|
PIOGLITAZONE 15 MG TABLET [25528]
|
Facility
|
IP
|
$0.44
|
|
|
Service Code
|
NDC 0781-5420-92
|
| Hospital Charge Code |
1710878
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.11 |
| Max. Negotiated Rate |
$0.37 |
| Rate for Payer: Blue Shield of California Commercial |
$0.31
|
| Rate for Payer: Blue Shield of California EPN |
$0.23
|
| Rate for Payer: Cash Price |
$0.20
|
| Rate for Payer: Cigna of CA HMO |
$0.31
|
| Rate for Payer: Cigna of CA PPO |
$0.31
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.18
|
| Rate for Payer: Galaxy Health WC |
$0.37
|
| Rate for Payer: Global Benefits Group Commercial |
$0.26
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.29
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.17
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.11
|
| Rate for Payer: Multiplan Commercial |
$0.35
|
| Rate for Payer: Networks By Design Commercial |
$0.29
|
| Rate for Payer: Prime Health Services Commercial |
$0.37
|
|
|
PIOGLITAZONE 15 MG TABLET [25528]
|
Facility
|
OP
|
$0.44
|
|
|
Service Code
|
NDC 0781-5420-92
|
| Hospital Charge Code |
1710878
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.11 |
| Max. Negotiated Rate |
$0.37 |
| Rate for Payer: Aetna of CA HMO/PPO |
$0.29
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.37
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.24
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.24
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.26
|
| Rate for Payer: Blue Distinction Transplant |
$0.26
|
| Rate for Payer: Blue Shield of California Commercial |
$0.32
|
| Rate for Payer: Blue Shield of California EPN |
$0.26
|
| Rate for Payer: Cash Price |
$0.20
|
| Rate for Payer: Cigna of CA HMO |
$0.31
|
| Rate for Payer: Cigna of CA PPO |
$0.31
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.37
|
| Rate for Payer: Dignity Health Media |
$0.37
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.37
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.18
|
| Rate for Payer: EPIC Health Plan Transplant |
$0.18
|
| Rate for Payer: Galaxy Health WC |
$0.37
|
| Rate for Payer: Global Benefits Group Commercial |
$0.26
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$0.33
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.29
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.17
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.11
|
| Rate for Payer: Multiplan Commercial |
$0.35
|
| Rate for Payer: Networks By Design Commercial |
$0.29
|
| Rate for Payer: Prime Health Services Commercial |
$0.37
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.26
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.26
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.22
|
| Rate for Payer: United Healthcare All Other HMO |
$0.22
|
| Rate for Payer: United Healthcare HMO Rider |
$0.22
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.22
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.37
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.37
|
| Rate for Payer: Vantage Medical Group Senior |
$0.37
|
|
|
PIOGLITAZONE 30 MG TABLET [25529]
|
Facility
|
OP
|
$0.22
|
|
|
Service Code
|
NDC 33342-055-07
|
| Hospital Charge Code |
1712291
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.05 |
| Max. Negotiated Rate |
$0.19 |
| Rate for Payer: Aetna of CA HMO/PPO |
$0.14
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.19
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.12
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.12
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.13
|
| Rate for Payer: Blue Distinction Transplant |
$0.13
|
| Rate for Payer: Blue Shield of California Commercial |
$0.16
|
| Rate for Payer: Blue Shield of California EPN |
$0.13
|
| Rate for Payer: Cash Price |
$0.10
|
| Rate for Payer: Cigna of CA HMO |
$0.15
|
| Rate for Payer: Cigna of CA PPO |
$0.15
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.19
|
| Rate for Payer: Dignity Health Media |
$0.19
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.19
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.09
|
| Rate for Payer: EPIC Health Plan Transplant |
$0.09
|
| Rate for Payer: Galaxy Health WC |
$0.19
|
| Rate for Payer: Global Benefits Group Commercial |
$0.13
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$0.17
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.15
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.08
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.05
|
| Rate for Payer: Multiplan Commercial |
$0.18
|
| Rate for Payer: Networks By Design Commercial |
$0.14
|
| Rate for Payer: Prime Health Services Commercial |
$0.19
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.13
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.13
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.11
|
| Rate for Payer: United Healthcare All Other HMO |
$0.11
|
| Rate for Payer: United Healthcare HMO Rider |
$0.11
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.11
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.19
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.19
|
| Rate for Payer: Vantage Medical Group Senior |
$0.19
|
|
|
PIOGLITAZONE 30 MG TABLET [25529]
|
Facility
|
IP
|
$0.22
|
|
|
Service Code
|
NDC 33342-055-07
|
| Hospital Charge Code |
1712291
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.05 |
| Max. Negotiated Rate |
$0.19 |
| Rate for Payer: Blue Shield of California Commercial |
$0.16
|
| Rate for Payer: Blue Shield of California EPN |
$0.11
|
| Rate for Payer: Cash Price |
$0.10
|
| Rate for Payer: Cigna of CA HMO |
$0.15
|
| Rate for Payer: Cigna of CA PPO |
$0.15
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.09
|
| Rate for Payer: Galaxy Health WC |
$0.19
|
| Rate for Payer: Global Benefits Group Commercial |
$0.13
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.15
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.08
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.05
|
| Rate for Payer: Multiplan Commercial |
$0.18
|
| Rate for Payer: Networks By Design Commercial |
$0.14
|
| Rate for Payer: Prime Health Services Commercial |
$0.19
|
|
|
PIPERACILLIN-TAZOBACTAM 2.25 GRAM/50 ML IN DEXTROSE(ISO) IV PIGGYBACK [34523]
|
Facility
|
OP
|
$0.37
|
|
|
Service Code
|
CPT J2543
|
| Hospital Charge Code |
NDG34523
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.09 |
| Max. Negotiated Rate |
$10.78 |
| Rate for Payer: Aetna of CA HMO/PPO |
$7.41
|
| 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 |
$0.20
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$10.78
|
| Rate for Payer: Blue Distinction Transplant |
$0.22
|
| Rate for Payer: Blue Shield of California Commercial |
$0.27
|
| Rate for Payer: Blue Shield of California EPN |
$4.01
|
| Rate for Payer: Cash Price |
$0.17
|
| 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 Media |
$0.31
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.31
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.15
|
| Rate for Payer: EPIC Health Plan Transplant |
$0.15
|
| Rate for Payer: Galaxy Health WC |
$0.31
|
| Rate for Payer: Global Benefits Group Commercial |
$0.22
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$0.28
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.25
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.14
|
| 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 |
$0.19
|
| 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
|
|
|
PIPERACILLIN-TAZOBACTAM 2.25 GRAM/50 ML IN DEXTROSE(ISO) IV PIGGYBACK [34523]
|
Facility
|
IP
|
$0.37
|
|
|
Service Code
|
CPT J2543
|
| Hospital Charge Code |
NDG34523
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.09 |
| Max. Negotiated Rate |
$0.31 |
| Rate for Payer: Blue Shield of California Commercial |
$0.26
|
| Rate for Payer: Blue Shield of California EPN |
$0.19
|
| 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: EPIC Health Plan Commercial |
$0.15
|
| Rate for Payer: EPIC Health Plan Transplant |
$0.15
|
| Rate for Payer: Galaxy Health WC |
$0.31
|
| Rate for Payer: Global Benefits Group Commercial |
$0.22
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.25
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.14
|
| 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 |
$0.19
|
| Rate for Payer: Prime Health Services Commercial |
$0.31
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.14
|
| Rate for Payer: United Healthcare All Other HMO |
$0.14
|
| Rate for Payer: United Healthcare HMO Rider |
$0.13
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.12
|
|
|
PIPERACILLIN-TAZOBACTAM 2.25 GRAM INTRAVENOUS SOLUTION [18304]
|
Facility
|
OP
|
$6.60
|
|
|
Service Code
|
CPT J2543
|
| Hospital Charge Code |
ERX18304
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.58 |
| Max. Negotiated Rate |
$10.78 |
| Rate for Payer: Aetna of CA HMO/PPO |
$7.41
|
| Rate for Payer: Aetna of CA HMO/PPO |
$7.41
|
| Rate for Payer: Aetna of CA HMO/PPO |
$7.41
|
| Rate for Payer: Aetna of CA HMO/PPO |
$7.41
|
| Rate for Payer: Aetna of CA HMO/PPO |
$7.41
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$7.84
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$7.14
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3.50
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$9.44
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$5.61
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2.27
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$5.07
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$3.63
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4.62
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$6.10
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$5.07
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$6.10
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2.27
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4.62
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$3.63
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$10.78
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$10.78
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$10.78
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$10.78
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$10.78
|
| Rate for Payer: Blue Distinction Transplant |
$5.04
|
| Rate for Payer: Blue Distinction Transplant |
$6.66
|
| Rate for Payer: Blue Distinction Transplant |
$3.96
|
| Rate for Payer: Blue Distinction Transplant |
$2.47
|
| Rate for Payer: Blue Distinction Transplant |
$5.53
|
| Rate for Payer: Blue Shield of California Commercial |
$8.18
|
| Rate for Payer: Blue Shield of California Commercial |
$3.04
|
| Rate for Payer: Blue Shield of California Commercial |
$4.86
|
| Rate for Payer: Blue Shield of California Commercial |
$6.19
|
| Rate for Payer: Blue Shield of California Commercial |
$6.80
|
| Rate for Payer: Blue Shield of California EPN |
$4.01
|
| Rate for Payer: Blue Shield of California EPN |
$4.01
|
| Rate for Payer: Blue Shield of California EPN |
$4.01
|
| Rate for Payer: Blue Shield of California EPN |
$4.01
|
| Rate for Payer: Blue Shield of California EPN |
$4.01
|
| Rate for Payer: Cash Price |
$5.00
|
| Rate for Payer: Cash Price |
$2.97
|
| Rate for Payer: Cash Price |
$4.15
|
| Rate for Payer: Cash Price |
$4.15
|
| Rate for Payer: Cash Price |
$5.00
|
| Rate for Payer: Cash Price |
$3.78
|
| Rate for Payer: Cash Price |
$3.78
|
| Rate for Payer: Cash Price |
$2.97
|
| Rate for Payer: Cash Price |
$1.85
|
| Rate for Payer: Cash Price |
$1.85
|
| Rate for Payer: Cigna of CA HMO |
$6.45
|
| Rate for Payer: Cigna of CA HMO |
$2.88
|
| Rate for Payer: Cigna of CA HMO |
$7.77
|
| Rate for Payer: Cigna of CA HMO |
$5.88
|
| Rate for Payer: Cigna of CA HMO |
$4.62
|
| Rate for Payer: Cigna of CA PPO |
$4.62
|
| Rate for Payer: Cigna of CA PPO |
$6.45
|
| Rate for Payer: Cigna of CA PPO |
$7.77
|
| Rate for Payer: Cigna of CA PPO |
$2.88
|
| Rate for Payer: Cigna of CA PPO |
$5.88
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$9.44
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$7.84
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$7.14
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$5.61
|
| Rate for Payer: Dignity Health Media |
$9.44
|
| Rate for Payer: Dignity Health Media |
$3.50
|
| Rate for Payer: Dignity Health Media |
$7.14
|
| Rate for Payer: Dignity Health Media |
$5.61
|
| Rate for Payer: Dignity Health Media |
$7.84
|
| Rate for Payer: Dignity Health Medi-Cal |
$7.84
|
| Rate for Payer: Dignity Health Medi-Cal |
$7.14
|
| Rate for Payer: Dignity Health Medi-Cal |
$3.50
|
| Rate for Payer: Dignity Health Medi-Cal |
$9.44
|
| Rate for Payer: Dignity Health Medi-Cal |
$5.61
|
| Rate for Payer: EPIC Health Plan Commercial |
$3.36
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.64
|
| Rate for Payer: EPIC Health Plan Commercial |
$3.69
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.65
|
| Rate for Payer: EPIC Health Plan Commercial |
$4.44
|
| Rate for Payer: EPIC Health Plan Transplant |
$2.64
|
| Rate for Payer: EPIC Health Plan Transplant |
$4.44
|
| Rate for Payer: EPIC Health Plan Transplant |
$1.65
|
| Rate for Payer: EPIC Health Plan Transplant |
$3.36
|
| Rate for Payer: EPIC Health Plan Transplant |
$3.69
|
| Rate for Payer: Galaxy Health WC |
$5.61
|
| Rate for Payer: Galaxy Health WC |
$9.44
|
| Rate for Payer: Galaxy Health WC |
$3.50
|
| Rate for Payer: Galaxy Health WC |
$7.14
|
| Rate for Payer: Galaxy Health WC |
$7.84
|
| Rate for Payer: Global Benefits Group Commercial |
$6.66
|
| Rate for Payer: Global Benefits Group Commercial |
$5.04
|
| Rate for Payer: Global Benefits Group Commercial |
$3.96
|
| Rate for Payer: Global Benefits Group Commercial |
$5.53
|
| Rate for Payer: Global Benefits Group Commercial |
$2.47
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$3.09
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$6.30
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$8.32
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$4.95
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$6.92
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2.75
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$5.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$7.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$6.15
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3.51
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2.51
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3.20
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1.57
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4.23
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.58
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.02
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.21
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.66
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.99
|
| Rate for Payer: Multiplan Commercial |
$6.72
|
| Rate for Payer: Multiplan Commercial |
$3.30
|
| Rate for Payer: Multiplan Commercial |
$5.28
|
| Rate for Payer: Multiplan Commercial |
$7.38
|
| Rate for Payer: Multiplan Commercial |
$8.88
|
| Rate for Payer: Networks By Design Commercial |
$5.55
|
| Rate for Payer: Networks By Design Commercial |
$3.30
|
| Rate for Payer: Networks By Design Commercial |
$4.61
|
| Rate for Payer: Networks By Design Commercial |
$4.20
|
| Rate for Payer: Networks By Design Commercial |
$2.06
|
| Rate for Payer: Prime Health Services Commercial |
$7.84
|
| Rate for Payer: Prime Health Services Commercial |
$5.61
|
| Rate for Payer: Prime Health Services Commercial |
$3.50
|
| Rate for Payer: Prime Health Services Commercial |
$7.14
|
| Rate for Payer: Prime Health Services Commercial |
$9.44
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2.47
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3.96
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$5.04
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$6.66
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$5.53
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$5.04
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$3.96
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$6.66
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2.47
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$5.53
|
| Rate for Payer: United Healthcare All Other Commercial |
$4.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$4.61
|
| Rate for Payer: United Healthcare All Other Commercial |
$5.55
|
| Rate for Payer: United Healthcare All Other Commercial |
$2.06
|
| Rate for Payer: United Healthcare All Other Commercial |
$3.30
|
| Rate for Payer: United Healthcare All Other HMO |
$2.06
|
| Rate for Payer: United Healthcare All Other HMO |
$4.61
|
| Rate for Payer: United Healthcare All Other HMO |
$3.30
|
| Rate for Payer: United Healthcare All Other HMO |
$4.20
|
| Rate for Payer: United Healthcare All Other HMO |
$5.55
|
| Rate for Payer: United Healthcare HMO Rider |
$4.61
|
| Rate for Payer: United Healthcare HMO Rider |
$5.55
|
| Rate for Payer: United Healthcare HMO Rider |
$2.06
|
| Rate for Payer: United Healthcare HMO Rider |
$4.20
|
| Rate for Payer: United Healthcare HMO Rider |
$3.30
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3.30
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$4.61
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$5.55
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$4.20
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2.06
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$7.84
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$5.61
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$9.44
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$7.14
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$9.44
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$7.14
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$3.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$7.84
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$5.61
|
| Rate for Payer: Vantage Medical Group Senior |
$7.14
|
| Rate for Payer: Vantage Medical Group Senior |
$9.44
|
| Rate for Payer: Vantage Medical Group Senior |
$7.84
|
| Rate for Payer: Vantage Medical Group Senior |
$3.50
|
| Rate for Payer: Vantage Medical Group Senior |
$5.61
|
|
|
PIPERACILLIN-TAZOBACTAM 2.25 GRAM INTRAVENOUS SOLUTION [18304]
|
Facility
|
IP
|
$11.10
|
|
|
Service Code
|
CPT J2543
|
| Hospital Charge Code |
ERX18304
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$2.66 |
| Max. Negotiated Rate |
$9.44 |
| Rate for Payer: Blue Shield of California Commercial |
$7.90
|
| Rate for Payer: Blue Shield of California Commercial |
$5.98
|
| Rate for Payer: Blue Shield of California Commercial |
$6.56
|
| Rate for Payer: Blue Shield of California Commercial |
$2.93
|
| Rate for Payer: Blue Shield of California Commercial |
$4.70
|
| Rate for Payer: Blue Shield of California EPN |
$2.11
|
| Rate for Payer: Blue Shield of California EPN |
$3.38
|
| Rate for Payer: Blue Shield of California EPN |
$5.68
|
| Rate for Payer: Blue Shield of California EPN |
$4.72
|
| Rate for Payer: Blue Shield of California EPN |
$4.30
|
| Rate for Payer: Cash Price |
$4.15
|
| Rate for Payer: Cash Price |
$2.97
|
| Rate for Payer: Cash Price |
$5.00
|
| Rate for Payer: Cash Price |
$3.78
|
| Rate for Payer: Cash Price |
$1.85
|
| Rate for Payer: Cigna of CA HMO |
$6.45
|
| Rate for Payer: Cigna of CA HMO |
$2.88
|
| Rate for Payer: Cigna of CA HMO |
$4.62
|
| Rate for Payer: Cigna of CA HMO |
$5.88
|
| Rate for Payer: Cigna of CA HMO |
$7.77
|
| Rate for Payer: Cigna of CA PPO |
$6.45
|
| Rate for Payer: Cigna of CA PPO |
$2.88
|
| Rate for Payer: Cigna of CA PPO |
$4.62
|
| Rate for Payer: Cigna of CA PPO |
$5.88
|
| Rate for Payer: Cigna of CA PPO |
$7.77
|
| Rate for Payer: EPIC Health Plan Commercial |
$3.36
|
| Rate for Payer: EPIC Health Plan Commercial |
$4.44
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.65
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.64
|
| Rate for Payer: EPIC Health Plan Commercial |
$3.69
|
| Rate for Payer: EPIC Health Plan Transplant |
$3.69
|
| Rate for Payer: EPIC Health Plan Transplant |
$3.36
|
| Rate for Payer: EPIC Health Plan Transplant |
$1.65
|
| Rate for Payer: EPIC Health Plan Transplant |
$4.44
|
| Rate for Payer: EPIC Health Plan Transplant |
$2.64
|
| Rate for Payer: Galaxy Health WC |
$7.84
|
| Rate for Payer: Galaxy Health WC |
$3.50
|
| Rate for Payer: Galaxy Health WC |
$7.14
|
| Rate for Payer: Galaxy Health WC |
$5.61
|
| Rate for Payer: Galaxy Health WC |
$9.44
|
| Rate for Payer: Global Benefits Group Commercial |
$5.53
|
| Rate for Payer: Global Benefits Group Commercial |
$5.04
|
| Rate for Payer: Global Benefits Group Commercial |
$3.96
|
| Rate for Payer: Global Benefits Group Commercial |
$2.47
|
| Rate for Payer: Global Benefits Group Commercial |
$6.66
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2.75
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$6.15
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$7.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$5.60
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2.51
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3.20
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3.51
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4.23
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1.57
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.02
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.58
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.99
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.66
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.21
|
| Rate for Payer: Multiplan Commercial |
$7.38
|
| Rate for Payer: Multiplan Commercial |
$5.28
|
| Rate for Payer: Multiplan Commercial |
$3.30
|
| Rate for Payer: Multiplan Commercial |
$6.72
|
| Rate for Payer: Multiplan Commercial |
$8.88
|
| Rate for Payer: Networks By Design Commercial |
$2.06
|
| Rate for Payer: Networks By Design Commercial |
$3.30
|
| Rate for Payer: Networks By Design Commercial |
$5.55
|
| Rate for Payer: Networks By Design Commercial |
$4.20
|
| Rate for Payer: Networks By Design Commercial |
$4.61
|
| Rate for Payer: Prime Health Services Commercial |
$7.14
|
| Rate for Payer: Prime Health Services Commercial |
$5.61
|
| Rate for Payer: Prime Health Services Commercial |
$9.44
|
| Rate for Payer: Prime Health Services Commercial |
$3.50
|
| Rate for Payer: Prime Health Services Commercial |
$7.84
|
| Rate for Payer: United Healthcare All Other Commercial |
$2.49
|
| Rate for Payer: United Healthcare All Other Commercial |
$3.48
|
| Rate for Payer: United Healthcare All Other Commercial |
$3.17
|
| Rate for Payer: United Healthcare All Other Commercial |
$4.19
|
| Rate for Payer: United Healthcare All Other Commercial |
$1.56
|
| Rate for Payer: United Healthcare All Other HMO |
$1.52
|
| Rate for Payer: United Healthcare All Other HMO |
$4.09
|
| Rate for Payer: United Healthcare All Other HMO |
$2.43
|
| Rate for Payer: United Healthcare All Other HMO |
$3.10
|
| Rate for Payer: United Healthcare All Other HMO |
$3.40
|
| Rate for Payer: United Healthcare HMO Rider |
$3.33
|
| Rate for Payer: United Healthcare HMO Rider |
$3.03
|
| Rate for Payer: United Healthcare HMO Rider |
$1.49
|
| Rate for Payer: United Healthcare HMO Rider |
$4.00
|
| Rate for Payer: United Healthcare HMO Rider |
$2.38
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3.04
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1.36
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2.77
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3.66
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2.18
|
|
|
PIPERACILLIN-TAZOBACTAM 3.375 GRAM/50 ML DEXTROSE(ISO-OS) IV PIGGYBACK [34524]
|
Facility
|
OP
|
$0.48
|
|
|
Service Code
|
CPT J2543
|
| Hospital Charge Code |
NDG34524
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.12 |
| Max. Negotiated Rate |
$10.78 |
| Rate for Payer: Aetna of CA HMO/PPO |
$7.41
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.41
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.26
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.26
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$10.78
|
| Rate for Payer: Blue Distinction Transplant |
$0.29
|
| Rate for Payer: Blue Shield of California Commercial |
$0.35
|
| Rate for Payer: Blue Shield of California EPN |
$4.01
|
| Rate for Payer: Cash Price |
$0.22
|
| Rate for Payer: Cash Price |
$0.22
|
| Rate for Payer: Cigna of CA HMO |
$0.34
|
| Rate for Payer: Cigna of CA PPO |
$0.34
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.41
|
| Rate for Payer: Dignity Health Media |
$0.41
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.41
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.19
|
| Rate for Payer: EPIC Health Plan Transplant |
$0.19
|
| Rate for Payer: Galaxy Health WC |
$0.41
|
| Rate for Payer: Global Benefits Group Commercial |
$0.29
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$0.36
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.32
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.18
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.12
|
| Rate for Payer: Multiplan Commercial |
$0.38
|
| Rate for Payer: Networks By Design Commercial |
$0.24
|
| Rate for Payer: Prime Health Services Commercial |
$0.41
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.29
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.29
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.24
|
| Rate for Payer: United Healthcare All Other HMO |
$0.24
|
| Rate for Payer: United Healthcare HMO Rider |
$0.24
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.24
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.41
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.41
|
| Rate for Payer: Vantage Medical Group Senior |
$0.41
|
|
|
PIPERACILLIN-TAZOBACTAM 3.375 GRAM/50 ML DEXTROSE(ISO-OS) IV PIGGYBACK [34524]
|
Facility
|
OP
|
$0.49
|
|
|
Service Code
|
CPT J2543
|
| Hospital Charge Code |
1753480
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.12 |
| Max. Negotiated Rate |
$10.78 |
| Rate for Payer: Aetna of CA HMO/PPO |
$7.41
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.42
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.27
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.27
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$10.78
|
| Rate for Payer: Blue Distinction Transplant |
$0.29
|
| Rate for Payer: Blue Shield of California Commercial |
$0.36
|
| Rate for Payer: Blue Shield of California EPN |
$4.01
|
| Rate for Payer: Cash Price |
$0.22
|
| Rate for Payer: Cash Price |
$0.22
|
| Rate for Payer: Cigna of CA HMO |
$0.34
|
| Rate for Payer: Cigna of CA PPO |
$0.34
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.42
|
| Rate for Payer: Dignity Health Media |
$0.42
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.42
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.20
|
| Rate for Payer: EPIC Health Plan Transplant |
$0.20
|
| Rate for Payer: Galaxy Health WC |
$0.42
|
| Rate for Payer: Global Benefits Group Commercial |
$0.29
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$0.37
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.33
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.19
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.12
|
| Rate for Payer: Multiplan Commercial |
$0.39
|
| Rate for Payer: Networks By Design Commercial |
$0.25
|
| Rate for Payer: Prime Health Services Commercial |
$0.42
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.29
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.29
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.25
|
| Rate for Payer: United Healthcare All Other HMO |
$0.25
|
| Rate for Payer: United Healthcare HMO Rider |
$0.25
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.25
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.42
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.42
|
| Rate for Payer: Vantage Medical Group Senior |
$0.42
|
|
|
PIPERACILLIN-TAZOBACTAM 3.375 GRAM/50 ML DEXTROSE(ISO-OS) IV PIGGYBACK [34524]
|
Facility
|
IP
|
$0.49
|
|
|
Service Code
|
CPT J2543
|
| Hospital Charge Code |
1753480
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.12 |
| Max. Negotiated Rate |
$0.42 |
| Rate for Payer: Blue Shield of California Commercial |
$0.35
|
| Rate for Payer: Blue Shield of California EPN |
$0.25
|
| Rate for Payer: Cash Price |
$0.22
|
| Rate for Payer: Cigna of CA HMO |
$0.34
|
| Rate for Payer: Cigna of CA PPO |
$0.34
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.20
|
| Rate for Payer: EPIC Health Plan Transplant |
$0.20
|
| Rate for Payer: Galaxy Health WC |
$0.42
|
| Rate for Payer: Global Benefits Group Commercial |
$0.29
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.33
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.19
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.12
|
| Rate for Payer: Multiplan Commercial |
$0.39
|
| Rate for Payer: Networks By Design Commercial |
$0.25
|
| Rate for Payer: Prime Health Services Commercial |
$0.42
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.19
|
| 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 |
$0.16
|
|
|
PIPERACILLIN-TAZOBACTAM 3.375 GRAM/50 ML DEXTROSE(ISO-OS) IV PIGGYBACK [34524]
|
Facility
|
IP
|
$0.48
|
|
|
Service Code
|
CPT J2543
|
| Hospital Charge Code |
NDG34524
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.12 |
| Max. Negotiated Rate |
$0.41 |
| Rate for Payer: Blue Shield of California Commercial |
$0.34
|
| Rate for Payer: Blue Shield of California EPN |
$0.25
|
| Rate for Payer: Cash Price |
$0.22
|
| Rate for Payer: Cigna of CA HMO |
$0.34
|
| Rate for Payer: Cigna of CA PPO |
$0.34
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.19
|
| Rate for Payer: EPIC Health Plan Transplant |
$0.19
|
| Rate for Payer: Galaxy Health WC |
$0.41
|
| Rate for Payer: Global Benefits Group Commercial |
$0.29
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.32
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.18
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.12
|
| Rate for Payer: Multiplan Commercial |
$0.38
|
| Rate for Payer: Networks By Design Commercial |
$0.24
|
| Rate for Payer: Prime Health Services Commercial |
$0.41
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.18
|
| Rate for Payer: United Healthcare All Other HMO |
$0.18
|
| Rate for Payer: United Healthcare HMO Rider |
$0.17
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.16
|
|
|
PIPERACILLIN-TAZOBACTAM 3.375 GRAM INTRAVENOUS SOLUTION [18303]
|
Facility
|
IP
|
$10.56
|
|
|
Service Code
|
CPT J2543
|
| Hospital Charge Code |
1721150
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$2.53 |
| Max. Negotiated Rate |
$8.98 |
| Rate for Payer: Blue Shield of California Commercial |
$7.52
|
| Rate for Payer: Blue Shield of California Commercial |
$8.36
|
| Rate for Payer: Blue Shield of California EPN |
$5.41
|
| Rate for Payer: Blue Shield of California EPN |
$6.01
|
| Rate for Payer: Cash Price |
$4.75
|
| Rate for Payer: Cash Price |
$5.28
|
| Rate for Payer: Cigna of CA HMO |
$7.39
|
| Rate for Payer: Cigna of CA HMO |
$8.22
|
| Rate for Payer: Cigna of CA PPO |
$8.22
|
| Rate for Payer: Cigna of CA PPO |
$7.39
|
| Rate for Payer: EPIC Health Plan Commercial |
$4.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$4.22
|
| Rate for Payer: EPIC Health Plan Transplant |
$4.22
|
| Rate for Payer: EPIC Health Plan Transplant |
$4.70
|
| Rate for Payer: Galaxy Health WC |
$8.98
|
| Rate for Payer: Galaxy Health WC |
$9.98
|
| Rate for Payer: Global Benefits Group Commercial |
$7.04
|
| Rate for Payer: Global Benefits Group Commercial |
$6.34
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$7.83
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$7.04
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4.02
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4.47
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.53
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.82
|
| Rate for Payer: Multiplan Commercial |
$8.45
|
| Rate for Payer: Multiplan Commercial |
$9.39
|
| Rate for Payer: Networks By Design Commercial |
$5.28
|
| Rate for Payer: Networks By Design Commercial |
$5.87
|
| Rate for Payer: Prime Health Services Commercial |
$8.98
|
| Rate for Payer: Prime Health Services Commercial |
$9.98
|
| Rate for Payer: United Healthcare All Other Commercial |
$3.99
|
| Rate for Payer: United Healthcare All Other Commercial |
$4.43
|
| Rate for Payer: United Healthcare All Other HMO |
$3.89
|
| Rate for Payer: United Healthcare All Other HMO |
$4.33
|
| Rate for Payer: United Healthcare HMO Rider |
$3.81
|
| Rate for Payer: United Healthcare HMO Rider |
$4.24
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3.48
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3.87
|
|
|
PIPERACILLIN-TAZOBACTAM 3.375 GRAM INTRAVENOUS SOLUTION [18303]
|
Facility
|
OP
|
$11.74
|
|
|
Service Code
|
CPT J2543
|
| Hospital Charge Code |
1721150
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$2.82 |
| Max. Negotiated Rate |
$10.78 |
| Rate for Payer: Aetna of CA HMO/PPO |
$7.41
|
| Rate for Payer: Aetna of CA HMO/PPO |
$7.41
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$9.98
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$8.98
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$6.46
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$5.81
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$5.81
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$6.46
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$10.78
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$10.78
|
| Rate for Payer: Blue Distinction Transplant |
$7.04
|
| Rate for Payer: Blue Distinction Transplant |
$6.34
|
| Rate for Payer: Blue Shield of California Commercial |
$7.78
|
| Rate for Payer: Blue Shield of California Commercial |
$8.65
|
| Rate for Payer: Blue Shield of California EPN |
$4.01
|
| Rate for Payer: Blue Shield of California EPN |
$4.01
|
| Rate for Payer: Cash Price |
$4.75
|
| Rate for Payer: Cash Price |
$4.75
|
| Rate for Payer: Cash Price |
$5.28
|
| Rate for Payer: Cash Price |
$5.28
|
| Rate for Payer: Cigna of CA HMO |
$8.22
|
| Rate for Payer: Cigna of CA HMO |
$7.39
|
| Rate for Payer: Cigna of CA PPO |
$8.22
|
| Rate for Payer: Cigna of CA PPO |
$7.39
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$8.98
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$9.98
|
| Rate for Payer: Dignity Health Media |
$9.98
|
| Rate for Payer: Dignity Health Media |
$8.98
|
| Rate for Payer: Dignity Health Medi-Cal |
$8.98
|
| Rate for Payer: Dignity Health Medi-Cal |
$9.98
|
| Rate for Payer: EPIC Health Plan Commercial |
$4.22
|
| Rate for Payer: EPIC Health Plan Commercial |
$4.70
|
| Rate for Payer: EPIC Health Plan Transplant |
$4.22
|
| Rate for Payer: EPIC Health Plan Transplant |
$4.70
|
| Rate for Payer: Galaxy Health WC |
$9.98
|
| Rate for Payer: Galaxy Health WC |
$8.98
|
| Rate for Payer: Global Benefits Group Commercial |
$6.34
|
| Rate for Payer: Global Benefits Group Commercial |
$7.04
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$7.92
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$8.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$7.04
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$7.83
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4.47
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4.02
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.53
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.82
|
| Rate for Payer: Multiplan Commercial |
$9.39
|
| Rate for Payer: Multiplan Commercial |
$8.45
|
| Rate for Payer: Networks By Design Commercial |
$5.28
|
| Rate for Payer: Networks By Design Commercial |
$5.87
|
| Rate for Payer: Prime Health Services Commercial |
$9.98
|
| Rate for Payer: Prime Health Services Commercial |
$8.98
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$7.04
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$6.34
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$6.34
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$7.04
|
| Rate for Payer: United Healthcare All Other Commercial |
$5.28
|
| Rate for Payer: United Healthcare All Other Commercial |
$5.87
|
| Rate for Payer: United Healthcare All Other HMO |
$5.87
|
| Rate for Payer: United Healthcare All Other HMO |
$5.28
|
| Rate for Payer: United Healthcare HMO Rider |
$5.87
|
| Rate for Payer: United Healthcare HMO Rider |
$5.28
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$5.28
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$5.87
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$8.98
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$9.98
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$8.98
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$9.98
|
| Rate for Payer: Vantage Medical Group Senior |
$9.98
|
| Rate for Payer: Vantage Medical Group Senior |
$8.98
|
|
|
PIPERACILLIN-TAZOBACTAM 4.5 GRAM/100 ML DEXTROSE(ISO-OSM) IV PIGGYBACK [108121]
|
Facility
|
OP
|
$0.31
|
|
|
Service Code
|
CPT J2543
|
| Hospital Charge Code |
NDG108121
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.07 |
| Max. Negotiated Rate |
$10.78 |
| Rate for Payer: Aetna of CA HMO/PPO |
$7.41
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.26
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.17
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.17
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$10.78
|
| Rate for Payer: Blue Distinction Transplant |
$0.19
|
| Rate for Payer: Blue Shield of California Commercial |
$0.23
|
| Rate for Payer: Blue Shield of California EPN |
$4.01
|
| Rate for Payer: Cash Price |
$0.14
|
| Rate for Payer: Cash Price |
$0.14
|
| Rate for Payer: Cigna of CA HMO |
$0.22
|
| Rate for Payer: Cigna of CA PPO |
$0.22
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.26
|
| Rate for Payer: Dignity Health Media |
$0.26
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.26
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.12
|
| Rate for Payer: EPIC Health Plan Transplant |
$0.12
|
| Rate for Payer: Galaxy Health WC |
$0.26
|
| Rate for Payer: Global Benefits Group Commercial |
$0.19
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$0.23
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.21
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.12
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.07
|
| Rate for Payer: Multiplan Commercial |
$0.25
|
| Rate for Payer: Networks By Design Commercial |
$0.16
|
| Rate for Payer: Prime Health Services Commercial |
$0.26
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.19
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.19
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.16
|
| Rate for Payer: United Healthcare All Other HMO |
$0.16
|
| Rate for Payer: United Healthcare HMO Rider |
$0.16
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.16
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.26
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.26
|
| Rate for Payer: Vantage Medical Group Senior |
$0.26
|
|
|
PIPERACILLIN-TAZOBACTAM 4.5 GRAM/100 ML DEXTROSE(ISO-OSM) IV PIGGYBACK [108121]
|
Facility
|
IP
|
$0.31
|
|
|
Service Code
|
CPT J2543
|
| Hospital Charge Code |
NDG108121
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.07 |
| Max. Negotiated Rate |
$0.26 |
| Rate for Payer: Blue Shield of California Commercial |
$0.22
|
| Rate for Payer: Blue Shield of California EPN |
$0.16
|
| Rate for Payer: Cash Price |
$0.14
|
| Rate for Payer: Cigna of CA HMO |
$0.22
|
| Rate for Payer: Cigna of CA PPO |
$0.22
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.12
|
| Rate for Payer: EPIC Health Plan Transplant |
$0.12
|
| Rate for Payer: Galaxy Health WC |
$0.26
|
| Rate for Payer: Global Benefits Group Commercial |
$0.19
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.21
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.12
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.07
|
| Rate for Payer: Multiplan Commercial |
$0.25
|
| Rate for Payer: Networks By Design Commercial |
$0.16
|
| Rate for Payer: Prime Health Services Commercial |
$0.26
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.12
|
| Rate for Payer: United Healthcare All Other HMO |
$0.11
|
| Rate for Payer: United Healthcare HMO Rider |
$0.11
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.10
|
|
|
PIPERACILLIN-TAZOBACTAM 4.5 GRAM INTRAVENOUS SOLUTION [18302]
|
Facility
|
IP
|
$17.52
|
|
|
Service Code
|
CPT J2543
|
| Hospital Charge Code |
1721132
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$4.20 |
| Max. Negotiated Rate |
$14.89 |
| Rate for Payer: Blue Shield of California Commercial |
$12.47
|
| Rate for Payer: Blue Shield of California Commercial |
$11.91
|
| Rate for Payer: Blue Shield of California Commercial |
$9.48
|
| Rate for Payer: Blue Shield of California Commercial |
$5.81
|
| Rate for Payer: Blue Shield of California Commercial |
$11.96
|
| Rate for Payer: Blue Shield of California Commercial |
$5.87
|
| Rate for Payer: Blue Shield of California EPN |
$4.22
|
| Rate for Payer: Blue Shield of California EPN |
$8.97
|
| Rate for Payer: Blue Shield of California EPN |
$8.57
|
| Rate for Payer: Blue Shield of California EPN |
$6.82
|
| Rate for Payer: Blue Shield of California EPN |
$4.18
|
| Rate for Payer: Blue Shield of California EPN |
$8.60
|
| Rate for Payer: Cash Price |
$7.56
|
| Rate for Payer: Cash Price |
$5.99
|
| Rate for Payer: Cash Price |
$3.67
|
| Rate for Payer: Cash Price |
$3.71
|
| Rate for Payer: Cash Price |
$7.88
|
| Rate for Payer: Cash Price |
$7.53
|
| Rate for Payer: Cigna of CA HMO |
$5.71
|
| Rate for Payer: Cigna of CA HMO |
$11.71
|
| Rate for Payer: Cigna of CA HMO |
$11.76
|
| Rate for Payer: Cigna of CA HMO |
$12.26
|
| Rate for Payer: Cigna of CA HMO |
$9.32
|
| Rate for Payer: Cigna of CA HMO |
$5.77
|
| Rate for Payer: Cigna of CA PPO |
$5.77
|
| Rate for Payer: Cigna of CA PPO |
$9.32
|
| Rate for Payer: Cigna of CA PPO |
$12.26
|
| Rate for Payer: Cigna of CA PPO |
$11.76
|
| Rate for Payer: Cigna of CA PPO |
$11.71
|
| Rate for Payer: Cigna of CA PPO |
$5.71
|
| Rate for Payer: EPIC Health Plan Commercial |
$6.69
|
| Rate for Payer: EPIC Health Plan Commercial |
$7.01
|
| Rate for Payer: EPIC Health Plan Commercial |
$3.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$6.72
|
| Rate for Payer: EPIC Health Plan Commercial |
$3.26
|
| Rate for Payer: EPIC Health Plan Commercial |
$5.33
|
| Rate for Payer: EPIC Health Plan Transplant |
$7.01
|
| Rate for Payer: EPIC Health Plan Transplant |
$6.69
|
| Rate for Payer: EPIC Health Plan Transplant |
$5.33
|
| Rate for Payer: EPIC Health Plan Transplant |
$6.72
|
| Rate for Payer: EPIC Health Plan Transplant |
$3.30
|
| Rate for Payer: EPIC Health Plan Transplant |
$3.26
|
| Rate for Payer: Galaxy Health WC |
$14.89
|
| Rate for Payer: Galaxy Health WC |
$6.94
|
| Rate for Payer: Galaxy Health WC |
$14.22
|
| Rate for Payer: Galaxy Health WC |
$14.28
|
| Rate for Payer: Galaxy Health WC |
$11.32
|
| Rate for Payer: Galaxy Health WC |
$7.00
|
| Rate for Payer: Global Benefits Group Commercial |
$4.90
|
| Rate for Payer: Global Benefits Group Commercial |
$10.51
|
| Rate for Payer: Global Benefits Group Commercial |
$10.08
|
| Rate for Payer: Global Benefits Group Commercial |
$10.04
|
| Rate for Payer: Global Benefits Group Commercial |
$7.99
|
| Rate for Payer: Global Benefits Group Commercial |
$4.94
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$5.44
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$11.16
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$8.88
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$11.21
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$11.69
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$5.50
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$6.37
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$6.40
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$5.07
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$6.68
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3.14
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3.11
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.20
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.03
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.02
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.20
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.98
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.96
|
| Rate for Payer: Multiplan Commercial |
$13.38
|
| Rate for Payer: Multiplan Commercial |
$6.59
|
| Rate for Payer: Multiplan Commercial |
$6.53
|
| Rate for Payer: Multiplan Commercial |
$14.02
|
| Rate for Payer: Multiplan Commercial |
$10.66
|
| Rate for Payer: Multiplan Commercial |
$13.44
|
| Rate for Payer: Networks By Design Commercial |
$6.66
|
| Rate for Payer: Networks By Design Commercial |
$8.36
|
| Rate for Payer: Networks By Design Commercial |
$8.76
|
| Rate for Payer: Networks By Design Commercial |
$4.12
|
| Rate for Payer: Networks By Design Commercial |
$4.08
|
| Rate for Payer: Networks By Design Commercial |
$8.40
|
| Rate for Payer: Prime Health Services Commercial |
$11.32
|
| Rate for Payer: Prime Health Services Commercial |
$14.89
|
| Rate for Payer: Prime Health Services Commercial |
$14.28
|
| Rate for Payer: Prime Health Services Commercial |
$14.22
|
| Rate for Payer: Prime Health Services Commercial |
$6.94
|
| Rate for Payer: Prime Health Services Commercial |
$7.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$5.03
|
| Rate for Payer: United Healthcare All Other Commercial |
$3.08
|
| Rate for Payer: United Healthcare All Other Commercial |
$6.62
|
| Rate for Payer: United Healthcare All Other Commercial |
$6.32
|
| Rate for Payer: United Healthcare All Other Commercial |
$3.11
|
| Rate for Payer: United Healthcare All Other Commercial |
$6.34
|
| Rate for Payer: United Healthcare All Other HMO |
$6.17
|
| Rate for Payer: United Healthcare All Other HMO |
$3.01
|
| Rate for Payer: United Healthcare All Other HMO |
$6.20
|
| Rate for Payer: United Healthcare All Other HMO |
$6.46
|
| Rate for Payer: United Healthcare All Other HMO |
$4.91
|
| Rate for Payer: United Healthcare All Other HMO |
$3.04
|
| Rate for Payer: United Healthcare HMO Rider |
$2.97
|
| Rate for Payer: United Healthcare HMO Rider |
$4.81
|
| Rate for Payer: United Healthcare HMO Rider |
$6.04
|
| Rate for Payer: United Healthcare HMO Rider |
$6.06
|
| Rate for Payer: United Healthcare HMO Rider |
$6.32
|
| Rate for Payer: United Healthcare HMO Rider |
$2.94
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2.69
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$5.78
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2.72
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$4.40
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$5.54
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$5.52
|
|
|
PIPERACILLIN-TAZOBACTAM 4.5 GRAM INTRAVENOUS SOLUTION [18302]
|
Facility
|
OP
|
$17.52
|
|
|
Service Code
|
CPT J2543
|
| Hospital Charge Code |
1721132
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$4.01 |
| Max. Negotiated Rate |
$14.89 |
| Rate for Payer: Aetna of CA HMO/PPO |
$7.41
|
| Rate for Payer: Aetna of CA HMO/PPO |
$7.41
|
| Rate for Payer: Aetna of CA HMO/PPO |
$7.41
|
| Rate for Payer: Aetna of CA HMO/PPO |
$7.41
|
| Rate for Payer: Aetna of CA HMO/PPO |
$7.41
|
| Rate for Payer: Aetna of CA HMO/PPO |
$7.41
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$7.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$11.32
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$14.22
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$14.28
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$14.89
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$6.94
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$9.20
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4.53
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$9.64
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$7.33
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4.49
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$9.24
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4.49
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$9.64
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$9.24
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4.53
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$9.20
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$7.33
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$10.78
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$10.78
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$10.78
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$10.78
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$10.78
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$10.78
|
| Rate for Payer: Blue Distinction Transplant |
$10.51
|
| Rate for Payer: Blue Distinction Transplant |
$10.04
|
| Rate for Payer: Blue Distinction Transplant |
$7.99
|
| Rate for Payer: Blue Distinction Transplant |
$4.94
|
| Rate for Payer: Blue Distinction Transplant |
$4.90
|
| Rate for Payer: Blue Distinction Transplant |
$10.08
|
| Rate for Payer: Blue Shield of California Commercial |
$9.82
|
| Rate for Payer: Blue Shield of California Commercial |
$12.38
|
| Rate for Payer: Blue Shield of California Commercial |
$12.91
|
| Rate for Payer: Blue Shield of California Commercial |
$6.01
|
| Rate for Payer: Blue Shield of California Commercial |
$6.07
|
| Rate for Payer: Blue Shield of California Commercial |
$12.33
|
| Rate for Payer: Blue Shield of California EPN |
$4.01
|
| Rate for Payer: Blue Shield of California EPN |
$4.01
|
| Rate for Payer: Blue Shield of California EPN |
$4.01
|
| Rate for Payer: Blue Shield of California EPN |
$4.01
|
| Rate for Payer: Blue Shield of California EPN |
$4.01
|
| Rate for Payer: Blue Shield of California EPN |
$4.01
|
| Rate for Payer: Cash Price |
$3.71
|
| Rate for Payer: Cash Price |
$3.71
|
| Rate for Payer: Cash Price |
$3.67
|
| Rate for Payer: Cash Price |
$7.56
|
| Rate for Payer: Cash Price |
$3.67
|
| Rate for Payer: Cash Price |
$7.88
|
| Rate for Payer: Cash Price |
$7.53
|
| Rate for Payer: Cash Price |
$7.53
|
| Rate for Payer: Cash Price |
$7.88
|
| Rate for Payer: Cash Price |
$5.99
|
| Rate for Payer: Cash Price |
$5.99
|
| Rate for Payer: Cash Price |
$7.56
|
| Rate for Payer: Cigna of CA HMO |
$11.71
|
| Rate for Payer: Cigna of CA HMO |
$5.77
|
| Rate for Payer: Cigna of CA HMO |
$11.76
|
| Rate for Payer: Cigna of CA HMO |
$9.32
|
| Rate for Payer: Cigna of CA HMO |
$12.26
|
| Rate for Payer: Cigna of CA HMO |
$5.71
|
| Rate for Payer: Cigna of CA PPO |
$11.71
|
| Rate for Payer: Cigna of CA PPO |
$5.71
|
| Rate for Payer: Cigna of CA PPO |
$12.26
|
| Rate for Payer: Cigna of CA PPO |
$11.76
|
| Rate for Payer: Cigna of CA PPO |
$9.32
|
| Rate for Payer: Cigna of CA PPO |
$5.77
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$7.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$14.28
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$14.22
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$14.89
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$6.94
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$11.32
|
| Rate for Payer: Dignity Health Media |
$14.22
|
| Rate for Payer: Dignity Health Media |
$11.32
|
| Rate for Payer: Dignity Health Media |
$14.28
|
| Rate for Payer: Dignity Health Media |
$14.89
|
| Rate for Payer: Dignity Health Media |
$6.94
|
| Rate for Payer: Dignity Health Media |
$7.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$14.89
|
| Rate for Payer: Dignity Health Medi-Cal |
$6.94
|
| Rate for Payer: Dignity Health Medi-Cal |
$14.28
|
| Rate for Payer: Dignity Health Medi-Cal |
$7.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$11.32
|
| Rate for Payer: Dignity Health Medi-Cal |
$14.22
|
| Rate for Payer: EPIC Health Plan Commercial |
$7.01
|
| Rate for Payer: EPIC Health Plan Commercial |
$6.72
|
| Rate for Payer: EPIC Health Plan Commercial |
$6.69
|
| Rate for Payer: EPIC Health Plan Commercial |
$3.26
|
| Rate for Payer: EPIC Health Plan Commercial |
$5.33
|
| Rate for Payer: EPIC Health Plan Commercial |
$3.30
|
| Rate for Payer: EPIC Health Plan Transplant |
$6.69
|
| Rate for Payer: EPIC Health Plan Transplant |
$7.01
|
| Rate for Payer: EPIC Health Plan Transplant |
$6.72
|
| Rate for Payer: EPIC Health Plan Transplant |
$5.33
|
| Rate for Payer: EPIC Health Plan Transplant |
$3.26
|
| Rate for Payer: EPIC Health Plan Transplant |
$3.30
|
| Rate for Payer: Galaxy Health WC |
$14.28
|
| Rate for Payer: Galaxy Health WC |
$6.94
|
| Rate for Payer: Galaxy Health WC |
$7.00
|
| Rate for Payer: Galaxy Health WC |
$11.32
|
| Rate for Payer: Galaxy Health WC |
$14.22
|
| Rate for Payer: Galaxy Health WC |
$14.89
|
| Rate for Payer: Global Benefits Group Commercial |
$10.04
|
| Rate for Payer: Global Benefits Group Commercial |
$4.90
|
| Rate for Payer: Global Benefits Group Commercial |
$7.99
|
| Rate for Payer: Global Benefits Group Commercial |
$10.08
|
| Rate for Payer: Global Benefits Group Commercial |
$4.94
|
| Rate for Payer: Global Benefits Group Commercial |
$10.51
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$6.18
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$13.14
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$9.99
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$12.55
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$12.60
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$6.12
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$11.69
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$11.21
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$5.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$8.88
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$5.44
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$11.16
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3.14
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$6.40
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3.11
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$5.07
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$6.37
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$6.68
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.20
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.20
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.96
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.98
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.03
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.02
|
| Rate for Payer: Multiplan Commercial |
$13.38
|
| Rate for Payer: Multiplan Commercial |
$13.44
|
| Rate for Payer: Multiplan Commercial |
$14.02
|
| Rate for Payer: Multiplan Commercial |
$10.66
|
| Rate for Payer: Multiplan Commercial |
$6.53
|
| Rate for Payer: Multiplan Commercial |
$6.59
|
| Rate for Payer: Networks By Design Commercial |
$8.40
|
| Rate for Payer: Networks By Design Commercial |
$8.36
|
| Rate for Payer: Networks By Design Commercial |
$4.12
|
| Rate for Payer: Networks By Design Commercial |
$8.76
|
| Rate for Payer: Networks By Design Commercial |
$6.66
|
| Rate for Payer: Networks By Design Commercial |
$4.08
|
| Rate for Payer: Prime Health Services Commercial |
$7.00
|
| Rate for Payer: Prime Health Services Commercial |
$6.94
|
| Rate for Payer: Prime Health Services Commercial |
$11.32
|
| Rate for Payer: Prime Health Services Commercial |
$14.22
|
| Rate for Payer: Prime Health Services Commercial |
$14.28
|
| Rate for Payer: Prime Health Services Commercial |
$14.89
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$10.08
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$10.51
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$4.90
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$7.99
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$4.94
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$10.04
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$4.90
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$10.08
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$4.94
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$10.51
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$10.04
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$7.99
|
| Rate for Payer: United Healthcare All Other Commercial |
$8.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$6.66
|
| Rate for Payer: United Healthcare All Other Commercial |
$4.12
|
| Rate for Payer: United Healthcare All Other Commercial |
$8.76
|
| Rate for Payer: United Healthcare All Other Commercial |
$4.08
|
| Rate for Payer: United Healthcare All Other Commercial |
$8.36
|
| Rate for Payer: United Healthcare All Other HMO |
$4.08
|
| Rate for Payer: United Healthcare All Other HMO |
$8.76
|
| Rate for Payer: United Healthcare All Other HMO |
$8.36
|
| Rate for Payer: United Healthcare All Other HMO |
$6.66
|
| Rate for Payer: United Healthcare All Other HMO |
$8.40
|
| Rate for Payer: United Healthcare All Other HMO |
$4.12
|
| Rate for Payer: United Healthcare HMO Rider |
$4.08
|
| Rate for Payer: United Healthcare HMO Rider |
$8.40
|
| Rate for Payer: United Healthcare HMO Rider |
$4.12
|
| Rate for Payer: United Healthcare HMO Rider |
$8.76
|
| Rate for Payer: United Healthcare HMO Rider |
$8.36
|
| Rate for Payer: United Healthcare HMO Rider |
$6.66
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$4.08
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$8.36
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$8.40
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$6.66
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$4.12
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$8.76
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$14.28
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$7.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$14.22
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$6.94
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$11.32
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$14.89
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$14.89
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$11.32
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$14.28
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$14.22
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$7.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$6.94
|
| Rate for Payer: Vantage Medical Group Senior |
$11.32
|
| Rate for Payer: Vantage Medical Group Senior |
$14.22
|
| Rate for Payer: Vantage Medical Group Senior |
$14.28
|
| Rate for Payer: Vantage Medical Group Senior |
$14.89
|
| Rate for Payer: Vantage Medical Group Senior |
$7.00
|
| Rate for Payer: Vantage Medical Group Senior |
$6.94
|
|
|
PNEUMOCOCCAL 13-VAL CONJ VACCINE-DIP CRM (PF) 0.5 ML IM SYRINGE [103895]
|
Facility
|
IP
|
$541.63
|
|
|
Service Code
|
CPT 90670
|
| Hospital Charge Code |
1721197
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$129.99 |
| Max. Negotiated Rate |
$460.39 |
| Rate for Payer: Blue Shield of California Commercial |
$385.64
|
| Rate for Payer: Blue Shield of California EPN |
$277.31
|
| Rate for Payer: Cash Price |
$243.73
|
| Rate for Payer: Cigna of CA HMO |
$379.14
|
| Rate for Payer: Cigna of CA PPO |
$379.14
|
| Rate for Payer: EPIC Health Plan Commercial |
$216.65
|
| Rate for Payer: EPIC Health Plan Transplant |
$216.65
|
| Rate for Payer: Galaxy Health WC |
$460.39
|
| Rate for Payer: Global Benefits Group Commercial |
$324.98
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$361.27
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$206.36
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$129.99
|
| Rate for Payer: Multiplan Commercial |
$433.30
|
| Rate for Payer: Networks By Design Commercial |
$270.82
|
| Rate for Payer: Prime Health Services Commercial |
$460.39
|
| Rate for Payer: United Healthcare All Other Commercial |
$204.52
|
| Rate for Payer: United Healthcare All Other HMO |
$199.75
|
| Rate for Payer: United Healthcare HMO Rider |
$195.42
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$178.74
|
|
|
PNEUMOCOCCAL 13-VAL CONJ VACCINE-DIP CRM (PF) 0.5 ML IM SYRINGE [103895]
|
Facility
|
OP
|
$541.63
|
|
|
Service Code
|
CPT 90670
|
| Hospital Charge Code |
1721197
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$129.99 |
| Max. Negotiated Rate |
$1,793.60 |
| Rate for Payer: Aetna of CA HMO/PPO |
$1,793.60
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$460.39
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$297.90
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$297.90
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$249.29
|
| Rate for Payer: Blue Distinction Transplant |
$324.98
|
| Rate for Payer: Blue Shield of California Commercial |
$399.18
|
| Rate for Payer: Blue Shield of California EPN |
$241.50
|
| Rate for Payer: Cash Price |
$243.73
|
| Rate for Payer: Cash Price |
$243.73
|
| Rate for Payer: Cigna of CA HMO |
$379.14
|
| Rate for Payer: Cigna of CA PPO |
$379.14
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$460.39
|
| Rate for Payer: Dignity Health Media |
$460.39
|
| Rate for Payer: Dignity Health Medi-Cal |
$460.39
|
| Rate for Payer: EPIC Health Plan Commercial |
$216.65
|
| Rate for Payer: EPIC Health Plan Transplant |
$216.65
|
| Rate for Payer: Galaxy Health WC |
$460.39
|
| Rate for Payer: Global Benefits Group Commercial |
$324.98
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$406.22
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$361.27
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$498.66
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$129.99
|
| Rate for Payer: Multiplan Commercial |
$433.30
|
| Rate for Payer: Networks By Design Commercial |
$270.82
|
| Rate for Payer: Prime Health Services Commercial |
$460.39
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$324.98
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$324.98
|
| Rate for Payer: United Healthcare All Other Commercial |
$270.82
|
| Rate for Payer: United Healthcare All Other HMO |
$270.82
|
| Rate for Payer: United Healthcare HMO Rider |
$270.82
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$270.82
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$460.39
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$460.39
|
| Rate for Payer: Vantage Medical Group Senior |
$460.39
|
|
|
PNEUMOCOCCAL 20-VALENT CONJ VACCINE-DIP CRM (PF) 0.5 ML IM SYRINGE [231988]
|
Facility
|
IP
|
$607.71
|
|
|
Service Code
|
CPT 90677
|
| Hospital Charge Code |
NDG231988A
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$145.85 |
| Max. Negotiated Rate |
$516.55 |
| Rate for Payer: Blue Shield of California Commercial |
$432.69
|
| Rate for Payer: Blue Shield of California Commercial |
$446.29
|
| Rate for Payer: Blue Shield of California EPN |
$311.15
|
| Rate for Payer: Blue Shield of California EPN |
$320.93
|
| Rate for Payer: Cash Price |
$273.47
|
| Rate for Payer: Cash Price |
$282.06
|
| Rate for Payer: Cigna of CA HMO |
$425.40
|
| Rate for Payer: Cigna of CA HMO |
$438.77
|
| Rate for Payer: Cigna of CA PPO |
$438.77
|
| Rate for Payer: Cigna of CA PPO |
$425.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$250.72
|
| Rate for Payer: EPIC Health Plan Commercial |
$243.08
|
| Rate for Payer: EPIC Health Plan Transplant |
$243.08
|
| Rate for Payer: EPIC Health Plan Transplant |
$250.72
|
| Rate for Payer: Galaxy Health WC |
$516.55
|
| Rate for Payer: Galaxy Health WC |
$532.79
|
| Rate for Payer: Global Benefits Group Commercial |
$376.09
|
| Rate for Payer: Global Benefits Group Commercial |
$364.63
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$418.08
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$405.34
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$231.54
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$238.81
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$145.85
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$150.43
|
| Rate for Payer: Multiplan Commercial |
$486.17
|
| Rate for Payer: Multiplan Commercial |
$501.45
|
| Rate for Payer: Networks By Design Commercial |
$303.86
|
| Rate for Payer: Networks By Design Commercial |
$313.40
|
| Rate for Payer: Prime Health Services Commercial |
$516.55
|
| Rate for Payer: Prime Health Services Commercial |
$532.79
|
| Rate for Payer: United Healthcare All Other Commercial |
$229.47
|
| Rate for Payer: United Healthcare All Other Commercial |
$236.68
|
| Rate for Payer: United Healthcare All Other HMO |
$224.12
|
| Rate for Payer: United Healthcare All Other HMO |
$231.17
|
| Rate for Payer: United Healthcare HMO Rider |
$219.26
|
| Rate for Payer: United Healthcare HMO Rider |
$226.15
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$200.54
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$206.85
|
|
|
PNEUMOCOCCAL 20-VALENT CONJ VACCINE-DIP CRM (PF) 0.5 ML IM SYRINGE [231988]
|
Facility
|
OP
|
$607.71
|
|
|
Service Code
|
CPT 90677
|
| Hospital Charge Code |
NDG231988A
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$145.85 |
| Max. Negotiated Rate |
$2,006.82 |
| Rate for Payer: Aetna of CA HMO/PPO |
$2,006.82
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,006.82
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$516.55
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$532.79
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$344.75
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$334.24
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$334.24
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$344.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$506.31
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$506.31
|
| Rate for Payer: Blue Distinction Transplant |
$364.63
|
| Rate for Payer: Blue Distinction Transplant |
$376.09
|
| Rate for Payer: Blue Shield of California Commercial |
$447.88
|
| Rate for Payer: Blue Shield of California Commercial |
$461.96
|
| Rate for Payer: Blue Shield of California EPN |
$354.90
|
| Rate for Payer: Blue Shield of California EPN |
$366.06
|
| Rate for Payer: Cash Price |
$273.47
|
| Rate for Payer: Cash Price |
$282.06
|
| Rate for Payer: Cash Price |
$282.06
|
| Rate for Payer: Cash Price |
$273.47
|
| Rate for Payer: Cigna of CA HMO |
$438.77
|
| Rate for Payer: Cigna of CA HMO |
$425.40
|
| Rate for Payer: Cigna of CA PPO |
$438.77
|
| Rate for Payer: Cigna of CA PPO |
$425.40
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$516.55
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$532.79
|
| Rate for Payer: Dignity Health Media |
$516.55
|
| Rate for Payer: Dignity Health Media |
$532.79
|
| Rate for Payer: Dignity Health Medi-Cal |
$516.55
|
| Rate for Payer: Dignity Health Medi-Cal |
$532.79
|
| Rate for Payer: EPIC Health Plan Commercial |
$243.08
|
| Rate for Payer: EPIC Health Plan Commercial |
$250.72
|
| Rate for Payer: EPIC Health Plan Transplant |
$250.72
|
| Rate for Payer: EPIC Health Plan Transplant |
$243.08
|
| Rate for Payer: Galaxy Health WC |
$532.79
|
| Rate for Payer: Galaxy Health WC |
$516.55
|
| Rate for Payer: Global Benefits Group Commercial |
$376.09
|
| Rate for Payer: Global Benefits Group Commercial |
$364.63
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$455.78
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$470.11
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$418.08
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$405.34
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$556.93
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$556.93
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$150.43
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$145.85
|
| Rate for Payer: Multiplan Commercial |
$501.45
|
| Rate for Payer: Multiplan Commercial |
$486.17
|
| Rate for Payer: Networks By Design Commercial |
$303.86
|
| Rate for Payer: Networks By Design Commercial |
$313.40
|
| Rate for Payer: Prime Health Services Commercial |
$532.79
|
| Rate for Payer: Prime Health Services Commercial |
$516.55
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$376.09
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$364.63
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$376.09
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$364.63
|
| Rate for Payer: United Healthcare All Other Commercial |
$303.86
|
| Rate for Payer: United Healthcare All Other Commercial |
$313.40
|
| Rate for Payer: United Healthcare All Other HMO |
$313.40
|
| Rate for Payer: United Healthcare All Other HMO |
$303.86
|
| Rate for Payer: United Healthcare HMO Rider |
$313.40
|
| Rate for Payer: United Healthcare HMO Rider |
$303.86
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$303.86
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$313.40
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$516.55
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$532.79
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$516.55
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$532.79
|
| Rate for Payer: Vantage Medical Group Senior |
$532.79
|
| Rate for Payer: Vantage Medical Group Senior |
$516.55
|
|
|
PNEUMOCOCCAL 23 POLYVALENT VACCINE 25 MCG/0.5 ML INJECTION SOLUTION [11037]
|
Facility
|
OP
|
$280.99
|
|
|
Service Code
|
CPT 90732
|
| Hospital Charge Code |
NDG11037
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$37.06 |
| Max. Negotiated Rate |
$927.91 |
| Rate for Payer: Aetna of CA HMO/PPO |
$927.91
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$238.84
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$154.54
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$154.54
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$37.06
|
| Rate for Payer: Blue Distinction Transplant |
$168.59
|
| Rate for Payer: Blue Shield of California Commercial |
$207.09
|
| Rate for Payer: Blue Shield of California EPN |
$132.55
|
| Rate for Payer: Cash Price |
$126.45
|
| Rate for Payer: Cash Price |
$126.45
|
| Rate for Payer: Cigna of CA HMO |
$196.69
|
| Rate for Payer: Cigna of CA PPO |
$196.69
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$238.84
|
| Rate for Payer: Dignity Health Media |
$238.84
|
| Rate for Payer: Dignity Health Medi-Cal |
$238.84
|
| Rate for Payer: EPIC Health Plan Commercial |
$112.40
|
| Rate for Payer: EPIC Health Plan Transplant |
$112.40
|
| Rate for Payer: Galaxy Health WC |
$238.84
|
| Rate for Payer: Global Benefits Group Commercial |
$168.59
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$210.74
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$187.42
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$262.07
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$67.44
|
| Rate for Payer: Multiplan Commercial |
$224.79
|
| Rate for Payer: Networks By Design Commercial |
$140.50
|
| Rate for Payer: Prime Health Services Commercial |
$238.84
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$168.59
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$168.59
|
| Rate for Payer: United Healthcare All Other Commercial |
$140.50
|
| Rate for Payer: United Healthcare All Other HMO |
$140.50
|
| Rate for Payer: United Healthcare HMO Rider |
$140.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$140.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$238.84
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$238.84
|
| Rate for Payer: Vantage Medical Group Senior |
$238.84
|
|
|
PNEUMOCOCCAL 23 POLYVALENT VACCINE 25 MCG/0.5 ML INJECTION SOLUTION [11037]
|
Facility
|
IP
|
$280.99
|
|
|
Service Code
|
CPT 90732
|
| Hospital Charge Code |
NDG11037
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$67.44 |
| Max. Negotiated Rate |
$238.84 |
| Rate for Payer: Blue Shield of California Commercial |
$200.06
|
| Rate for Payer: Blue Shield of California EPN |
$143.87
|
| Rate for Payer: Cash Price |
$126.45
|
| Rate for Payer: Cigna of CA HMO |
$196.69
|
| Rate for Payer: Cigna of CA PPO |
$196.69
|
| Rate for Payer: EPIC Health Plan Commercial |
$112.40
|
| Rate for Payer: EPIC Health Plan Transplant |
$112.40
|
| Rate for Payer: Galaxy Health WC |
$238.84
|
| Rate for Payer: Global Benefits Group Commercial |
$168.59
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$187.42
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$107.06
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$67.44
|
| Rate for Payer: Multiplan Commercial |
$224.79
|
| Rate for Payer: Networks By Design Commercial |
$140.50
|
| Rate for Payer: Prime Health Services Commercial |
$238.84
|
| Rate for Payer: United Healthcare All Other Commercial |
$106.10
|
| Rate for Payer: United Healthcare All Other HMO |
$103.63
|
| Rate for Payer: United Healthcare HMO Rider |
$101.38
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$92.73
|
|
|
PNEUMOCOCCAL 23 POLYVALENT VACCINE 25 MCG/0.5 ML INJECTION SYRINGE [113995]
|
Facility
|
IP
|
$280.99
|
|
|
Service Code
|
CPT 90732
|
| Hospital Charge Code |
1720337
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$67.44 |
| Max. Negotiated Rate |
$238.84 |
| Rate for Payer: Blue Shield of California Commercial |
$200.06
|
| Rate for Payer: Blue Shield of California EPN |
$143.87
|
| Rate for Payer: Cash Price |
$126.45
|
| Rate for Payer: Cigna of CA HMO |
$196.69
|
| Rate for Payer: Cigna of CA PPO |
$196.69
|
| Rate for Payer: EPIC Health Plan Commercial |
$112.40
|
| Rate for Payer: EPIC Health Plan Transplant |
$112.40
|
| Rate for Payer: Galaxy Health WC |
$238.84
|
| Rate for Payer: Global Benefits Group Commercial |
$168.59
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$187.42
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$107.06
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$67.44
|
| Rate for Payer: Multiplan Commercial |
$224.79
|
| Rate for Payer: Networks By Design Commercial |
$140.50
|
| Rate for Payer: Prime Health Services Commercial |
$238.84
|
| Rate for Payer: United Healthcare All Other Commercial |
$106.10
|
| Rate for Payer: United Healthcare All Other HMO |
$103.63
|
| Rate for Payer: United Healthcare HMO Rider |
$101.38
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$92.73
|
|
