|
PRISMASATE BGK 4/0/1.2 DIALYSIS SOLUTION [4080471]
|
Facility
|
OP
|
$0.01
|
|
|
Service Code
|
NDC 0000-1139-19
|
| Hospital Charge Code |
ERX4080471
|
|
Hospital Revenue Code
|
250
|
| Max. Negotiated Rate |
$0.01 |
| Rate for Payer: Aetna of CA HMO/PPO |
$0.01
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.01
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.01
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.01
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.01
|
| Rate for Payer: Blue Distinction Transplant |
$0.01
|
| Rate for Payer: Blue Shield of California Commercial |
$0.01
|
| Rate for Payer: Blue Shield of California EPN |
$0.01
|
| Rate for Payer: Cigna of CA HMO |
$0.01
|
| Rate for Payer: Cigna of CA PPO |
$0.01
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.01
|
| Rate for Payer: Dignity Health Media |
$0.01
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.01
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.00
|
| Rate for Payer: EPIC Health Plan Transplant |
$0.00
|
| Rate for Payer: Galaxy Health WC |
$0.01
|
| Rate for Payer: Global Benefits Group Commercial |
$0.01
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$0.01
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.01
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.00
|
| Rate for Payer: Multiplan Commercial |
$0.01
|
| Rate for Payer: Networks By Design Commercial |
$0.01
|
| Rate for Payer: Prime Health Services Commercial |
$0.01
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.01
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.01
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.01
|
| Rate for Payer: United Healthcare All Other HMO |
$0.01
|
| Rate for Payer: United Healthcare HMO Rider |
$0.01
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.01
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.01
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.01
|
| Rate for Payer: Vantage Medical Group Senior |
$0.01
|
|
|
PRISMASATE BK 0/3.5 DIALYSIS SOLUTION [4080472]
|
Facility
|
OP
|
$0.01
|
|
|
Service Code
|
NDC 0000-1053-53
|
| Hospital Charge Code |
ERX4080472
|
|
Hospital Revenue Code
|
250
|
| Max. Negotiated Rate |
$0.01 |
| Rate for Payer: Aetna of CA HMO/PPO |
$0.01
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.01
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.01
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.01
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.01
|
| Rate for Payer: Blue Distinction Transplant |
$0.01
|
| Rate for Payer: Blue Shield of California Commercial |
$0.01
|
| Rate for Payer: Blue Shield of California EPN |
$0.01
|
| Rate for Payer: Cigna of CA HMO |
$0.01
|
| Rate for Payer: Cigna of CA PPO |
$0.01
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.01
|
| Rate for Payer: Dignity Health Media |
$0.01
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.01
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.00
|
| Rate for Payer: EPIC Health Plan Transplant |
$0.00
|
| Rate for Payer: Galaxy Health WC |
$0.01
|
| Rate for Payer: Global Benefits Group Commercial |
$0.01
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$0.01
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.01
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.00
|
| Rate for Payer: Multiplan Commercial |
$0.01
|
| Rate for Payer: Networks By Design Commercial |
$0.01
|
| Rate for Payer: Prime Health Services Commercial |
$0.01
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.01
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.01
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.01
|
| Rate for Payer: United Healthcare All Other HMO |
$0.01
|
| Rate for Payer: United Healthcare HMO Rider |
$0.01
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.01
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.01
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.01
|
| Rate for Payer: Vantage Medical Group Senior |
$0.01
|
|
|
PRISMASATE BK 0/3.5 DIALYSIS SOLUTION [4080472]
|
Facility
|
OP
|
$0.01
|
|
|
Service Code
|
NDC 0000-1139-15
|
| Hospital Charge Code |
ERX4080472
|
|
Hospital Revenue Code
|
250
|
| Max. Negotiated Rate |
$0.01 |
| Rate for Payer: Aetna of CA HMO/PPO |
$0.01
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.01
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.01
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.01
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.01
|
| Rate for Payer: Blue Distinction Transplant |
$0.01
|
| Rate for Payer: Blue Shield of California Commercial |
$0.01
|
| Rate for Payer: Blue Shield of California EPN |
$0.01
|
| Rate for Payer: Cigna of CA HMO |
$0.01
|
| Rate for Payer: Cigna of CA PPO |
$0.01
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.01
|
| Rate for Payer: Dignity Health Media |
$0.01
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.01
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.00
|
| Rate for Payer: EPIC Health Plan Transplant |
$0.00
|
| Rate for Payer: Galaxy Health WC |
$0.01
|
| Rate for Payer: Global Benefits Group Commercial |
$0.01
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$0.01
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.01
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.00
|
| Rate for Payer: Multiplan Commercial |
$0.01
|
| Rate for Payer: Networks By Design Commercial |
$0.01
|
| Rate for Payer: Prime Health Services Commercial |
$0.01
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.01
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.01
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.01
|
| Rate for Payer: United Healthcare All Other HMO |
$0.01
|
| Rate for Payer: United Healthcare HMO Rider |
$0.01
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.01
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.01
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.01
|
| Rate for Payer: Vantage Medical Group Senior |
$0.01
|
|
|
PRISMASATE BK 0/3.5 DIALYSIS SOLUTION [4080472]
|
Facility
|
IP
|
$0.01
|
|
|
Service Code
|
NDC 0000-1139-15
|
| Hospital Charge Code |
ERX4080472
|
|
Hospital Revenue Code
|
250
|
| Max. Negotiated Rate |
$0.01 |
| Rate for Payer: Blue Shield of California Commercial |
$0.01
|
| Rate for Payer: Blue Shield of California EPN |
$0.01
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.00
|
| Rate for Payer: Galaxy Health WC |
$0.01
|
| Rate for Payer: Global Benefits Group Commercial |
$0.01
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.01
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.00
|
| Rate for Payer: Multiplan Commercial |
$0.01
|
| Rate for Payer: Networks By Design Commercial |
$0.01
|
| Rate for Payer: Prime Health Services Commercial |
$0.01
|
|
|
PRISMASATE BK 0/3.5 DIALYSIS SOLUTION [4080472]
|
Facility
|
IP
|
$0.01
|
|
|
Service Code
|
NDC 0000-1053-53
|
| Hospital Charge Code |
ERX4080472
|
|
Hospital Revenue Code
|
250
|
| Max. Negotiated Rate |
$0.01 |
| Rate for Payer: Blue Shield of California Commercial |
$0.01
|
| Rate for Payer: Blue Shield of California EPN |
$0.01
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.00
|
| Rate for Payer: Galaxy Health WC |
$0.01
|
| Rate for Payer: Global Benefits Group Commercial |
$0.01
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.01
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.00
|
| Rate for Payer: Multiplan Commercial |
$0.01
|
| Rate for Payer: Networks By Design Commercial |
$0.01
|
| Rate for Payer: Prime Health Services Commercial |
$0.01
|
|
|
PROBENECID 500 MG TABLET [6561]
|
Facility
|
OP
|
$0.71
|
|
|
Service Code
|
NDC 0591-5347-01
|
| Hospital Charge Code |
1711315
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.17 |
| Max. Negotiated Rate |
$0.60 |
| Rate for Payer: Aetna of CA HMO/PPO |
$0.47
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.60
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.39
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.39
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.42
|
| Rate for Payer: Blue Distinction Transplant |
$0.43
|
| Rate for Payer: Blue Shield of California Commercial |
$0.52
|
| Rate for Payer: Blue Shield of California EPN |
$0.41
|
| Rate for Payer: Cash Price |
$0.32
|
| Rate for Payer: Cigna of CA HMO |
$0.50
|
| Rate for Payer: Cigna of CA PPO |
$0.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.60
|
| Rate for Payer: Dignity Health Media |
$0.60
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.28
|
| Rate for Payer: EPIC Health Plan Transplant |
$0.28
|
| Rate for Payer: Galaxy Health WC |
$0.60
|
| Rate for Payer: Global Benefits Group Commercial |
$0.43
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$0.53
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.47
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.27
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.17
|
| Rate for Payer: Multiplan Commercial |
$0.57
|
| Rate for Payer: Networks By Design Commercial |
$0.46
|
| Rate for Payer: Prime Health Services Commercial |
$0.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.43
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.43
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.36
|
| Rate for Payer: United Healthcare All Other HMO |
$0.36
|
| Rate for Payer: United Healthcare HMO Rider |
$0.36
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.36
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.60
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.60
|
| Rate for Payer: Vantage Medical Group Senior |
$0.60
|
|
|
PROBENECID 500 MG TABLET [6561]
|
Facility
|
IP
|
$0.71
|
|
|
Service Code
|
NDC 0591-5347-01
|
| Hospital Charge Code |
1711315
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.17 |
| Max. Negotiated Rate |
$0.60 |
| Rate for Payer: Blue Shield of California Commercial |
$0.51
|
| Rate for Payer: Blue Shield of California EPN |
$0.36
|
| Rate for Payer: Cash Price |
$0.32
|
| Rate for Payer: Cigna of CA HMO |
$0.50
|
| Rate for Payer: Cigna of CA PPO |
$0.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.28
|
| Rate for Payer: Galaxy Health WC |
$0.60
|
| Rate for Payer: Global Benefits Group Commercial |
$0.43
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.47
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.27
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.17
|
| Rate for Payer: Multiplan Commercial |
$0.57
|
| Rate for Payer: Networks By Design Commercial |
$0.46
|
| Rate for Payer: Prime Health Services Commercial |
$0.60
|
|
|
PROCAINAMIDE 100 MG/ML INJECTION SOLUTION [6562]
|
Facility
|
IP
|
$10.52
|
|
|
Service Code
|
CPT J2690
|
| Hospital Charge Code |
1720209
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$2.52 |
| Max. Negotiated Rate |
$8.94 |
| Rate for Payer: Blue Shield of California Commercial |
$7.49
|
| Rate for Payer: Blue Shield of California Commercial |
$51.26
|
| Rate for Payer: Blue Shield of California EPN |
$5.39
|
| Rate for Payer: Blue Shield of California EPN |
$36.86
|
| Rate for Payer: Cash Price |
$4.73
|
| Rate for Payer: Cash Price |
$32.40
|
| Rate for Payer: Cigna of CA HMO |
$7.36
|
| Rate for Payer: Cigna of CA HMO |
$50.40
|
| Rate for Payer: Cigna of CA PPO |
$50.40
|
| Rate for Payer: Cigna of CA PPO |
$7.36
|
| Rate for Payer: EPIC Health Plan Commercial |
$28.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$4.21
|
| Rate for Payer: EPIC Health Plan Transplant |
$4.21
|
| Rate for Payer: EPIC Health Plan Transplant |
$28.80
|
| Rate for Payer: Galaxy Health WC |
$8.94
|
| Rate for Payer: Galaxy Health WC |
$61.20
|
| Rate for Payer: Global Benefits Group Commercial |
$43.20
|
| Rate for Payer: Global Benefits Group Commercial |
$6.31
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$48.02
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$7.02
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4.01
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$27.43
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.52
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$17.28
|
| Rate for Payer: Multiplan Commercial |
$8.42
|
| Rate for Payer: Multiplan Commercial |
$57.60
|
| Rate for Payer: Networks By Design Commercial |
$5.26
|
| Rate for Payer: Networks By Design Commercial |
$36.00
|
| Rate for Payer: Prime Health Services Commercial |
$8.94
|
| Rate for Payer: Prime Health Services Commercial |
$61.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$3.97
|
| Rate for Payer: United Healthcare All Other Commercial |
$27.19
|
| Rate for Payer: United Healthcare All Other HMO |
$3.88
|
| Rate for Payer: United Healthcare All Other HMO |
$26.55
|
| Rate for Payer: United Healthcare HMO Rider |
$3.80
|
| Rate for Payer: United Healthcare HMO Rider |
$25.98
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3.47
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$23.76
|
|
|
PROCAINAMIDE 100 MG/ML INJECTION SOLUTION [6562]
|
Facility
|
OP
|
$10.52
|
|
|
Service Code
|
CPT J2690
|
| Hospital Charge Code |
1720209
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$2.52 |
| Max. Negotiated Rate |
$920.26 |
| Rate for Payer: Aetna of CA HMO/PPO |
$920.26
|
| Rate for Payer: Aetna of CA HMO/PPO |
$920.26
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$182.90
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$182.90
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$160.95
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$160.95
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$160.95
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$160.95
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$65.48
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$65.48
|
| Rate for Payer: Blue Distinction Transplant |
$43.20
|
| Rate for Payer: Blue Distinction Transplant |
$6.31
|
| Rate for Payer: Blue Shield of California Commercial |
$53.06
|
| Rate for Payer: Blue Shield of California Commercial |
$7.75
|
| Rate for Payer: Blue Shield of California EPN |
$142.85
|
| Rate for Payer: Blue Shield of California EPN |
$142.85
|
| Rate for Payer: Cash Price |
$32.40
|
| Rate for Payer: Cash Price |
$4.73
|
| Rate for Payer: Cash Price |
$32.40
|
| Rate for Payer: Cash Price |
$4.73
|
| Rate for Payer: Cigna of CA HMO |
$50.40
|
| Rate for Payer: Cigna of CA HMO |
$7.36
|
| Rate for Payer: Cigna of CA PPO |
$7.36
|
| Rate for Payer: Cigna of CA PPO |
$50.40
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$219.48
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$219.48
|
| Rate for Payer: Dignity Health Media |
$146.32
|
| Rate for Payer: Dignity Health Media |
$146.32
|
| Rate for Payer: Dignity Health Medi-Cal |
$160.95
|
| Rate for Payer: Dignity Health Medi-Cal |
$160.95
|
| Rate for Payer: EPIC Health Plan Commercial |
$197.53
|
| Rate for Payer: EPIC Health Plan Commercial |
$197.53
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$146.32
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$146.32
|
| Rate for Payer: EPIC Health Plan Transplant |
$146.32
|
| Rate for Payer: EPIC Health Plan Transplant |
$146.32
|
| Rate for Payer: Galaxy Health WC |
$8.94
|
| Rate for Payer: Galaxy Health WC |
$61.20
|
| Rate for Payer: Global Benefits Group Commercial |
$6.31
|
| Rate for Payer: Global Benefits Group Commercial |
$43.20
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$7.89
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$54.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$239.96
|
| Rate for Payer: Heritage Provider Network Commercial |
$239.96
|
| Rate for Payer: Heritage Provider Network Transplant |
$239.96
|
| Rate for Payer: Heritage Provider Network Transplant |
$239.96
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$237.03
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$237.03
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal Transplant |
$237.03
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal Transplant |
$237.03
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$146.32
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$146.32
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$7.02
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$48.02
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$286.48
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$286.48
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$146.32
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$146.32
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.52
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$17.28
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$184.36
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$184.36
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$196.06
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$196.06
|
| Rate for Payer: Multiplan Commercial |
$8.42
|
| Rate for Payer: Multiplan Commercial |
$57.60
|
| Rate for Payer: Networks By Design Commercial |
$36.00
|
| Rate for Payer: Networks By Design Commercial |
$5.26
|
| Rate for Payer: Prime Health Services Commercial |
$8.94
|
| Rate for Payer: Prime Health Services Commercial |
$61.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$43.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$6.31
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$43.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$6.31
|
| Rate for Payer: United Healthcare All Other Commercial |
$36.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$5.26
|
| Rate for Payer: United Healthcare All Other HMO |
$5.26
|
| Rate for Payer: United Healthcare All Other HMO |
$36.00
|
| Rate for Payer: United Healthcare HMO Rider |
$5.26
|
| Rate for Payer: United Healthcare HMO Rider |
$36.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$5.26
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$36.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$219.48
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$219.48
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$160.95
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$160.95
|
| Rate for Payer: Vantage Medical Group Senior |
$146.32
|
| Rate for Payer: Vantage Medical Group Senior |
$146.32
|
|
|
PROCAINAMIDE 500 MG/ML INJECTION SOLUTION [6563]
|
Facility
|
IP
|
$360.00
|
|
|
Service Code
|
CPT J2690
|
| Hospital Charge Code |
1720217
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$86.40 |
| Max. Negotiated Rate |
$306.00 |
| Rate for Payer: Blue Shield of California Commercial |
$256.32
|
| Rate for Payer: Blue Shield of California Commercial |
$31.09
|
| Rate for Payer: Blue Shield of California EPN |
$184.32
|
| Rate for Payer: Blue Shield of California EPN |
$22.35
|
| Rate for Payer: Cash Price |
$162.00
|
| Rate for Payer: Cash Price |
$19.65
|
| Rate for Payer: Cigna of CA HMO |
$252.00
|
| Rate for Payer: Cigna of CA HMO |
$30.56
|
| Rate for Payer: Cigna of CA PPO |
$30.56
|
| Rate for Payer: Cigna of CA PPO |
$252.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$17.46
|
| Rate for Payer: EPIC Health Plan Commercial |
$144.00
|
| Rate for Payer: EPIC Health Plan Transplant |
$144.00
|
| Rate for Payer: EPIC Health Plan Transplant |
$17.46
|
| Rate for Payer: Galaxy Health WC |
$306.00
|
| Rate for Payer: Galaxy Health WC |
$37.11
|
| Rate for Payer: Global Benefits Group Commercial |
$26.20
|
| Rate for Payer: Global Benefits Group Commercial |
$216.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$29.12
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$240.12
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$137.16
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$16.63
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$86.40
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$10.48
|
| Rate for Payer: Multiplan Commercial |
$288.00
|
| Rate for Payer: Multiplan Commercial |
$34.93
|
| Rate for Payer: Networks By Design Commercial |
$180.00
|
| Rate for Payer: Networks By Design Commercial |
$21.83
|
| Rate for Payer: Prime Health Services Commercial |
$306.00
|
| Rate for Payer: Prime Health Services Commercial |
$37.11
|
| Rate for Payer: United Healthcare All Other Commercial |
$135.94
|
| Rate for Payer: United Healthcare All Other Commercial |
$16.49
|
| Rate for Payer: United Healthcare All Other HMO |
$132.77
|
| Rate for Payer: United Healthcare All Other HMO |
$16.10
|
| Rate for Payer: United Healthcare HMO Rider |
$129.89
|
| Rate for Payer: United Healthcare HMO Rider |
$15.75
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$118.80
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$14.41
|
|
|
PROCAINAMIDE 500 MG/ML INJECTION SOLUTION [6563]
|
Facility
|
OP
|
$360.00
|
|
|
Service Code
|
CPT J2690
|
| Hospital Charge Code |
1720217
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$65.48 |
| Max. Negotiated Rate |
$920.26 |
| Rate for Payer: Aetna of CA HMO/PPO |
$920.26
|
| Rate for Payer: Aetna of CA HMO/PPO |
$920.26
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$182.90
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$182.90
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$160.95
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$160.95
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$160.95
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$160.95
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$65.48
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$65.48
|
| Rate for Payer: Blue Distinction Transplant |
$26.20
|
| Rate for Payer: Blue Distinction Transplant |
$216.00
|
| Rate for Payer: Blue Shield of California Commercial |
$32.18
|
| Rate for Payer: Blue Shield of California Commercial |
$265.32
|
| Rate for Payer: Blue Shield of California EPN |
$142.85
|
| Rate for Payer: Blue Shield of California EPN |
$142.85
|
| Rate for Payer: Cash Price |
$19.65
|
| Rate for Payer: Cash Price |
$162.00
|
| Rate for Payer: Cash Price |
$19.65
|
| Rate for Payer: Cash Price |
$162.00
|
| Rate for Payer: Cigna of CA HMO |
$30.56
|
| Rate for Payer: Cigna of CA HMO |
$252.00
|
| Rate for Payer: Cigna of CA PPO |
$252.00
|
| Rate for Payer: Cigna of CA PPO |
$30.56
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$219.48
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$219.48
|
| Rate for Payer: Dignity Health Media |
$146.32
|
| Rate for Payer: Dignity Health Media |
$146.32
|
| Rate for Payer: Dignity Health Medi-Cal |
$160.95
|
| Rate for Payer: Dignity Health Medi-Cal |
$160.95
|
| Rate for Payer: EPIC Health Plan Commercial |
$197.53
|
| Rate for Payer: EPIC Health Plan Commercial |
$197.53
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$146.32
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$146.32
|
| Rate for Payer: EPIC Health Plan Transplant |
$146.32
|
| Rate for Payer: EPIC Health Plan Transplant |
$146.32
|
| Rate for Payer: Galaxy Health WC |
$306.00
|
| Rate for Payer: Galaxy Health WC |
$37.11
|
| Rate for Payer: Global Benefits Group Commercial |
$216.00
|
| Rate for Payer: Global Benefits Group Commercial |
$26.20
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$270.00
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$32.74
|
| Rate for Payer: Heritage Provider Network Commercial |
$239.96
|
| Rate for Payer: Heritage Provider Network Commercial |
$239.96
|
| Rate for Payer: Heritage Provider Network Transplant |
$239.96
|
| Rate for Payer: Heritage Provider Network Transplant |
$239.96
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$237.03
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$237.03
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal Transplant |
$237.03
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal Transplant |
$237.03
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$146.32
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$146.32
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$240.12
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$29.12
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$286.48
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$286.48
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$146.32
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$146.32
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$86.40
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$10.48
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$184.36
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$184.36
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$196.06
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$196.06
|
| Rate for Payer: Multiplan Commercial |
$288.00
|
| Rate for Payer: Multiplan Commercial |
$34.93
|
| Rate for Payer: Networks By Design Commercial |
$21.83
|
| Rate for Payer: Networks By Design Commercial |
$180.00
|
| Rate for Payer: Prime Health Services Commercial |
$306.00
|
| Rate for Payer: Prime Health Services Commercial |
$37.11
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$26.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$216.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$26.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$216.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$21.83
|
| Rate for Payer: United Healthcare All Other Commercial |
$180.00
|
| Rate for Payer: United Healthcare All Other HMO |
$180.00
|
| Rate for Payer: United Healthcare All Other HMO |
$21.83
|
| Rate for Payer: United Healthcare HMO Rider |
$180.00
|
| Rate for Payer: United Healthcare HMO Rider |
$21.83
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$180.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$21.83
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$219.48
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$219.48
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$160.95
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$160.95
|
| Rate for Payer: Vantage Medical Group Senior |
$146.32
|
| Rate for Payer: Vantage Medical Group Senior |
$146.32
|
|
|
PROCAINAMIDE ORAL SOLUTION (IV FORM) 50 MG/ML [4080440]
|
Facility
|
OP
|
$1.29
|
|
|
Service Code
|
NDC 9994-0804-40
|
| Hospital Charge Code |
1715897
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.31 |
| Max. Negotiated Rate |
$1.10 |
| Rate for Payer: Aetna of CA HMO/PPO |
$0.85
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1.10
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.71
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.71
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.77
|
| Rate for Payer: Blue Distinction Transplant |
$0.77
|
| Rate for Payer: Blue Shield of California Commercial |
$0.95
|
| Rate for Payer: Blue Shield of California EPN |
$0.75
|
| Rate for Payer: Cash Price |
$0.58
|
| Rate for Payer: Cigna of CA HMO |
$0.90
|
| Rate for Payer: Cigna of CA PPO |
$0.90
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1.10
|
| Rate for Payer: Dignity Health Media |
$1.10
|
| Rate for Payer: Dignity Health Medi-Cal |
$1.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.52
|
| Rate for Payer: EPIC Health Plan Transplant |
$0.52
|
| Rate for Payer: Galaxy Health WC |
$1.10
|
| Rate for Payer: Global Benefits Group Commercial |
$0.77
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$0.97
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.86
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.49
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.31
|
| Rate for Payer: Multiplan Commercial |
$1.03
|
| Rate for Payer: Networks By Design Commercial |
$0.84
|
| Rate for Payer: Prime Health Services Commercial |
$1.10
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.77
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.77
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.65
|
| Rate for Payer: United Healthcare All Other HMO |
$0.65
|
| Rate for Payer: United Healthcare HMO Rider |
$0.65
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.65
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1.10
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1.10
|
| Rate for Payer: Vantage Medical Group Senior |
$1.10
|
|
|
PROCAINAMIDE ORAL SOLUTION (IV FORM) 50 MG/ML [4080440]
|
Facility
|
IP
|
$1.29
|
|
|
Service Code
|
NDC 9994-0804-40
|
| Hospital Charge Code |
1715897
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.31 |
| Max. Negotiated Rate |
$1.10 |
| Rate for Payer: Blue Shield of California Commercial |
$0.92
|
| Rate for Payer: Blue Shield of California EPN |
$0.66
|
| Rate for Payer: Cash Price |
$0.58
|
| Rate for Payer: Cigna of CA HMO |
$0.90
|
| Rate for Payer: Cigna of CA PPO |
$0.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.52
|
| Rate for Payer: Galaxy Health WC |
$1.10
|
| Rate for Payer: Global Benefits Group Commercial |
$0.77
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.86
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.49
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.31
|
| Rate for Payer: Multiplan Commercial |
$1.03
|
| Rate for Payer: Networks By Design Commercial |
$0.84
|
| Rate for Payer: Prime Health Services Commercial |
$1.10
|
|
|
PROCARBAZINE ORAL SUSPENSION COMPOUND 10 MG/ML [4080323]
|
Facility
|
OP
|
$12.07
|
|
|
Service Code
|
NDC 9994-0803-23
|
| Hospital Charge Code |
1715155
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$2.90 |
| Max. Negotiated Rate |
$10.26 |
| Rate for Payer: Aetna of CA HMO/PPO |
$7.92
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$10.26
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$6.64
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$6.64
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$7.19
|
| Rate for Payer: Blue Distinction Transplant |
$7.24
|
| Rate for Payer: Blue Shield of California Commercial |
$8.90
|
| Rate for Payer: Blue Shield of California EPN |
$7.05
|
| Rate for Payer: Cash Price |
$5.43
|
| Rate for Payer: Cigna of CA HMO |
$8.45
|
| Rate for Payer: Cigna of CA PPO |
$8.45
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$10.26
|
| Rate for Payer: Dignity Health Media |
$10.26
|
| Rate for Payer: Dignity Health Medi-Cal |
$10.26
|
| Rate for Payer: EPIC Health Plan Commercial |
$4.83
|
| Rate for Payer: EPIC Health Plan Transplant |
$4.83
|
| Rate for Payer: Galaxy Health WC |
$10.26
|
| Rate for Payer: Global Benefits Group Commercial |
$7.24
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$9.05
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$8.05
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4.60
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.90
|
| Rate for Payer: Multiplan Commercial |
$9.66
|
| Rate for Payer: Networks By Design Commercial |
$7.85
|
| Rate for Payer: Prime Health Services Commercial |
$10.26
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$7.24
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$7.24
|
| Rate for Payer: United Healthcare All Other Commercial |
$6.04
|
| Rate for Payer: United Healthcare All Other HMO |
$6.04
|
| Rate for Payer: United Healthcare HMO Rider |
$6.04
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$6.04
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$10.26
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$10.26
|
| Rate for Payer: Vantage Medical Group Senior |
$10.26
|
|
|
PROCARBAZINE ORAL SUSPENSION COMPOUND 10 MG/ML [4080323]
|
Facility
|
IP
|
$12.07
|
|
|
Service Code
|
NDC 9994-0803-23
|
| Hospital Charge Code |
1715155
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$2.90 |
| Max. Negotiated Rate |
$10.26 |
| Rate for Payer: Blue Shield of California Commercial |
$8.59
|
| Rate for Payer: Blue Shield of California EPN |
$6.18
|
| Rate for Payer: Cash Price |
$5.43
|
| Rate for Payer: Cigna of CA HMO |
$8.45
|
| Rate for Payer: Cigna of CA PPO |
$8.45
|
| Rate for Payer: EPIC Health Plan Commercial |
$4.83
|
| Rate for Payer: Galaxy Health WC |
$10.26
|
| Rate for Payer: Global Benefits Group Commercial |
$7.24
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$8.05
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4.60
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.90
|
| Rate for Payer: Multiplan Commercial |
$9.66
|
| Rate for Payer: Networks By Design Commercial |
$7.85
|
| Rate for Payer: Prime Health Services Commercial |
$10.26
|
|
|
PROCEDURES FOR OBESITY
|
Facility
|
IP
|
$17,821.51
|
|
|
Service Code
|
APR-DRG 4031
|
| Min. Negotiated Rate |
$13,670.97 |
| Max. Negotiated Rate |
$17,821.51 |
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$13,670.97
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$17,821.51
|
|
|
PROCEDURES FOR OBESITY
|
Facility
|
IP
|
$20,690.96
|
|
|
Service Code
|
APR-DRG 4032
|
| Min. Negotiated Rate |
$15,872.15 |
| Max. Negotiated Rate |
$20,690.96 |
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$15,872.15
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$20,690.96
|
|
|
PROCEDURES FOR OBESITY
|
Facility
|
IP
|
$29,517.47
|
|
|
Service Code
|
APR-DRG 4033
|
| Min. Negotiated Rate |
$22,643.01 |
| Max. Negotiated Rate |
$29,517.47 |
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$22,643.01
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$29,517.47
|
|
|
PROCEDURES FOR OBESITY
|
Facility
|
IP
|
$60,288.77
|
|
|
Service Code
|
APR-DRG 4034
|
| Min. Negotiated Rate |
$46,247.83 |
| Max. Negotiated Rate |
$60,288.77 |
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$46,247.83
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$60,288.77
|
|
|
PROCEDURE WITH DIAGNOSIS OF REHABILITATION, AFTERCARE OR OTHER CONTACT WITH HEALTH SERVICES
|
Facility
|
IP
|
$43,820.42
|
|
|
Service Code
|
APR-DRG 8503
|
| Min. Negotiated Rate |
$33,614.88 |
| Max. Negotiated Rate |
$43,820.42 |
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$33,614.88
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$43,820.42
|
|
|
PROCEDURE WITH DIAGNOSIS OF REHABILITATION, AFTERCARE OR OTHER CONTACT WITH HEALTH SERVICES
|
Facility
|
IP
|
$35,745.86
|
|
|
Service Code
|
APR-DRG 8502
|
| Min. Negotiated Rate |
$27,420.84 |
| Max. Negotiated Rate |
$35,745.86 |
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$27,420.84
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$35,745.86
|
|
|
PROCEDURE WITH DIAGNOSIS OF REHABILITATION, AFTERCARE OR OTHER CONTACT WITH HEALTH SERVICES
|
Facility
|
IP
|
$93,099.56
|
|
|
Service Code
|
APR-DRG 8504
|
| Min. Negotiated Rate |
$71,417.16 |
| Max. Negotiated Rate |
$93,099.56 |
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$71,417.16
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$93,099.56
|
|
|
PROCEDURE WITH DIAGNOSIS OF REHABILITATION, AFTERCARE OR OTHER CONTACT WITH HEALTH SERVICES
|
Facility
|
IP
|
$26,357.16
|
|
|
Service Code
|
APR-DRG 8501
|
| Min. Negotiated Rate |
$20,218.72 |
| Max. Negotiated Rate |
$26,357.16 |
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$20,218.72
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$26,357.16
|
|
|
PROCHLORPERAZINE 25 MG RECTAL SUPPOSITORY [11138]
|
Facility
|
OP
|
$10.46
|
|
|
Service Code
|
NDC 0574-7226-12
|
| Hospital Charge Code |
1748022
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$2.51 |
| Max. Negotiated Rate |
$8.89 |
| Rate for Payer: Aetna of CA HMO/PPO |
$6.86
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$8.89
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$5.75
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$5.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$6.23
|
| Rate for Payer: Blue Distinction Transplant |
$6.28
|
| Rate for Payer: Blue Shield of California Commercial |
$7.71
|
| Rate for Payer: Blue Shield of California EPN |
$6.11
|
| Rate for Payer: Cash Price |
$4.71
|
| Rate for Payer: Cigna of CA HMO |
$7.32
|
| Rate for Payer: Cigna of CA PPO |
$7.32
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$8.89
|
| Rate for Payer: Dignity Health Media |
$8.89
|
| Rate for Payer: Dignity Health Medi-Cal |
$8.89
|
| Rate for Payer: EPIC Health Plan Commercial |
$4.18
|
| Rate for Payer: EPIC Health Plan Transplant |
$4.18
|
| Rate for Payer: Galaxy Health WC |
$8.89
|
| Rate for Payer: Global Benefits Group Commercial |
$6.28
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$7.84
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$6.98
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3.99
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.51
|
| Rate for Payer: Multiplan Commercial |
$8.37
|
| Rate for Payer: Networks By Design Commercial |
$6.80
|
| Rate for Payer: Prime Health Services Commercial |
$8.89
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$6.28
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$6.28
|
| Rate for Payer: United Healthcare All Other Commercial |
$5.23
|
| Rate for Payer: United Healthcare All Other HMO |
$5.23
|
| Rate for Payer: United Healthcare HMO Rider |
$5.23
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$5.23
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$8.89
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$8.89
|
| Rate for Payer: Vantage Medical Group Senior |
$8.89
|
|
|
PROCHLORPERAZINE 25 MG RECTAL SUPPOSITORY [11138]
|
Facility
|
IP
|
$10.46
|
|
|
Service Code
|
NDC 0713-0135-06
|
| Hospital Charge Code |
1748022
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$2.51 |
| Max. Negotiated Rate |
$8.89 |
| Rate for Payer: Blue Shield of California Commercial |
$7.45
|
| Rate for Payer: Blue Shield of California EPN |
$5.36
|
| Rate for Payer: Cash Price |
$4.71
|
| Rate for Payer: Cigna of CA HMO |
$7.32
|
| Rate for Payer: Cigna of CA PPO |
$7.32
|
| Rate for Payer: EPIC Health Plan Commercial |
$4.18
|
| Rate for Payer: Galaxy Health WC |
$8.89
|
| Rate for Payer: Global Benefits Group Commercial |
$6.28
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$6.98
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3.99
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.51
|
| Rate for Payer: Multiplan Commercial |
$8.37
|
| Rate for Payer: Networks By Design Commercial |
$6.80
|
| Rate for Payer: Prime Health Services Commercial |
$8.89
|
|
