|
PENICILLAMINE 250 MG CAPSULE [10894]
|
Facility
|
OP
|
$314.26
|
|
|
Service Code
|
NDC 2501070515
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$62.85 |
| Max. Negotiated Rate |
$282.83 |
| Rate for Payer: Adventist Health Commercial |
$62.85
|
| Rate for Payer: Aetna of CA HMO/PPO |
$190.85
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$267.12
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$172.84
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$235.69
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$152.16
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$182.81
|
| Rate for Payer: Blue Shield of California Commercial |
$199.24
|
| Rate for Payer: Blue Shield of California EPN |
$125.39
|
| Rate for Payer: Cash Price |
$141.42
|
| Rate for Payer: Central Health Plan Commercial |
$251.41
|
| 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 Medi-Cal |
$267.12
|
| Rate for Payer: Dignity Health Medicare Advantage |
$267.12
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$219.98
|
| Rate for Payer: EPIC Health Plan Commercial |
$125.70
|
| Rate for Payer: EPIC Health Plan Senior |
$125.70
|
| Rate for Payer: Galaxy Health WC |
$267.12
|
| Rate for Payer: Global Benefits Group Commercial |
$188.56
|
| Rate for Payer: Health Management Network EPO/PPO |
$282.83
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$199.56
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$114.08
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$185.41
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$62.85
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$219.98
|
| Rate for Payer: Multiplan Commercial |
$235.69
|
| Rate for Payer: Networks By Design Commercial |
$204.27
|
| Rate for Payer: Prime Health Services Commercial |
$267.12
|
| Rate for Payer: Riverside University Health System MISP |
$125.70
|
| 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 2501070515
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$62.85 |
| Max. Negotiated Rate |
$282.83 |
| Rate for Payer: Adventist Health Commercial |
$62.85
|
| Rate for Payer: Blue Shield of California Commercial |
$252.04
|
| Rate for Payer: Blue Shield of California EPN |
$158.39
|
| Rate for Payer: Cash Price |
$141.42
|
| Rate for Payer: Central Health Plan Commercial |
$251.41
|
| Rate for Payer: Cigna of CA HMO |
$219.98
|
| Rate for Payer: Cigna of CA PPO |
$219.98
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$219.98
|
| Rate for Payer: EPIC Health Plan Commercial |
$125.70
|
| Rate for Payer: EPIC Health Plan Senior |
$125.70
|
| Rate for Payer: Galaxy Health WC |
$267.12
|
| Rate for Payer: Global Benefits Group Commercial |
$188.56
|
| Rate for Payer: Health Management Network EPO/PPO |
$282.83
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$199.56
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$185.41
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$62.85
|
| Rate for Payer: Multiplan Commercial |
$235.69
|
| 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 9994080316
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.35 |
| Max. Negotiated Rate |
$1.57 |
| Rate for Payer: Adventist Health Commercial |
$0.35
|
| Rate for Payer: Aetna of CA HMO/PPO |
$1.06
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1.49
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.96
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1.31
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$0.85
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1.02
|
| Rate for Payer: Blue Shield of California Commercial |
$1.11
|
| Rate for Payer: Blue Shield of California EPN |
$0.70
|
| Rate for Payer: Cash Price |
$0.79
|
| Rate for Payer: Central Health Plan Commercial |
$1.40
|
| Rate for Payer: Cigna of CA HMO |
$1.23
|
| Rate for Payer: Cigna of CA PPO |
$1.23
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1.49
|
| Rate for Payer: Dignity Health Medi-Cal |
$1.49
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1.49
|
| 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 |
$1.49
|
| Rate for Payer: Global Benefits Group Commercial |
$1.05
|
| Rate for Payer: Health Management Network EPO/PPO |
$1.57
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1.11
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.64
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1.03
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.35
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$1.23
|
| Rate for Payer: Multiplan Commercial |
$1.31
|
| Rate for Payer: Networks By Design Commercial |
$1.14
|
| Rate for Payer: Prime Health Services Commercial |
$1.49
|
| Rate for Payer: Riverside University Health System MISP |
$0.70
|
| 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 9994080316
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.35 |
| Max. Negotiated Rate |
$1.57 |
| Rate for Payer: Adventist Health Commercial |
$0.35
|
| Rate for Payer: Blue Shield of California Commercial |
$1.40
|
| Rate for Payer: Blue Shield of California EPN |
$0.88
|
| Rate for Payer: Cash Price |
$0.79
|
| Rate for Payer: Central Health Plan Commercial |
$1.40
|
| 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 |
$1.49
|
| Rate for Payer: Global Benefits Group Commercial |
$1.05
|
| Rate for Payer: Health Management Network EPO/PPO |
$1.57
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1.11
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1.03
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.35
|
| Rate for Payer: Multiplan Commercial |
$1.31
|
| 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
|
IP
|
$267.92
|
|
|
Service Code
|
HCPCS J0561
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$53.58 |
| Max. Negotiated Rate |
$241.13 |
| Rate for Payer: Adventist Health Commercial |
$53.58
|
| Rate for Payer: Blue Shield of California Commercial |
$214.87
|
| Rate for Payer: Blue Shield of California EPN |
$135.03
|
| Rate for Payer: Cash Price |
$120.56
|
| Rate for Payer: Central Health Plan Commercial |
$214.34
|
| Rate for Payer: Cigna of CA HMO |
$187.54
|
| Rate for Payer: Cigna of CA PPO |
$187.54
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$187.54
|
| Rate for Payer: EPIC Health Plan Commercial |
$107.17
|
| Rate for Payer: EPIC Health Plan Senior |
$107.17
|
| Rate for Payer: Galaxy Health WC |
$227.73
|
| Rate for Payer: Global Benefits Group Commercial |
$160.75
|
| Rate for Payer: Health Management Network EPO/PPO |
$241.13
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$170.13
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$158.07
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$53.58
|
| Rate for Payer: Multiplan Commercial |
$200.94
|
| Rate for Payer: Networks By Design Commercial |
$133.96
|
| Rate for Payer: Prime Health Services Commercial |
$227.73
|
| Rate for Payer: United Healthcare All Other Commercial |
$100.55
|
| Rate for Payer: United Healthcare All Other HMO |
$97.87
|
| Rate for Payer: United Healthcare HMO Rider |
$95.75
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$87.74
|
|
|
PENICILLIN G BENZATHINE 1,200,000 UNIT/2 ML INTRAMUSCULAR SYRINGE [108049]
|
Facility
|
OP
|
$267.92
|
|
|
Service Code
|
HCPCS J0561
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$7.95 |
| Max. Negotiated Rate |
$241.13 |
| Rate for Payer: Adventist Health Commercial |
$53.58
|
| Rate for Payer: Adventist Health Medi-Cal |
$32.59
|
| Rate for Payer: Aetna of CA HMO/PPO |
$167.20
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$40.74
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$35.85
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$35.85
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$7.95
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$9.92
|
| Rate for Payer: Blue Shield of California Commercial |
$33.55
|
| Rate for Payer: Blue Shield of California EPN |
$30.50
|
| Rate for Payer: Cash Price |
$120.56
|
| Rate for Payer: Cash Price |
$120.56
|
| Rate for Payer: Central Health Plan Commercial |
$214.34
|
| Rate for Payer: Cigna of CA HMO |
$187.54
|
| Rate for Payer: Cigna of CA PPO |
$187.54
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$40.74
|
| Rate for Payer: Dignity Health Medi-Cal |
$35.85
|
| Rate for Payer: Dignity Health Medicare Advantage |
$35.85
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$187.54
|
| Rate for Payer: EPIC Health Plan Commercial |
$53.77
|
| Rate for Payer: EPIC Health Plan Senior |
$35.85
|
| Rate for Payer: Galaxy Health WC |
$227.73
|
| Rate for Payer: Global Benefits Group Commercial |
$160.75
|
| Rate for Payer: Health Management Network EPO/PPO |
$241.13
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$53.45
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$32.59
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$32.59
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$170.13
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$69.22
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$45.63
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$53.58
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$43.67
|
| Rate for Payer: Multiplan Commercial |
$200.94
|
| Rate for Payer: Networks By Design Commercial |
$133.96
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$32.59
|
| Rate for Payer: Prime Health Services Commercial |
$227.73
|
| Rate for Payer: Prime Health Services Medicare |
$34.55
|
| Rate for Payer: Riverside University Health System MISP |
$35.85
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$160.75
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$160.75
|
| Rate for Payer: United Healthcare All Other Commercial |
$100.55
|
| Rate for Payer: United Healthcare All Other HMO |
$97.87
|
| Rate for Payer: United Healthcare HMO Rider |
$95.75
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$87.74
|
| Rate for Payer: Upland Medical Group Pediatric |
$32.59
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$40.74
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$35.85
|
| Rate for Payer: Vantage Medical Group Senior |
$35.85
|
|
|
PENICILLIN G BENZATHINE 2,400,000 UNIT/4 ML INTRAMUSCULAR SYRINGE [108050]
|
Facility
|
IP
|
$274.51
|
|
|
Service Code
|
HCPCS J0561
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$54.90 |
| Max. Negotiated Rate |
$247.06 |
| Rate for Payer: Adventist Health Commercial |
$54.90
|
| Rate for Payer: Blue Shield of California Commercial |
$220.16
|
| Rate for Payer: Blue Shield of California EPN |
$138.35
|
| Rate for Payer: Cash Price |
$123.53
|
| Rate for Payer: Central Health Plan Commercial |
$219.61
|
| Rate for Payer: Cigna of CA HMO |
$192.16
|
| Rate for Payer: Cigna of CA PPO |
$192.16
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$192.16
|
| Rate for Payer: EPIC Health Plan Commercial |
$109.80
|
| Rate for Payer: EPIC Health Plan Senior |
$109.80
|
| Rate for Payer: Galaxy Health WC |
$233.33
|
| Rate for Payer: Global Benefits Group Commercial |
$164.71
|
| Rate for Payer: Health Management Network EPO/PPO |
$247.06
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$174.31
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$161.96
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$54.90
|
| Rate for Payer: Multiplan Commercial |
$205.88
|
| Rate for Payer: Networks By Design Commercial |
$137.25
|
| Rate for Payer: Prime Health Services Commercial |
$233.33
|
| Rate for Payer: United Healthcare All Other Commercial |
$103.02
|
| Rate for Payer: United Healthcare All Other HMO |
$100.28
|
| Rate for Payer: United Healthcare HMO Rider |
$98.11
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$89.90
|
|
|
PENICILLIN G BENZATHINE 2,400,000 UNIT/4 ML INTRAMUSCULAR SYRINGE [108050]
|
Facility
|
OP
|
$274.51
|
|
|
Service Code
|
HCPCS J0561
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$7.95 |
| Max. Negotiated Rate |
$247.06 |
| Rate for Payer: Adventist Health Commercial |
$54.90
|
| Rate for Payer: Adventist Health Medi-Cal |
$32.59
|
| Rate for Payer: Aetna of CA HMO/PPO |
$167.20
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$40.74
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$35.85
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$35.85
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$7.95
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$9.92
|
| Rate for Payer: Blue Shield of California Commercial |
$33.55
|
| Rate for Payer: Blue Shield of California EPN |
$30.50
|
| Rate for Payer: Cash Price |
$123.53
|
| Rate for Payer: Cash Price |
$123.53
|
| Rate for Payer: Central Health Plan Commercial |
$219.61
|
| Rate for Payer: Cigna of CA HMO |
$192.16
|
| Rate for Payer: Cigna of CA PPO |
$192.16
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$40.74
|
| Rate for Payer: Dignity Health Medi-Cal |
$35.85
|
| Rate for Payer: Dignity Health Medicare Advantage |
$35.85
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$192.16
|
| Rate for Payer: EPIC Health Plan Commercial |
$53.77
|
| Rate for Payer: EPIC Health Plan Senior |
$35.85
|
| Rate for Payer: Galaxy Health WC |
$233.33
|
| Rate for Payer: Global Benefits Group Commercial |
$164.71
|
| Rate for Payer: Health Management Network EPO/PPO |
$247.06
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$53.45
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$32.59
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$32.59
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$174.31
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$69.22
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$45.63
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$54.90
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$43.67
|
| Rate for Payer: Multiplan Commercial |
$205.88
|
| Rate for Payer: Networks By Design Commercial |
$137.25
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$32.59
|
| Rate for Payer: Prime Health Services Commercial |
$233.33
|
| Rate for Payer: Prime Health Services Medicare |
$34.55
|
| Rate for Payer: Riverside University Health System MISP |
$35.85
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$164.71
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$164.71
|
| Rate for Payer: United Healthcare All Other Commercial |
$103.02
|
| Rate for Payer: United Healthcare All Other HMO |
$100.28
|
| Rate for Payer: United Healthcare HMO Rider |
$98.11
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$89.90
|
| Rate for Payer: Upland Medical Group Pediatric |
$32.59
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$40.74
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$35.85
|
| Rate for Payer: Vantage Medical Group Senior |
$35.85
|
|
|
PENICILLIN G BENZATHINE 600,000 UNIT/ML INTRAMUSCULAR SYRINGE [10897]
|
Facility
|
OP
|
$309.39
|
|
|
Service Code
|
HCPCS J0561
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$7.95 |
| Max. Negotiated Rate |
$278.45 |
| Rate for Payer: Adventist Health Commercial |
$61.88
|
| Rate for Payer: Adventist Health Medi-Cal |
$32.59
|
| Rate for Payer: Aetna of CA HMO/PPO |
$167.20
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$40.74
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$35.85
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$35.85
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$7.95
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$9.92
|
| Rate for Payer: Blue Shield of California Commercial |
$33.55
|
| Rate for Payer: Blue Shield of California EPN |
$30.50
|
| Rate for Payer: Cash Price |
$139.23
|
| Rate for Payer: Cash Price |
$139.23
|
| Rate for Payer: Central Health Plan Commercial |
$247.51
|
| Rate for Payer: Cigna of CA HMO |
$216.57
|
| Rate for Payer: Cigna of CA PPO |
$216.57
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$40.74
|
| Rate for Payer: Dignity Health Medi-Cal |
$35.85
|
| Rate for Payer: Dignity Health Medicare Advantage |
$35.85
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$216.57
|
| Rate for Payer: EPIC Health Plan Commercial |
$53.77
|
| Rate for Payer: EPIC Health Plan Senior |
$35.85
|
| Rate for Payer: Galaxy Health WC |
$262.98
|
| Rate for Payer: Global Benefits Group Commercial |
$185.63
|
| Rate for Payer: Health Management Network EPO/PPO |
$278.45
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$53.45
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$32.59
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$32.59
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$196.46
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$69.22
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$45.63
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$61.88
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$43.67
|
| Rate for Payer: Multiplan Commercial |
$232.04
|
| Rate for Payer: Networks By Design Commercial |
$154.69
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$32.59
|
| Rate for Payer: Prime Health Services Commercial |
$262.98
|
| Rate for Payer: Prime Health Services Medicare |
$34.55
|
| Rate for Payer: Riverside University Health System MISP |
$35.85
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$185.63
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$185.63
|
| Rate for Payer: United Healthcare All Other Commercial |
$116.11
|
| Rate for Payer: United Healthcare All Other HMO |
$113.02
|
| Rate for Payer: United Healthcare HMO Rider |
$110.58
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$101.33
|
| Rate for Payer: Upland Medical Group Pediatric |
$32.59
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$40.74
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$35.85
|
| Rate for Payer: Vantage Medical Group Senior |
$35.85
|
|
|
PENICILLIN G BENZATHINE 600,000 UNIT/ML INTRAMUSCULAR SYRINGE [10897]
|
Facility
|
IP
|
$309.39
|
|
|
Service Code
|
HCPCS J0561
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$61.88 |
| Max. Negotiated Rate |
$278.45 |
| Rate for Payer: Adventist Health Commercial |
$61.88
|
| Rate for Payer: Blue Shield of California Commercial |
$248.13
|
| Rate for Payer: Blue Shield of California EPN |
$155.93
|
| Rate for Payer: Cash Price |
$139.23
|
| Rate for Payer: Central Health Plan Commercial |
$247.51
|
| Rate for Payer: Cigna of CA HMO |
$216.57
|
| Rate for Payer: Cigna of CA PPO |
$216.57
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$216.57
|
| Rate for Payer: EPIC Health Plan Commercial |
$123.76
|
| Rate for Payer: EPIC Health Plan Senior |
$123.76
|
| Rate for Payer: Galaxy Health WC |
$262.98
|
| Rate for Payer: Global Benefits Group Commercial |
$185.63
|
| Rate for Payer: Health Management Network EPO/PPO |
$278.45
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$196.46
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$182.54
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$61.88
|
| Rate for Payer: Multiplan Commercial |
$232.04
|
| Rate for Payer: Networks By Design Commercial |
$154.69
|
| Rate for Payer: Prime Health Services Commercial |
$262.98
|
| Rate for Payer: United Healthcare All Other Commercial |
$116.11
|
| Rate for Payer: United Healthcare All Other HMO |
$113.02
|
| Rate for Payer: United Healthcare HMO Rider |
$110.58
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$101.33
|
|
|
PENICILLIN G BENZATHINE AND PROCAINE 1,200,000 UNIT/2 ML IM SYRINGE [108051]
|
Facility
|
IP
|
$145.87
|
|
|
Service Code
|
HCPCS J0558
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$29.17 |
| Max. Negotiated Rate |
$131.28 |
| Rate for Payer: Adventist Health Commercial |
$29.17
|
| Rate for Payer: Blue Shield of California Commercial |
$116.99
|
| Rate for Payer: Blue Shield of California EPN |
$73.52
|
| Rate for Payer: Cash Price |
$65.64
|
| Rate for Payer: Central Health Plan Commercial |
$116.70
|
| Rate for Payer: Cigna of CA HMO |
$102.11
|
| Rate for Payer: Cigna of CA PPO |
$102.11
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$102.11
|
| Rate for Payer: EPIC Health Plan Commercial |
$58.35
|
| Rate for Payer: EPIC Health Plan Senior |
$58.35
|
| Rate for Payer: Galaxy Health WC |
$123.99
|
| Rate for Payer: Global Benefits Group Commercial |
$87.52
|
| Rate for Payer: Health Management Network EPO/PPO |
$131.28
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$92.63
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$86.06
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$29.17
|
| Rate for Payer: Multiplan Commercial |
$109.40
|
| Rate for Payer: Networks By Design Commercial |
$72.94
|
| Rate for Payer: Prime Health Services Commercial |
$123.99
|
| Rate for Payer: United Healthcare All Other Commercial |
$54.75
|
| Rate for Payer: United Healthcare All Other HMO |
$53.29
|
| Rate for Payer: United Healthcare HMO Rider |
$52.13
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$47.77
|
|
|
PENICILLIN G BENZATHINE AND PROCAINE 1,200,000 UNIT/2 ML IM SYRINGE [108051]
|
Facility
|
OP
|
$145.87
|
|
|
Service Code
|
HCPCS J0558
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$6.29 |
| Max. Negotiated Rate |
$131.28 |
| Rate for Payer: Adventist Health Commercial |
$29.17
|
| Rate for Payer: Adventist Health Medi-Cal |
$19.52
|
| Rate for Payer: Aetna of CA HMO/PPO |
$107.62
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$24.40
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$21.47
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$21.47
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$6.29
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$7.84
|
| Rate for Payer: Blue Shield of California Commercial |
$26.74
|
| Rate for Payer: Blue Shield of California EPN |
$24.31
|
| Rate for Payer: Cash Price |
$65.64
|
| Rate for Payer: Cash Price |
$65.64
|
| Rate for Payer: Central Health Plan Commercial |
$116.70
|
| Rate for Payer: Cigna of CA HMO |
$102.11
|
| Rate for Payer: Cigna of CA PPO |
$102.11
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$24.40
|
| Rate for Payer: Dignity Health Medi-Cal |
$21.47
|
| Rate for Payer: Dignity Health Medicare Advantage |
$21.47
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$102.11
|
| Rate for Payer: EPIC Health Plan Commercial |
$32.21
|
| Rate for Payer: EPIC Health Plan Senior |
$21.47
|
| Rate for Payer: Galaxy Health WC |
$123.99
|
| Rate for Payer: Global Benefits Group Commercial |
$87.52
|
| Rate for Payer: Health Management Network EPO/PPO |
$131.28
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$32.01
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$19.52
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$19.52
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$92.63
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$45.56
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$27.33
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$29.17
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$26.16
|
| Rate for Payer: Multiplan Commercial |
$109.40
|
| Rate for Payer: Networks By Design Commercial |
$72.94
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$19.52
|
| Rate for Payer: Prime Health Services Commercial |
$123.99
|
| Rate for Payer: Prime Health Services Medicare |
$20.69
|
| Rate for Payer: Riverside University Health System MISP |
$21.47
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$87.52
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$87.52
|
| Rate for Payer: United Healthcare All Other Commercial |
$54.75
|
| Rate for Payer: United Healthcare All Other HMO |
$53.29
|
| Rate for Payer: United Healthcare HMO Rider |
$52.13
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$47.77
|
| Rate for Payer: Upland Medical Group Pediatric |
$19.52
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$24.40
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$21.47
|
| Rate for Payer: Vantage Medical Group Senior |
$21.47
|
|
|
PENICILLIN G POTASSIUM 20 MILLION UNIT SOLUTION FOR INJECTION [6085]
|
Facility
|
OP
|
$59.99
|
|
|
Service Code
|
HCPCS J2540
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.64 |
| Max. Negotiated Rate |
$53.99 |
| Rate for Payer: Adventist Health Commercial |
$12.00
|
| Rate for Payer: Adventist Health Commercial |
$12.21
|
| Rate for Payer: Adventist Health Commercial |
$11.94
|
| Rate for Payer: Aetna of CA HMO/PPO |
$4.79
|
| Rate for Payer: Aetna of CA HMO/PPO |
$4.79
|
| Rate for Payer: Aetna of CA HMO/PPO |
$4.79
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$50.74
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$50.99
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$51.90
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$33.58
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$32.99
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$32.84
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$45.80
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$44.77
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$44.99
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$3.98
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$3.98
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$3.98
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4.96
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4.96
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4.96
|
| Rate for Payer: Blue Shield of California Commercial |
$1.96
|
| Rate for Payer: Blue Shield of California Commercial |
$1.96
|
| Rate for Payer: Blue Shield of California Commercial |
$1.96
|
| Rate for Payer: Blue Shield of California EPN |
$1.78
|
| Rate for Payer: Blue Shield of California EPN |
$1.78
|
| Rate for Payer: Blue Shield of California EPN |
$1.78
|
| Rate for Payer: Cash Price |
$26.86
|
| Rate for Payer: Cash Price |
$26.86
|
| Rate for Payer: Cash Price |
$27.00
|
| Rate for Payer: Cash Price |
$27.00
|
| Rate for Payer: Cash Price |
$27.48
|
| Rate for Payer: Cash Price |
$27.48
|
| Rate for Payer: Central Health Plan Commercial |
$47.76
|
| Rate for Payer: Central Health Plan Commercial |
$47.99
|
| Rate for Payer: Central Health Plan Commercial |
$48.85
|
| Rate for Payer: Cigna of CA HMO |
$41.79
|
| Rate for Payer: Cigna of CA HMO |
$42.74
|
| Rate for Payer: Cigna of CA HMO |
$41.99
|
| Rate for Payer: Cigna of CA PPO |
$41.79
|
| Rate for Payer: Cigna of CA PPO |
$41.99
|
| Rate for Payer: Cigna of CA PPO |
$42.74
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$51.90
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$50.74
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$50.99
|
| Rate for Payer: Dignity Health Medi-Cal |
$50.74
|
| Rate for Payer: Dignity Health Medi-Cal |
$50.99
|
| Rate for Payer: Dignity Health Medi-Cal |
$51.90
|
| Rate for Payer: Dignity Health Medicare Advantage |
$50.74
|
| Rate for Payer: Dignity Health Medicare Advantage |
$50.99
|
| Rate for Payer: Dignity Health Medicare Advantage |
$51.90
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$41.99
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$42.74
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$41.79
|
| Rate for Payer: EPIC Health Plan Commercial |
$24.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$23.88
|
| Rate for Payer: EPIC Health Plan Commercial |
$24.42
|
| Rate for Payer: EPIC Health Plan Senior |
$24.42
|
| Rate for Payer: EPIC Health Plan Senior |
$24.00
|
| Rate for Payer: EPIC Health Plan Senior |
$23.88
|
| Rate for Payer: Galaxy Health WC |
$51.90
|
| Rate for Payer: Galaxy Health WC |
$50.99
|
| Rate for Payer: Galaxy Health WC |
$50.74
|
| Rate for Payer: Global Benefits Group Commercial |
$36.64
|
| Rate for Payer: Global Benefits Group Commercial |
$35.99
|
| Rate for Payer: Global Benefits Group Commercial |
$35.82
|
| Rate for Payer: Health Management Network EPO/PPO |
$53.73
|
| Rate for Payer: Health Management Network EPO/PPO |
$54.95
|
| Rate for Payer: Health Management Network EPO/PPO |
$53.99
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$0.64
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$0.64
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$0.64
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$38.09
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$38.77
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$37.91
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$9.96
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$9.96
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$9.96
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$36.03
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$35.22
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$35.39
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$11.94
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$12.21
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$12.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$41.99
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$41.79
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$42.74
|
| Rate for Payer: Multiplan Commercial |
$44.77
|
| Rate for Payer: Multiplan Commercial |
$44.99
|
| Rate for Payer: Multiplan Commercial |
$45.80
|
| Rate for Payer: Networks By Design Commercial |
$30.00
|
| Rate for Payer: Networks By Design Commercial |
$29.85
|
| Rate for Payer: Networks By Design Commercial |
$30.53
|
| Rate for Payer: Prime Health Services Commercial |
$51.90
|
| Rate for Payer: Prime Health Services Commercial |
$50.99
|
| Rate for Payer: Prime Health Services Commercial |
$50.74
|
| Rate for Payer: Riverside University Health System MISP |
$24.00
|
| Rate for Payer: Riverside University Health System MISP |
$24.42
|
| Rate for Payer: Riverside University Health System MISP |
$23.88
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$35.99
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$36.64
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$35.82
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$35.99
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$36.64
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$35.82
|
| Rate for Payer: United Healthcare All Other Commercial |
$22.41
|
| Rate for Payer: United Healthcare All Other Commercial |
$22.92
|
| Rate for Payer: United Healthcare All Other Commercial |
$22.51
|
| Rate for Payer: United Healthcare All Other HMO |
$22.31
|
| Rate for Payer: United Healthcare All Other HMO |
$21.91
|
| Rate for Payer: United Healthcare All Other HMO |
$21.81
|
| Rate for Payer: United Healthcare HMO Rider |
$21.44
|
| Rate for Payer: United Healthcare HMO Rider |
$21.82
|
| Rate for Payer: United Healthcare HMO Rider |
$21.34
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$20.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$19.55
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$19.65
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$51.90
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$50.74
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$50.99
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$50.99
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$51.90
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$50.74
|
| Rate for Payer: Vantage Medical Group Senior |
$51.90
|
| Rate for Payer: Vantage Medical Group Senior |
$50.74
|
| Rate for Payer: Vantage Medical Group Senior |
$50.99
|
|
|
PENICILLIN G POTASSIUM 20 MILLION UNIT SOLUTION FOR INJECTION [6085]
|
Facility
|
IP
|
$61.06
|
|
|
Service Code
|
HCPCS J2540
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$12.21 |
| Max. Negotiated Rate |
$54.95 |
| Rate for Payer: Adventist Health Commercial |
$12.21
|
| Rate for Payer: Adventist Health Commercial |
$12.00
|
| Rate for Payer: Adventist Health Commercial |
$11.94
|
| Rate for Payer: Blue Shield of California Commercial |
$48.97
|
| Rate for Payer: Blue Shield of California Commercial |
$48.11
|
| Rate for Payer: Blue Shield of California Commercial |
$47.88
|
| Rate for Payer: Blue Shield of California EPN |
$30.09
|
| Rate for Payer: Blue Shield of California EPN |
$30.77
|
| Rate for Payer: Blue Shield of California EPN |
$30.23
|
| Rate for Payer: Cash Price |
$27.48
|
| Rate for Payer: Cash Price |
$26.86
|
| Rate for Payer: Cash Price |
$27.00
|
| Rate for Payer: Central Health Plan Commercial |
$47.99
|
| Rate for Payer: Central Health Plan Commercial |
$47.76
|
| Rate for Payer: Central Health Plan Commercial |
$48.85
|
| Rate for Payer: Cigna of CA HMO |
$42.74
|
| Rate for Payer: Cigna of CA HMO |
$41.79
|
| Rate for Payer: Cigna of CA HMO |
$41.99
|
| Rate for Payer: Cigna of CA PPO |
$42.74
|
| Rate for Payer: Cigna of CA PPO |
$41.99
|
| Rate for Payer: Cigna of CA PPO |
$41.79
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$42.74
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$41.99
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$41.79
|
| Rate for Payer: EPIC Health Plan Commercial |
$24.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$23.88
|
| Rate for Payer: EPIC Health Plan Commercial |
$24.42
|
| Rate for Payer: EPIC Health Plan Senior |
$24.00
|
| Rate for Payer: EPIC Health Plan Senior |
$23.88
|
| Rate for Payer: EPIC Health Plan Senior |
$24.42
|
| Rate for Payer: Galaxy Health WC |
$50.99
|
| Rate for Payer: Galaxy Health WC |
$50.74
|
| Rate for Payer: Galaxy Health WC |
$51.90
|
| Rate for Payer: Global Benefits Group Commercial |
$36.64
|
| Rate for Payer: Global Benefits Group Commercial |
$35.99
|
| Rate for Payer: Global Benefits Group Commercial |
$35.82
|
| Rate for Payer: Health Management Network EPO/PPO |
$54.95
|
| Rate for Payer: Health Management Network EPO/PPO |
$53.73
|
| Rate for Payer: Health Management Network EPO/PPO |
$53.99
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$37.91
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$38.77
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$38.09
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$36.03
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$35.39
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$35.22
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$12.21
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$12.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$11.94
|
| Rate for Payer: Multiplan Commercial |
$45.80
|
| Rate for Payer: Multiplan Commercial |
$44.99
|
| Rate for Payer: Multiplan Commercial |
$44.77
|
| Rate for Payer: Networks By Design Commercial |
$30.53
|
| Rate for Payer: Networks By Design Commercial |
$29.85
|
| Rate for Payer: Networks By Design Commercial |
$30.00
|
| Rate for Payer: Prime Health Services Commercial |
$50.99
|
| Rate for Payer: Prime Health Services Commercial |
$51.90
|
| Rate for Payer: Prime Health Services Commercial |
$50.74
|
| Rate for Payer: United Healthcare All Other Commercial |
$22.41
|
| Rate for Payer: United Healthcare All Other Commercial |
$22.92
|
| Rate for Payer: United Healthcare All Other Commercial |
$22.51
|
| Rate for Payer: United Healthcare All Other HMO |
$21.91
|
| Rate for Payer: United Healthcare All Other HMO |
$21.81
|
| Rate for Payer: United Healthcare All Other HMO |
$22.31
|
| Rate for Payer: United Healthcare HMO Rider |
$21.34
|
| Rate for Payer: United Healthcare HMO Rider |
$21.44
|
| Rate for Payer: United Healthcare HMO Rider |
$21.82
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$19.65
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$20.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$19.55
|
|
|
PENICILLIN G POTASSIUM 5 MILLION UNIT SOLUTION FOR INJECTION [6086]
|
Facility
|
IP
|
$5.23
|
|
|
Service Code
|
HCPCS J2540
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.05 |
| Max. Negotiated Rate |
$4.71 |
| Rate for Payer: Adventist Health Commercial |
$1.05
|
| Rate for Payer: Adventist Health Commercial |
$1.01
|
| Rate for Payer: Adventist Health Commercial |
$3.05
|
| Rate for Payer: Blue Shield of California Commercial |
$4.19
|
| Rate for Payer: Blue Shield of California Commercial |
$4.05
|
| Rate for Payer: Blue Shield of California Commercial |
$12.24
|
| Rate for Payer: Blue Shield of California EPN |
$7.69
|
| Rate for Payer: Blue Shield of California EPN |
$2.64
|
| Rate for Payer: Blue Shield of California EPN |
$2.55
|
| Rate for Payer: Cash Price |
$2.35
|
| Rate for Payer: Cash Price |
$6.87
|
| Rate for Payer: Cash Price |
$2.27
|
| Rate for Payer: Central Health Plan Commercial |
$4.04
|
| Rate for Payer: Central Health Plan Commercial |
$12.21
|
| Rate for Payer: Central Health Plan Commercial |
$4.18
|
| Rate for Payer: Cigna of CA HMO |
$3.66
|
| Rate for Payer: Cigna of CA HMO |
$10.68
|
| Rate for Payer: Cigna of CA HMO |
$3.54
|
| Rate for Payer: Cigna of CA PPO |
$3.66
|
| Rate for Payer: Cigna of CA PPO |
$3.54
|
| Rate for Payer: Cigna of CA PPO |
$10.68
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$3.66
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$3.54
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$10.68
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.02
|
| Rate for Payer: EPIC Health Plan Commercial |
$6.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.09
|
| Rate for Payer: EPIC Health Plan Senior |
$2.02
|
| Rate for Payer: EPIC Health Plan Senior |
$6.10
|
| Rate for Payer: EPIC Health Plan Senior |
$2.09
|
| Rate for Payer: Galaxy Health WC |
$4.29
|
| Rate for Payer: Galaxy Health WC |
$12.97
|
| Rate for Payer: Galaxy Health WC |
$4.45
|
| Rate for Payer: Global Benefits Group Commercial |
$3.14
|
| Rate for Payer: Global Benefits Group Commercial |
$3.03
|
| Rate for Payer: Global Benefits Group Commercial |
$9.16
|
| Rate for Payer: Health Management Network EPO/PPO |
$4.71
|
| Rate for Payer: Health Management Network EPO/PPO |
$13.73
|
| Rate for Payer: Health Management Network EPO/PPO |
$4.54
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$9.69
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$3.32
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$3.21
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$3.09
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2.98
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$9.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.05
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.01
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.05
|
| Rate for Payer: Multiplan Commercial |
$3.92
|
| Rate for Payer: Multiplan Commercial |
$3.79
|
| Rate for Payer: Multiplan Commercial |
$11.45
|
| Rate for Payer: Networks By Design Commercial |
$2.62
|
| Rate for Payer: Networks By Design Commercial |
$7.63
|
| Rate for Payer: Networks By Design Commercial |
$2.52
|
| Rate for Payer: Prime Health Services Commercial |
$4.29
|
| Rate for Payer: Prime Health Services Commercial |
$4.45
|
| Rate for Payer: Prime Health Services Commercial |
$12.97
|
| Rate for Payer: United Healthcare All Other Commercial |
$5.73
|
| Rate for Payer: United Healthcare All Other Commercial |
$1.96
|
| Rate for Payer: United Healthcare All Other Commercial |
$1.90
|
| Rate for Payer: United Healthcare All Other HMO |
$1.84
|
| Rate for Payer: United Healthcare All Other HMO |
$5.57
|
| Rate for Payer: United Healthcare All Other HMO |
$1.91
|
| Rate for Payer: United Healthcare HMO Rider |
$5.45
|
| Rate for Payer: United Healthcare HMO Rider |
$1.80
|
| Rate for Payer: United Healthcare HMO Rider |
$1.87
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1.65
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1.71
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$5.00
|
|
|
PENICILLIN G POTASSIUM 5 MILLION UNIT SOLUTION FOR INJECTION [6086]
|
Facility
|
OP
|
$5.05
|
|
|
Service Code
|
HCPCS J2540
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.64 |
| Max. Negotiated Rate |
$9.96 |
| Rate for Payer: Adventist Health Commercial |
$1.01
|
| Rate for Payer: Adventist Health Commercial |
$1.05
|
| Rate for Payer: Adventist Health Commercial |
$3.05
|
| Rate for Payer: Aetna of CA HMO/PPO |
$4.79
|
| Rate for Payer: Aetna of CA HMO/PPO |
$4.79
|
| Rate for Payer: Aetna of CA HMO/PPO |
$4.79
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$12.97
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$4.29
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$4.45
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2.88
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2.78
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$8.39
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$3.92
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$11.45
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$3.79
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$3.98
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$3.98
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$3.98
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4.96
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4.96
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4.96
|
| Rate for Payer: Blue Shield of California Commercial |
$1.96
|
| Rate for Payer: Blue Shield of California Commercial |
$1.96
|
| Rate for Payer: Blue Shield of California Commercial |
$1.96
|
| Rate for Payer: Blue Shield of California EPN |
$1.78
|
| Rate for Payer: Blue Shield of California EPN |
$1.78
|
| Rate for Payer: Blue Shield of California EPN |
$1.78
|
| Rate for Payer: Cash Price |
$6.87
|
| Rate for Payer: Cash Price |
$6.87
|
| Rate for Payer: Cash Price |
$2.27
|
| Rate for Payer: Cash Price |
$2.27
|
| Rate for Payer: Cash Price |
$2.35
|
| Rate for Payer: Cash Price |
$2.35
|
| Rate for Payer: Central Health Plan Commercial |
$12.21
|
| Rate for Payer: Central Health Plan Commercial |
$4.04
|
| Rate for Payer: Central Health Plan Commercial |
$4.18
|
| Rate for Payer: Cigna of CA HMO |
$10.68
|
| Rate for Payer: Cigna of CA HMO |
$3.66
|
| Rate for Payer: Cigna of CA HMO |
$3.54
|
| Rate for Payer: Cigna of CA PPO |
$10.68
|
| Rate for Payer: Cigna of CA PPO |
$3.54
|
| Rate for Payer: Cigna of CA PPO |
$3.66
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$4.45
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$12.97
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$4.29
|
| Rate for Payer: Dignity Health Medi-Cal |
$12.97
|
| Rate for Payer: Dignity Health Medi-Cal |
$4.29
|
| Rate for Payer: Dignity Health Medi-Cal |
$4.45
|
| Rate for Payer: Dignity Health Medicare Advantage |
$12.97
|
| Rate for Payer: Dignity Health Medicare Advantage |
$4.29
|
| Rate for Payer: Dignity Health Medicare Advantage |
$4.45
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$3.54
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$3.66
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$10.68
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.02
|
| Rate for Payer: EPIC Health Plan Commercial |
$6.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.09
|
| Rate for Payer: EPIC Health Plan Senior |
$2.09
|
| Rate for Payer: EPIC Health Plan Senior |
$2.02
|
| Rate for Payer: EPIC Health Plan Senior |
$6.10
|
| Rate for Payer: Galaxy Health WC |
$4.45
|
| Rate for Payer: Galaxy Health WC |
$4.29
|
| Rate for Payer: Galaxy Health WC |
$12.97
|
| Rate for Payer: Global Benefits Group Commercial |
$3.14
|
| Rate for Payer: Global Benefits Group Commercial |
$3.03
|
| Rate for Payer: Global Benefits Group Commercial |
$9.16
|
| Rate for Payer: Health Management Network EPO/PPO |
$13.73
|
| Rate for Payer: Health Management Network EPO/PPO |
$4.71
|
| Rate for Payer: Health Management Network EPO/PPO |
$4.54
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$0.64
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$0.64
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$0.64
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$3.21
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$3.32
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$9.69
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$9.96
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$9.96
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$9.96
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$3.09
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$9.00
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2.98
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.05
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.05
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.01
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$3.54
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$10.68
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$3.66
|
| Rate for Payer: Multiplan Commercial |
$11.45
|
| Rate for Payer: Multiplan Commercial |
$3.79
|
| Rate for Payer: Multiplan Commercial |
$3.92
|
| Rate for Payer: Networks By Design Commercial |
$2.52
|
| Rate for Payer: Networks By Design Commercial |
$7.63
|
| Rate for Payer: Networks By Design Commercial |
$2.62
|
| Rate for Payer: Prime Health Services Commercial |
$4.45
|
| Rate for Payer: Prime Health Services Commercial |
$4.29
|
| Rate for Payer: Prime Health Services Commercial |
$12.97
|
| Rate for Payer: Riverside University Health System MISP |
$2.02
|
| Rate for Payer: Riverside University Health System MISP |
$2.09
|
| Rate for Payer: Riverside University Health System MISP |
$6.10
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3.03
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3.14
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$9.16
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$3.03
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$3.14
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$9.16
|
| Rate for Payer: United Healthcare All Other Commercial |
$5.73
|
| Rate for Payer: United Healthcare All Other Commercial |
$1.96
|
| Rate for Payer: United Healthcare All Other Commercial |
$1.90
|
| Rate for Payer: United Healthcare All Other HMO |
$1.91
|
| Rate for Payer: United Healthcare All Other HMO |
$1.84
|
| Rate for Payer: United Healthcare All Other HMO |
$5.57
|
| Rate for Payer: United Healthcare HMO Rider |
$1.80
|
| Rate for Payer: United Healthcare HMO Rider |
$1.87
|
| Rate for Payer: United Healthcare HMO Rider |
$5.45
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1.71
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$5.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1.65
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$4.45
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$12.97
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$4.29
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4.29
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4.45
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$12.97
|
| Rate for Payer: Vantage Medical Group Senior |
$4.45
|
| Rate for Payer: Vantage Medical Group Senior |
$12.97
|
| Rate for Payer: Vantage Medical Group Senior |
$4.29
|
|
|
PENICILLIN G SODIUM 5 MILLION UNIT SOLUTION FOR INJECTION [6087]
|
Facility
|
OP
|
$55.29
|
|
|
Service Code
|
HCPCS J2540
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.64 |
| Max. Negotiated Rate |
$49.76 |
| Rate for Payer: Adventist Health Commercial |
$11.06
|
| Rate for Payer: Aetna of CA HMO/PPO |
$4.79
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$47.00
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$30.41
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$41.47
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$3.98
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4.96
|
| Rate for Payer: Blue Shield of California Commercial |
$1.96
|
| Rate for Payer: Blue Shield of California EPN |
$1.78
|
| Rate for Payer: Cash Price |
$24.88
|
| Rate for Payer: Cash Price |
$24.88
|
| Rate for Payer: Central Health Plan Commercial |
$44.23
|
| Rate for Payer: Cigna of CA HMO |
$38.70
|
| Rate for Payer: Cigna of CA PPO |
$38.70
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$47.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$47.00
|
| Rate for Payer: Dignity Health Medicare Advantage |
$47.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$38.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$22.12
|
| Rate for Payer: EPIC Health Plan Senior |
$22.12
|
| Rate for Payer: Galaxy Health WC |
$47.00
|
| Rate for Payer: Global Benefits Group Commercial |
$33.17
|
| Rate for Payer: Health Management Network EPO/PPO |
$49.76
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$0.64
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$35.11
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$9.96
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$32.62
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$11.06
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$38.70
|
| Rate for Payer: Multiplan Commercial |
$41.47
|
| Rate for Payer: Networks By Design Commercial |
$27.64
|
| Rate for Payer: Prime Health Services Commercial |
$47.00
|
| Rate for Payer: Riverside University Health System MISP |
$22.12
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$33.17
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$33.17
|
| Rate for Payer: United Healthcare All Other Commercial |
$20.75
|
| Rate for Payer: United Healthcare All Other HMO |
$20.20
|
| Rate for Payer: United Healthcare HMO Rider |
$19.76
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$18.11
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$47.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$47.00
|
| Rate for Payer: Vantage Medical Group Senior |
$47.00
|
|
|
PENICILLIN G SODIUM 5 MILLION UNIT SOLUTION FOR INJECTION [6087]
|
Facility
|
IP
|
$55.29
|
|
|
Service Code
|
HCPCS J2540
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$11.06 |
| Max. Negotiated Rate |
$49.76 |
| Rate for Payer: Adventist Health Commercial |
$11.06
|
| Rate for Payer: Blue Shield of California Commercial |
$44.34
|
| Rate for Payer: Blue Shield of California EPN |
$27.87
|
| Rate for Payer: Cash Price |
$24.88
|
| Rate for Payer: Central Health Plan Commercial |
$44.23
|
| Rate for Payer: Cigna of CA HMO |
$38.70
|
| Rate for Payer: Cigna of CA PPO |
$38.70
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$38.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$22.12
|
| Rate for Payer: EPIC Health Plan Senior |
$22.12
|
| Rate for Payer: Galaxy Health WC |
$47.00
|
| Rate for Payer: Global Benefits Group Commercial |
$33.17
|
| Rate for Payer: Health Management Network EPO/PPO |
$49.76
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$35.11
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$32.62
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$11.06
|
| Rate for Payer: Multiplan Commercial |
$41.47
|
| Rate for Payer: Networks By Design Commercial |
$27.64
|
| Rate for Payer: Prime Health Services Commercial |
$47.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$20.75
|
| Rate for Payer: United Healthcare All Other HMO |
$20.20
|
| Rate for Payer: United Healthcare HMO Rider |
$19.76
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$18.11
|
|
|
PENICILLIN V POTASSIUM 0.625 MG/ML (1,000 UNITS/ML) ORAL SOLN [4081501]
|
Facility
|
OP
|
$0.08
|
|
|
Service Code
|
NDC 9994081501
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| 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 |
$0.06
|
| 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
|
|
|
PENICILLIN V POTASSIUM 0.625 MG/ML (1,000 UNITS/ML) ORAL SOLN [4081501]
|
Facility
|
IP
|
$0.08
|
|
|
Service Code
|
NDC 9994081501
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| 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: Cigna of CA HMO |
$0.06
|
| Rate for Payer: Cigna of CA PPO |
$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
|
|
|
PENICILLIN V POTASSIUM 250 MG/5 ML ORAL SOLUTION [6091]
|
Facility
|
IP
|
$0.08
|
|
|
Service Code
|
NDC 0093412774
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| 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: Cigna of CA HMO |
$0.06
|
| Rate for Payer: Cigna of CA PPO |
$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
|
|
|
PENICILLIN V POTASSIUM 250 MG/5 ML ORAL SOLUTION [6091]
|
Facility
|
OP
|
$0.08
|
|
|
Service Code
|
NDC 0093412774
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| 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 |
$0.06
|
| 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
|
|
|
PENICILLIN V POTASSIUM 250 MG TABLET [6092]
|
Facility
|
IP
|
$0.10
|
|
|
Service Code
|
NDC 5723704001
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.02 |
| Max. Negotiated Rate |
$0.09 |
| Rate for Payer: Adventist Health Commercial |
$0.02
|
| Rate for Payer: Blue Shield of California Commercial |
$0.08
|
| Rate for Payer: Blue Shield of California EPN |
$0.05
|
| Rate for Payer: Cash Price |
$0.05
|
| Rate for Payer: Central Health Plan Commercial |
$0.08
|
| Rate for Payer: Cigna of CA HMO |
$0.07
|
| Rate for Payer: Cigna of CA PPO |
$0.07
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$0.07
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.04
|
| Rate for Payer: EPIC Health Plan Senior |
$0.04
|
| Rate for Payer: Galaxy Health WC |
$0.09
|
| Rate for Payer: Global Benefits Group Commercial |
$0.06
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.09
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$0.06
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$0.06
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.02
|
| Rate for Payer: Multiplan Commercial |
$0.08
|
| Rate for Payer: Networks By Design Commercial |
$0.07
|
| Rate for Payer: Prime Health Services Commercial |
$0.09
|
|
|
PENICILLIN V POTASSIUM 250 MG TABLET [6092]
|
Facility
|
IP
|
$0.10
|
|
|
Service Code
|
NDC 0143983701
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.02 |
| Max. Negotiated Rate |
$0.09 |
| Rate for Payer: Adventist Health Commercial |
$0.02
|
| Rate for Payer: Blue Shield of California Commercial |
$0.08
|
| Rate for Payer: Blue Shield of California EPN |
$0.05
|
| Rate for Payer: Cash Price |
$0.05
|
| Rate for Payer: Central Health Plan Commercial |
$0.08
|
| Rate for Payer: Cigna of CA HMO |
$0.07
|
| Rate for Payer: Cigna of CA PPO |
$0.07
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$0.07
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.04
|
| Rate for Payer: EPIC Health Plan Senior |
$0.04
|
| Rate for Payer: Galaxy Health WC |
$0.09
|
| Rate for Payer: Global Benefits Group Commercial |
$0.06
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.09
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$0.06
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$0.06
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.02
|
| Rate for Payer: Multiplan Commercial |
$0.08
|
| Rate for Payer: Networks By Design Commercial |
$0.07
|
| Rate for Payer: Prime Health Services Commercial |
$0.09
|
|
|
PENICILLIN V POTASSIUM 250 MG TABLET [6092]
|
Facility
|
OP
|
$0.10
|
|
|
Service Code
|
NDC 5723704001
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.02 |
| Max. Negotiated Rate |
$0.09 |
| Rate for Payer: Adventist Health Commercial |
$0.02
|
| Rate for Payer: Aetna of CA HMO/PPO |
$0.06
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.09
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.06
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.08
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$0.05
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.06
|
| 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 |
$0.05
|
| Rate for Payer: Central Health Plan Commercial |
$0.08
|
| Rate for Payer: Cigna of CA HMO |
$0.07
|
| Rate for Payer: Cigna of CA PPO |
$0.07
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.09
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.09
|
| Rate for Payer: Dignity Health Medicare Advantage |
$0.09
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$0.07
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.04
|
| Rate for Payer: EPIC Health Plan Senior |
$0.04
|
| Rate for Payer: Galaxy Health WC |
$0.09
|
| Rate for Payer: Global Benefits Group Commercial |
$0.06
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.09
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$0.06
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.04
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$0.06
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.02
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$0.07
|
| Rate for Payer: Multiplan Commercial |
$0.08
|
| Rate for Payer: Networks By Design Commercial |
$0.07
|
| Rate for Payer: Prime Health Services Commercial |
$0.09
|
| Rate for Payer: Riverside University Health System MISP |
$0.04
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.06
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.06
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.05
|
| Rate for Payer: United Healthcare All Other HMO |
$0.05
|
| Rate for Payer: United Healthcare HMO Rider |
$0.05
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.05
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.09
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.09
|
| Rate for Payer: Vantage Medical Group Senior |
$0.09
|
|
