|
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
|
|
|
PENICILLIN V POTASSIUM 250 MG TABLET [6092]
|
Facility
|
IP
|
$0.22
|
|
|
Service Code
|
NDC 0093117210
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.04 |
| Max. Negotiated Rate |
$0.20 |
| Rate for Payer: Adventist Health Commercial |
$0.04
|
| Rate for Payer: Blue Shield of California Commercial |
$0.18
|
| Rate for Payer: Blue Shield of California EPN |
$0.11
|
| Rate for Payer: Cash Price |
$0.10
|
| Rate for Payer: Central Health Plan Commercial |
$0.18
|
| Rate for Payer: Cigna of CA HMO |
$0.15
|
| Rate for Payer: Cigna of CA PPO |
$0.15
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$0.15
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.09
|
| Rate for Payer: EPIC Health Plan Senior |
$0.09
|
| Rate for Payer: Galaxy Health WC |
$0.19
|
| Rate for Payer: Global Benefits Group Commercial |
$0.13
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.20
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$0.14
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$0.13
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.04
|
| Rate for Payer: Multiplan Commercial |
$0.17
|
| Rate for Payer: Networks By Design Commercial |
$0.14
|
| Rate for Payer: Prime Health Services Commercial |
$0.19
|
|
|
PENICILLIN V POTASSIUM 250 MG TABLET [6092]
|
Facility
|
OP
|
$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: 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
|
|
|
PENICILLIN V POTASSIUM 50 MG/ML ORAL SOLUTION FOR DESENSITIZATION [40803012]
|
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 50 MG/ML ORAL SOLUTION FOR DESENSITIZATION [40803012]
|
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 5 MG/ML ORAL SOLUTION FOR DESENSITIZATION [40803010]
|
Facility
|
OP
|
$0.01
|
|
|
Service Code
|
NDC 9994300009
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Max. Negotiated Rate |
$0.01 |
| Rate for Payer: Adventist Health Commercial |
$0.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$0.01
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.01
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.01
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.01
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$0.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.01
|
| Rate for Payer: Blue Shield of California Commercial |
$0.01
|
| Rate for Payer: Blue Shield of California EPN |
$0.00
|
| Rate for Payer: Central Health Plan Commercial |
$0.01
|
| Rate for Payer: Cigna of CA HMO |
$0.01
|
| Rate for Payer: Cigna of CA PPO |
$0.01
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.01
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.01
|
| Rate for Payer: Dignity Health Medicare Advantage |
$0.01
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$0.01
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.00
|
| Rate for Payer: EPIC Health Plan Senior |
$0.00
|
| Rate for Payer: Galaxy Health WC |
$0.01
|
| Rate for Payer: Global Benefits Group Commercial |
$0.01
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.01
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$0.01
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.00
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$0.01
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$0.01
|
| Rate for Payer: Multiplan Commercial |
$0.01
|
| Rate for Payer: Networks By Design Commercial |
$0.01
|
| Rate for Payer: Prime Health Services Commercial |
$0.01
|
| Rate for Payer: Riverside University Health System MISP |
$0.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.01
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.01
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.01
|
| Rate for Payer: United Healthcare All Other HMO |
$0.01
|
| Rate for Payer: United Healthcare HMO Rider |
$0.01
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.01
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.01
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.01
|
| Rate for Payer: Vantage Medical Group Senior |
$0.01
|
|
|
PENICILLIN V POTASSIUM 5 MG/ML ORAL SOLUTION FOR DESENSITIZATION [40803010]
|
Facility
|
IP
|
$0.01
|
|
|
Service Code
|
NDC 9994300009
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Max. Negotiated Rate |
$0.01 |
| Rate for Payer: Adventist Health Commercial |
$0.00
|
| Rate for Payer: Blue Shield of California Commercial |
$0.01
|
| Rate for Payer: Blue Shield of California EPN |
$0.01
|
| Rate for Payer: Central Health Plan Commercial |
$0.01
|
| Rate for Payer: Cigna of CA HMO |
$0.01
|
| Rate for Payer: Cigna of CA PPO |
$0.01
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$0.01
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.00
|
| Rate for Payer: EPIC Health Plan Senior |
$0.00
|
| Rate for Payer: Galaxy Health WC |
$0.01
|
| Rate for Payer: Global Benefits Group Commercial |
$0.01
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.01
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$0.01
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$0.01
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.00
|
| Rate for Payer: Multiplan Commercial |
$0.01
|
| Rate for Payer: Networks By Design Commercial |
$0.01
|
| Rate for Payer: Prime Health Services Commercial |
$0.01
|
|
|
PENICILLIN V POTASSIUM 6.25 MG/ML (10,000 UNITS/ML) ORAL SOLN [4081500]
|
Facility
|
OP
|
$0.08
|
|
|
Service Code
|
NDC 9994081500
|
| 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 6.25 MG/ML (10,000 UNITS/ML) ORAL SOLN [4081500]
|
Facility
|
IP
|
$0.08
|
|
|
Service Code
|
NDC 9994081500
|
| 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
|
|
|
PENIS PROCEDURES WITH CC/MCC
|
Facility
|
IP
|
$61,246.94
|
|
|
Service Code
|
MSDRG 709
|
| Min. Negotiated Rate |
$7,611.00 |
| Max. Negotiated Rate |
$61,246.94 |
| Rate for Payer: Aetna of CA HMO/PPO |
$61,246.94
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$39,563.03
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$55,389.63
|
| Rate for Payer: EPIC Health Plan Commercial |
$54,445.17
|
| Rate for Payer: EPIC Health Plan Senior |
$36,296.78
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$32,997.07
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$46,195.90
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$44,216.07
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$32,997.07
|
| Rate for Payer: Prime Health Services Medicare |
$34,976.89
|
| Rate for Payer: United Healthcare All Other Commercial |
$12,844.00
|
| Rate for Payer: United Healthcare All Other HMO |
$10,823.00
|
| Rate for Payer: United Healthcare HMO Rider |
$8,307.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$7,611.00
|
|
|
PENIS PROCEDURES WITHOUT CC/MCC
|
Facility
|
IP
|
$36,878.18
|
|
|
Service Code
|
MSDRG 710
|
| Min. Negotiated Rate |
$7,611.00 |
| Max. Negotiated Rate |
$36,878.18 |
| Rate for Payer: Aetna of CA HMO/PPO |
$36,878.18
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$23,821.80
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$33,351.36
|
| Rate for Payer: EPIC Health Plan Commercial |
$33,374.60
|
| Rate for Payer: EPIC Health Plan Senior |
$22,249.73
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$20,227.03
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$28,317.84
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$27,104.22
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$20,227.03
|
| Rate for Payer: Prime Health Services Medicare |
$21,440.65
|
| Rate for Payer: United Healthcare All Other Commercial |
$12,844.00
|
| Rate for Payer: United Healthcare All Other HMO |
$10,823.00
|
| Rate for Payer: United Healthcare HMO Rider |
$8,307.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$7,611.00
|
|
|
PENIS, TESTES AND SCROTAL PROCEDURES
|
Facility
|
IP
|
$13,251.36
|
|
|
Service Code
|
APR-DRG 4831
|
| Min. Negotiated Rate |
$8,369.28 |
| Max. Negotiated Rate |
$13,251.36 |
| Rate for Payer: Adventist Health Medi-Cal |
$8,369.28
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$9,973.39
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$13,251.36
|
|
|
PENIS, TESTES AND SCROTAL PROCEDURES
|
Facility
|
IP
|
$52,105.09
|
|
|
Service Code
|
APR-DRG 4834
|
| Min. Negotiated Rate |
$32,908.48 |
| Max. Negotiated Rate |
$52,105.09 |
| Rate for Payer: Adventist Health Medi-Cal |
$32,908.48
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$39,215.93
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$52,105.09
|
|
|
PENIS, TESTES AND SCROTAL PROCEDURES
|
Facility
|
IP
|
$31,818.16
|
|
|
Service Code
|
APR-DRG 4833
|
| Min. Negotiated Rate |
$20,095.68 |
| Max. Negotiated Rate |
$31,818.16 |
| Rate for Payer: Adventist Health Medi-Cal |
$20,095.68
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$23,947.35
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$31,818.16
|
|
|
PENIS, TESTES AND SCROTAL PROCEDURES
|
Facility
|
IP
|
$20,371.51
|
|
|
Service Code
|
APR-DRG 4832
|
| Min. Negotiated Rate |
$12,866.22 |
| Max. Negotiated Rate |
$20,371.51 |
| Rate for Payer: Adventist Health Medi-Cal |
$12,866.22
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$15,332.25
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$20,371.51
|
|
|
PENTAMIDINE 300 MG SOLUTION FOR INHALATION [28235]
|
Facility
|
OP
|
$173.40
|
|
|
Service Code
|
NDC 1392552201
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$34.68 |
| Max. Negotiated Rate |
$156.06 |
| Rate for Payer: Adventist Health Commercial |
$34.68
|
| Rate for Payer: Aetna of CA HMO/PPO |
$105.31
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$147.39
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$95.37
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$130.05
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$83.96
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$100.87
|
| Rate for Payer: Blue Shield of California Commercial |
$109.94
|
| Rate for Payer: Blue Shield of California EPN |
$69.19
|
| Rate for Payer: Cash Price |
$78.03
|
| Rate for Payer: Central Health Plan Commercial |
$138.72
|
| Rate for Payer: Cigna of CA HMO |
$121.38
|
| Rate for Payer: Cigna of CA PPO |
$121.38
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$147.39
|
| Rate for Payer: Dignity Health Medi-Cal |
$147.39
|
| Rate for Payer: Dignity Health Medicare Advantage |
$147.39
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$121.38
|
| Rate for Payer: EPIC Health Plan Commercial |
$69.36
|
| Rate for Payer: EPIC Health Plan Senior |
$69.36
|
| Rate for Payer: Galaxy Health WC |
$147.39
|
| Rate for Payer: Global Benefits Group Commercial |
$104.04
|
| Rate for Payer: Health Management Network EPO/PPO |
$156.06
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$110.11
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$62.94
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$102.31
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$34.68
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$121.38
|
| Rate for Payer: Multiplan Commercial |
$130.05
|
| Rate for Payer: Networks By Design Commercial |
$112.71
|
| Rate for Payer: Prime Health Services Commercial |
$147.39
|
| Rate for Payer: Riverside University Health System MISP |
$69.36
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$104.04
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$104.04
|
| Rate for Payer: United Healthcare All Other Commercial |
$86.70
|
| Rate for Payer: United Healthcare All Other HMO |
$86.70
|
| Rate for Payer: United Healthcare HMO Rider |
$86.70
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$86.70
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$147.39
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$147.39
|
| Rate for Payer: Vantage Medical Group Senior |
$147.39
|
|
|
PENTAMIDINE 300 MG SOLUTION FOR INHALATION [28235]
|
Facility
|
IP
|
$173.40
|
|
|
Service Code
|
NDC 0121110255
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$34.68 |
| Max. Negotiated Rate |
$156.06 |
| Rate for Payer: Adventist Health Commercial |
$34.68
|
| Rate for Payer: Blue Shield of California Commercial |
$139.07
|
| Rate for Payer: Blue Shield of California EPN |
$87.39
|
| Rate for Payer: Cash Price |
$78.03
|
| Rate for Payer: Central Health Plan Commercial |
$138.72
|
| Rate for Payer: Cigna of CA HMO |
$121.38
|
| Rate for Payer: Cigna of CA PPO |
$121.38
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$121.38
|
| Rate for Payer: EPIC Health Plan Commercial |
$69.36
|
| Rate for Payer: EPIC Health Plan Senior |
$69.36
|
| Rate for Payer: Galaxy Health WC |
$147.39
|
| Rate for Payer: Global Benefits Group Commercial |
$104.04
|
| Rate for Payer: Health Management Network EPO/PPO |
$156.06
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$110.11
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$102.31
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$34.68
|
| Rate for Payer: Multiplan Commercial |
$130.05
|
| Rate for Payer: Networks By Design Commercial |
$112.71
|
| Rate for Payer: Prime Health Services Commercial |
$147.39
|
|
|
PENTAMIDINE 300 MG SOLUTION FOR INHALATION [28235]
|
Facility
|
OP
|
$108.00
|
|
|
Service Code
|
NDC 3982230302
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$21.60 |
| Max. Negotiated Rate |
$97.20 |
| Rate for Payer: Adventist Health Commercial |
$21.60
|
| Rate for Payer: Aetna of CA HMO/PPO |
$65.59
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$91.80
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$59.40
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$81.00
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$52.29
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$62.82
|
| Rate for Payer: Blue Shield of California Commercial |
$68.47
|
| Rate for Payer: Blue Shield of California EPN |
$43.09
|
| Rate for Payer: Cash Price |
$48.60
|
| Rate for Payer: Central Health Plan Commercial |
$86.40
|
| Rate for Payer: Cigna of CA HMO |
$75.60
|
| Rate for Payer: Cigna of CA PPO |
$75.60
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$91.80
|
| Rate for Payer: Dignity Health Medi-Cal |
$91.80
|
| Rate for Payer: Dignity Health Medicare Advantage |
$91.80
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$75.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$43.20
|
| Rate for Payer: EPIC Health Plan Senior |
$43.20
|
| Rate for Payer: Galaxy Health WC |
$91.80
|
| Rate for Payer: Global Benefits Group Commercial |
$64.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$97.20
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$68.58
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$39.20
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$63.72
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$21.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$75.60
|
| Rate for Payer: Multiplan Commercial |
$81.00
|
| Rate for Payer: Networks By Design Commercial |
$70.20
|
| Rate for Payer: Prime Health Services Commercial |
$91.80
|
| Rate for Payer: Riverside University Health System MISP |
$43.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$64.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$64.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$54.00
|
| Rate for Payer: United Healthcare All Other HMO |
$54.00
|
| Rate for Payer: United Healthcare HMO Rider |
$54.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$54.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$91.80
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$91.80
|
| Rate for Payer: Vantage Medical Group Senior |
$91.80
|
|
|
PENTAMIDINE 300 MG SOLUTION FOR INHALATION [28235]
|
Facility
|
OP
|
$173.40
|
|
|
Service Code
|
NDC 0121110255
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$34.68 |
| Max. Negotiated Rate |
$156.06 |
| Rate for Payer: Adventist Health Commercial |
$34.68
|
| Rate for Payer: Aetna of CA HMO/PPO |
$105.31
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$147.39
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$95.37
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$130.05
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$83.96
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$100.87
|
| Rate for Payer: Blue Shield of California Commercial |
$109.94
|
| Rate for Payer: Blue Shield of California EPN |
$69.19
|
| Rate for Payer: Cash Price |
$78.03
|
| Rate for Payer: Central Health Plan Commercial |
$138.72
|
| Rate for Payer: Cigna of CA HMO |
$121.38
|
| Rate for Payer: Cigna of CA PPO |
$121.38
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$147.39
|
| Rate for Payer: Dignity Health Medi-Cal |
$147.39
|
| Rate for Payer: Dignity Health Medicare Advantage |
$147.39
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$121.38
|
| Rate for Payer: EPIC Health Plan Commercial |
$69.36
|
| Rate for Payer: EPIC Health Plan Senior |
$69.36
|
| Rate for Payer: Galaxy Health WC |
$147.39
|
| Rate for Payer: Global Benefits Group Commercial |
$104.04
|
| Rate for Payer: Health Management Network EPO/PPO |
$156.06
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$110.11
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$62.94
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$102.31
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$34.68
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$121.38
|
| Rate for Payer: Multiplan Commercial |
$130.05
|
| Rate for Payer: Networks By Design Commercial |
$112.71
|
| Rate for Payer: Prime Health Services Commercial |
$147.39
|
| Rate for Payer: Riverside University Health System MISP |
$69.36
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$104.04
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$104.04
|
| Rate for Payer: United Healthcare All Other Commercial |
$86.70
|
| Rate for Payer: United Healthcare All Other HMO |
$86.70
|
| Rate for Payer: United Healthcare HMO Rider |
$86.70
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$86.70
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$147.39
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$147.39
|
| Rate for Payer: Vantage Medical Group Senior |
$147.39
|
|
|
PENTAMIDINE 300 MG SOLUTION FOR INHALATION [28235]
|
Facility
|
IP
|
$173.40
|
|
|
Service Code
|
NDC 1392552201
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$34.68 |
| Max. Negotiated Rate |
$156.06 |
| Rate for Payer: Adventist Health Commercial |
$34.68
|
| Rate for Payer: Blue Shield of California Commercial |
$139.07
|
| Rate for Payer: Blue Shield of California EPN |
$87.39
|
| Rate for Payer: Cash Price |
$78.03
|
| Rate for Payer: Central Health Plan Commercial |
$138.72
|
| Rate for Payer: Cigna of CA HMO |
$121.38
|
| Rate for Payer: Cigna of CA PPO |
$121.38
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$121.38
|
| Rate for Payer: EPIC Health Plan Commercial |
$69.36
|
| Rate for Payer: EPIC Health Plan Senior |
$69.36
|
| Rate for Payer: Galaxy Health WC |
$147.39
|
| Rate for Payer: Global Benefits Group Commercial |
$104.04
|
| Rate for Payer: Health Management Network EPO/PPO |
$156.06
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$110.11
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$102.31
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$34.68
|
| Rate for Payer: Multiplan Commercial |
$130.05
|
| Rate for Payer: Networks By Design Commercial |
$112.71
|
| Rate for Payer: Prime Health Services Commercial |
$147.39
|
|
|
PENTAMIDINE 300 MG SOLUTION FOR INHALATION [28235]
|
Facility
|
OP
|
$108.00
|
|
|
Service Code
|
NDC 3982230301
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$21.60 |
| Max. Negotiated Rate |
$97.20 |
| Rate for Payer: Adventist Health Commercial |
$21.60
|
| Rate for Payer: Aetna of CA HMO/PPO |
$65.59
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$91.80
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$59.40
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$81.00
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$52.29
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$62.82
|
| Rate for Payer: Blue Shield of California Commercial |
$68.47
|
| Rate for Payer: Blue Shield of California EPN |
$43.09
|
| Rate for Payer: Cash Price |
$48.60
|
| Rate for Payer: Central Health Plan Commercial |
$86.40
|
| Rate for Payer: Cigna of CA HMO |
$75.60
|
| Rate for Payer: Cigna of CA PPO |
$75.60
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$91.80
|
| Rate for Payer: Dignity Health Medi-Cal |
$91.80
|
| Rate for Payer: Dignity Health Medicare Advantage |
$91.80
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$75.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$43.20
|
| Rate for Payer: EPIC Health Plan Senior |
$43.20
|
| Rate for Payer: Galaxy Health WC |
$91.80
|
| Rate for Payer: Global Benefits Group Commercial |
$64.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$97.20
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$68.58
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$39.20
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$63.72
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$21.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$75.60
|
| Rate for Payer: Multiplan Commercial |
$81.00
|
| Rate for Payer: Networks By Design Commercial |
$70.20
|
| Rate for Payer: Prime Health Services Commercial |
$91.80
|
| Rate for Payer: Riverside University Health System MISP |
$43.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$64.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$64.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$54.00
|
| Rate for Payer: United Healthcare All Other HMO |
$54.00
|
| Rate for Payer: United Healthcare HMO Rider |
$54.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$54.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$91.80
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$91.80
|
| Rate for Payer: Vantage Medical Group Senior |
$91.80
|
|
|
PENTAMIDINE 300 MG SOLUTION FOR INHALATION [28235]
|
Facility
|
IP
|
$108.00
|
|
|
Service Code
|
NDC 3982230302
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$21.60 |
| Max. Negotiated Rate |
$97.20 |
| Rate for Payer: Adventist Health Commercial |
$21.60
|
| Rate for Payer: Blue Shield of California Commercial |
$86.62
|
| Rate for Payer: Blue Shield of California EPN |
$54.43
|
| Rate for Payer: Cash Price |
$48.60
|
| Rate for Payer: Central Health Plan Commercial |
$86.40
|
| Rate for Payer: Cigna of CA HMO |
$75.60
|
| Rate for Payer: Cigna of CA PPO |
$75.60
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$75.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$43.20
|
| Rate for Payer: EPIC Health Plan Senior |
$43.20
|
| Rate for Payer: Galaxy Health WC |
$91.80
|
| Rate for Payer: Global Benefits Group Commercial |
$64.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$97.20
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$68.58
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$63.72
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$21.60
|
| Rate for Payer: Multiplan Commercial |
$81.00
|
| Rate for Payer: Networks By Design Commercial |
$70.20
|
| Rate for Payer: Prime Health Services Commercial |
$91.80
|
|
|
PENTAMIDINE 300 MG SOLUTION FOR INHALATION [28235]
|
Facility
|
IP
|
$108.00
|
|
|
Service Code
|
NDC 3982230301
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$21.60 |
| Max. Negotiated Rate |
$97.20 |
| Rate for Payer: Adventist Health Commercial |
$21.60
|
| Rate for Payer: Blue Shield of California Commercial |
$86.62
|
| Rate for Payer: Blue Shield of California EPN |
$54.43
|
| Rate for Payer: Cash Price |
$48.60
|
| Rate for Payer: Central Health Plan Commercial |
$86.40
|
| Rate for Payer: Cigna of CA HMO |
$75.60
|
| Rate for Payer: Cigna of CA PPO |
$75.60
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$75.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$43.20
|
| Rate for Payer: EPIC Health Plan Senior |
$43.20
|
| Rate for Payer: Galaxy Health WC |
$91.80
|
| Rate for Payer: Global Benefits Group Commercial |
$64.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$97.20
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$68.58
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$63.72
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$21.60
|
| Rate for Payer: Multiplan Commercial |
$81.00
|
| Rate for Payer: Networks By Design Commercial |
$70.20
|
| Rate for Payer: Prime Health Services Commercial |
$91.80
|
|
|
PENTAMIDINE 300 MG SOLUTION FOR INJECTION [27430]
|
Facility
|
OP
|
$200.27
|
|
|
Service Code
|
HCPCS J2516
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.16 |
| Max. Negotiated Rate |
$180.24 |
| Rate for Payer: Adventist Health Commercial |
$40.05
|
| Rate for Payer: Aetna of CA HMO/PPO |
$121.62
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$170.23
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$110.15
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$150.20
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$0.64
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.80
|
| Rate for Payer: Blue Shield of California Commercial |
$126.97
|
| Rate for Payer: Blue Shield of California EPN |
$79.91
|
| Rate for Payer: Cash Price |
$90.12
|
| Rate for Payer: Cash Price |
$90.12
|
| Rate for Payer: Central Health Plan Commercial |
$160.22
|
| Rate for Payer: Cigna of CA HMO |
$140.19
|
| Rate for Payer: Cigna of CA PPO |
$140.19
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$170.23
|
| Rate for Payer: Dignity Health Medi-Cal |
$170.23
|
| Rate for Payer: Dignity Health Medicare Advantage |
$170.23
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$140.19
|
| Rate for Payer: EPIC Health Plan Commercial |
$80.11
|
| Rate for Payer: EPIC Health Plan Senior |
$80.11
|
| Rate for Payer: Galaxy Health WC |
$170.23
|
| Rate for Payer: Global Benefits Group Commercial |
$120.16
|
| Rate for Payer: Health Management Network EPO/PPO |
$180.24
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$0.16
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$127.17
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$8.93
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$118.16
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$40.05
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$140.19
|
| Rate for Payer: Multiplan Commercial |
$150.20
|
| Rate for Payer: Networks By Design Commercial |
$100.14
|
| Rate for Payer: Prime Health Services Commercial |
$170.23
|
| Rate for Payer: Riverside University Health System MISP |
$80.11
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$120.16
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$120.16
|
| Rate for Payer: United Healthcare All Other Commercial |
$75.16
|
| Rate for Payer: United Healthcare All Other HMO |
$73.16
|
| Rate for Payer: United Healthcare HMO Rider |
$71.58
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$65.59
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$170.23
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$170.23
|
| Rate for Payer: Vantage Medical Group Senior |
$170.23
|
|
|
PENTAMIDINE 300 MG SOLUTION FOR INJECTION [27430]
|
Facility
|
IP
|
$200.27
|
|
|
Service Code
|
HCPCS J2516
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$40.05 |
| Max. Negotiated Rate |
$180.24 |
| Rate for Payer: Adventist Health Commercial |
$40.05
|
| Rate for Payer: Blue Shield of California Commercial |
$160.62
|
| Rate for Payer: Blue Shield of California EPN |
$100.94
|
| Rate for Payer: Cash Price |
$90.12
|
| Rate for Payer: Central Health Plan Commercial |
$160.22
|
| Rate for Payer: Cigna of CA HMO |
$140.19
|
| Rate for Payer: Cigna of CA PPO |
$140.19
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$140.19
|
| Rate for Payer: EPIC Health Plan Commercial |
$80.11
|
| Rate for Payer: EPIC Health Plan Senior |
$80.11
|
| Rate for Payer: Galaxy Health WC |
$170.23
|
| Rate for Payer: Global Benefits Group Commercial |
$120.16
|
| Rate for Payer: Health Management Network EPO/PPO |
$180.24
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$127.17
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$118.16
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$40.05
|
| Rate for Payer: Multiplan Commercial |
$150.20
|
| Rate for Payer: Networks By Design Commercial |
$100.14
|
| Rate for Payer: Prime Health Services Commercial |
$170.23
|
| Rate for Payer: United Healthcare All Other Commercial |
$75.16
|
| Rate for Payer: United Healthcare All Other HMO |
$73.16
|
| Rate for Payer: United Healthcare HMO Rider |
$71.58
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$65.59
|
|
