|
PIOGLITAZONE 30 MG TABLET [25529]
|
Facility
|
IP
|
$0.22
|
|
|
Service Code
|
NDC 3334205507
|
| 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
|
|
|
PIPERACILLIN-TAZOBACTAM 2.25 GRAM/50 ML IN DEXTROSE(ISO) IV PIGGYBACK [34523]
|
Facility
|
OP
|
$0.36
|
|
|
Service Code
|
HCPCS J2543
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.07 |
| Max. Negotiated Rate |
$12.49 |
| Rate for Payer: Adventist Health Commercial |
$0.07
|
| Rate for Payer: Aetna of CA HMO/PPO |
$6.93
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.31
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.20
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.27
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$10.01
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$12.49
|
| Rate for Payer: Blue Shield of California Commercial |
$2.31
|
| Rate for Payer: Blue Shield of California EPN |
$2.10
|
| Rate for Payer: Cash Price |
$0.16
|
| Rate for Payer: Cash Price |
$0.16
|
| Rate for Payer: Central Health Plan Commercial |
$0.29
|
| Rate for Payer: Cigna of CA HMO |
$0.25
|
| Rate for Payer: Cigna of CA PPO |
$0.25
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.31
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.31
|
| Rate for Payer: Dignity Health Medicare Advantage |
$0.31
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$0.25
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.14
|
| Rate for Payer: EPIC Health Plan Senior |
$0.14
|
| Rate for Payer: Galaxy Health WC |
$0.31
|
| Rate for Payer: Global Benefits Group Commercial |
$0.22
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.32
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$1.22
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$0.23
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.13
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$0.21
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.07
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$0.25
|
| Rate for Payer: Multiplan Commercial |
$0.27
|
| Rate for Payer: Networks By Design Commercial |
$0.18
|
| Rate for Payer: Prime Health Services Commercial |
$0.31
|
| Rate for Payer: Riverside University Health System MISP |
$0.14
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.22
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.22
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.14
|
| Rate for Payer: United Healthcare All Other HMO |
$0.13
|
| Rate for Payer: United Healthcare HMO Rider |
$0.13
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.12
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.31
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.31
|
| Rate for Payer: Vantage Medical Group Senior |
$0.31
|
|
|
PIPERACILLIN-TAZOBACTAM 2.25 GRAM/50 ML IN DEXTROSE(ISO) IV PIGGYBACK [34523]
|
Facility
|
IP
|
$0.36
|
|
|
Service Code
|
HCPCS J2543
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.07 |
| Max. Negotiated Rate |
$0.32 |
| Rate for Payer: Adventist Health Commercial |
$0.07
|
| Rate for Payer: Blue Shield of California Commercial |
$0.29
|
| Rate for Payer: Blue Shield of California EPN |
$0.18
|
| Rate for Payer: Cash Price |
$0.16
|
| Rate for Payer: Central Health Plan Commercial |
$0.29
|
| Rate for Payer: Cigna of CA HMO |
$0.25
|
| Rate for Payer: Cigna of CA PPO |
$0.25
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$0.25
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.14
|
| Rate for Payer: EPIC Health Plan Senior |
$0.14
|
| Rate for Payer: Galaxy Health WC |
$0.31
|
| Rate for Payer: Global Benefits Group Commercial |
$0.22
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.32
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$0.23
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$0.21
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.07
|
| Rate for Payer: Multiplan Commercial |
$0.27
|
| Rate for Payer: Networks By Design Commercial |
$0.18
|
| Rate for Payer: Prime Health Services Commercial |
$0.31
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.14
|
| Rate for Payer: United Healthcare All Other HMO |
$0.13
|
| Rate for Payer: United Healthcare HMO Rider |
$0.13
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.12
|
|
|
PIPERACILLIN-TAZOBACTAM 2.25 GRAM/50 ML INTRAVENOUS PIGGYBACK [248263]
|
Facility
|
IP
|
$21.10
|
|
|
Service Code
|
HCPCS J2543
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$4.22 |
| Max. Negotiated Rate |
$18.99 |
| Rate for Payer: Adventist Health Commercial |
$4.22
|
| Rate for Payer: Blue Shield of California Commercial |
$16.92
|
| Rate for Payer: Blue Shield of California EPN |
$10.63
|
| Rate for Payer: Cash Price |
$9.50
|
| Rate for Payer: Central Health Plan Commercial |
$16.88
|
| Rate for Payer: Cigna of CA HMO |
$14.77
|
| Rate for Payer: Cigna of CA PPO |
$14.77
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$14.77
|
| Rate for Payer: EPIC Health Plan Commercial |
$8.44
|
| Rate for Payer: EPIC Health Plan Senior |
$8.44
|
| Rate for Payer: Galaxy Health WC |
$17.93
|
| Rate for Payer: Global Benefits Group Commercial |
$12.66
|
| Rate for Payer: Health Management Network EPO/PPO |
$18.99
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$13.40
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$12.45
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.22
|
| Rate for Payer: Multiplan Commercial |
$15.82
|
| Rate for Payer: Networks By Design Commercial |
$10.55
|
| Rate for Payer: Prime Health Services Commercial |
$17.93
|
| Rate for Payer: United Healthcare All Other Commercial |
$7.92
|
| Rate for Payer: United Healthcare All Other HMO |
$7.71
|
| Rate for Payer: United Healthcare HMO Rider |
$7.54
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$6.91
|
|
|
PIPERACILLIN-TAZOBACTAM 2.25 GRAM/50 ML INTRAVENOUS PIGGYBACK [248263]
|
Facility
|
OP
|
$21.10
|
|
|
Service Code
|
HCPCS J2543
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.22 |
| Max. Negotiated Rate |
$18.99 |
| Rate for Payer: Adventist Health Commercial |
$4.22
|
| Rate for Payer: Aetna of CA HMO/PPO |
$6.93
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$17.93
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$11.61
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$15.82
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$10.01
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$12.49
|
| Rate for Payer: Blue Shield of California Commercial |
$2.31
|
| Rate for Payer: Blue Shield of California EPN |
$2.10
|
| Rate for Payer: Cash Price |
$9.50
|
| Rate for Payer: Cash Price |
$9.50
|
| Rate for Payer: Central Health Plan Commercial |
$16.88
|
| Rate for Payer: Cigna of CA HMO |
$14.77
|
| Rate for Payer: Cigna of CA PPO |
$14.77
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$17.93
|
| Rate for Payer: Dignity Health Medi-Cal |
$17.93
|
| Rate for Payer: Dignity Health Medicare Advantage |
$17.93
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$14.77
|
| Rate for Payer: EPIC Health Plan Commercial |
$8.44
|
| Rate for Payer: EPIC Health Plan Senior |
$8.44
|
| Rate for Payer: Galaxy Health WC |
$17.93
|
| Rate for Payer: Global Benefits Group Commercial |
$12.66
|
| Rate for Payer: Health Management Network EPO/PPO |
$18.99
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$1.22
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$13.40
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$7.66
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$12.45
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.22
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$14.77
|
| Rate for Payer: Multiplan Commercial |
$15.82
|
| Rate for Payer: Networks By Design Commercial |
$10.55
|
| Rate for Payer: Prime Health Services Commercial |
$17.93
|
| Rate for Payer: Riverside University Health System MISP |
$8.44
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$12.66
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$12.66
|
| Rate for Payer: United Healthcare All Other Commercial |
$7.92
|
| Rate for Payer: United Healthcare All Other HMO |
$7.71
|
| Rate for Payer: United Healthcare HMO Rider |
$7.54
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$6.91
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$17.93
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$17.93
|
| Rate for Payer: Vantage Medical Group Senior |
$17.93
|
|
|
PIPERACILLIN-TAZOBACTAM 2.25 GRAM INTRAVENOUS SOLUTION [18304]
|
Facility
|
IP
|
$3.96
|
|
|
Service Code
|
HCPCS J2543
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.79 |
| Max. Negotiated Rate |
$3.56 |
| Rate for Payer: Adventist Health Commercial |
$0.79
|
| Rate for Payer: Adventist Health Commercial |
$0.72
|
| Rate for Payer: Adventist Health Commercial |
$0.72
|
| Rate for Payer: Adventist Health Commercial |
$2.22
|
| Rate for Payer: Adventist Health Commercial |
$0.82
|
| Rate for Payer: Blue Shield of California Commercial |
$2.88
|
| Rate for Payer: Blue Shield of California Commercial |
$3.30
|
| Rate for Payer: Blue Shield of California Commercial |
$3.18
|
| Rate for Payer: Blue Shield of California Commercial |
$8.90
|
| Rate for Payer: Blue Shield of California Commercial |
$2.89
|
| Rate for Payer: Blue Shield of California EPN |
$2.00
|
| Rate for Payer: Blue Shield of California EPN |
$1.81
|
| Rate for Payer: Blue Shield of California EPN |
$2.08
|
| Rate for Payer: Blue Shield of California EPN |
$1.81
|
| Rate for Payer: Blue Shield of California EPN |
$5.59
|
| Rate for Payer: Cash Price |
$1.62
|
| Rate for Payer: Cash Price |
$1.62
|
| Rate for Payer: Cash Price |
$1.78
|
| Rate for Payer: Cash Price |
$1.85
|
| Rate for Payer: Cash Price |
$5.00
|
| Rate for Payer: Central Health Plan Commercial |
$3.30
|
| Rate for Payer: Central Health Plan Commercial |
$2.87
|
| Rate for Payer: Central Health Plan Commercial |
$8.88
|
| Rate for Payer: Central Health Plan Commercial |
$2.88
|
| Rate for Payer: Central Health Plan Commercial |
$3.17
|
| Rate for Payer: Cigna of CA HMO |
$2.88
|
| Rate for Payer: Cigna of CA HMO |
$2.52
|
| Rate for Payer: Cigna of CA HMO |
$7.77
|
| Rate for Payer: Cigna of CA HMO |
$2.51
|
| Rate for Payer: Cigna of CA HMO |
$2.77
|
| Rate for Payer: Cigna of CA PPO |
$2.51
|
| Rate for Payer: Cigna of CA PPO |
$7.77
|
| Rate for Payer: Cigna of CA PPO |
$2.88
|
| Rate for Payer: Cigna of CA PPO |
$2.77
|
| Rate for Payer: Cigna of CA PPO |
$2.52
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$2.52
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$2.88
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$2.77
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$2.51
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$7.77
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.44
|
| Rate for Payer: EPIC Health Plan Commercial |
$4.44
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.58
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.65
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.44
|
| Rate for Payer: EPIC Health Plan Senior |
$1.44
|
| Rate for Payer: EPIC Health Plan Senior |
$4.44
|
| Rate for Payer: EPIC Health Plan Senior |
$1.44
|
| Rate for Payer: EPIC Health Plan Senior |
$1.65
|
| Rate for Payer: EPIC Health Plan Senior |
$1.58
|
| Rate for Payer: Galaxy Health WC |
$3.37
|
| Rate for Payer: Galaxy Health WC |
$9.44
|
| Rate for Payer: Galaxy Health WC |
$3.50
|
| Rate for Payer: Galaxy Health WC |
$3.06
|
| Rate for Payer: Galaxy Health WC |
$3.05
|
| Rate for Payer: Global Benefits Group Commercial |
$2.47
|
| Rate for Payer: Global Benefits Group Commercial |
$2.38
|
| Rate for Payer: Global Benefits Group Commercial |
$6.66
|
| Rate for Payer: Global Benefits Group Commercial |
$2.16
|
| Rate for Payer: Global Benefits Group Commercial |
$2.15
|
| Rate for Payer: Health Management Network EPO/PPO |
$3.71
|
| Rate for Payer: Health Management Network EPO/PPO |
$3.23
|
| Rate for Payer: Health Management Network EPO/PPO |
$3.24
|
| Rate for Payer: Health Management Network EPO/PPO |
$9.99
|
| Rate for Payer: Health Management Network EPO/PPO |
$3.56
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$2.51
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$7.05
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$2.29
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$2.28
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$2.62
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2.12
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2.12
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$6.55
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2.34
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2.43
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.22
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.72
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.72
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.82
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.79
|
| Rate for Payer: Multiplan Commercial |
$3.09
|
| Rate for Payer: Multiplan Commercial |
$2.70
|
| Rate for Payer: Multiplan Commercial |
$2.69
|
| Rate for Payer: Multiplan Commercial |
$2.97
|
| Rate for Payer: Multiplan Commercial |
$8.32
|
| Rate for Payer: Networks By Design Commercial |
$5.55
|
| Rate for Payer: Networks By Design Commercial |
$2.06
|
| Rate for Payer: Networks By Design Commercial |
$1.98
|
| Rate for Payer: Networks By Design Commercial |
$1.79
|
| Rate for Payer: Networks By Design Commercial |
$1.80
|
| Rate for Payer: Prime Health Services Commercial |
$3.50
|
| Rate for Payer: Prime Health Services Commercial |
$3.05
|
| Rate for Payer: Prime Health Services Commercial |
$3.06
|
| Rate for Payer: Prime Health Services Commercial |
$9.44
|
| Rate for Payer: Prime Health Services Commercial |
$3.37
|
| Rate for Payer: United Healthcare All Other Commercial |
$1.35
|
| Rate for Payer: United Healthcare All Other Commercial |
$1.55
|
| Rate for Payer: United Healthcare All Other Commercial |
$4.17
|
| Rate for Payer: United Healthcare All Other Commercial |
$1.35
|
| Rate for Payer: United Healthcare All Other Commercial |
$1.49
|
| Rate for Payer: United Healthcare All Other HMO |
$1.32
|
| Rate for Payer: United Healthcare All Other HMO |
$1.31
|
| Rate for Payer: United Healthcare All Other HMO |
$4.05
|
| Rate for Payer: United Healthcare All Other HMO |
$1.45
|
| Rate for Payer: United Healthcare All Other HMO |
$1.51
|
| Rate for Payer: United Healthcare HMO Rider |
$1.47
|
| Rate for Payer: United Healthcare HMO Rider |
$3.97
|
| Rate for Payer: United Healthcare HMO Rider |
$1.29
|
| Rate for Payer: United Healthcare HMO Rider |
$1.28
|
| Rate for Payer: United Healthcare HMO Rider |
$1.42
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1.30
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1.35
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1.18
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3.64
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1.18
|
|
|
PIPERACILLIN-TAZOBACTAM 2.25 GRAM INTRAVENOUS SOLUTION [18304]
|
Facility
|
OP
|
$3.60
|
|
|
Service Code
|
HCPCS J2543
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.72 |
| Max. Negotiated Rate |
$12.49 |
| Rate for Payer: Adventist Health Commercial |
$0.72
|
| Rate for Payer: Adventist Health Commercial |
$2.22
|
| Rate for Payer: Adventist Health Commercial |
$0.79
|
| Rate for Payer: Adventist Health Commercial |
$0.72
|
| Rate for Payer: Adventist Health Commercial |
$0.82
|
| Rate for Payer: Aetna of CA HMO/PPO |
$6.93
|
| Rate for Payer: Aetna of CA HMO/PPO |
$6.93
|
| Rate for Payer: Aetna of CA HMO/PPO |
$6.93
|
| Rate for Payer: Aetna of CA HMO/PPO |
$6.93
|
| Rate for Payer: Aetna of CA HMO/PPO |
$6.93
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3.50
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3.06
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$9.44
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3.05
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3.37
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2.27
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$6.11
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1.97
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1.98
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2.18
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$3.09
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2.70
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$8.32
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2.69
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2.97
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$10.01
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$10.01
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$10.01
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$10.01
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$10.01
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$12.49
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$12.49
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$12.49
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$12.49
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$12.49
|
| Rate for Payer: Blue Shield of California Commercial |
$2.31
|
| Rate for Payer: Blue Shield of California Commercial |
$2.31
|
| Rate for Payer: Blue Shield of California Commercial |
$2.31
|
| Rate for Payer: Blue Shield of California Commercial |
$2.31
|
| Rate for Payer: Blue Shield of California Commercial |
$2.31
|
| Rate for Payer: Blue Shield of California EPN |
$2.10
|
| Rate for Payer: Blue Shield of California EPN |
$2.10
|
| Rate for Payer: Blue Shield of California EPN |
$2.10
|
| Rate for Payer: Blue Shield of California EPN |
$2.10
|
| Rate for Payer: Blue Shield of California EPN |
$2.10
|
| Rate for Payer: Cash Price |
$5.00
|
| Rate for Payer: Cash Price |
$1.62
|
| Rate for Payer: Cash Price |
$1.62
|
| Rate for Payer: Cash Price |
$1.85
|
| Rate for Payer: Cash Price |
$1.78
|
| Rate for Payer: Cash Price |
$1.62
|
| Rate for Payer: Cash Price |
$5.00
|
| Rate for Payer: Cash Price |
$1.78
|
| Rate for Payer: Cash Price |
$1.62
|
| Rate for Payer: Cash Price |
$1.85
|
| Rate for Payer: Central Health Plan Commercial |
$2.88
|
| Rate for Payer: Central Health Plan Commercial |
$8.88
|
| Rate for Payer: Central Health Plan Commercial |
$3.17
|
| Rate for Payer: Central Health Plan Commercial |
$2.87
|
| Rate for Payer: Central Health Plan Commercial |
$3.30
|
| Rate for Payer: Cigna of CA HMO |
$7.77
|
| Rate for Payer: Cigna of CA HMO |
$2.51
|
| Rate for Payer: Cigna of CA HMO |
$2.88
|
| Rate for Payer: Cigna of CA HMO |
$2.77
|
| Rate for Payer: Cigna of CA HMO |
$2.52
|
| Rate for Payer: Cigna of CA PPO |
$2.51
|
| Rate for Payer: Cigna of CA PPO |
$2.88
|
| Rate for Payer: Cigna of CA PPO |
$2.52
|
| Rate for Payer: Cigna of CA PPO |
$2.77
|
| Rate for Payer: Cigna of CA PPO |
$7.77
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3.37
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3.06
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$9.44
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3.05
|
| Rate for Payer: Dignity Health Medi-Cal |
$3.37
|
| Rate for Payer: Dignity Health Medi-Cal |
$3.05
|
| Rate for Payer: Dignity Health Medi-Cal |
$9.44
|
| Rate for Payer: Dignity Health Medi-Cal |
$3.50
|
| Rate for Payer: Dignity Health Medi-Cal |
$3.06
|
| Rate for Payer: Dignity Health Medicare Advantage |
$3.06
|
| Rate for Payer: Dignity Health Medicare Advantage |
$9.44
|
| Rate for Payer: Dignity Health Medicare Advantage |
$3.50
|
| Rate for Payer: Dignity Health Medicare Advantage |
$3.37
|
| Rate for Payer: Dignity Health Medicare Advantage |
$3.05
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$2.77
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$2.88
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$2.51
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$7.77
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$2.52
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.44
|
| Rate for Payer: EPIC Health Plan Commercial |
$4.44
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.65
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.58
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.44
|
| Rate for Payer: EPIC Health Plan Senior |
$1.44
|
| Rate for Payer: EPIC Health Plan Senior |
$1.44
|
| Rate for Payer: EPIC Health Plan Senior |
$4.44
|
| Rate for Payer: EPIC Health Plan Senior |
$1.58
|
| Rate for Payer: EPIC Health Plan Senior |
$1.65
|
| Rate for Payer: Galaxy Health WC |
$3.06
|
| Rate for Payer: Galaxy Health WC |
$9.44
|
| Rate for Payer: Galaxy Health WC |
$3.05
|
| Rate for Payer: Galaxy Health WC |
$3.37
|
| Rate for Payer: Galaxy Health WC |
$3.50
|
| Rate for Payer: Global Benefits Group Commercial |
$2.15
|
| Rate for Payer: Global Benefits Group Commercial |
$2.38
|
| Rate for Payer: Global Benefits Group Commercial |
$2.47
|
| Rate for Payer: Global Benefits Group Commercial |
$6.66
|
| Rate for Payer: Global Benefits Group Commercial |
$2.16
|
| Rate for Payer: Health Management Network EPO/PPO |
$3.71
|
| Rate for Payer: Health Management Network EPO/PPO |
$3.23
|
| Rate for Payer: Health Management Network EPO/PPO |
$3.24
|
| Rate for Payer: Health Management Network EPO/PPO |
$3.56
|
| Rate for Payer: Health Management Network EPO/PPO |
$9.99
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$1.22
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$1.22
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$1.22
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$1.22
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$1.22
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$2.51
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$7.05
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$2.28
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$2.29
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$2.62
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1.50
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1.31
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1.30
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1.44
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$4.03
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2.34
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2.12
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2.43
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2.12
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$6.55
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.79
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.72
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.82
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.72
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.22
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$2.88
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$2.51
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$7.77
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$2.52
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$2.77
|
| Rate for Payer: Multiplan Commercial |
$2.69
|
| Rate for Payer: Multiplan Commercial |
$3.09
|
| Rate for Payer: Multiplan Commercial |
$2.97
|
| Rate for Payer: Multiplan Commercial |
$2.70
|
| Rate for Payer: Multiplan Commercial |
$8.32
|
| Rate for Payer: Networks By Design Commercial |
$5.55
|
| Rate for Payer: Networks By Design Commercial |
$1.98
|
| Rate for Payer: Networks By Design Commercial |
$1.79
|
| Rate for Payer: Networks By Design Commercial |
$2.06
|
| Rate for Payer: Networks By Design Commercial |
$1.80
|
| Rate for Payer: Prime Health Services Commercial |
$3.05
|
| Rate for Payer: Prime Health Services Commercial |
$9.44
|
| Rate for Payer: Prime Health Services Commercial |
$3.37
|
| Rate for Payer: Prime Health Services Commercial |
$3.50
|
| Rate for Payer: Prime Health Services Commercial |
$3.06
|
| Rate for Payer: Riverside University Health System MISP |
$1.65
|
| Rate for Payer: Riverside University Health System MISP |
$1.44
|
| Rate for Payer: Riverside University Health System MISP |
$4.44
|
| Rate for Payer: Riverside University Health System MISP |
$1.58
|
| Rate for Payer: Riverside University Health System MISP |
$1.44
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$6.66
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2.38
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2.15
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2.16
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2.47
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2.15
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2.16
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2.38
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$6.66
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2.47
|
| Rate for Payer: United Healthcare All Other Commercial |
$1.49
|
| Rate for Payer: United Healthcare All Other Commercial |
$4.17
|
| Rate for Payer: United Healthcare All Other Commercial |
$1.35
|
| Rate for Payer: United Healthcare All Other Commercial |
$1.55
|
| Rate for Payer: United Healthcare All Other Commercial |
$1.35
|
| Rate for Payer: United Healthcare All Other HMO |
$1.31
|
| Rate for Payer: United Healthcare All Other HMO |
$1.45
|
| Rate for Payer: United Healthcare All Other HMO |
$4.05
|
| Rate for Payer: United Healthcare All Other HMO |
$1.32
|
| Rate for Payer: United Healthcare All Other HMO |
$1.51
|
| Rate for Payer: United Healthcare HMO Rider |
$1.29
|
| Rate for Payer: United Healthcare HMO Rider |
$1.42
|
| Rate for Payer: United Healthcare HMO Rider |
$1.28
|
| Rate for Payer: United Healthcare HMO Rider |
$1.47
|
| Rate for Payer: United Healthcare HMO Rider |
$3.97
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1.18
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3.64
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1.30
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1.18
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1.35
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3.05
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3.37
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$9.44
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3.06
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$3.06
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$9.44
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$3.05
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$3.37
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$3.50
|
| Rate for Payer: Vantage Medical Group Senior |
$3.37
|
| Rate for Payer: Vantage Medical Group Senior |
$3.05
|
| Rate for Payer: Vantage Medical Group Senior |
$3.06
|
| Rate for Payer: Vantage Medical Group Senior |
$3.50
|
| Rate for Payer: Vantage Medical Group Senior |
$9.44
|
|
|
PIPERACILLIN-TAZOBACTAM 3.375 GRAM/50 ML DEXTROSE(ISO-OS) IV PIGGYBACK [34524]
|
Facility
|
OP
|
$0.48
|
|
|
Service Code
|
HCPCS J2543
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.10 |
| Max. Negotiated Rate |
$12.49 |
| Rate for Payer: Adventist Health Commercial |
$0.10
|
| Rate for Payer: Adventist Health Commercial |
$0.10
|
| Rate for Payer: Aetna of CA HMO/PPO |
$6.93
|
| Rate for Payer: Aetna of CA HMO/PPO |
$6.93
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.41
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.42
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.27
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.26
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.37
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.36
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$10.01
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$10.01
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$12.49
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$12.49
|
| Rate for Payer: Blue Shield of California Commercial |
$2.31
|
| Rate for Payer: Blue Shield of California Commercial |
$2.31
|
| Rate for Payer: Blue Shield of California EPN |
$2.10
|
| Rate for Payer: Blue Shield of California EPN |
$2.10
|
| Rate for Payer: Cash Price |
$0.22
|
| Rate for Payer: Cash Price |
$0.22
|
| Rate for Payer: Cash Price |
$0.22
|
| Rate for Payer: Cash Price |
$0.22
|
| Rate for Payer: Central Health Plan Commercial |
$0.39
|
| Rate for Payer: Central Health Plan Commercial |
$0.38
|
| Rate for Payer: Cigna of CA HMO |
$0.34
|
| Rate for Payer: Cigna of CA HMO |
$0.34
|
| Rate for Payer: Cigna of CA PPO |
$0.34
|
| Rate for Payer: Cigna of CA PPO |
$0.34
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.42
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.41
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.41
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.42
|
| Rate for Payer: Dignity Health Medicare Advantage |
$0.42
|
| Rate for Payer: Dignity Health Medicare Advantage |
$0.41
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$0.34
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$0.34
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.19
|
| Rate for Payer: EPIC Health Plan Senior |
$0.20
|
| Rate for Payer: EPIC Health Plan Senior |
$0.19
|
| Rate for Payer: Galaxy Health WC |
$0.41
|
| Rate for Payer: Galaxy Health WC |
$0.42
|
| Rate for Payer: Global Benefits Group Commercial |
$0.29
|
| Rate for Payer: Global Benefits Group Commercial |
$0.29
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.43
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.44
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$1.22
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$1.22
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$0.31
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$0.30
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.17
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.18
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$0.29
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$0.28
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.10
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.10
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$0.34
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$0.34
|
| Rate for Payer: Multiplan Commercial |
$0.37
|
| Rate for Payer: Multiplan Commercial |
$0.36
|
| Rate for Payer: Networks By Design Commercial |
$0.25
|
| Rate for Payer: Networks By Design Commercial |
$0.24
|
| Rate for Payer: Prime Health Services Commercial |
$0.42
|
| Rate for Payer: Prime Health Services Commercial |
$0.41
|
| Rate for Payer: Riverside University Health System MISP |
$0.19
|
| Rate for Payer: Riverside University Health System MISP |
$0.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.29
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.29
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.29
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.29
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.18
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.18
|
| Rate for Payer: United Healthcare All Other HMO |
$0.18
|
| Rate for Payer: United Healthcare All Other HMO |
$0.18
|
| Rate for Payer: United Healthcare HMO Rider |
$0.18
|
| Rate for Payer: United Healthcare HMO Rider |
$0.17
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.16
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.16
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.41
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.42
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.41
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.42
|
| Rate for Payer: Vantage Medical Group Senior |
$0.42
|
| Rate for Payer: Vantage Medical Group Senior |
$0.41
|
|
|
PIPERACILLIN-TAZOBACTAM 3.375 GRAM/50 ML DEXTROSE(ISO-OS) IV PIGGYBACK [34524]
|
Facility
|
IP
|
$0.49
|
|
|
Service Code
|
HCPCS J2543
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.10 |
| Max. Negotiated Rate |
$0.44 |
| Rate for Payer: Adventist Health Commercial |
$0.10
|
| Rate for Payer: Adventist Health Commercial |
$0.10
|
| Rate for Payer: Blue Shield of California Commercial |
$0.39
|
| Rate for Payer: Blue Shield of California Commercial |
$0.38
|
| Rate for Payer: Blue Shield of California EPN |
$0.24
|
| Rate for Payer: Blue Shield of California EPN |
$0.25
|
| Rate for Payer: Cash Price |
$0.22
|
| Rate for Payer: Cash Price |
$0.22
|
| Rate for Payer: Central Health Plan Commercial |
$0.39
|
| Rate for Payer: Central Health Plan Commercial |
$0.38
|
| Rate for Payer: Cigna of CA HMO |
$0.34
|
| Rate for Payer: Cigna of CA HMO |
$0.34
|
| Rate for Payer: Cigna of CA PPO |
$0.34
|
| Rate for Payer: Cigna of CA PPO |
$0.34
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$0.34
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$0.34
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.19
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.20
|
| Rate for Payer: EPIC Health Plan Senior |
$0.19
|
| Rate for Payer: EPIC Health Plan Senior |
$0.20
|
| Rate for Payer: Galaxy Health WC |
$0.42
|
| Rate for Payer: Galaxy Health WC |
$0.41
|
| Rate for Payer: Global Benefits Group Commercial |
$0.29
|
| Rate for Payer: Global Benefits Group Commercial |
$0.29
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.43
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.44
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$0.31
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$0.30
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$0.28
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$0.29
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.10
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.10
|
| Rate for Payer: Multiplan Commercial |
$0.36
|
| Rate for Payer: Multiplan Commercial |
$0.37
|
| Rate for Payer: Networks By Design Commercial |
$0.24
|
| Rate for Payer: Networks By Design Commercial |
$0.25
|
| Rate for Payer: Prime Health Services Commercial |
$0.42
|
| Rate for Payer: Prime Health Services Commercial |
$0.41
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.18
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.18
|
| Rate for Payer: United Healthcare All Other HMO |
$0.18
|
| Rate for Payer: United Healthcare All Other HMO |
$0.18
|
| Rate for Payer: United Healthcare HMO Rider |
$0.17
|
| Rate for Payer: United Healthcare HMO Rider |
$0.18
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.16
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.16
|
|
|
PIPERACILLIN-TAZOBACTAM 3.375 GRAM/50 ML INTRAVENOUS PIGGYBACK [248092]
|
Facility
|
IP
|
$27.40
|
|
|
Service Code
|
HCPCS J2543
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$5.48 |
| Max. Negotiated Rate |
$24.66 |
| Rate for Payer: Adventist Health Commercial |
$5.48
|
| Rate for Payer: Blue Shield of California Commercial |
$21.97
|
| Rate for Payer: Blue Shield of California EPN |
$13.81
|
| Rate for Payer: Cash Price |
$12.33
|
| Rate for Payer: Central Health Plan Commercial |
$21.92
|
| Rate for Payer: Cigna of CA HMO |
$19.18
|
| Rate for Payer: Cigna of CA PPO |
$19.18
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$19.18
|
| Rate for Payer: EPIC Health Plan Commercial |
$10.96
|
| Rate for Payer: EPIC Health Plan Senior |
$10.96
|
| Rate for Payer: Galaxy Health WC |
$23.29
|
| Rate for Payer: Global Benefits Group Commercial |
$16.44
|
| Rate for Payer: Health Management Network EPO/PPO |
$24.66
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$17.40
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$16.17
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5.48
|
| Rate for Payer: Multiplan Commercial |
$20.55
|
| Rate for Payer: Networks By Design Commercial |
$13.70
|
| Rate for Payer: Prime Health Services Commercial |
$23.29
|
| Rate for Payer: United Healthcare All Other Commercial |
$10.28
|
| Rate for Payer: United Healthcare All Other HMO |
$10.01
|
| Rate for Payer: United Healthcare HMO Rider |
$9.79
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$8.97
|
|
|
PIPERACILLIN-TAZOBACTAM 3.375 GRAM/50 ML INTRAVENOUS PIGGYBACK [248092]
|
Facility
|
OP
|
$27.40
|
|
|
Service Code
|
HCPCS J2543
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.22 |
| Max. Negotiated Rate |
$24.66 |
| Rate for Payer: Adventist Health Commercial |
$5.48
|
| Rate for Payer: Aetna of CA HMO/PPO |
$6.93
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$23.29
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$15.07
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$20.55
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$10.01
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$12.49
|
| Rate for Payer: Blue Shield of California Commercial |
$2.31
|
| Rate for Payer: Blue Shield of California EPN |
$2.10
|
| Rate for Payer: Cash Price |
$12.33
|
| Rate for Payer: Cash Price |
$12.33
|
| Rate for Payer: Central Health Plan Commercial |
$21.92
|
| Rate for Payer: Cigna of CA HMO |
$19.18
|
| Rate for Payer: Cigna of CA PPO |
$19.18
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$23.29
|
| Rate for Payer: Dignity Health Medi-Cal |
$23.29
|
| Rate for Payer: Dignity Health Medicare Advantage |
$23.29
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$19.18
|
| Rate for Payer: EPIC Health Plan Commercial |
$10.96
|
| Rate for Payer: EPIC Health Plan Senior |
$10.96
|
| Rate for Payer: Galaxy Health WC |
$23.29
|
| Rate for Payer: Global Benefits Group Commercial |
$16.44
|
| Rate for Payer: Health Management Network EPO/PPO |
$24.66
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$1.22
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$17.40
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$9.95
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$16.17
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5.48
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$19.18
|
| Rate for Payer: Multiplan Commercial |
$20.55
|
| Rate for Payer: Networks By Design Commercial |
$13.70
|
| Rate for Payer: Prime Health Services Commercial |
$23.29
|
| Rate for Payer: Riverside University Health System MISP |
$10.96
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$16.44
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$16.44
|
| Rate for Payer: United Healthcare All Other Commercial |
$10.28
|
| Rate for Payer: United Healthcare All Other HMO |
$10.01
|
| Rate for Payer: United Healthcare HMO Rider |
$9.79
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$8.97
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$23.29
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$23.29
|
| Rate for Payer: Vantage Medical Group Senior |
$23.29
|
|
|
PIPERACILLIN-TAZOBACTAM 3.375 GRAM INTRAVENOUS SOLUTION [18303]
|
Facility
|
IP
|
$6.60
|
|
|
Service Code
|
HCPCS J2543
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.32 |
| Max. Negotiated Rate |
$5.94 |
| Rate for Payer: Adventist Health Commercial |
$1.32
|
| Rate for Payer: Adventist Health Commercial |
$0.84
|
| Rate for Payer: Blue Shield of California Commercial |
$5.29
|
| Rate for Payer: Blue Shield of California Commercial |
$3.37
|
| Rate for Payer: Blue Shield of California EPN |
$2.12
|
| Rate for Payer: Blue Shield of California EPN |
$3.33
|
| Rate for Payer: Cash Price |
$2.97
|
| Rate for Payer: Cash Price |
$1.89
|
| Rate for Payer: Central Health Plan Commercial |
$5.28
|
| Rate for Payer: Central Health Plan Commercial |
$3.36
|
| Rate for Payer: Cigna of CA HMO |
$2.94
|
| Rate for Payer: Cigna of CA HMO |
$4.62
|
| Rate for Payer: Cigna of CA PPO |
$2.94
|
| Rate for Payer: Cigna of CA PPO |
$4.62
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$2.94
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$4.62
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.68
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.64
|
| Rate for Payer: EPIC Health Plan Senior |
$1.68
|
| Rate for Payer: EPIC Health Plan Senior |
$2.64
|
| Rate for Payer: Galaxy Health WC |
$5.61
|
| Rate for Payer: Galaxy Health WC |
$3.57
|
| Rate for Payer: Global Benefits Group Commercial |
$2.52
|
| Rate for Payer: Global Benefits Group Commercial |
$3.96
|
| Rate for Payer: Health Management Network EPO/PPO |
$3.78
|
| Rate for Payer: Health Management Network EPO/PPO |
$5.94
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$4.19
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$2.67
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2.48
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$3.89
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.32
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.84
|
| Rate for Payer: Multiplan Commercial |
$3.15
|
| Rate for Payer: Multiplan Commercial |
$4.95
|
| Rate for Payer: Networks By Design Commercial |
$2.10
|
| Rate for Payer: Networks By Design Commercial |
$3.30
|
| Rate for Payer: Prime Health Services Commercial |
$5.61
|
| Rate for Payer: Prime Health Services Commercial |
$3.57
|
| Rate for Payer: United Healthcare All Other Commercial |
$1.58
|
| Rate for Payer: United Healthcare All Other Commercial |
$2.48
|
| Rate for Payer: United Healthcare All Other HMO |
$2.41
|
| Rate for Payer: United Healthcare All Other HMO |
$1.53
|
| Rate for Payer: United Healthcare HMO Rider |
$1.50
|
| Rate for Payer: United Healthcare HMO Rider |
$2.36
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1.38
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2.16
|
|
|
PIPERACILLIN-TAZOBACTAM 3.375 GRAM INTRAVENOUS SOLUTION [18303]
|
Facility
|
OP
|
$4.20
|
|
|
Service Code
|
HCPCS J2543
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.84 |
| Max. Negotiated Rate |
$12.49 |
| Rate for Payer: Adventist Health Commercial |
$0.84
|
| Rate for Payer: Adventist Health Commercial |
$1.32
|
| Rate for Payer: Aetna of CA HMO/PPO |
$6.93
|
| Rate for Payer: Aetna of CA HMO/PPO |
$6.93
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3.57
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$5.61
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$3.63
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2.31
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4.95
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$3.15
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$10.01
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$10.01
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$12.49
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$12.49
|
| Rate for Payer: Blue Shield of California Commercial |
$2.31
|
| Rate for Payer: Blue Shield of California Commercial |
$2.31
|
| Rate for Payer: Blue Shield of California EPN |
$2.10
|
| Rate for Payer: Blue Shield of California EPN |
$2.10
|
| Rate for Payer: Cash Price |
$1.89
|
| Rate for Payer: Cash Price |
$2.97
|
| Rate for Payer: Cash Price |
$1.89
|
| Rate for Payer: Cash Price |
$2.97
|
| Rate for Payer: Central Health Plan Commercial |
$5.28
|
| Rate for Payer: Central Health Plan Commercial |
$3.36
|
| Rate for Payer: Cigna of CA HMO |
$2.94
|
| Rate for Payer: Cigna of CA HMO |
$4.62
|
| Rate for Payer: Cigna of CA PPO |
$2.94
|
| Rate for Payer: Cigna of CA PPO |
$4.62
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$5.61
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3.57
|
| Rate for Payer: Dignity Health Medi-Cal |
$3.57
|
| Rate for Payer: Dignity Health Medi-Cal |
$5.61
|
| Rate for Payer: Dignity Health Medicare Advantage |
$5.61
|
| Rate for Payer: Dignity Health Medicare Advantage |
$3.57
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$2.94
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$4.62
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.64
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.68
|
| Rate for Payer: EPIC Health Plan Senior |
$2.64
|
| Rate for Payer: EPIC Health Plan Senior |
$1.68
|
| Rate for Payer: Galaxy Health WC |
$3.57
|
| Rate for Payer: Galaxy Health WC |
$5.61
|
| Rate for Payer: Global Benefits Group Commercial |
$3.96
|
| Rate for Payer: Global Benefits Group Commercial |
$2.52
|
| Rate for Payer: Health Management Network EPO/PPO |
$3.78
|
| Rate for Payer: Health Management Network EPO/PPO |
$5.94
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$1.22
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$1.22
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$4.19
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$2.67
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1.52
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$2.40
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$3.89
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2.48
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.32
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.84
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$4.62
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$2.94
|
| Rate for Payer: Multiplan Commercial |
$4.95
|
| Rate for Payer: Multiplan Commercial |
$3.15
|
| Rate for Payer: Networks By Design Commercial |
$3.30
|
| Rate for Payer: Networks By Design Commercial |
$2.10
|
| Rate for Payer: Prime Health Services Commercial |
$5.61
|
| Rate for Payer: Prime Health Services Commercial |
$3.57
|
| Rate for Payer: Riverside University Health System MISP |
$1.68
|
| Rate for Payer: Riverside University Health System MISP |
$2.64
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3.96
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2.52
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$3.96
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2.52
|
| Rate for Payer: United Healthcare All Other Commercial |
$1.58
|
| Rate for Payer: United Healthcare All Other Commercial |
$2.48
|
| Rate for Payer: United Healthcare All Other HMO |
$2.41
|
| Rate for Payer: United Healthcare All Other HMO |
$1.53
|
| Rate for Payer: United Healthcare HMO Rider |
$2.36
|
| Rate for Payer: United Healthcare HMO Rider |
$1.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2.16
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1.38
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3.57
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$5.61
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$3.57
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$5.61
|
| Rate for Payer: Vantage Medical Group Senior |
$5.61
|
| Rate for Payer: Vantage Medical Group Senior |
$3.57
|
|
|
PIPERACILLIN-TAZOBACTAM 40.5 GRAM INTRAVENOUS SOLUTION [12587]
|
Facility
|
OP
|
$82.80
|
|
|
Service Code
|
HCPCS J2543
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.22 |
| Max. Negotiated Rate |
$74.52 |
| Rate for Payer: Adventist Health Commercial |
$16.56
|
| Rate for Payer: Adventist Health Commercial |
$17.50
|
| Rate for Payer: Adventist Health Commercial |
$35.22
|
| Rate for Payer: Aetna of CA HMO/PPO |
$6.93
|
| Rate for Payer: Aetna of CA HMO/PPO |
$6.93
|
| Rate for Payer: Aetna of CA HMO/PPO |
$6.93
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$149.70
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$70.38
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$74.36
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$48.11
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$45.54
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$96.87
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$65.61
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$62.10
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$132.09
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$10.01
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$10.01
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$10.01
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$12.49
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$12.49
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$12.49
|
| Rate for Payer: Blue Shield of California Commercial |
$2.31
|
| Rate for Payer: Blue Shield of California Commercial |
$2.31
|
| Rate for Payer: Blue Shield of California Commercial |
$2.31
|
| Rate for Payer: Blue Shield of California EPN |
$2.10
|
| Rate for Payer: Blue Shield of California EPN |
$2.10
|
| Rate for Payer: Blue Shield of California EPN |
$2.10
|
| Rate for Payer: Cash Price |
$39.37
|
| Rate for Payer: Cash Price |
$79.25
|
| Rate for Payer: Cash Price |
$37.26
|
| Rate for Payer: Cash Price |
$79.25
|
| Rate for Payer: Cash Price |
$39.37
|
| Rate for Payer: Cash Price |
$37.26
|
| Rate for Payer: Central Health Plan Commercial |
$66.24
|
| Rate for Payer: Central Health Plan Commercial |
$140.90
|
| Rate for Payer: Central Health Plan Commercial |
$69.98
|
| Rate for Payer: Cigna of CA HMO |
$123.28
|
| Rate for Payer: Cigna of CA HMO |
$61.24
|
| Rate for Payer: Cigna of CA HMO |
$57.96
|
| Rate for Payer: Cigna of CA PPO |
$57.96
|
| Rate for Payer: Cigna of CA PPO |
$123.28
|
| Rate for Payer: Cigna of CA PPO |
$61.24
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$74.36
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$149.70
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$70.38
|
| Rate for Payer: Dignity Health Medi-Cal |
$149.70
|
| Rate for Payer: Dignity Health Medi-Cal |
$70.38
|
| Rate for Payer: Dignity Health Medi-Cal |
$74.36
|
| Rate for Payer: Dignity Health Medicare Advantage |
$149.70
|
| Rate for Payer: Dignity Health Medicare Advantage |
$70.38
|
| Rate for Payer: Dignity Health Medicare Advantage |
$74.36
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$61.24
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$57.96
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$123.28
|
| Rate for Payer: EPIC Health Plan Commercial |
$70.45
|
| Rate for Payer: EPIC Health Plan Commercial |
$34.99
|
| Rate for Payer: EPIC Health Plan Commercial |
$33.12
|
| Rate for Payer: EPIC Health Plan Senior |
$33.12
|
| Rate for Payer: EPIC Health Plan Senior |
$70.45
|
| Rate for Payer: EPIC Health Plan Senior |
$34.99
|
| Rate for Payer: Galaxy Health WC |
$149.70
|
| Rate for Payer: Galaxy Health WC |
$70.38
|
| Rate for Payer: Galaxy Health WC |
$74.36
|
| Rate for Payer: Global Benefits Group Commercial |
$49.68
|
| Rate for Payer: Global Benefits Group Commercial |
$105.67
|
| Rate for Payer: Global Benefits Group Commercial |
$52.49
|
| Rate for Payer: Health Management Network EPO/PPO |
$74.52
|
| Rate for Payer: Health Management Network EPO/PPO |
$158.51
|
| Rate for Payer: Health Management Network EPO/PPO |
$78.73
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$1.22
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$1.22
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$1.22
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$111.84
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$55.55
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$52.58
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$30.06
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$31.76
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$63.93
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$51.61
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$103.91
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$48.85
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$35.22
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$17.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$16.56
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$57.96
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$123.28
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$61.24
|
| Rate for Payer: Multiplan Commercial |
$132.09
|
| Rate for Payer: Multiplan Commercial |
$62.10
|
| Rate for Payer: Multiplan Commercial |
$65.61
|
| Rate for Payer: Networks By Design Commercial |
$41.40
|
| Rate for Payer: Networks By Design Commercial |
$88.06
|
| Rate for Payer: Networks By Design Commercial |
$43.74
|
| Rate for Payer: Prime Health Services Commercial |
$74.36
|
| Rate for Payer: Prime Health Services Commercial |
$70.38
|
| Rate for Payer: Prime Health Services Commercial |
$149.70
|
| Rate for Payer: Riverside University Health System MISP |
$33.12
|
| Rate for Payer: Riverside University Health System MISP |
$34.99
|
| Rate for Payer: Riverside University Health System MISP |
$70.45
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$49.68
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$52.49
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$105.67
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$49.68
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$52.49
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$105.67
|
| Rate for Payer: United Healthcare All Other Commercial |
$66.10
|
| Rate for Payer: United Healthcare All Other Commercial |
$32.83
|
| Rate for Payer: United Healthcare All Other Commercial |
$31.07
|
| Rate for Payer: United Healthcare All Other HMO |
$31.96
|
| Rate for Payer: United Healthcare All Other HMO |
$30.25
|
| Rate for Payer: United Healthcare All Other HMO |
$64.34
|
| Rate for Payer: United Healthcare HMO Rider |
$29.59
|
| Rate for Payer: United Healthcare HMO Rider |
$31.27
|
| Rate for Payer: United Healthcare HMO Rider |
$62.95
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$28.65
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$57.68
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$27.12
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$74.36
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$149.70
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$70.38
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$70.38
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$74.36
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$149.70
|
| Rate for Payer: Vantage Medical Group Senior |
$74.36
|
| Rate for Payer: Vantage Medical Group Senior |
$149.70
|
| Rate for Payer: Vantage Medical Group Senior |
$70.38
|
|
|
PIPERACILLIN-TAZOBACTAM 40.5 GRAM INTRAVENOUS SOLUTION [12587]
|
Facility
|
IP
|
$87.48
|
|
|
Service Code
|
HCPCS J2543
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$17.50 |
| Max. Negotiated Rate |
$78.73 |
| Rate for Payer: Adventist Health Commercial |
$17.50
|
| Rate for Payer: Adventist Health Commercial |
$16.56
|
| Rate for Payer: Adventist Health Commercial |
$35.22
|
| Rate for Payer: Blue Shield of California Commercial |
$70.16
|
| Rate for Payer: Blue Shield of California Commercial |
$66.41
|
| Rate for Payer: Blue Shield of California Commercial |
$141.25
|
| Rate for Payer: Blue Shield of California EPN |
$88.76
|
| Rate for Payer: Blue Shield of California EPN |
$44.09
|
| Rate for Payer: Blue Shield of California EPN |
$41.73
|
| Rate for Payer: Cash Price |
$39.37
|
| Rate for Payer: Cash Price |
$79.25
|
| Rate for Payer: Cash Price |
$37.26
|
| Rate for Payer: Central Health Plan Commercial |
$66.24
|
| Rate for Payer: Central Health Plan Commercial |
$140.90
|
| Rate for Payer: Central Health Plan Commercial |
$69.98
|
| Rate for Payer: Cigna of CA HMO |
$61.24
|
| Rate for Payer: Cigna of CA HMO |
$123.28
|
| Rate for Payer: Cigna of CA HMO |
$57.96
|
| Rate for Payer: Cigna of CA PPO |
$61.24
|
| Rate for Payer: Cigna of CA PPO |
$57.96
|
| Rate for Payer: Cigna of CA PPO |
$123.28
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$61.24
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$57.96
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$123.28
|
| Rate for Payer: EPIC Health Plan Commercial |
$33.12
|
| Rate for Payer: EPIC Health Plan Commercial |
$70.45
|
| Rate for Payer: EPIC Health Plan Commercial |
$34.99
|
| Rate for Payer: EPIC Health Plan Senior |
$33.12
|
| Rate for Payer: EPIC Health Plan Senior |
$70.45
|
| Rate for Payer: EPIC Health Plan Senior |
$34.99
|
| Rate for Payer: Galaxy Health WC |
$70.38
|
| Rate for Payer: Galaxy Health WC |
$149.70
|
| Rate for Payer: Galaxy Health WC |
$74.36
|
| Rate for Payer: Global Benefits Group Commercial |
$52.49
|
| Rate for Payer: Global Benefits Group Commercial |
$49.68
|
| Rate for Payer: Global Benefits Group Commercial |
$105.67
|
| Rate for Payer: Health Management Network EPO/PPO |
$78.73
|
| Rate for Payer: Health Management Network EPO/PPO |
$158.51
|
| Rate for Payer: Health Management Network EPO/PPO |
$74.52
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$111.84
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$55.55
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$52.58
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$51.61
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$48.85
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$103.91
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$17.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$16.56
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$35.22
|
| Rate for Payer: Multiplan Commercial |
$65.61
|
| Rate for Payer: Multiplan Commercial |
$62.10
|
| Rate for Payer: Multiplan Commercial |
$132.09
|
| Rate for Payer: Networks By Design Commercial |
$43.74
|
| Rate for Payer: Networks By Design Commercial |
$88.06
|
| Rate for Payer: Networks By Design Commercial |
$41.40
|
| Rate for Payer: Prime Health Services Commercial |
$70.38
|
| Rate for Payer: Prime Health Services Commercial |
$74.36
|
| Rate for Payer: Prime Health Services Commercial |
$149.70
|
| Rate for Payer: United Healthcare All Other Commercial |
$66.10
|
| Rate for Payer: United Healthcare All Other Commercial |
$32.83
|
| Rate for Payer: United Healthcare All Other Commercial |
$31.07
|
| Rate for Payer: United Healthcare All Other HMO |
$30.25
|
| Rate for Payer: United Healthcare All Other HMO |
$64.34
|
| Rate for Payer: United Healthcare All Other HMO |
$31.96
|
| Rate for Payer: United Healthcare HMO Rider |
$62.95
|
| Rate for Payer: United Healthcare HMO Rider |
$29.59
|
| Rate for Payer: United Healthcare HMO Rider |
$31.27
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$27.12
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$28.65
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$57.68
|
|
|
PIPERACILLIN-TAZOBACTAM 4.5 GRAM/100 ML DEXTROSE(ISO-OSM) IV PIGGYBACK [108121]
|
Facility
|
IP
|
$0.30
|
|
|
Service Code
|
HCPCS J2543
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.06 |
| Max. Negotiated Rate |
$0.27 |
| Rate for Payer: Adventist Health Commercial |
$0.06
|
| Rate for Payer: Blue Shield of California Commercial |
$0.24
|
| Rate for Payer: Blue Shield of California EPN |
$0.15
|
| Rate for Payer: Cash Price |
$0.14
|
| Rate for Payer: Central Health Plan Commercial |
$0.24
|
| Rate for Payer: Cigna of CA HMO |
$0.21
|
| Rate for Payer: Cigna of CA PPO |
$0.21
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$0.21
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.12
|
| Rate for Payer: EPIC Health Plan Senior |
$0.12
|
| Rate for Payer: Galaxy Health WC |
$0.26
|
| Rate for Payer: Global Benefits Group Commercial |
$0.18
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.27
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$0.19
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$0.18
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.06
|
| Rate for Payer: Multiplan Commercial |
$0.23
|
| Rate for Payer: Networks By Design Commercial |
$0.15
|
| Rate for Payer: Prime Health Services Commercial |
$0.26
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.11
|
| Rate for Payer: United Healthcare All Other HMO |
$0.11
|
| Rate for Payer: United Healthcare HMO Rider |
$0.11
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.10
|
|
|
PIPERACILLIN-TAZOBACTAM 4.5 GRAM/100 ML DEXTROSE(ISO-OSM) IV PIGGYBACK [108121]
|
Facility
|
OP
|
$0.30
|
|
|
Service Code
|
HCPCS J2543
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.06 |
| Max. Negotiated Rate |
$12.49 |
| Rate for Payer: Adventist Health Commercial |
$0.06
|
| Rate for Payer: Aetna of CA HMO/PPO |
$6.93
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.26
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.17
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.23
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$10.01
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$12.49
|
| Rate for Payer: Blue Shield of California Commercial |
$2.31
|
| Rate for Payer: Blue Shield of California EPN |
$2.10
|
| Rate for Payer: Cash Price |
$0.14
|
| Rate for Payer: Cash Price |
$0.14
|
| Rate for Payer: Central Health Plan Commercial |
$0.24
|
| Rate for Payer: Cigna of CA HMO |
$0.21
|
| Rate for Payer: Cigna of CA PPO |
$0.21
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.26
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.26
|
| Rate for Payer: Dignity Health Medicare Advantage |
$0.26
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$0.21
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.12
|
| Rate for Payer: EPIC Health Plan Senior |
$0.12
|
| Rate for Payer: Galaxy Health WC |
$0.26
|
| Rate for Payer: Global Benefits Group Commercial |
$0.18
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.27
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$1.22
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$0.19
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.11
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$0.18
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.06
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$0.21
|
| Rate for Payer: Multiplan Commercial |
$0.23
|
| Rate for Payer: Networks By Design Commercial |
$0.15
|
| Rate for Payer: Prime Health Services Commercial |
$0.26
|
| Rate for Payer: Riverside University Health System MISP |
$0.12
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.18
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.18
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.11
|
| Rate for Payer: United Healthcare All Other HMO |
$0.11
|
| Rate for Payer: United Healthcare HMO Rider |
$0.11
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.10
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.26
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.26
|
| Rate for Payer: Vantage Medical Group Senior |
$0.26
|
|
|
PIPERACILLIN-TAZOBACTAM 4.5 GRAM/100 ML INTRAVENOUS PIGGYBACK [247540]
|
Facility
|
IP
|
$33.70
|
|
|
Service Code
|
HCPCS J2543
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$6.74 |
| Max. Negotiated Rate |
$30.33 |
| Rate for Payer: Adventist Health Commercial |
$6.74
|
| Rate for Payer: Blue Shield of California Commercial |
$27.03
|
| Rate for Payer: Blue Shield of California EPN |
$16.98
|
| Rate for Payer: Cash Price |
$15.16
|
| Rate for Payer: Central Health Plan Commercial |
$26.96
|
| Rate for Payer: Cigna of CA HMO |
$23.59
|
| Rate for Payer: Cigna of CA PPO |
$23.59
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$23.59
|
| Rate for Payer: EPIC Health Plan Commercial |
$13.48
|
| Rate for Payer: EPIC Health Plan Senior |
$13.48
|
| Rate for Payer: Galaxy Health WC |
$28.64
|
| Rate for Payer: Global Benefits Group Commercial |
$20.22
|
| Rate for Payer: Health Management Network EPO/PPO |
$30.33
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$21.40
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$19.88
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6.74
|
| Rate for Payer: Multiplan Commercial |
$25.27
|
| Rate for Payer: Networks By Design Commercial |
$16.85
|
| Rate for Payer: Prime Health Services Commercial |
$28.64
|
| Rate for Payer: United Healthcare All Other Commercial |
$12.65
|
| Rate for Payer: United Healthcare All Other HMO |
$12.31
|
| Rate for Payer: United Healthcare HMO Rider |
$12.04
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$11.04
|
|
|
PIPERACILLIN-TAZOBACTAM 4.5 GRAM/100 ML INTRAVENOUS PIGGYBACK [247540]
|
Facility
|
OP
|
$33.70
|
|
|
Service Code
|
HCPCS J2543
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.22 |
| Max. Negotiated Rate |
$30.33 |
| Rate for Payer: Adventist Health Commercial |
$6.74
|
| Rate for Payer: Aetna of CA HMO/PPO |
$6.93
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$28.64
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$18.54
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$25.27
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$10.01
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$12.49
|
| Rate for Payer: Blue Shield of California Commercial |
$2.31
|
| Rate for Payer: Blue Shield of California EPN |
$2.10
|
| Rate for Payer: Cash Price |
$15.16
|
| Rate for Payer: Cash Price |
$15.16
|
| Rate for Payer: Central Health Plan Commercial |
$26.96
|
| Rate for Payer: Cigna of CA HMO |
$23.59
|
| Rate for Payer: Cigna of CA PPO |
$23.59
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$28.64
|
| Rate for Payer: Dignity Health Medi-Cal |
$28.64
|
| Rate for Payer: Dignity Health Medicare Advantage |
$28.64
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$23.59
|
| Rate for Payer: EPIC Health Plan Commercial |
$13.48
|
| Rate for Payer: EPIC Health Plan Senior |
$13.48
|
| Rate for Payer: Galaxy Health WC |
$28.64
|
| Rate for Payer: Global Benefits Group Commercial |
$20.22
|
| Rate for Payer: Health Management Network EPO/PPO |
$30.33
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$1.22
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$21.40
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$12.23
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$19.88
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6.74
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$23.59
|
| Rate for Payer: Multiplan Commercial |
$25.27
|
| Rate for Payer: Networks By Design Commercial |
$16.85
|
| Rate for Payer: Prime Health Services Commercial |
$28.64
|
| Rate for Payer: Riverside University Health System MISP |
$13.48
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$20.22
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$20.22
|
| Rate for Payer: United Healthcare All Other Commercial |
$12.65
|
| Rate for Payer: United Healthcare All Other HMO |
$12.31
|
| Rate for Payer: United Healthcare HMO Rider |
$12.04
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$11.04
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$28.64
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$28.64
|
| Rate for Payer: Vantage Medical Group Senior |
$28.64
|
|
|
PIPERACILLIN-TAZOBACTAM 4.5 GRAM INTRAVENOUS SOLUTION [18302]
|
Facility
|
IP
|
$6.73
|
|
|
Service Code
|
HCPCS J2543
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.35 |
| Max. Negotiated Rate |
$6.06 |
| Rate for Payer: Adventist Health Commercial |
$1.35
|
| Rate for Payer: Adventist Health Commercial |
$1.63
|
| Rate for Payer: Adventist Health Commercial |
$1.56
|
| Rate for Payer: Adventist Health Commercial |
$2.54
|
| Rate for Payer: Blue Shield of California Commercial |
$5.40
|
| Rate for Payer: Blue Shield of California Commercial |
$10.19
|
| Rate for Payer: Blue Shield of California Commercial |
$6.54
|
| Rate for Payer: Blue Shield of California Commercial |
$6.26
|
| Rate for Payer: Blue Shield of California EPN |
$3.39
|
| Rate for Payer: Blue Shield of California EPN |
$6.40
|
| Rate for Payer: Blue Shield of California EPN |
$3.93
|
| Rate for Payer: Blue Shield of California EPN |
$4.11
|
| Rate for Payer: Cash Price |
$3.67
|
| Rate for Payer: Cash Price |
$5.72
|
| Rate for Payer: Cash Price |
$3.51
|
| Rate for Payer: Cash Price |
$3.03
|
| Rate for Payer: Central Health Plan Commercial |
$6.53
|
| Rate for Payer: Central Health Plan Commercial |
$5.38
|
| Rate for Payer: Central Health Plan Commercial |
$10.16
|
| Rate for Payer: Central Health Plan Commercial |
$6.24
|
| Rate for Payer: Cigna of CA HMO |
$4.71
|
| Rate for Payer: Cigna of CA HMO |
$5.46
|
| Rate for Payer: Cigna of CA HMO |
$5.71
|
| Rate for Payer: Cigna of CA HMO |
$8.89
|
| Rate for Payer: Cigna of CA PPO |
$8.89
|
| Rate for Payer: Cigna of CA PPO |
$4.71
|
| Rate for Payer: Cigna of CA PPO |
$5.46
|
| Rate for Payer: Cigna of CA PPO |
$5.71
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$8.89
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$5.71
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$5.46
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$4.71
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.69
|
| Rate for Payer: EPIC Health Plan Commercial |
$3.26
|
| Rate for Payer: EPIC Health Plan Commercial |
$3.12
|
| Rate for Payer: EPIC Health Plan Commercial |
$5.08
|
| Rate for Payer: EPIC Health Plan Senior |
$2.69
|
| Rate for Payer: EPIC Health Plan Senior |
$3.12
|
| Rate for Payer: EPIC Health Plan Senior |
$3.26
|
| Rate for Payer: EPIC Health Plan Senior |
$5.08
|
| Rate for Payer: Galaxy Health WC |
$6.63
|
| Rate for Payer: Galaxy Health WC |
$10.79
|
| Rate for Payer: Galaxy Health WC |
$5.72
|
| Rate for Payer: Galaxy Health WC |
$6.94
|
| Rate for Payer: Global Benefits Group Commercial |
$4.90
|
| Rate for Payer: Global Benefits Group Commercial |
$4.04
|
| Rate for Payer: Global Benefits Group Commercial |
$4.68
|
| Rate for Payer: Global Benefits Group Commercial |
$7.62
|
| Rate for Payer: Health Management Network EPO/PPO |
$7.34
|
| Rate for Payer: Health Management Network EPO/PPO |
$6.06
|
| Rate for Payer: Health Management Network EPO/PPO |
$7.02
|
| Rate for Payer: Health Management Network EPO/PPO |
$11.43
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$5.18
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$4.27
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$4.95
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$8.06
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$3.97
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$4.81
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$4.60
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$7.49
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.35
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.54
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.63
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.56
|
| Rate for Payer: Multiplan Commercial |
$6.12
|
| Rate for Payer: Multiplan Commercial |
$5.05
|
| Rate for Payer: Multiplan Commercial |
$9.53
|
| Rate for Payer: Multiplan Commercial |
$5.85
|
| Rate for Payer: Networks By Design Commercial |
$4.08
|
| Rate for Payer: Networks By Design Commercial |
$6.35
|
| Rate for Payer: Networks By Design Commercial |
$3.90
|
| Rate for Payer: Networks By Design Commercial |
$3.37
|
| Rate for Payer: Prime Health Services Commercial |
$6.63
|
| Rate for Payer: Prime Health Services Commercial |
$5.72
|
| Rate for Payer: Prime Health Services Commercial |
$10.79
|
| Rate for Payer: Prime Health Services Commercial |
$6.94
|
| Rate for Payer: United Healthcare All Other Commercial |
$3.06
|
| Rate for Payer: United Healthcare All Other Commercial |
$2.93
|
| Rate for Payer: United Healthcare All Other Commercial |
$4.77
|
| Rate for Payer: United Healthcare All Other Commercial |
$2.53
|
| Rate for Payer: United Healthcare All Other HMO |
$2.46
|
| Rate for Payer: United Healthcare All Other HMO |
$4.64
|
| Rate for Payer: United Healthcare All Other HMO |
$2.98
|
| Rate for Payer: United Healthcare All Other HMO |
$2.85
|
| Rate for Payer: United Healthcare HMO Rider |
$4.54
|
| Rate for Payer: United Healthcare HMO Rider |
$2.79
|
| Rate for Payer: United Healthcare HMO Rider |
$2.92
|
| Rate for Payer: United Healthcare HMO Rider |
$2.41
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2.67
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$4.16
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2.20
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2.55
|
|
|
PIPERACILLIN-TAZOBACTAM 4.5 GRAM INTRAVENOUS SOLUTION [18302]
|
Facility
|
OP
|
$8.16
|
|
|
Service Code
|
HCPCS J2543
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.22 |
| Max. Negotiated Rate |
$12.49 |
| Rate for Payer: Adventist Health Commercial |
$1.63
|
| Rate for Payer: Adventist Health Commercial |
$1.35
|
| Rate for Payer: Adventist Health Commercial |
$2.54
|
| Rate for Payer: Adventist Health Commercial |
$1.56
|
| Rate for Payer: Aetna of CA HMO/PPO |
$6.93
|
| Rate for Payer: Aetna of CA HMO/PPO |
$6.93
|
| Rate for Payer: Aetna of CA HMO/PPO |
$6.93
|
| Rate for Payer: Aetna of CA HMO/PPO |
$6.93
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$6.63
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$5.72
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$6.94
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$10.79
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$6.99
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4.29
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4.49
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$3.70
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$6.12
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$5.05
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$9.53
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$5.85
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$10.01
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$10.01
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$10.01
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$10.01
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$12.49
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$12.49
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$12.49
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$12.49
|
| Rate for Payer: Blue Shield of California Commercial |
$2.31
|
| Rate for Payer: Blue Shield of California Commercial |
$2.31
|
| Rate for Payer: Blue Shield of California Commercial |
$2.31
|
| Rate for Payer: Blue Shield of California Commercial |
$2.31
|
| Rate for Payer: Blue Shield of California EPN |
$2.10
|
| Rate for Payer: Blue Shield of California EPN |
$2.10
|
| Rate for Payer: Blue Shield of California EPN |
$2.10
|
| Rate for Payer: Blue Shield of California EPN |
$2.10
|
| Rate for Payer: Cash Price |
$3.03
|
| Rate for Payer: Cash Price |
$3.67
|
| Rate for Payer: Cash Price |
$3.51
|
| Rate for Payer: Cash Price |
$3.03
|
| Rate for Payer: Cash Price |
$5.72
|
| Rate for Payer: Cash Price |
$3.67
|
| Rate for Payer: Cash Price |
$3.51
|
| Rate for Payer: Cash Price |
$5.72
|
| Rate for Payer: Central Health Plan Commercial |
$10.16
|
| Rate for Payer: Central Health Plan Commercial |
$5.38
|
| Rate for Payer: Central Health Plan Commercial |
$6.24
|
| Rate for Payer: Central Health Plan Commercial |
$6.53
|
| Rate for Payer: Cigna of CA HMO |
$4.71
|
| Rate for Payer: Cigna of CA HMO |
$5.71
|
| Rate for Payer: Cigna of CA HMO |
$8.89
|
| Rate for Payer: Cigna of CA HMO |
$5.46
|
| Rate for Payer: Cigna of CA PPO |
$5.71
|
| Rate for Payer: Cigna of CA PPO |
$4.71
|
| Rate for Payer: Cigna of CA PPO |
$8.89
|
| Rate for Payer: Cigna of CA PPO |
$5.46
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$6.94
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$6.63
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$10.79
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$5.72
|
| Rate for Payer: Dignity Health Medi-Cal |
$5.72
|
| Rate for Payer: Dignity Health Medi-Cal |
$10.79
|
| Rate for Payer: Dignity Health Medi-Cal |
$6.94
|
| Rate for Payer: Dignity Health Medi-Cal |
$6.63
|
| Rate for Payer: Dignity Health Medicare Advantage |
$6.63
|
| Rate for Payer: Dignity Health Medicare Advantage |
$5.72
|
| Rate for Payer: Dignity Health Medicare Advantage |
$6.94
|
| Rate for Payer: Dignity Health Medicare Advantage |
$10.79
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$5.46
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$5.71
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$8.89
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$4.71
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.69
|
| Rate for Payer: EPIC Health Plan Commercial |
$3.12
|
| Rate for Payer: EPIC Health Plan Commercial |
$3.26
|
| Rate for Payer: EPIC Health Plan Commercial |
$5.08
|
| Rate for Payer: EPIC Health Plan Senior |
$3.12
|
| Rate for Payer: EPIC Health Plan Senior |
$3.26
|
| Rate for Payer: EPIC Health Plan Senior |
$5.08
|
| Rate for Payer: EPIC Health Plan Senior |
$2.69
|
| Rate for Payer: Galaxy Health WC |
$6.63
|
| Rate for Payer: Galaxy Health WC |
$10.79
|
| Rate for Payer: Galaxy Health WC |
$5.72
|
| Rate for Payer: Galaxy Health WC |
$6.94
|
| Rate for Payer: Global Benefits Group Commercial |
$4.90
|
| Rate for Payer: Global Benefits Group Commercial |
$4.04
|
| Rate for Payer: Global Benefits Group Commercial |
$4.68
|
| Rate for Payer: Global Benefits Group Commercial |
$7.62
|
| Rate for Payer: Health Management Network EPO/PPO |
$6.06
|
| Rate for Payer: Health Management Network EPO/PPO |
$11.43
|
| Rate for Payer: Health Management Network EPO/PPO |
$7.34
|
| Rate for Payer: Health Management Network EPO/PPO |
$7.02
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$1.22
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$1.22
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$1.22
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$1.22
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$4.95
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$5.18
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$8.06
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$4.27
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$4.61
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$2.96
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$2.44
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$2.83
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$4.60
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$3.97
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$7.49
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$4.81
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.35
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.56
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.63
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.54
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$5.46
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$5.71
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$4.71
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$8.89
|
| Rate for Payer: Multiplan Commercial |
$5.05
|
| Rate for Payer: Multiplan Commercial |
$5.85
|
| Rate for Payer: Multiplan Commercial |
$6.12
|
| Rate for Payer: Multiplan Commercial |
$9.53
|
| Rate for Payer: Networks By Design Commercial |
$3.37
|
| Rate for Payer: Networks By Design Commercial |
$4.08
|
| Rate for Payer: Networks By Design Commercial |
$3.90
|
| Rate for Payer: Networks By Design Commercial |
$6.35
|
| Rate for Payer: Prime Health Services Commercial |
$6.63
|
| Rate for Payer: Prime Health Services Commercial |
$10.79
|
| Rate for Payer: Prime Health Services Commercial |
$5.72
|
| Rate for Payer: Prime Health Services Commercial |
$6.94
|
| Rate for Payer: Riverside University Health System MISP |
$2.69
|
| Rate for Payer: Riverside University Health System MISP |
$3.12
|
| Rate for Payer: Riverside University Health System MISP |
$5.08
|
| Rate for Payer: Riverside University Health System MISP |
$3.26
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$7.62
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$4.04
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$4.90
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$4.68
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$4.04
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$7.62
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$4.68
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$4.90
|
| Rate for Payer: United Healthcare All Other Commercial |
$4.77
|
| Rate for Payer: United Healthcare All Other Commercial |
$2.93
|
| Rate for Payer: United Healthcare All Other Commercial |
$2.53
|
| Rate for Payer: United Healthcare All Other Commercial |
$3.06
|
| Rate for Payer: United Healthcare All Other HMO |
$2.46
|
| Rate for Payer: United Healthcare All Other HMO |
$2.98
|
| Rate for Payer: United Healthcare All Other HMO |
$4.64
|
| Rate for Payer: United Healthcare All Other HMO |
$2.85
|
| Rate for Payer: United Healthcare HMO Rider |
$2.79
|
| Rate for Payer: United Healthcare HMO Rider |
$4.54
|
| Rate for Payer: United Healthcare HMO Rider |
$2.41
|
| Rate for Payer: United Healthcare HMO Rider |
$2.92
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$4.16
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2.20
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2.67
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2.55
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$6.94
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$5.72
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$10.79
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$6.63
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$10.79
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$5.72
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$6.63
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$6.94
|
| Rate for Payer: Vantage Medical Group Senior |
$6.63
|
| Rate for Payer: Vantage Medical Group Senior |
$10.79
|
| Rate for Payer: Vantage Medical Group Senior |
$5.72
|
| Rate for Payer: Vantage Medical Group Senior |
$6.94
|
|
|
PLACEMENT OF NEPHROSTOMY CATHETER, PERCUTANEOUS, INCLUDING DIAGNOSTIC NEPHROSTOGRAM AND/OR URETEROGRAM WHEN PERFORMED, IMAGING GUIDANCE (EG, ULTRASOUND AND/OR FLUOROSCOPY) AND ALL ASSOCIATED RADIOLOGICAL SUPERVISION AND INTERPRETATION
|
Facility
|
OP
|
$27,467.00
|
|
|
Service Code
|
CPT 50432
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,330.66 |
| Max. Negotiated Rate |
$27,467.00 |
| Rate for Payer: Adventist Health Medi-Cal |
$2,688.58
|
| Rate for Payer: Aetna of CA HMO/PPO |
$27,467.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$4,032.87
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,957.44
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,688.58
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$3,974.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,523.00
|
| Rate for Payer: Anthem Blue Cross of CA Workers' Comp |
$4,147.14
|
| Rate for Payer: Blue Shield of California Commercial |
$3,293.23
|
| Rate for Payer: Blue Shield of California EPN |
$2,069.82
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$4,032.87
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,957.44
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2,688.58
|
| Rate for Payer: EPIC Health Plan Commercial |
$4,436.16
|
| Rate for Payer: EPIC Health Plan Senior |
$2,957.44
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$4,409.27
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$1,330.66
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$2,688.58
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1,469.92
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$3,764.01
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$3,602.70
|
| Rate for Payer: Multiplan WC |
$4,147.14
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$2,688.58
|
| Rate for Payer: Preferred Health Network WC |
$4,231.78
|
| Rate for Payer: Prime Health Services Medicare |
$2,849.89
|
| Rate for Payer: Prime Health Services WC |
$4,104.83
|
| Rate for Payer: Riverside University Health System MISP |
$2,957.44
|
| Rate for Payer: United Healthcare All Other HMO |
$16,122.00
|
| Rate for Payer: United Healthcare HMO Rider |
$10,165.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$9,312.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$2,688.58
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$4,032.87
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,957.44
|
| Rate for Payer: Vantage Medical Group Senior |
$2,688.58
|
|
|
PLACEMENT OF SETON
|
Facility
|
OP
|
$27,467.00
|
|
|
Service Code
|
CPT 46020
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$331.07 |
| Max. Negotiated Rate |
$27,467.00 |
| Rate for Payer: Adventist Health Medi-Cal |
$3,569.96
|
| Rate for Payer: Aetna of CA HMO/PPO |
$27,467.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$5,354.94
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$3,926.96
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$3,569.96
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$3,974.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,523.00
|
| Rate for Payer: Anthem Blue Cross of CA Workers' Comp |
$5,551.91
|
| Rate for Payer: Blue Shield of California Commercial |
$5,036.70
|
| Rate for Payer: Blue Shield of California EPN |
$3,165.61
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$5,354.94
|
| Rate for Payer: Dignity Health Medi-Cal |
$3,926.96
|
| Rate for Payer: Dignity Health Medicare Advantage |
$3,569.96
|
| Rate for Payer: EPIC Health Plan Commercial |
$5,890.43
|
| Rate for Payer: EPIC Health Plan Senior |
$3,926.96
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$5,854.73
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$331.07
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$3,569.96
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$365.71
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$4,997.94
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$4,783.75
|
| Rate for Payer: Multiplan WC |
$5,551.91
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$3,569.96
|
| Rate for Payer: Preferred Health Network WC |
$5,665.21
|
| Rate for Payer: Prime Health Services Medicare |
$3,784.16
|
| Rate for Payer: Prime Health Services WC |
$5,495.25
|
| Rate for Payer: Riverside University Health System MISP |
$3,926.96
|
| Rate for Payer: United Healthcare All Other HMO |
$16,122.00
|
| Rate for Payer: United Healthcare HMO Rider |
$10,165.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$9,312.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$3,569.96
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$5,354.94
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$3,926.96
|
| Rate for Payer: Vantage Medical Group Senior |
$3,569.96
|
|
|
PLERIXAFOR 24 MG/1.2 ML (20 MG/ML) SUBCUTANEOUS SOLUTION [95849]
|
Facility
|
IP
|
$500.00
|
|
|
Service Code
|
HCPCS J2562
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$100.00 |
| Max. Negotiated Rate |
$450.00 |
| Rate for Payer: Adventist Health Commercial |
$100.00
|
| Rate for Payer: Adventist Health Commercial |
$211.40
|
| Rate for Payer: Blue Shield of California Commercial |
$401.00
|
| Rate for Payer: Blue Shield of California Commercial |
$847.71
|
| Rate for Payer: Blue Shield of California EPN |
$532.73
|
| Rate for Payer: Blue Shield of California EPN |
$252.00
|
| Rate for Payer: Cash Price |
$225.00
|
| Rate for Payer: Cash Price |
$475.65
|
| Rate for Payer: Central Health Plan Commercial |
$400.00
|
| Rate for Payer: Central Health Plan Commercial |
$845.60
|
| Rate for Payer: Cigna of CA HMO |
$739.90
|
| Rate for Payer: Cigna of CA HMO |
$350.00
|
| Rate for Payer: Cigna of CA PPO |
$739.90
|
| Rate for Payer: Cigna of CA PPO |
$350.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$739.90
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$350.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$422.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$200.00
|
| Rate for Payer: EPIC Health Plan Senior |
$422.80
|
| Rate for Payer: EPIC Health Plan Senior |
$200.00
|
| Rate for Payer: Galaxy Health WC |
$425.00
|
| Rate for Payer: Galaxy Health WC |
$898.45
|
| Rate for Payer: Global Benefits Group Commercial |
$634.20
|
| Rate for Payer: Global Benefits Group Commercial |
$300.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$951.30
|
| Rate for Payer: Health Management Network EPO/PPO |
$450.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$317.50
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$671.20
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$623.63
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$295.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$100.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$211.40
|
| Rate for Payer: Multiplan Commercial |
$792.75
|
| Rate for Payer: Multiplan Commercial |
$375.00
|
| Rate for Payer: Networks By Design Commercial |
$528.50
|
| Rate for Payer: Networks By Design Commercial |
$250.00
|
| Rate for Payer: Prime Health Services Commercial |
$425.00
|
| Rate for Payer: Prime Health Services Commercial |
$898.45
|
| Rate for Payer: United Healthcare All Other Commercial |
$396.69
|
| Rate for Payer: United Healthcare All Other Commercial |
$187.65
|
| Rate for Payer: United Healthcare All Other HMO |
$182.65
|
| Rate for Payer: United Healthcare All Other HMO |
$386.12
|
| Rate for Payer: United Healthcare HMO Rider |
$377.77
|
| Rate for Payer: United Healthcare HMO Rider |
$178.70
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$346.17
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$163.75
|
|
|
PLERIXAFOR 24 MG/1.2 ML (20 MG/ML) SUBCUTANEOUS SOLUTION [95849]
|
Facility
|
OP
|
$500.00
|
|
|
Service Code
|
HCPCS J2562
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$28.49 |
| Max. Negotiated Rate |
$643.19 |
| Rate for Payer: Adventist Health Commercial |
$100.00
|
| Rate for Payer: Adventist Health Commercial |
$211.40
|
| Rate for Payer: Adventist Health Medi-Cal |
$28.49
|
| Rate for Payer: Adventist Health Medi-Cal |
$28.49
|
| Rate for Payer: Aetna of CA HMO/PPO |
$154.80
|
| Rate for Payer: Aetna of CA HMO/PPO |
$154.80
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$35.61
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$35.61
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$31.34
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$31.34
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$31.34
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$31.34
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$515.41
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$515.41
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$643.19
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$643.19
|
| Rate for Payer: Blue Shield of California Commercial |
$47.38
|
| Rate for Payer: Blue Shield of California Commercial |
$47.38
|
| Rate for Payer: Blue Shield of California EPN |
$43.07
|
| Rate for Payer: Blue Shield of California EPN |
$43.07
|
| Rate for Payer: Cash Price |
$225.00
|
| Rate for Payer: Cash Price |
$475.65
|
| Rate for Payer: Cash Price |
$475.65
|
| Rate for Payer: Cash Price |
$225.00
|
| Rate for Payer: Central Health Plan Commercial |
$400.00
|
| Rate for Payer: Central Health Plan Commercial |
$845.60
|
| Rate for Payer: Cigna of CA HMO |
$350.00
|
| Rate for Payer: Cigna of CA HMO |
$739.90
|
| Rate for Payer: Cigna of CA PPO |
$350.00
|
| Rate for Payer: Cigna of CA PPO |
$739.90
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$35.61
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$35.61
|
| Rate for Payer: Dignity Health Medi-Cal |
$31.34
|
| Rate for Payer: Dignity Health Medi-Cal |
$31.34
|
| Rate for Payer: Dignity Health Medicare Advantage |
$31.34
|
| Rate for Payer: Dignity Health Medicare Advantage |
$31.34
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$739.90
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$350.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$47.01
|
| Rate for Payer: EPIC Health Plan Commercial |
$47.01
|
| Rate for Payer: EPIC Health Plan Senior |
$31.34
|
| Rate for Payer: EPIC Health Plan Senior |
$31.34
|
| Rate for Payer: Galaxy Health WC |
$898.45
|
| Rate for Payer: Galaxy Health WC |
$425.00
|
| Rate for Payer: Global Benefits Group Commercial |
$300.00
|
| Rate for Payer: Global Benefits Group Commercial |
$634.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$951.30
|
| Rate for Payer: Health Management Network EPO/PPO |
$450.00
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$46.72
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$46.72
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$28.49
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$28.49
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$28.49
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$28.49
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$671.20
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$317.50
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$66.73
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$66.73
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$39.89
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$39.89
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$211.40
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$100.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$38.18
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$38.18
|
| Rate for Payer: Multiplan Commercial |
$792.75
|
| Rate for Payer: Multiplan Commercial |
$375.00
|
| Rate for Payer: Networks By Design Commercial |
$528.50
|
| Rate for Payer: Networks By Design Commercial |
$250.00
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$28.49
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$28.49
|
| Rate for Payer: Prime Health Services Commercial |
$898.45
|
| Rate for Payer: Prime Health Services Commercial |
$425.00
|
| Rate for Payer: Prime Health Services Medicare |
$30.20
|
| Rate for Payer: Prime Health Services Medicare |
$30.20
|
| Rate for Payer: Riverside University Health System MISP |
$31.34
|
| Rate for Payer: Riverside University Health System MISP |
$31.34
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$634.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$300.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$300.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$634.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$396.69
|
| Rate for Payer: United Healthcare All Other Commercial |
$187.65
|
| Rate for Payer: United Healthcare All Other HMO |
$386.12
|
| Rate for Payer: United Healthcare All Other HMO |
$182.65
|
| Rate for Payer: United Healthcare HMO Rider |
$178.70
|
| Rate for Payer: United Healthcare HMO Rider |
$377.77
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$163.75
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$346.17
|
| Rate for Payer: Upland Medical Group Pediatric |
$28.49
|
| Rate for Payer: Upland Medical Group Pediatric |
$28.49
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$35.61
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$35.61
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$31.34
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$31.34
|
| Rate for Payer: Vantage Medical Group Senior |
$31.34
|
| Rate for Payer: Vantage Medical Group Senior |
$31.34
|
|
