|
Pelvic examination under anesthesia (other than local)
|
Facility
OP
|
$7,385.00
|
|
|
Service Code
|
CPT 57410
|
| Min. Negotiated Rate |
$142.48 |
| Max. Negotiated Rate |
$7,385.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$7,385.00
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$5,859.27
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$4,296.80
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$3,906.18
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,984.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$5,859.27
|
| Rate for Payer: Dignity Health Media |
$3,906.18
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,296.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$5,273.34
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$3,906.18
|
| Rate for Payer: EPIC Health Plan Transplant |
$3,906.18
|
| Rate for Payer: Heritage Provider Network Commercial |
$6,406.14
|
| Rate for Payer: Heritage Provider Network Transplant |
$6,406.14
|
| Rate for Payer: IEHP Medi-Cal |
$6,328.01
|
| Rate for Payer: IEHP Medi-Cal Transplant |
$6,328.01
|
| Rate for Payer: IEHP Medicare Advantage |
$3,906.18
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$142.48
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3,906.18
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$4,921.79
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$5,234.28
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$5,859.27
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,296.80
|
| Rate for Payer: Vantage Medical Group Senior |
$3,906.18
|
|
|
PEMBROLIZUMAB 25 MG/ML INTRAVENOUS SOLUTION [208822]
|
Facility
OP
|
$1,634.57
|
|
|
Service Code
|
CPT J9271
|
| Hospital Charge Code |
NDG2359
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$55.73 |
| Max. Negotiated Rate |
$1,389.38 |
| Rate for Payer: Aetna of CA HMO/PPO |
$109.77
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$69.66
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$61.30
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$61.30
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$92.01
|
| Rate for Payer: BCBS Transplant Transplant |
$980.74
|
| Rate for Payer: Blue Shield of California Commercial |
$1,204.68
|
| Rate for Payer: Blue Shield of California EPN |
$59.22
|
| Rate for Payer: Cash Price |
$735.56
|
| Rate for Payer: Cash Price |
$735.56
|
| Rate for Payer: Cigna of CA HMO |
$1,144.20
|
| Rate for Payer: Cigna of CA PPO |
$1,144.20
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$83.60
|
| Rate for Payer: Dignity Health Media |
$55.73
|
| Rate for Payer: Dignity Health Medi-Cal |
$61.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$75.24
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$55.73
|
| Rate for Payer: EPIC Health Plan Transplant |
$55.73
|
| Rate for Payer: Galaxy Health WC |
$1,389.38
|
| Rate for Payer: Global Benefits Group Commercial |
$980.74
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$1,225.93
|
| Rate for Payer: Heritage Provider Network Commercial |
$91.40
|
| Rate for Payer: Heritage Provider Network Transplant |
$91.40
|
| Rate for Payer: IEHP Medi-Cal |
$90.28
|
| Rate for Payer: IEHP Medi-Cal Transplant |
$90.28
|
| Rate for Payer: IEHP Medicare Advantage |
$55.73
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,090.26
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$114.36
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$55.73
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$392.30
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$70.22
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$74.68
|
| Rate for Payer: Multiplan Commercial |
$1,307.66
|
| Rate for Payer: Networks By Design Commercial |
$817.28
|
| Rate for Payer: Prime Health Services Commercial |
$1,389.38
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$980.74
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$980.74
|
| Rate for Payer: United Healthcare All Other Commercial |
$817.28
|
| Rate for Payer: United Healthcare All Other HMO |
$817.28
|
| Rate for Payer: United Healthcare HMO Rider |
$817.28
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$817.28
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$83.60
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$61.30
|
| Rate for Payer: Vantage Medical Group Senior |
$55.73
|
|
|
PEMBROLIZUMAB 25 MG/ML INTRAVENOUS SOLUTION [208822]
|
Facility
IP
|
$1,634.57
|
|
|
Service Code
|
CPT J9271
|
| Hospital Charge Code |
NDG2359
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$392.30 |
| Max. Negotiated Rate |
$1,389.38 |
| Rate for Payer: Blue Shield of California Commercial |
$1,163.81
|
| Rate for Payer: Blue Shield of California EPN |
$836.90
|
| Rate for Payer: Cash Price |
$735.56
|
| Rate for Payer: Cigna of CA HMO |
$1,144.20
|
| Rate for Payer: Cigna of CA PPO |
$1,144.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$653.83
|
| Rate for Payer: EPIC Health Plan Transplant |
$653.83
|
| Rate for Payer: Galaxy Health WC |
$1,389.38
|
| Rate for Payer: Global Benefits Group Commercial |
$980.74
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,090.26
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$622.77
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$392.30
|
| Rate for Payer: Multiplan Commercial |
$1,307.66
|
| Rate for Payer: Networks By Design Commercial |
$817.28
|
| Rate for Payer: Prime Health Services Commercial |
$1,389.38
|
|
|
PEMETREXED DISODIUM 100 MG INTRAVENOUS POWDER FOR SOLUTION [89350]
|
Facility
OP
|
$970.32
|
|
|
Service Code
|
CPT J9305
|
| Hospital Charge Code |
1755746
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$4.37 |
| Max. Negotiated Rate |
$824.77 |
| Rate for Payer: Aetna of CA HMO/PPO |
$8.60
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$5.46
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$4.81
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$4.81
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$86.62
|
| Rate for Payer: BCBS Transplant Transplant |
$582.19
|
| Rate for Payer: Blue Shield of California Commercial |
$715.13
|
| Rate for Payer: Blue Shield of California EPN |
$88.77
|
| Rate for Payer: Cash Price |
$436.64
|
| Rate for Payer: Cash Price |
$436.64
|
| Rate for Payer: Cigna of CA HMO |
$679.22
|
| Rate for Payer: Cigna of CA PPO |
$679.22
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$6.56
|
| Rate for Payer: Dignity Health Media |
$4.37
|
| Rate for Payer: Dignity Health Medi-Cal |
$4.81
|
| Rate for Payer: EPIC Health Plan Commercial |
$5.90
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$4.37
|
| Rate for Payer: EPIC Health Plan Transplant |
$4.37
|
| Rate for Payer: Galaxy Health WC |
$824.77
|
| Rate for Payer: Global Benefits Group Commercial |
$582.19
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$727.74
|
| Rate for Payer: Heritage Provider Network Commercial |
$7.17
|
| Rate for Payer: Heritage Provider Network Transplant |
$7.17
|
| Rate for Payer: IEHP Medi-Cal |
$7.08
|
| Rate for Payer: IEHP Medi-Cal Transplant |
$7.08
|
| Rate for Payer: IEHP Medicare Advantage |
$4.37
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$647.20
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$16.78
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4.37
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$232.88
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$5.51
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$5.86
|
| Rate for Payer: Multiplan Commercial |
$776.26
|
| Rate for Payer: Networks By Design Commercial |
$485.16
|
| Rate for Payer: Prime Health Services Commercial |
$824.77
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$582.19
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$582.19
|
| Rate for Payer: United Healthcare All Other Commercial |
$485.16
|
| Rate for Payer: United Healthcare All Other HMO |
$485.16
|
| Rate for Payer: United Healthcare HMO Rider |
$485.16
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$485.16
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$6.56
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4.81
|
| Rate for Payer: Vantage Medical Group Senior |
$4.37
|
|
|
PEMETREXED DISODIUM 100 MG INTRAVENOUS POWDER FOR SOLUTION [89350]
|
Facility
IP
|
$970.32
|
|
|
Service Code
|
CPT J9305
|
| Hospital Charge Code |
1755746
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$232.88 |
| Max. Negotiated Rate |
$824.77 |
| Rate for Payer: Blue Shield of California Commercial |
$690.87
|
| Rate for Payer: Blue Shield of California EPN |
$496.80
|
| Rate for Payer: Cash Price |
$436.64
|
| Rate for Payer: Cigna of CA HMO |
$679.22
|
| Rate for Payer: Cigna of CA PPO |
$679.22
|
| Rate for Payer: EPIC Health Plan Commercial |
$388.13
|
| Rate for Payer: EPIC Health Plan Transplant |
$388.13
|
| Rate for Payer: Galaxy Health WC |
$824.77
|
| Rate for Payer: Global Benefits Group Commercial |
$582.19
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$647.20
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$369.69
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$232.88
|
| Rate for Payer: Multiplan Commercial |
$776.26
|
| Rate for Payer: Networks By Design Commercial |
$485.16
|
| Rate for Payer: Prime Health Services Commercial |
$824.77
|
|
|
PEMETREXED DISODIUM 500 MG INTRAVENOUS POWDER FOR SOLUTION [37894]
|
Facility
OP
|
$951.60
|
|
|
Service Code
|
NDC 43598-387-11
|
| Hospital Charge Code |
1755727
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$228.38 |
| Max. Negotiated Rate |
$808.86 |
| Rate for Payer: Aetna of CA HMO/PPO |
$624.15
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$808.86
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$523.38
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$523.38
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$566.96
|
| Rate for Payer: BCBS Transplant Transplant |
$570.96
|
| Rate for Payer: Blue Shield of California Commercial |
$701.33
|
| Rate for Payer: Blue Shield of California EPN |
$555.73
|
| Rate for Payer: Cash Price |
$428.22
|
| Rate for Payer: Cash Price |
$428.22
|
| Rate for Payer: Cigna of CA HMO |
$666.12
|
| Rate for Payer: Cigna of CA PPO |
$666.12
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$808.86
|
| Rate for Payer: Dignity Health Media |
$808.86
|
| Rate for Payer: Dignity Health Medi-Cal |
$808.86
|
| Rate for Payer: EPIC Health Plan Commercial |
$380.64
|
| Rate for Payer: EPIC Health Plan Transplant |
$380.64
|
| Rate for Payer: Galaxy Health WC |
$808.86
|
| Rate for Payer: Global Benefits Group Commercial |
$570.96
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$713.70
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$634.72
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$362.56
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$228.38
|
| Rate for Payer: Multiplan Commercial |
$761.28
|
| Rate for Payer: Networks By Design Commercial |
$475.80
|
| Rate for Payer: Prime Health Services Commercial |
$808.86
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$570.96
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$570.96
|
| Rate for Payer: United Healthcare All Other Commercial |
$475.80
|
| Rate for Payer: United Healthcare All Other HMO |
$475.80
|
| Rate for Payer: United Healthcare HMO Rider |
$475.80
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$475.80
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$808.86
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$808.86
|
| Rate for Payer: Vantage Medical Group Senior |
$808.86
|
|
|
PEMETREXED DISODIUM 500 MG INTRAVENOUS POWDER FOR SOLUTION [37894]
|
Facility
IP
|
$951.60
|
|
|
Service Code
|
NDC 43598-387-11
|
| Hospital Charge Code |
1755727
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$228.38 |
| Max. Negotiated Rate |
$808.86 |
| Rate for Payer: Blue Shield of California Commercial |
$677.54
|
| Rate for Payer: Blue Shield of California EPN |
$487.22
|
| Rate for Payer: Cash Price |
$428.22
|
| Rate for Payer: Cigna of CA HMO |
$666.12
|
| Rate for Payer: Cigna of CA PPO |
$666.12
|
| Rate for Payer: EPIC Health Plan Commercial |
$380.64
|
| Rate for Payer: EPIC Health Plan Transplant |
$380.64
|
| Rate for Payer: Galaxy Health WC |
$808.86
|
| Rate for Payer: Global Benefits Group Commercial |
$570.96
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$634.72
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$362.56
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$228.38
|
| Rate for Payer: Multiplan Commercial |
$761.28
|
| Rate for Payer: Networks By Design Commercial |
$475.80
|
| Rate for Payer: Prime Health Services Commercial |
$808.86
|
|
|
PEMETREXED DISODIUM 500 MG INTRAVENOUS POWDER FOR SOLUTION [37894]
|
Facility
IP
|
$600.00
|
|
|
Service Code
|
NDC 55150-382-01
|
| Hospital Charge Code |
1755727
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$144.00 |
| Max. Negotiated Rate |
$510.00 |
| Rate for Payer: Blue Shield of California Commercial |
$427.20
|
| Rate for Payer: Blue Shield of California EPN |
$307.20
|
| Rate for Payer: Cash Price |
$270.00
|
| Rate for Payer: Cigna of CA HMO |
$420.00
|
| Rate for Payer: Cigna of CA PPO |
$420.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$240.00
|
| Rate for Payer: EPIC Health Plan Transplant |
$240.00
|
| Rate for Payer: Galaxy Health WC |
$510.00
|
| Rate for Payer: Global Benefits Group Commercial |
$360.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$400.20
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$228.60
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$144.00
|
| Rate for Payer: Multiplan Commercial |
$480.00
|
| Rate for Payer: Networks By Design Commercial |
$300.00
|
| Rate for Payer: Prime Health Services Commercial |
$510.00
|
|
|
PEMETREXED DISODIUM 500 MG INTRAVENOUS POWDER FOR SOLUTION [37894]
|
Facility
OP
|
$600.00
|
|
|
Service Code
|
NDC 55150-382-01
|
| Hospital Charge Code |
1755727
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$144.00 |
| Max. Negotiated Rate |
$510.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$393.54
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$510.00
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$330.00
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$330.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$357.48
|
| Rate for Payer: BCBS Transplant Transplant |
$360.00
|
| Rate for Payer: Blue Shield of California Commercial |
$442.20
|
| Rate for Payer: Blue Shield of California EPN |
$350.40
|
| Rate for Payer: Cash Price |
$270.00
|
| Rate for Payer: Cash Price |
$270.00
|
| Rate for Payer: Cigna of CA HMO |
$420.00
|
| Rate for Payer: Cigna of CA PPO |
$420.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$510.00
|
| Rate for Payer: Dignity Health Media |
$510.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$510.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$240.00
|
| Rate for Payer: EPIC Health Plan Transplant |
$240.00
|
| Rate for Payer: Galaxy Health WC |
$510.00
|
| Rate for Payer: Global Benefits Group Commercial |
$360.00
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$450.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$400.20
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$228.60
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$144.00
|
| Rate for Payer: Multiplan Commercial |
$480.00
|
| Rate for Payer: Networks By Design Commercial |
$300.00
|
| Rate for Payer: Prime Health Services Commercial |
$510.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$360.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$360.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$300.00
|
| Rate for Payer: United Healthcare All Other HMO |
$300.00
|
| Rate for Payer: United Healthcare HMO Rider |
$300.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$300.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$510.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$510.00
|
| Rate for Payer: Vantage Medical Group Senior |
$510.00
|
|
|
PEMIGATINIB 13.5 MG TABLET [227743]
|
Facility
IP
|
$1,500.86
|
|
|
Service Code
|
NDC 50881-028-01
|
| Hospital Charge Code |
ERX227743
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$360.21 |
| Max. Negotiated Rate |
$1,275.73 |
| Rate for Payer: Blue Shield of California Commercial |
$1,068.61
|
| Rate for Payer: Blue Shield of California EPN |
$768.44
|
| Rate for Payer: Cash Price |
$675.39
|
| Rate for Payer: Cigna of CA HMO |
$1,050.60
|
| Rate for Payer: Cigna of CA PPO |
$1,050.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$600.34
|
| Rate for Payer: Galaxy Health WC |
$1,275.73
|
| Rate for Payer: Global Benefits Group Commercial |
$900.52
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,001.07
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$571.83
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$360.21
|
| Rate for Payer: Multiplan Commercial |
$1,200.69
|
| Rate for Payer: Networks By Design Commercial |
$975.56
|
| Rate for Payer: Prime Health Services Commercial |
$1,275.73
|
|
|
PEMIGATINIB 13.5 MG TABLET [227743]
|
Facility
OP
|
$1,500.86
|
|
|
Service Code
|
NDC 50881-028-01
|
| Hospital Charge Code |
ERX227743
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$360.21 |
| Max. Negotiated Rate |
$1,275.73 |
| Rate for Payer: Aetna of CA HMO/PPO |
$984.41
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$1,275.73
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$825.47
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$825.47
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$894.21
|
| Rate for Payer: BCBS Transplant Transplant |
$900.52
|
| Rate for Payer: Blue Shield of California Commercial |
$1,106.13
|
| Rate for Payer: Blue Shield of California EPN |
$876.50
|
| Rate for Payer: Cash Price |
$675.39
|
| Rate for Payer: Cigna of CA HMO |
$1,050.60
|
| Rate for Payer: Cigna of CA PPO |
$1,050.60
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,275.73
|
| Rate for Payer: Dignity Health Media |
$1,275.73
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,275.73
|
| Rate for Payer: EPIC Health Plan Commercial |
$600.34
|
| Rate for Payer: EPIC Health Plan Transplant |
$600.34
|
| Rate for Payer: Galaxy Health WC |
$1,275.73
|
| Rate for Payer: Global Benefits Group Commercial |
$900.52
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$1,125.64
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,001.07
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$571.83
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$360.21
|
| Rate for Payer: Multiplan Commercial |
$1,200.69
|
| Rate for Payer: Networks By Design Commercial |
$975.56
|
| Rate for Payer: Prime Health Services Commercial |
$1,275.73
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$900.52
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$900.52
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$900.52
|
| Rate for Payer: United Healthcare All Other Commercial |
$750.43
|
| Rate for Payer: United Healthcare All Other HMO |
$750.43
|
| Rate for Payer: United Healthcare HMO Rider |
$750.43
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$750.43
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,275.73
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,275.73
|
| Rate for Payer: Vantage Medical Group Senior |
$1,275.73
|
|
|
PEMIGATINIB 4.5 MG TABLET [227741]
|
Facility
IP
|
$1,500.86
|
|
|
Service Code
|
NDC 50881-026-01
|
| Hospital Charge Code |
ERX227741
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$360.21 |
| Max. Negotiated Rate |
$1,275.73 |
| Rate for Payer: Blue Shield of California Commercial |
$1,068.61
|
| Rate for Payer: Blue Shield of California EPN |
$768.44
|
| Rate for Payer: Cash Price |
$675.39
|
| Rate for Payer: Cigna of CA HMO |
$1,050.60
|
| Rate for Payer: Cigna of CA PPO |
$1,050.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$600.34
|
| Rate for Payer: Galaxy Health WC |
$1,275.73
|
| Rate for Payer: Global Benefits Group Commercial |
$900.52
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,001.07
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$571.83
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$360.21
|
| Rate for Payer: Multiplan Commercial |
$1,200.69
|
| Rate for Payer: Networks By Design Commercial |
$975.56
|
| Rate for Payer: Prime Health Services Commercial |
$1,275.73
|
|
|
PEMIGATINIB 4.5 MG TABLET [227741]
|
Facility
OP
|
$1,500.86
|
|
|
Service Code
|
NDC 50881-026-01
|
| Hospital Charge Code |
ERX227741
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$360.21 |
| Max. Negotiated Rate |
$1,275.73 |
| Rate for Payer: Aetna of CA HMO/PPO |
$984.41
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$1,275.73
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$825.47
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$825.47
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$894.21
|
| Rate for Payer: BCBS Transplant Transplant |
$900.52
|
| Rate for Payer: Blue Shield of California Commercial |
$1,106.13
|
| Rate for Payer: Blue Shield of California EPN |
$876.50
|
| Rate for Payer: Cash Price |
$675.39
|
| Rate for Payer: Cigna of CA HMO |
$1,050.60
|
| Rate for Payer: Cigna of CA PPO |
$1,050.60
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,275.73
|
| Rate for Payer: Dignity Health Media |
$1,275.73
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,275.73
|
| Rate for Payer: EPIC Health Plan Commercial |
$600.34
|
| Rate for Payer: EPIC Health Plan Transplant |
$600.34
|
| Rate for Payer: Galaxy Health WC |
$1,275.73
|
| Rate for Payer: Global Benefits Group Commercial |
$900.52
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$1,125.64
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,001.07
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$571.83
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$360.21
|
| Rate for Payer: Multiplan Commercial |
$1,200.69
|
| Rate for Payer: Networks By Design Commercial |
$975.56
|
| Rate for Payer: Prime Health Services Commercial |
$1,275.73
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$900.52
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$900.52
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$900.52
|
| Rate for Payer: United Healthcare All Other Commercial |
$750.43
|
| Rate for Payer: United Healthcare All Other HMO |
$750.43
|
| Rate for Payer: United Healthcare HMO Rider |
$750.43
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$750.43
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,275.73
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,275.73
|
| Rate for Payer: Vantage Medical Group Senior |
$1,275.73
|
|
|
PEMIGATINIB 9 MG TABLET [227742]
|
Facility
IP
|
$1,500.86
|
|
|
Service Code
|
NDC 50881-027-01
|
| Hospital Charge Code |
ERX227742
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$360.21 |
| Max. Negotiated Rate |
$1,275.73 |
| Rate for Payer: Blue Shield of California Commercial |
$1,068.61
|
| Rate for Payer: Blue Shield of California EPN |
$768.44
|
| Rate for Payer: Cash Price |
$675.39
|
| Rate for Payer: Cigna of CA HMO |
$1,050.60
|
| Rate for Payer: Cigna of CA PPO |
$1,050.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$600.34
|
| Rate for Payer: Galaxy Health WC |
$1,275.73
|
| Rate for Payer: Global Benefits Group Commercial |
$900.52
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,001.07
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$571.83
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$360.21
|
| Rate for Payer: Multiplan Commercial |
$1,200.69
|
| Rate for Payer: Networks By Design Commercial |
$975.56
|
| Rate for Payer: Prime Health Services Commercial |
$1,275.73
|
|
|
PEMIGATINIB 9 MG TABLET [227742]
|
Facility
OP
|
$1,500.86
|
|
|
Service Code
|
NDC 50881-027-01
|
| Hospital Charge Code |
ERX227742
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$360.21 |
| Max. Negotiated Rate |
$1,275.73 |
| Rate for Payer: Aetna of CA HMO/PPO |
$984.41
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$1,275.73
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$825.47
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$825.47
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$894.21
|
| Rate for Payer: BCBS Transplant Transplant |
$900.52
|
| Rate for Payer: Blue Shield of California Commercial |
$1,106.13
|
| Rate for Payer: Blue Shield of California EPN |
$876.50
|
| Rate for Payer: Cash Price |
$675.39
|
| Rate for Payer: Cigna of CA HMO |
$1,050.60
|
| Rate for Payer: Cigna of CA PPO |
$1,050.60
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,275.73
|
| Rate for Payer: Dignity Health Media |
$1,275.73
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,275.73
|
| Rate for Payer: EPIC Health Plan Commercial |
$600.34
|
| Rate for Payer: EPIC Health Plan Transplant |
$600.34
|
| Rate for Payer: Galaxy Health WC |
$1,275.73
|
| Rate for Payer: Global Benefits Group Commercial |
$900.52
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$1,125.64
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,001.07
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$571.83
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$360.21
|
| Rate for Payer: Multiplan Commercial |
$1,200.69
|
| Rate for Payer: Networks By Design Commercial |
$975.56
|
| Rate for Payer: Prime Health Services Commercial |
$1,275.73
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$900.52
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$900.52
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$900.52
|
| Rate for Payer: United Healthcare All Other Commercial |
$750.43
|
| Rate for Payer: United Healthcare All Other HMO |
$750.43
|
| Rate for Payer: United Healthcare HMO Rider |
$750.43
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$750.43
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,275.73
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,275.73
|
| Rate for Payer: Vantage Medical Group Senior |
$1,275.73
|
|
|
PENICILLAMINE 250 MG CAPSULE [10894]
|
Facility
OP
|
$314.26
|
|
|
Service Code
|
NDC 25010-705-15
|
| Hospital Charge Code |
1710800
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$75.42 |
| Max. Negotiated Rate |
$267.12 |
| Rate for Payer: BCBS Transplant Transplant |
$188.56
|
| Rate for Payer: Aetna of CA HMO/PPO |
$206.12
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$267.12
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$172.84
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$172.84
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$187.24
|
| Rate for Payer: Blue Shield of California Commercial |
$231.61
|
| Rate for Payer: Blue Shield of California EPN |
$183.53
|
| Rate for Payer: Cash Price |
$141.42
|
| Rate for Payer: Cigna of CA HMO |
$219.98
|
| Rate for Payer: Cigna of CA PPO |
$219.98
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$267.12
|
| Rate for Payer: Dignity Health Media |
$267.12
|
| Rate for Payer: Dignity Health Medi-Cal |
$267.12
|
| Rate for Payer: EPIC Health Plan Commercial |
$125.70
|
| Rate for Payer: EPIC Health Plan Transplant |
$125.70
|
| Rate for Payer: Galaxy Health WC |
$267.12
|
| Rate for Payer: Global Benefits Group Commercial |
$188.56
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$235.70
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$209.61
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$119.73
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$75.42
|
| Rate for Payer: Multiplan Commercial |
$251.41
|
| Rate for Payer: Networks By Design Commercial |
$204.27
|
| Rate for Payer: Prime Health Services Commercial |
$267.12
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$188.56
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$188.56
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$188.56
|
| Rate for Payer: United Healthcare All Other Commercial |
$157.13
|
| Rate for Payer: United Healthcare All Other HMO |
$157.13
|
| Rate for Payer: United Healthcare HMO Rider |
$157.13
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$157.13
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$267.12
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$267.12
|
| Rate for Payer: Vantage Medical Group Senior |
$267.12
|
|
|
PENICILLAMINE 250 MG CAPSULE [10894]
|
Facility
IP
|
$314.26
|
|
|
Service Code
|
NDC 25010-705-15
|
| Hospital Charge Code |
1710800
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$75.42 |
| Max. Negotiated Rate |
$267.12 |
| Rate for Payer: Blue Shield of California Commercial |
$223.75
|
| Rate for Payer: Blue Shield of California EPN |
$160.90
|
| Rate for Payer: Cash Price |
$141.42
|
| Rate for Payer: Cigna of CA HMO |
$219.98
|
| Rate for Payer: Cigna of CA PPO |
$219.98
|
| Rate for Payer: EPIC Health Plan Commercial |
$125.70
|
| Rate for Payer: Galaxy Health WC |
$267.12
|
| Rate for Payer: Global Benefits Group Commercial |
$188.56
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$209.61
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$119.73
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$75.42
|
| Rate for Payer: Multiplan Commercial |
$251.41
|
| Rate for Payer: Networks By Design Commercial |
$204.27
|
| Rate for Payer: Prime Health Services Commercial |
$267.12
|
|
|
PENICILLAMINE ORAL SUSPENSION COMPOUND 50 MG/ML [4080316]
|
Facility
OP
|
$1.75
|
|
|
Service Code
|
NDC 9994-0803-16
|
| Hospital Charge Code |
1715235
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.42 |
| Max. Negotiated Rate |
$1.49 |
| Rate for Payer: Aetna of CA HMO/PPO |
$1.15
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$1.49
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$0.96
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$0.96
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1.04
|
| Rate for Payer: BCBS Transplant Transplant |
$1.05
|
| Rate for Payer: Blue Shield of California Commercial |
$1.29
|
| Rate for Payer: Blue Shield of California EPN |
$1.02
|
| Rate for Payer: Cash Price |
$0.79
|
| Rate for Payer: Cigna of CA HMO |
$1.22
|
| Rate for Payer: Cigna of CA PPO |
$1.22
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1.49
|
| Rate for Payer: Dignity Health Media |
$1.49
|
| Rate for Payer: Dignity Health Medi-Cal |
$1.49
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.70
|
| Rate for Payer: EPIC Health Plan Transplant |
$0.70
|
| Rate for Payer: Galaxy Health WC |
$1.49
|
| Rate for Payer: Global Benefits Group Commercial |
$1.05
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$1.31
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1.17
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.67
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.42
|
| Rate for Payer: Multiplan Commercial |
$1.40
|
| Rate for Payer: Networks By Design Commercial |
$1.14
|
| Rate for Payer: Prime Health Services Commercial |
$1.49
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$1.05
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1.05
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1.05
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.88
|
| Rate for Payer: United Healthcare All Other HMO |
$0.88
|
| Rate for Payer: United Healthcare HMO Rider |
$0.88
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.88
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1.49
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1.49
|
| Rate for Payer: Vantage Medical Group Senior |
$1.49
|
|
|
PENICILLAMINE ORAL SUSPENSION COMPOUND 50 MG/ML [4080316]
|
Facility
IP
|
$1.75
|
|
|
Service Code
|
NDC 9994-0803-16
|
| Hospital Charge Code |
1715235
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.42 |
| Max. Negotiated Rate |
$1.49 |
| Rate for Payer: Blue Shield of California Commercial |
$1.25
|
| Rate for Payer: Blue Shield of California EPN |
$0.90
|
| Rate for Payer: Cash Price |
$0.79
|
| Rate for Payer: Cigna of CA HMO |
$1.22
|
| Rate for Payer: Cigna of CA PPO |
$1.22
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.70
|
| Rate for Payer: Galaxy Health WC |
$1.49
|
| Rate for Payer: Global Benefits Group Commercial |
$1.05
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1.17
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.67
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.42
|
| Rate for Payer: Multiplan Commercial |
$1.40
|
| Rate for Payer: Networks By Design Commercial |
$1.14
|
| Rate for Payer: Prime Health Services Commercial |
$1.49
|
|
|
PENICILLIN G BENZATHINE 1,200,000 UNIT/2 ML INTRAMUSCULAR SYRINGE [108049]
|
Facility
OP
|
$151.23
|
|
|
Service Code
|
CPT J0561
|
| Hospital Charge Code |
1721205
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$8.57 |
| Max. Negotiated Rate |
$136.69 |
| Rate for Payer: Aetna of CA HMO/PPO |
$136.69
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$27.16
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$23.90
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$23.90
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$8.57
|
| Rate for Payer: BCBS Transplant Transplant |
$90.74
|
| Rate for Payer: Blue Shield of California Commercial |
$111.46
|
| Rate for Payer: Blue Shield of California EPN |
$17.22
|
| Rate for Payer: Cash Price |
$68.05
|
| Rate for Payer: Cash Price |
$68.05
|
| Rate for Payer: Cigna of CA HMO |
$105.86
|
| Rate for Payer: Cigna of CA PPO |
$105.86
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$32.60
|
| Rate for Payer: Dignity Health Media |
$21.73
|
| Rate for Payer: Dignity Health Medi-Cal |
$23.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$29.34
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$21.73
|
| Rate for Payer: EPIC Health Plan Transplant |
$21.73
|
| Rate for Payer: Galaxy Health WC |
$128.55
|
| Rate for Payer: Global Benefits Group Commercial |
$90.74
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$113.42
|
| Rate for Payer: Heritage Provider Network Commercial |
$35.64
|
| Rate for Payer: Heritage Provider Network Transplant |
$35.64
|
| Rate for Payer: IEHP Medi-Cal |
$35.20
|
| Rate for Payer: IEHP Medi-Cal Transplant |
$35.20
|
| Rate for Payer: IEHP Medicare Advantage |
$21.73
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$100.87
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$49.76
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$21.73
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$36.30
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$27.38
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$29.12
|
| Rate for Payer: Multiplan Commercial |
$120.98
|
| Rate for Payer: Networks By Design Commercial |
$75.62
|
| Rate for Payer: Prime Health Services Commercial |
$128.55
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$90.74
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$90.74
|
| Rate for Payer: United Healthcare All Other Commercial |
$75.62
|
| Rate for Payer: United Healthcare All Other HMO |
$75.62
|
| Rate for Payer: United Healthcare HMO Rider |
$75.62
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$75.62
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$32.60
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$23.90
|
| Rate for Payer: Vantage Medical Group Senior |
$21.73
|
|
|
PENICILLIN G BENZATHINE 1,200,000 UNIT/2 ML INTRAMUSCULAR SYRINGE [108049]
|
Facility
IP
|
$151.23
|
|
|
Service Code
|
CPT J0561
|
| Hospital Charge Code |
1721205
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$36.30 |
| Max. Negotiated Rate |
$128.55 |
| Rate for Payer: Blue Shield of California Commercial |
$107.68
|
| Rate for Payer: Blue Shield of California EPN |
$77.43
|
| Rate for Payer: Cash Price |
$68.05
|
| Rate for Payer: Cigna of CA HMO |
$105.86
|
| Rate for Payer: Cigna of CA PPO |
$105.86
|
| Rate for Payer: EPIC Health Plan Commercial |
$60.49
|
| Rate for Payer: EPIC Health Plan Transplant |
$60.49
|
| Rate for Payer: Galaxy Health WC |
$128.55
|
| Rate for Payer: Global Benefits Group Commercial |
$90.74
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$100.87
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$57.62
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$36.30
|
| Rate for Payer: Multiplan Commercial |
$120.98
|
| Rate for Payer: Networks By Design Commercial |
$75.62
|
| Rate for Payer: Prime Health Services Commercial |
$128.55
|
|
|
PENICILLIN G BENZATHINE 2,400,000 UNIT/4 ML INTRAMUSCULAR SYRINGE [108050]
|
Facility
IP
|
$154.95
|
|
|
Service Code
|
CPT J0561
|
| Hospital Charge Code |
1721206
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$37.19 |
| Max. Negotiated Rate |
$131.71 |
| Rate for Payer: Blue Shield of California Commercial |
$110.32
|
| Rate for Payer: Blue Shield of California EPN |
$79.33
|
| Rate for Payer: Cash Price |
$69.73
|
| Rate for Payer: Cigna of CA HMO |
$108.46
|
| Rate for Payer: Cigna of CA PPO |
$108.46
|
| Rate for Payer: EPIC Health Plan Commercial |
$61.98
|
| Rate for Payer: EPIC Health Plan Transplant |
$61.98
|
| Rate for Payer: Galaxy Health WC |
$131.71
|
| Rate for Payer: Global Benefits Group Commercial |
$92.97
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$103.35
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$59.04
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$37.19
|
| Rate for Payer: Multiplan Commercial |
$123.96
|
| Rate for Payer: Networks By Design Commercial |
$77.48
|
| Rate for Payer: Prime Health Services Commercial |
$131.71
|
|
|
PENICILLIN G BENZATHINE 2,400,000 UNIT/4 ML INTRAMUSCULAR SYRINGE [108050]
|
Facility
OP
|
$154.95
|
|
|
Service Code
|
CPT J0561
|
| Hospital Charge Code |
1721206
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$8.57 |
| Max. Negotiated Rate |
$136.69 |
| Rate for Payer: Aetna of CA HMO/PPO |
$136.69
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$27.16
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$23.90
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$23.90
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$8.57
|
| Rate for Payer: BCBS Transplant Transplant |
$92.97
|
| Rate for Payer: Blue Shield of California Commercial |
$114.20
|
| Rate for Payer: Blue Shield of California EPN |
$17.22
|
| Rate for Payer: Cash Price |
$69.73
|
| Rate for Payer: Cash Price |
$69.73
|
| Rate for Payer: Cigna of CA HMO |
$108.46
|
| Rate for Payer: Cigna of CA PPO |
$108.46
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$32.60
|
| Rate for Payer: Dignity Health Media |
$21.73
|
| Rate for Payer: Dignity Health Medi-Cal |
$23.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$29.34
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$21.73
|
| Rate for Payer: EPIC Health Plan Transplant |
$21.73
|
| Rate for Payer: Galaxy Health WC |
$131.71
|
| Rate for Payer: Global Benefits Group Commercial |
$92.97
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$116.21
|
| Rate for Payer: Heritage Provider Network Commercial |
$35.64
|
| Rate for Payer: Heritage Provider Network Transplant |
$35.64
|
| Rate for Payer: IEHP Medi-Cal |
$35.20
|
| Rate for Payer: IEHP Medi-Cal Transplant |
$35.20
|
| Rate for Payer: IEHP Medicare Advantage |
$21.73
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$103.35
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$49.76
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$21.73
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$37.19
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$27.38
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$29.12
|
| Rate for Payer: Multiplan Commercial |
$123.96
|
| Rate for Payer: Networks By Design Commercial |
$77.48
|
| Rate for Payer: Prime Health Services Commercial |
$131.71
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$92.97
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$92.97
|
| Rate for Payer: United Healthcare All Other Commercial |
$77.48
|
| Rate for Payer: United Healthcare All Other HMO |
$77.48
|
| Rate for Payer: United Healthcare HMO Rider |
$77.48
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$77.48
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$32.60
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$23.90
|
| Rate for Payer: Vantage Medical Group Senior |
$21.73
|
|
|
PENICILLIN G BENZATHINE 600,000 UNIT/ML INTRAMUSCULAR SYRINGE [10897]
|
Facility
IP
|
$174.64
|
|
|
Service Code
|
CPT J0561
|
| Hospital Charge Code |
1721204
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$41.91 |
| Max. Negotiated Rate |
$148.44 |
| Rate for Payer: Blue Shield of California Commercial |
$124.34
|
| Rate for Payer: Blue Shield of California EPN |
$89.42
|
| Rate for Payer: Cash Price |
$78.59
|
| Rate for Payer: Cigna of CA HMO |
$122.25
|
| Rate for Payer: Cigna of CA PPO |
$122.25
|
| Rate for Payer: EPIC Health Plan Commercial |
$69.86
|
| Rate for Payer: EPIC Health Plan Transplant |
$69.86
|
| Rate for Payer: Galaxy Health WC |
$148.44
|
| Rate for Payer: Global Benefits Group Commercial |
$104.78
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$116.48
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$66.54
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$41.91
|
| Rate for Payer: Multiplan Commercial |
$139.71
|
| Rate for Payer: Networks By Design Commercial |
$87.32
|
| Rate for Payer: Prime Health Services Commercial |
$148.44
|
|
|
PENICILLIN G BENZATHINE 600,000 UNIT/ML INTRAMUSCULAR SYRINGE [10897]
|
Facility
OP
|
$174.64
|
|
|
Service Code
|
CPT J0561
|
| Hospital Charge Code |
1721204
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$8.57 |
| Max. Negotiated Rate |
$148.44 |
| Rate for Payer: Aetna of CA HMO/PPO |
$136.69
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$27.16
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$23.90
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$23.90
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$8.57
|
| Rate for Payer: BCBS Transplant Transplant |
$104.78
|
| Rate for Payer: Blue Shield of California Commercial |
$128.71
|
| Rate for Payer: Blue Shield of California EPN |
$17.22
|
| Rate for Payer: Cash Price |
$78.59
|
| Rate for Payer: Cash Price |
$78.59
|
| Rate for Payer: Cigna of CA HMO |
$122.25
|
| Rate for Payer: Cigna of CA PPO |
$122.25
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$32.60
|
| Rate for Payer: Dignity Health Media |
$21.73
|
| Rate for Payer: Dignity Health Medi-Cal |
$23.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$29.34
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$21.73
|
| Rate for Payer: EPIC Health Plan Transplant |
$21.73
|
| Rate for Payer: Galaxy Health WC |
$148.44
|
| Rate for Payer: Global Benefits Group Commercial |
$104.78
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$130.98
|
| Rate for Payer: Heritage Provider Network Commercial |
$35.64
|
| Rate for Payer: Heritage Provider Network Transplant |
$35.64
|
| Rate for Payer: IEHP Medi-Cal |
$35.20
|
| Rate for Payer: IEHP Medi-Cal Transplant |
$35.20
|
| Rate for Payer: IEHP Medicare Advantage |
$21.73
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$116.48
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$49.76
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$21.73
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$41.91
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$27.38
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$29.12
|
| Rate for Payer: Multiplan Commercial |
$139.71
|
| Rate for Payer: Networks By Design Commercial |
$87.32
|
| Rate for Payer: Prime Health Services Commercial |
$148.44
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$104.78
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$104.78
|
| Rate for Payer: United Healthcare All Other Commercial |
$87.32
|
| Rate for Payer: United Healthcare All Other HMO |
$87.32
|
| Rate for Payer: United Healthcare HMO Rider |
$87.32
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$87.32
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$32.60
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$23.90
|
| Rate for Payer: Vantage Medical Group Senior |
$21.73
|
|
