1.43 |
| Rate for Payer: Blue Shield of California Commercial |
$1.20
|
| Rate for Payer: Blue Shield of California Commercial |
$2.31
|
| Rate for Payer: Blue Shield of California EPN |
$0.86
|
| Rate for Payer: Blue Shield of California EPN |
$1.66
|
| Rate for Payer: Cash Price |
$0.76
|
| Rate for Payer: Cash Price |
$1.46
|
| Rate for Payer: Cigna of CA HMO |
$1.18
|
| Rate for Payer: Cigna of CA HMO |
$2.27
|
| Rate for Payer: Cigna of CA PPO |
$2.27
|
| Rate for Payer: Cigna of CA PPO |
$1.18
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.67
|
| Rate for Payer: EPIC Health Plan Transplant |
$0.67
|
| Rate for Payer: EPIC Health Plan Transplant |
$1.30
|
| Rate for Payer: Galaxy Health WC |
$1.43
|
| Rate for Payer: Galaxy Health WC |
$2.75
|
| Rate for Payer: Global Benefits Group Commercial |
$1.94
|
| Rate for Payer: Global Benefits Group Commercial |
$1.01
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2.16
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1.12
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.64
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1.23
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.40
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.78
|
| Rate for Payer: Multiplan Commercial |
$1.34
|
| Rate for Payer: Multiplan Commercial |
$2.59
|
| Rate for Payer: Networks By Design Commercial |
$0.84
|
| Rate for Payer: Networks By Design Commercial |
$1.62
|
| Rate for Payer: Prime Health Services Commercial |
$1.43
|
| Rate for Payer: Prime Health Services Commercial |
$2.75
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.63
|
| Rate for Payer: United Healthcare All Other Commercial |
$1.22
|
| Rate for Payer: United Healthcare All Other HMO |
$0.62
|
| Rate for Payer: United Healthcare All Other HMO |
$1.19
|
| Rate for Payer: United Healthcare HMO Rider |
$0.61
|
| Rate for Payer: United Healthcare HMO Rider |
$1.17
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.55
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1.07
|
|
