|
PANTOPRAZOLE DR 40 MG GRANULES DELAYED-RELEASE FOR SUSP IN PACKET [89791]
|
Facility
|
OP
|
$16.99
|
|
|
Service Code
|
NDC 6068776799
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$3.40 |
| Max. Negotiated Rate |
$15.29 |
| Rate for Payer: Adventist Health Commercial |
$3.40
|
| Rate for Payer: Aetna of CA HMO/PPO |
$10.32
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$14.44
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$9.34
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$12.74
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$8.23
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$9.88
|
| Rate for Payer: Blue Shield of California Commercial |
$10.77
|
| Rate for Payer: Blue Shield of California EPN |
$6.78
|
| Rate for Payer: Cash Price |
$7.65
|
| Rate for Payer: Central Health Plan Commercial |
$13.59
|
| Rate for Payer: Cigna of CA HMO |
$11.89
|
| Rate for Payer: Cigna of CA PPO |
$11.89
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$14.44
|
| Rate for Payer: Dignity Health Medi-Cal |
$14.44
|
| Rate for Payer: Dignity Health Medicare Advantage |
$14.44
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$11.89
|
| Rate for Payer: EPIC Health Plan Commercial |
$6.80
|
| Rate for Payer: EPIC Health Plan Senior |
$6.80
|
| Rate for Payer: Galaxy Health WC |
$14.44
|
| Rate for Payer: Global Benefits Group Commercial |
$10.19
|
| Rate for Payer: Health Management Network EPO/PPO |
$15.29
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$10.79
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$6.17
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$10.02
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$11.89
|
| Rate for Payer: Multiplan Commercial |
$12.74
|
| Rate for Payer: Networks By Design Commercial |
$11.04
|
| Rate for Payer: Prime Health Services Commercial |
$14.44
|
| Rate for Payer: Riverside University Health System MISP |
$6.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$10.19
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$10.19
|
| Rate for Payer: United Healthcare All Other Commercial |
$8.49
|
| Rate for Payer: United Healthcare All Other HMO |
$8.49
|
| Rate for Payer: United Healthcare HMO Rider |
$8.49
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$8.49
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$14.44
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$14.44
|
| Rate for Payer: Vantage Medical Group Senior |
$14.44
|
|
|
PANTOPRAZOLE DR 40 MG GRANULES DELAYED-RELEASE FOR SUSP IN PACKET [89791]
|
Facility
|
IP
|
$7.98
|
|
|
Service Code
|
NDC 2724125638
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$1.60 |
| Max. Negotiated Rate |
$7.18 |
| Rate for Payer: Adventist Health Commercial |
$1.60
|
| Rate for Payer: Blue Shield of California Commercial |
$6.40
|
| Rate for Payer: Blue Shield of California EPN |
$4.02
|
| Rate for Payer: Cash Price |
$3.59
|
| Rate for Payer: Central Health Plan Commercial |
$6.38
|
| Rate for Payer: Cigna of CA HMO |
$5.59
|
| Rate for Payer: Cigna of CA PPO |
$5.59
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$5.59
|
| Rate for Payer: EPIC Health Plan Commercial |
$3.19
|
| Rate for Payer: EPIC Health Plan Senior |
$3.19
|
| Rate for Payer: Galaxy Health WC |
$6.78
|
| Rate for Payer: Global Benefits Group Commercial |
$4.79
|
| Rate for Payer: Health Management Network EPO/PPO |
$7.18
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$5.07
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$4.71
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.60
|
| Rate for Payer: Multiplan Commercial |
$5.99
|
| Rate for Payer: Networks By Design Commercial |
$5.19
|
| Rate for Payer: Prime Health Services Commercial |
$6.78
|
|
|
PANTOPRAZOLE DR 40 MG GRANULES DELAYED-RELEASE FOR SUSP IN PACKET [89791]
|
Facility
|
OP
|
$17.81
|
|
|
Service Code
|
NDC 0008084401
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$3.56 |
| Max. Negotiated Rate |
$16.03 |
| Rate for Payer: Adventist Health Commercial |
$3.56
|
| Rate for Payer: Aetna of CA HMO/PPO |
$10.82
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$15.14
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$9.80
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$13.36
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$8.62
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$10.36
|
| Rate for Payer: Blue Shield of California Commercial |
$11.29
|
| Rate for Payer: Blue Shield of California EPN |
$7.11
|
| Rate for Payer: Cash Price |
$8.01
|
| Rate for Payer: Central Health Plan Commercial |
$14.25
|
| Rate for Payer: Cigna of CA HMO |
$12.47
|
| Rate for Payer: Cigna of CA PPO |
$12.47
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$15.14
|
| Rate for Payer: Dignity Health Medi-Cal |
$15.14
|
| Rate for Payer: Dignity Health Medicare Advantage |
$15.14
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$12.47
|
| Rate for Payer: EPIC Health Plan Commercial |
$7.12
|
| Rate for Payer: EPIC Health Plan Senior |
$7.12
|
| Rate for Payer: Galaxy Health WC |
$15.14
|
| Rate for Payer: Global Benefits Group Commercial |
$10.69
|
| Rate for Payer: Health Management Network EPO/PPO |
$16.03
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$11.31
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$6.47
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$10.51
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.56
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$12.47
|
| Rate for Payer: Multiplan Commercial |
$13.36
|
| Rate for Payer: Networks By Design Commercial |
$11.58
|
| Rate for Payer: Prime Health Services Commercial |
$15.14
|
| Rate for Payer: Riverside University Health System MISP |
$7.12
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$10.69
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$10.69
|
| Rate for Payer: United Healthcare All Other Commercial |
$8.90
|
| Rate for Payer: United Healthcare All Other HMO |
$8.90
|
| Rate for Payer: United Healthcare HMO Rider |
$8.90
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$8.90
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$15.14
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$15.14
|
| Rate for Payer: Vantage Medical Group Senior |
$15.14
|
|
|
PAPAVERINE 30 MG/ML INJECTION SOLUTION [6030]
|
Facility
|
OP
|
$22.50
|
|
|
Service Code
|
HCPCS J2440
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$2.69 |
| Max. Negotiated Rate |
$229.17 |
| Rate for Payer: Adventist Health Commercial |
$4.50
|
| Rate for Payer: Adventist Health Commercial |
$3.90
|
| Rate for Payer: Adventist Health Commercial |
$4.97
|
| Rate for Payer: Aetna of CA HMO/PPO |
$229.17
|
| Rate for Payer: Aetna of CA HMO/PPO |
$229.17
|
| Rate for Payer: Aetna of CA HMO/PPO |
$229.17
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$21.12
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$19.12
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$16.57
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$13.67
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$10.72
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$12.38
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$18.64
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$14.62
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$16.88
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$2.69
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$2.69
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$2.69
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3.36
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3.36
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3.36
|
| Rate for Payer: Blue Shield of California Commercial |
$46.52
|
| Rate for Payer: Blue Shield of California Commercial |
$46.52
|
| Rate for Payer: Blue Shield of California Commercial |
$46.52
|
| Rate for Payer: Blue Shield of California EPN |
$42.29
|
| Rate for Payer: Blue Shield of California EPN |
$42.29
|
| Rate for Payer: Blue Shield of California EPN |
$42.29
|
| Rate for Payer: Cash Price |
$11.18
|
| Rate for Payer: Cash Price |
$8.78
|
| Rate for Payer: Cash Price |
$10.12
|
| Rate for Payer: Cash Price |
$8.78
|
| Rate for Payer: Cash Price |
$11.18
|
| Rate for Payer: Cash Price |
$10.12
|
| Rate for Payer: Central Health Plan Commercial |
$19.88
|
| Rate for Payer: Central Health Plan Commercial |
$15.60
|
| Rate for Payer: Central Health Plan Commercial |
$18.00
|
| Rate for Payer: Cigna of CA HMO |
$15.75
|
| Rate for Payer: Cigna of CA HMO |
$13.65
|
| Rate for Payer: Cigna of CA HMO |
$17.39
|
| Rate for Payer: Cigna of CA PPO |
$15.75
|
| Rate for Payer: Cigna of CA PPO |
$17.39
|
| Rate for Payer: Cigna of CA PPO |
$13.65
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$16.57
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$21.12
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$19.12
|
| Rate for Payer: Dignity Health Medi-Cal |
$21.12
|
| Rate for Payer: Dignity Health Medi-Cal |
$16.57
|
| Rate for Payer: Dignity Health Medi-Cal |
$19.12
|
| Rate for Payer: Dignity Health Medicare Advantage |
$21.12
|
| Rate for Payer: Dignity Health Medicare Advantage |
$16.57
|
| Rate for Payer: Dignity Health Medicare Advantage |
$19.12
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$17.39
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$15.75
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$13.65
|
| Rate for Payer: EPIC Health Plan Commercial |
$9.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$7.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$9.94
|
| Rate for Payer: EPIC Health Plan Senior |
$7.80
|
| Rate for Payer: EPIC Health Plan Senior |
$9.00
|
| Rate for Payer: EPIC Health Plan Senior |
$9.94
|
| Rate for Payer: Galaxy Health WC |
$21.12
|
| Rate for Payer: Galaxy Health WC |
$19.12
|
| Rate for Payer: Galaxy Health WC |
$16.57
|
| Rate for Payer: Global Benefits Group Commercial |
$11.70
|
| Rate for Payer: Global Benefits Group Commercial |
$14.91
|
| Rate for Payer: Global Benefits Group Commercial |
$13.50
|
| Rate for Payer: Health Management Network EPO/PPO |
$20.25
|
| Rate for Payer: Health Management Network EPO/PPO |
$22.36
|
| Rate for Payer: Health Management Network EPO/PPO |
$17.55
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$14.29
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$12.38
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$15.78
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$8.17
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$7.08
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$9.02
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$14.66
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$11.51
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$13.28
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.90
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.97
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$15.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$13.65
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$17.39
|
| Rate for Payer: Multiplan Commercial |
$14.62
|
| Rate for Payer: Multiplan Commercial |
$16.88
|
| Rate for Payer: Multiplan Commercial |
$18.64
|
| Rate for Payer: Networks By Design Commercial |
$11.25
|
| Rate for Payer: Networks By Design Commercial |
$9.75
|
| Rate for Payer: Networks By Design Commercial |
$12.43
|
| Rate for Payer: Prime Health Services Commercial |
$21.12
|
| Rate for Payer: Prime Health Services Commercial |
$19.12
|
| Rate for Payer: Prime Health Services Commercial |
$16.57
|
| Rate for Payer: Riverside University Health System MISP |
$9.00
|
| Rate for Payer: Riverside University Health System MISP |
$9.94
|
| Rate for Payer: Riverside University Health System MISP |
$7.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$13.50
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$14.91
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$11.70
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$13.50
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$14.91
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$11.70
|
| Rate for Payer: United Healthcare All Other Commercial |
$7.32
|
| Rate for Payer: United Healthcare All Other Commercial |
$9.33
|
| Rate for Payer: United Healthcare All Other Commercial |
$8.44
|
| Rate for Payer: United Healthcare All Other HMO |
$9.08
|
| Rate for Payer: United Healthcare All Other HMO |
$8.22
|
| Rate for Payer: United Healthcare All Other HMO |
$7.12
|
| Rate for Payer: United Healthcare HMO Rider |
$6.97
|
| Rate for Payer: United Healthcare HMO Rider |
$8.88
|
| Rate for Payer: United Healthcare HMO Rider |
$8.04
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$8.14
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$7.37
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$6.39
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$19.12
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$16.57
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$21.12
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$19.12
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$16.57
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$21.12
|
| Rate for Payer: Vantage Medical Group Senior |
$16.57
|
| Rate for Payer: Vantage Medical Group Senior |
$21.12
|
| Rate for Payer: Vantage Medical Group Senior |
$19.12
|
|
|
PAPAVERINE 30 MG/ML INJECTION SOLUTION [6030]
|
Facility
|
IP
|
$24.85
|
|
|
Service Code
|
HCPCS J2440
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$4.97 |
| Max. Negotiated Rate |
$22.36 |
| Rate for Payer: Adventist Health Commercial |
$4.97
|
| Rate for Payer: Adventist Health Commercial |
$4.50
|
| Rate for Payer: Adventist Health Commercial |
$3.90
|
| Rate for Payer: Blue Shield of California Commercial |
$19.93
|
| Rate for Payer: Blue Shield of California Commercial |
$18.05
|
| Rate for Payer: Blue Shield of California Commercial |
$15.64
|
| Rate for Payer: Blue Shield of California EPN |
$9.83
|
| Rate for Payer: Blue Shield of California EPN |
$12.52
|
| Rate for Payer: Blue Shield of California EPN |
$11.34
|
| Rate for Payer: Cash Price |
$11.18
|
| Rate for Payer: Cash Price |
$8.78
|
| Rate for Payer: Cash Price |
$10.12
|
| Rate for Payer: Central Health Plan Commercial |
$18.00
|
| Rate for Payer: Central Health Plan Commercial |
$15.60
|
| Rate for Payer: Central Health Plan Commercial |
$19.88
|
| Rate for Payer: Cigna of CA HMO |
$17.39
|
| Rate for Payer: Cigna of CA HMO |
$13.65
|
| Rate for Payer: Cigna of CA HMO |
$15.75
|
| Rate for Payer: Cigna of CA PPO |
$17.39
|
| Rate for Payer: Cigna of CA PPO |
$15.75
|
| Rate for Payer: Cigna of CA PPO |
$13.65
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$17.39
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$15.75
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$13.65
|
| Rate for Payer: EPIC Health Plan Commercial |
$9.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$7.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$9.94
|
| Rate for Payer: EPIC Health Plan Senior |
$9.00
|
| Rate for Payer: EPIC Health Plan Senior |
$7.80
|
| Rate for Payer: EPIC Health Plan Senior |
$9.94
|
| Rate for Payer: Galaxy Health WC |
$19.12
|
| Rate for Payer: Galaxy Health WC |
$16.57
|
| Rate for Payer: Galaxy Health WC |
$21.12
|
| Rate for Payer: Global Benefits Group Commercial |
$14.91
|
| Rate for Payer: Global Benefits Group Commercial |
$13.50
|
| Rate for Payer: Global Benefits Group Commercial |
$11.70
|
| Rate for Payer: Health Management Network EPO/PPO |
$22.36
|
| Rate for Payer: Health Management Network EPO/PPO |
$17.55
|
| Rate for Payer: Health Management Network EPO/PPO |
$20.25
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$12.38
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$15.78
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$14.29
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$14.66
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$13.28
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$11.51
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.97
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.90
|
| Rate for Payer: Multiplan Commercial |
$18.64
|
| Rate for Payer: Multiplan Commercial |
$16.88
|
| Rate for Payer: Multiplan Commercial |
$14.62
|
| Rate for Payer: Networks By Design Commercial |
$12.43
|
| Rate for Payer: Networks By Design Commercial |
$9.75
|
| Rate for Payer: Networks By Design Commercial |
$11.25
|
| Rate for Payer: Prime Health Services Commercial |
$19.12
|
| Rate for Payer: Prime Health Services Commercial |
$21.12
|
| Rate for Payer: Prime Health Services Commercial |
$16.57
|
| Rate for Payer: United Healthcare All Other Commercial |
$7.32
|
| Rate for Payer: United Healthcare All Other Commercial |
$9.33
|
| Rate for Payer: United Healthcare All Other Commercial |
$8.44
|
| Rate for Payer: United Healthcare All Other HMO |
$8.22
|
| Rate for Payer: United Healthcare All Other HMO |
$7.12
|
| Rate for Payer: United Healthcare All Other HMO |
$9.08
|
| Rate for Payer: United Healthcare HMO Rider |
$6.97
|
| Rate for Payer: United Healthcare HMO Rider |
$8.04
|
| Rate for Payer: United Healthcare HMO Rider |
$8.88
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$7.37
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$8.14
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$6.39
|
|
|
PARATHYROID AUTOTRANSPLANTATION (LIST SEPARATELY IN ADDITION TO CODE FOR PRIMARY PROCEDURE)
|
Facility
|
OP
|
$27,467.00
|
|
|
Service Code
|
CPT 60512
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$69.80 |
| Max. Negotiated Rate |
$27,467.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$27,467.00
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$4,736.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$6,587.00
|
| Rate for Payer: Blue Shield of California Commercial |
$5,036.70
|
| Rate for Payer: Blue Shield of California EPN |
$3,165.61
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$69.80
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$77.10
|
| Rate for Payer: United Healthcare All Other HMO |
$1,593.00
|
| Rate for Payer: United Healthcare HMO Rider |
$1,093.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,000.00
|
|
|
PARATHYROIDECTOMY OR EXPLORATION OF PARATHYROID(S);
|
Facility
|
OP
|
$27,467.00
|
|
|
Service Code
|
CPT 60500
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,305.69 |
| Max. Negotiated Rate |
$27,467.00 |
| Rate for Payer: Adventist Health Medi-Cal |
$7,613.89
|
| Rate for Payer: Aetna of CA HMO/PPO |
$27,467.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$11,420.83
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$8,375.28
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$7,613.89
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$11,461.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$15,933.00
|
| Rate for Payer: Anthem Blue Cross of CA Workers' Comp |
$11,976.10
|
| Rate for Payer: Blue Shield of California Commercial |
$9,831.25
|
| Rate for Payer: Blue Shield of California EPN |
$6,179.04
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$11,420.83
|
| Rate for Payer: Dignity Health Medi-Cal |
$8,375.28
|
| Rate for Payer: Dignity Health Medicare Advantage |
$7,613.89
|
| Rate for Payer: EPIC Health Plan Commercial |
$12,562.92
|
| Rate for Payer: EPIC Health Plan Senior |
$8,375.28
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$12,486.78
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$1,305.69
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$7,613.89
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1,442.33
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$10,659.45
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$10,202.61
|
| Rate for Payer: Multiplan WC |
$11,976.10
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$7,613.89
|
| Rate for Payer: Preferred Health Network WC |
$12,220.51
|
| Rate for Payer: Prime Health Services Medicare |
$8,070.72
|
| Rate for Payer: Prime Health Services WC |
$11,853.89
|
| Rate for Payer: Riverside University Health System MISP |
$8,375.28
|
| Rate for Payer: United Healthcare All Other HMO |
$26,788.00
|
| Rate for Payer: United Healthcare HMO Rider |
$16,872.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$15,456.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$7,613.89
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$11,420.83
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$8,375.28
|
| Rate for Payer: Vantage Medical Group Senior |
$7,613.89
|
|
|
PARAVAGINAL DEFECT REPAIR (INCLUDING REPAIR OF CYSTOCELE, IF PERFORMED); VAGINAL APPROACH
|
Facility
|
OP
|
$27,467.00
|
|
|
Service Code
|
CPT 57285
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$858.45 |
| Max. Negotiated Rate |
$27,467.00 |
| Rate for Payer: Vantage Medical Group Senior |
$9,537.49
|
| Rate for Payer: Adventist Health Medi-Cal |
$9,537.49
|
| Rate for Payer: Aetna of CA HMO/PPO |
$27,467.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$14,306.24
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$10,491.24
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$9,537.49
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$6,419.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$8,924.00
|
| Rate for Payer: Anthem Blue Cross of CA Workers' Comp |
$14,970.61
|
| Rate for Payer: Blue Shield of California Commercial |
$5,036.70
|
| Rate for Payer: Blue Shield of California EPN |
$3,165.61
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$14,306.24
|
| Rate for Payer: Dignity Health Medi-Cal |
$10,491.24
|
| Rate for Payer: Dignity Health Medicare Advantage |
$9,537.49
|
| Rate for Payer: EPIC Health Plan Commercial |
$15,736.86
|
| Rate for Payer: EPIC Health Plan Senior |
$10,491.24
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$15,641.48
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$858.45
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$9,537.49
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$948.29
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$13,352.49
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$12,780.24
|
| Rate for Payer: Multiplan WC |
$14,970.61
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$9,537.49
|
| Rate for Payer: Preferred Health Network WC |
$15,276.13
|
| Rate for Payer: Prime Health Services Medicare |
$10,109.74
|
| Rate for Payer: Prime Health Services WC |
$14,817.85
|
| Rate for Payer: Riverside University Health System MISP |
$10,491.24
|
| Rate for Payer: United Healthcare All Other HMO |
$26,788.00
|
| Rate for Payer: United Healthcare HMO Rider |
$16,872.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$15,456.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$9,537.49
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$14,306.24
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$10,491.24
|
|
|
PARENTERAL AMINO ACID 15 % COMBINATION NO.5 INTRAVENOUS SOLUTION [222465]
|
Facility
|
IP
|
$0.08
|
|
|
Service Code
|
NDC 0338050206
|
| Hospital Charge Code |
901700001
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.02 |
| Max. Negotiated Rate |
$0.07 |
| Rate for Payer: Adventist Health Commercial |
$0.02
|
| Rate for Payer: Blue Shield of California Commercial |
$0.06
|
| Rate for Payer: Blue Shield of California EPN |
$0.04
|
| Rate for Payer: Cash Price |
$0.04
|
| Rate for Payer: Central Health Plan Commercial |
$0.06
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$0.06
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.03
|
| Rate for Payer: EPIC Health Plan Senior |
$0.03
|
| Rate for Payer: Galaxy Health WC |
$0.07
|
| Rate for Payer: Global Benefits Group Commercial |
$0.05
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.07
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$0.05
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$0.05
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.02
|
| Rate for Payer: Multiplan Commercial |
$0.06
|
| Rate for Payer: Networks By Design Commercial |
$0.05
|
| Rate for Payer: Prime Health Services Commercial |
$0.07
|
|
|
PARENTERAL AMINO ACID 15 % COMBINATION NO.5 INTRAVENOUS SOLUTION [222465]
|
Facility
|
OP
|
$0.08
|
|
|
Service Code
|
NDC 0338050206
|
| Hospital Charge Code |
901700001
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.02 |
| Max. Negotiated Rate |
$0.07 |
| Rate for Payer: Adventist Health Commercial |
$0.02
|
| Rate for Payer: Aetna of CA HMO/PPO |
$0.05
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.07
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.04
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.06
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$0.04
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.05
|
| Rate for Payer: Blue Shield of California Commercial |
$0.05
|
| Rate for Payer: Blue Shield of California EPN |
$0.03
|
| Rate for Payer: Cash Price |
$0.04
|
| Rate for Payer: Central Health Plan Commercial |
$0.06
|
| Rate for Payer: Cigna of CA HMO |
$0.05
|
| Rate for Payer: Cigna of CA PPO |
$0.06
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.07
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.07
|
| Rate for Payer: Dignity Health Medicare Advantage |
$0.07
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$0.06
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.03
|
| Rate for Payer: EPIC Health Plan Senior |
$0.03
|
| Rate for Payer: Galaxy Health WC |
$0.07
|
| Rate for Payer: Global Benefits Group Commercial |
$0.05
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.07
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$0.05
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.03
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$0.05
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.02
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$0.06
|
| Rate for Payer: Multiplan Commercial |
$0.06
|
| Rate for Payer: Networks By Design Commercial |
$0.05
|
| Rate for Payer: Prime Health Services Commercial |
$0.07
|
| Rate for Payer: Riverside University Health System MISP |
$0.03
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.05
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.05
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.04
|
| Rate for Payer: United Healthcare All Other HMO |
$0.04
|
| Rate for Payer: United Healthcare HMO Rider |
$0.04
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.04
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.07
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.07
|
| Rate for Payer: Vantage Medical Group Senior |
$0.07
|
|
|
PARENTERAL AMINO ACID 15 % COMBINATION NO.6 INTRAVENOUS SOLUTION [224619]
|
Facility
|
IP
|
$0.05
|
|
|
Service Code
|
NDC 0264450000
|
| Hospital Charge Code |
901700001
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.01 |
| Max. Negotiated Rate |
$0.05 |
| Rate for Payer: Adventist Health Commercial |
$0.01
|
| Rate for Payer: Blue Shield of California Commercial |
$0.04
|
| Rate for Payer: Blue Shield of California EPN |
$0.03
|
| Rate for Payer: Cash Price |
$0.02
|
| Rate for Payer: Central Health Plan Commercial |
$0.04
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$0.04
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.02
|
| Rate for Payer: EPIC Health Plan Senior |
$0.02
|
| Rate for Payer: Galaxy Health WC |
$0.04
|
| Rate for Payer: Global Benefits Group Commercial |
$0.03
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.05
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$0.03
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$0.03
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.01
|
| Rate for Payer: Multiplan Commercial |
$0.04
|
| Rate for Payer: Networks By Design Commercial |
$0.03
|
| Rate for Payer: Prime Health Services Commercial |
$0.04
|
|
|
PARENTERAL AMINO ACID 15 % COMBINATION NO.6 INTRAVENOUS SOLUTION [224619]
|
Facility
|
OP
|
$0.05
|
|
|
Service Code
|
NDC 0264450000
|
| Hospital Charge Code |
901700001
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.01 |
| Max. Negotiated Rate |
$0.05 |
| Rate for Payer: Adventist Health Commercial |
$0.01
|
| Rate for Payer: Aetna of CA HMO/PPO |
$0.03
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.04
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.03
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.04
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$0.02
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.03
|
| Rate for Payer: Blue Shield of California Commercial |
$0.03
|
| Rate for Payer: Blue Shield of California EPN |
$0.02
|
| Rate for Payer: Cash Price |
$0.02
|
| Rate for Payer: Central Health Plan Commercial |
$0.04
|
| Rate for Payer: Cigna of CA HMO |
$0.03
|
| Rate for Payer: Cigna of CA PPO |
$0.04
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.04
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.04
|
| Rate for Payer: Dignity Health Medicare Advantage |
$0.04
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$0.04
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.02
|
| Rate for Payer: EPIC Health Plan Senior |
$0.02
|
| Rate for Payer: Galaxy Health WC |
$0.04
|
| Rate for Payer: Global Benefits Group Commercial |
$0.03
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.05
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$0.03
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.02
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$0.03
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.01
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$0.04
|
| Rate for Payer: Multiplan Commercial |
$0.04
|
| Rate for Payer: Networks By Design Commercial |
$0.03
|
| Rate for Payer: Prime Health Services Commercial |
$0.04
|
| Rate for Payer: Riverside University Health System MISP |
$0.02
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.03
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.03
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.03
|
| Rate for Payer: United Healthcare All Other HMO |
$0.03
|
| Rate for Payer: United Healthcare HMO Rider |
$0.03
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.03
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.04
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.04
|
| Rate for Payer: Vantage Medical Group Senior |
$0.04
|
|
|
PARICALCITOL 1 MCG CAPSULE [41497]
|
Facility
|
OP
|
$1.78
|
|
|
Service Code
|
NDC 6586293630
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.36 |
| Max. Negotiated Rate |
$1.60 |
| Rate for Payer: Adventist Health Commercial |
$0.36
|
| Rate for Payer: Aetna of CA HMO/PPO |
$1.08
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1.51
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.98
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1.33
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$0.86
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1.04
|
| Rate for Payer: Blue Shield of California Commercial |
$1.13
|
| Rate for Payer: Blue Shield of California EPN |
$0.71
|
| Rate for Payer: Cash Price |
$0.80
|
| Rate for Payer: Central Health Plan Commercial |
$1.42
|
| Rate for Payer: Cigna of CA HMO |
$1.25
|
| Rate for Payer: Cigna of CA PPO |
$1.25
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1.51
|
| Rate for Payer: Dignity Health Medi-Cal |
$1.51
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1.51
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1.25
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.71
|
| Rate for Payer: EPIC Health Plan Senior |
$0.71
|
| Rate for Payer: Galaxy Health WC |
$1.51
|
| Rate for Payer: Global Benefits Group Commercial |
$1.07
|
| Rate for Payer: Health Management Network EPO/PPO |
$1.60
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1.13
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.65
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1.05
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.36
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$1.25
|
| Rate for Payer: Multiplan Commercial |
$1.33
|
| Rate for Payer: Networks By Design Commercial |
$1.16
|
| Rate for Payer: Prime Health Services Commercial |
$1.51
|
| Rate for Payer: Riverside University Health System MISP |
$0.71
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1.07
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1.07
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.89
|
| Rate for Payer: United Healthcare All Other HMO |
$0.89
|
| Rate for Payer: United Healthcare HMO Rider |
$0.89
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.89
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1.51
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1.51
|
| Rate for Payer: Vantage Medical Group Senior |
$1.51
|
|
|
PARICALCITOL 1 MCG CAPSULE [41497]
|
Facility
|
IP
|
$1.20
|
|
|
Service Code
|
NDC 4948368703
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.24 |
| Max. Negotiated Rate |
$1.08 |
| Rate for Payer: Adventist Health Commercial |
$0.24
|
| Rate for Payer: Blue Shield of California Commercial |
$0.96
|
| Rate for Payer: Blue Shield of California EPN |
$0.60
|
| Rate for Payer: Cash Price |
$0.54
|
| Rate for Payer: Central Health Plan Commercial |
$0.96
|
| Rate for Payer: Cigna of CA HMO |
$0.84
|
| Rate for Payer: Cigna of CA PPO |
$0.84
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$0.84
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.48
|
| Rate for Payer: EPIC Health Plan Senior |
$0.48
|
| Rate for Payer: Galaxy Health WC |
$1.02
|
| Rate for Payer: Global Benefits Group Commercial |
$0.72
|
| Rate for Payer: Health Management Network EPO/PPO |
$1.08
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$0.76
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$0.71
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.24
|
| Rate for Payer: Multiplan Commercial |
$0.90
|
| Rate for Payer: Networks By Design Commercial |
$0.78
|
| Rate for Payer: Prime Health Services Commercial |
$1.02
|
|
|
PARICALCITOL 1 MCG CAPSULE [41497]
|
Facility
|
OP
|
$1.20
|
|
|
Service Code
|
NDC 4948368703
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.24 |
| Max. Negotiated Rate |
$1.08 |
| Rate for Payer: Adventist Health Commercial |
$0.24
|
| Rate for Payer: Aetna of CA HMO/PPO |
$0.73
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1.02
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.66
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.90
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$0.58
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.70
|
| Rate for Payer: Blue Shield of California Commercial |
$0.76
|
| Rate for Payer: Blue Shield of California EPN |
$0.48
|
| Rate for Payer: Cash Price |
$0.54
|
| Rate for Payer: Central Health Plan Commercial |
$0.96
|
| Rate for Payer: Cigna of CA HMO |
$0.84
|
| Rate for Payer: Cigna of CA PPO |
$0.84
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1.02
|
| Rate for Payer: Dignity Health Medi-Cal |
$1.02
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1.02
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$0.84
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.48
|
| Rate for Payer: EPIC Health Plan Senior |
$0.48
|
| Rate for Payer: Galaxy Health WC |
$1.02
|
| Rate for Payer: Global Benefits Group Commercial |
$0.72
|
| Rate for Payer: Health Management Network EPO/PPO |
$1.08
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$0.76
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.44
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$0.71
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.24
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$0.84
|
| Rate for Payer: Multiplan Commercial |
$0.90
|
| Rate for Payer: Networks By Design Commercial |
$0.78
|
| Rate for Payer: Prime Health Services Commercial |
$1.02
|
| Rate for Payer: Riverside University Health System MISP |
$0.48
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.72
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.72
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.60
|
| Rate for Payer: United Healthcare All Other HMO |
$0.60
|
| Rate for Payer: United Healthcare HMO Rider |
$0.60
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.60
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1.02
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1.02
|
| Rate for Payer: Vantage Medical Group Senior |
$1.02
|
|
|
PARICALCITOL 1 MCG CAPSULE [41497]
|
Facility
|
IP
|
$1.78
|
|
|
Service Code
|
NDC 6586293630
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.36 |
| Max. Negotiated Rate |
$1.60 |
| Rate for Payer: Adventist Health Commercial |
$0.36
|
| Rate for Payer: Blue Shield of California Commercial |
$1.43
|
| Rate for Payer: Blue Shield of California EPN |
$0.90
|
| Rate for Payer: Cash Price |
$0.80
|
| Rate for Payer: Central Health Plan Commercial |
$1.42
|
| Rate for Payer: Cigna of CA HMO |
$1.25
|
| Rate for Payer: Cigna of CA PPO |
$1.25
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1.25
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.71
|
| Rate for Payer: EPIC Health Plan Senior |
$0.71
|
| Rate for Payer: Galaxy Health WC |
$1.51
|
| Rate for Payer: Global Benefits Group Commercial |
$1.07
|
| Rate for Payer: Health Management Network EPO/PPO |
$1.60
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1.13
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1.05
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.36
|
| Rate for Payer: Multiplan Commercial |
$1.33
|
| Rate for Payer: Networks By Design Commercial |
$1.16
|
| Rate for Payer: Prime Health Services Commercial |
$1.51
|
|
|
PARICALCITOL 2 MCG CAPSULE [41498]
|
Facility
|
OP
|
$10.00
|
|
|
Service Code
|
NDC 6945214613
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$2.00 |
| Max. Negotiated Rate |
$9.00 |
| Rate for Payer: Adventist Health Commercial |
$2.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$6.07
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$8.50
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$5.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$7.50
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$4.84
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5.82
|
| Rate for Payer: Blue Shield of California Commercial |
$6.34
|
| Rate for Payer: Blue Shield of California EPN |
$3.99
|
| Rate for Payer: Cash Price |
$4.50
|
| Rate for Payer: Central Health Plan Commercial |
$8.00
|
| Rate for Payer: Cigna of CA HMO |
$7.00
|
| Rate for Payer: Cigna of CA PPO |
$7.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$8.50
|
| Rate for Payer: Dignity Health Medi-Cal |
$8.50
|
| Rate for Payer: Dignity Health Medicare Advantage |
$8.50
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$7.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$4.00
|
| Rate for Payer: EPIC Health Plan Senior |
$4.00
|
| Rate for Payer: Galaxy Health WC |
$8.50
|
| Rate for Payer: Global Benefits Group Commercial |
$6.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$9.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$6.35
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$3.63
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$5.90
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$7.00
|
| Rate for Payer: Multiplan Commercial |
$7.50
|
| Rate for Payer: Networks By Design Commercial |
$6.50
|
| Rate for Payer: Prime Health Services Commercial |
$8.50
|
| Rate for Payer: Riverside University Health System MISP |
$4.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$6.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$6.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$5.00
|
| Rate for Payer: United Healthcare All Other HMO |
$5.00
|
| Rate for Payer: United Healthcare HMO Rider |
$5.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$5.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$8.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$8.50
|
| Rate for Payer: Vantage Medical Group Senior |
$8.50
|
|
|
PARICALCITOL 2 MCG CAPSULE [41498]
|
Facility
|
IP
|
$10.00
|
|
|
Service Code
|
NDC 6945214613
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$2.00 |
| Max. Negotiated Rate |
$9.00 |
| Rate for Payer: Adventist Health Commercial |
$2.00
|
| Rate for Payer: Blue Shield of California Commercial |
$8.02
|
| Rate for Payer: Blue Shield of California EPN |
$5.04
|
| Rate for Payer: Cash Price |
$4.50
|
| Rate for Payer: Central Health Plan Commercial |
$8.00
|
| Rate for Payer: Cigna of CA HMO |
$7.00
|
| Rate for Payer: Cigna of CA PPO |
$7.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$7.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$4.00
|
| Rate for Payer: EPIC Health Plan Senior |
$4.00
|
| Rate for Payer: Galaxy Health WC |
$8.50
|
| Rate for Payer: Global Benefits Group Commercial |
$6.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$9.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$6.35
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$5.90
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.00
|
| Rate for Payer: Multiplan Commercial |
$7.50
|
| Rate for Payer: Networks By Design Commercial |
$6.50
|
| Rate for Payer: Prime Health Services Commercial |
$8.50
|
|
|
PARICALCITOL 2 MCG CAPSULE [41498]
|
Facility
|
OP
|
$3.54
|
|
|
Service Code
|
NDC 6586293730
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.71 |
| Max. Negotiated Rate |
$3.19 |
| Rate for Payer: Adventist Health Commercial |
$0.71
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2.15
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3.01
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1.95
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2.65
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1.71
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2.06
|
| Rate for Payer: Blue Shield of California Commercial |
$2.24
|
| Rate for Payer: Blue Shield of California EPN |
$1.41
|
| Rate for Payer: Cash Price |
$1.59
|
| Rate for Payer: Central Health Plan Commercial |
$2.83
|
| Rate for Payer: Cigna of CA HMO |
$2.48
|
| Rate for Payer: Cigna of CA PPO |
$2.48
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3.01
|
| Rate for Payer: Dignity Health Medi-Cal |
$3.01
|
| Rate for Payer: Dignity Health Medicare Advantage |
$3.01
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$2.48
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.42
|
| Rate for Payer: EPIC Health Plan Senior |
$1.42
|
| Rate for Payer: Galaxy Health WC |
$3.01
|
| Rate for Payer: Global Benefits Group Commercial |
$2.12
|
| Rate for Payer: Health Management Network EPO/PPO |
$3.19
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$2.25
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1.29
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2.09
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.71
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$2.48
|
| Rate for Payer: Multiplan Commercial |
$2.65
|
| Rate for Payer: Networks By Design Commercial |
$2.30
|
| Rate for Payer: Prime Health Services Commercial |
$3.01
|
| Rate for Payer: Riverside University Health System MISP |
$1.42
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2.12
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2.12
|
| Rate for Payer: United Healthcare All Other Commercial |
$1.77
|
| Rate for Payer: United Healthcare All Other HMO |
$1.77
|
| Rate for Payer: United Healthcare HMO Rider |
$1.77
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1.77
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3.01
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$3.01
|
| Rate for Payer: Vantage Medical Group Senior |
$3.01
|
|
|
PARICALCITOL 2 MCG CAPSULE [41498]
|
Facility
|
IP
|
$3.54
|
|
|
Service Code
|
NDC 6586293730
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.71 |
| Max. Negotiated Rate |
$3.19 |
| Rate for Payer: Adventist Health Commercial |
$0.71
|
| Rate for Payer: Blue Shield of California Commercial |
$2.84
|
| Rate for Payer: Blue Shield of California EPN |
$1.78
|
| Rate for Payer: Cash Price |
$1.59
|
| Rate for Payer: Central Health Plan Commercial |
$2.83
|
| Rate for Payer: Cigna of CA HMO |
$2.48
|
| Rate for Payer: Cigna of CA PPO |
$2.48
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$2.48
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.42
|
| Rate for Payer: EPIC Health Plan Senior |
$1.42
|
| Rate for Payer: Galaxy Health WC |
$3.01
|
| Rate for Payer: Global Benefits Group Commercial |
$2.12
|
| Rate for Payer: Health Management Network EPO/PPO |
$3.19
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$2.25
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2.09
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.71
|
| Rate for Payer: Multiplan Commercial |
$2.65
|
| Rate for Payer: Networks By Design Commercial |
$2.30
|
| Rate for Payer: Prime Health Services Commercial |
$3.01
|
|
|
PARICALCITOL 2 MCG/ML INTRAVENOUS SOLUTION [31688]
|
Facility
|
OP
|
$7.27
|
|
|
Service Code
|
HCPCS J2501
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.90 |
| Max. Negotiated Rate |
$11.53 |
| Rate for Payer: Adventist Health Commercial |
$1.45
|
| Rate for Payer: Aetna of CA HMO/PPO |
$5.03
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$6.18
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$5.45
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$9.24
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$11.53
|
| Rate for Payer: Blue Shield of California Commercial |
$1.00
|
| Rate for Payer: Blue Shield of California EPN |
$0.91
|
| Rate for Payer: Cash Price |
$3.27
|
| Rate for Payer: Cash Price |
$3.27
|
| Rate for Payer: Central Health Plan Commercial |
$5.82
|
| Rate for Payer: Cigna of CA HMO |
$5.09
|
| Rate for Payer: Cigna of CA PPO |
$5.09
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$6.18
|
| Rate for Payer: Dignity Health Medi-Cal |
$6.18
|
| Rate for Payer: Dignity Health Medicare Advantage |
$6.18
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$5.09
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.91
|
| Rate for Payer: EPIC Health Plan Senior |
$2.91
|
| Rate for Payer: Galaxy Health WC |
$6.18
|
| Rate for Payer: Global Benefits Group Commercial |
$4.36
|
| Rate for Payer: Health Management Network EPO/PPO |
$6.54
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$0.90
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$4.62
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1.84
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$4.29
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.45
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$5.09
|
| Rate for Payer: Multiplan Commercial |
$5.45
|
| Rate for Payer: Networks By Design Commercial |
$3.63
|
| Rate for Payer: Prime Health Services Commercial |
$6.18
|
| Rate for Payer: Riverside University Health System MISP |
$2.91
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$4.36
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$4.36
|
| Rate for Payer: United Healthcare All Other Commercial |
$2.73
|
| Rate for Payer: United Healthcare All Other HMO |
$2.66
|
| Rate for Payer: United Healthcare HMO Rider |
$2.60
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2.38
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$6.18
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$6.18
|
| Rate for Payer: Vantage Medical Group Senior |
$6.18
|
|
|
PARICALCITOL 2 MCG/ML INTRAVENOUS SOLUTION [31688]
|
Facility
|
IP
|
$7.27
|
|
|
Service Code
|
HCPCS J2501
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.45 |
| Max. Negotiated Rate |
$6.54 |
| Rate for Payer: Adventist Health Commercial |
$1.45
|
| Rate for Payer: Blue Shield of California Commercial |
$5.83
|
| Rate for Payer: Blue Shield of California EPN |
$3.66
|
| Rate for Payer: Cash Price |
$3.27
|
| Rate for Payer: Central Health Plan Commercial |
$5.82
|
| Rate for Payer: Cigna of CA HMO |
$5.09
|
| Rate for Payer: Cigna of CA PPO |
$5.09
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$5.09
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.91
|
| Rate for Payer: EPIC Health Plan Senior |
$2.91
|
| Rate for Payer: Galaxy Health WC |
$6.18
|
| Rate for Payer: Global Benefits Group Commercial |
$4.36
|
| Rate for Payer: Health Management Network EPO/PPO |
$6.54
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$4.62
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$4.29
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.45
|
| Rate for Payer: Multiplan Commercial |
$5.45
|
| Rate for Payer: Networks By Design Commercial |
$3.63
|
| Rate for Payer: Prime Health Services Commercial |
$6.18
|
| Rate for Payer: United Healthcare All Other Commercial |
$2.73
|
| Rate for Payer: United Healthcare All Other HMO |
$2.66
|
| Rate for Payer: United Healthcare HMO Rider |
$2.60
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2.38
|
|
|
PARICALCITOL 5 MCG/ML INTRAVENOUS SOLUTION [22960]
|
Facility
|
OP
|
$18.18
|
|
|
Service Code
|
HCPCS J2501
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.90 |
| Max. Negotiated Rate |
$16.36 |
| Rate for Payer: Adventist Health Commercial |
$3.64
|
| Rate for Payer: Aetna of CA HMO/PPO |
$5.03
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$15.45
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$10.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$13.63
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$9.24
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$11.53
|
| Rate for Payer: Blue Shield of California Commercial |
$1.00
|
| Rate for Payer: Blue Shield of California EPN |
$0.91
|
| Rate for Payer: Cash Price |
$8.18
|
| Rate for Payer: Cash Price |
$8.18
|
| Rate for Payer: Central Health Plan Commercial |
$14.54
|
| Rate for Payer: Cigna of CA HMO |
$12.73
|
| Rate for Payer: Cigna of CA PPO |
$12.73
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$15.45
|
| Rate for Payer: Dignity Health Medi-Cal |
$15.45
|
| Rate for Payer: Dignity Health Medicare Advantage |
$15.45
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$12.73
|
| Rate for Payer: EPIC Health Plan Commercial |
$7.27
|
| Rate for Payer: EPIC Health Plan Senior |
$7.27
|
| Rate for Payer: Galaxy Health WC |
$15.45
|
| Rate for Payer: Global Benefits Group Commercial |
$10.91
|
| Rate for Payer: Health Management Network EPO/PPO |
$16.36
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$0.90
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$11.54
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1.84
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$10.73
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.64
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$12.73
|
| Rate for Payer: Multiplan Commercial |
$13.63
|
| Rate for Payer: Networks By Design Commercial |
$9.09
|
| Rate for Payer: Prime Health Services Commercial |
$15.45
|
| Rate for Payer: Riverside University Health System MISP |
$7.27
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$10.91
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$10.91
|
| Rate for Payer: United Healthcare All Other Commercial |
$6.82
|
| Rate for Payer: United Healthcare All Other HMO |
$6.64
|
| Rate for Payer: United Healthcare HMO Rider |
$6.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$5.95
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$15.45
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$15.45
|
| Rate for Payer: Vantage Medical Group Senior |
$15.45
|
|
|
PARICALCITOL 5 MCG/ML INTRAVENOUS SOLUTION [22960]
|
Facility
|
IP
|
$18.18
|
|
|
Service Code
|
HCPCS J2501
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$3.64 |
| Max. Negotiated Rate |
$16.36 |
| Rate for Payer: Adventist Health Commercial |
$3.64
|
| Rate for Payer: Blue Shield of California Commercial |
$14.58
|
| Rate for Payer: Blue Shield of California EPN |
$9.16
|
| Rate for Payer: Cash Price |
$8.18
|
| Rate for Payer: Central Health Plan Commercial |
$14.54
|
| Rate for Payer: Cigna of CA HMO |
$12.73
|
| Rate for Payer: Cigna of CA PPO |
$12.73
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$12.73
|
| Rate for Payer: EPIC Health Plan Commercial |
$7.27
|
| Rate for Payer: EPIC Health Plan Senior |
$7.27
|
| Rate for Payer: Galaxy Health WC |
$15.45
|
| Rate for Payer: Global Benefits Group Commercial |
$10.91
|
| Rate for Payer: Health Management Network EPO/PPO |
$16.36
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$11.54
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$10.73
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.64
|
| Rate for Payer: Multiplan Commercial |
$13.63
|
| Rate for Payer: Networks By Design Commercial |
$9.09
|
| Rate for Payer: Prime Health Services Commercial |
$15.45
|
| Rate for Payer: United Healthcare All Other Commercial |
$6.82
|
| Rate for Payer: United Healthcare All Other HMO |
$6.64
|
| Rate for Payer: United Healthcare HMO Rider |
$6.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$5.95
|
|
|
PAROXETINE 10 MG/5 ML ORAL SUSPENSION [22959]
|
Facility
|
IP
|
$1.76
|
|
|
Service Code
|
NDC 7095431910
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.35 |
| Max. Negotiated Rate |
$1.58 |
| Rate for Payer: Adventist Health Commercial |
$0.35
|
| Rate for Payer: Blue Shield of California Commercial |
$1.41
|
| Rate for Payer: Blue Shield of California EPN |
$0.89
|
| Rate for Payer: Cash Price |
$0.79
|
| Rate for Payer: Central Health Plan Commercial |
$1.41
|
| Rate for Payer: Cigna of CA HMO |
$1.23
|
| Rate for Payer: Cigna of CA PPO |
$1.23
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1.23
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.70
|
| Rate for Payer: EPIC Health Plan Senior |
$0.70
|
| Rate for Payer: Galaxy Health WC |
$1.50
|
| Rate for Payer: Global Benefits Group Commercial |
$1.06
|
| Rate for Payer: Health Management Network EPO/PPO |
$1.58
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1.12
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1.04
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.35
|
| Rate for Payer: Multiplan Commercial |
$1.32
|
| Rate for Payer: Networks By Design Commercial |
$1.14
|
| Rate for Payer: Prime Health Services Commercial |
$1.50
|
|
