|
PENICILLIN G BENZATHINE 600,000 UNIT/ML INTRAMUSCULAR SYRINGE [10897]
|
Facility
|
IP
|
$255.69
|
|
|
Service Code
|
HCPCS J0561
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$51.14 |
| Max. Negotiated Rate |
$230.12 |
| Rate for Payer: Adventist Health Commercial |
$51.14
|
| Rate for Payer: Blue Shield of California Commercial |
$197.65
|
| Rate for Payer: Blue Shield of California EPN |
$128.87
|
| Rate for Payer: Cash Price |
$140.63
|
| Rate for Payer: Central Health Plan Commercial |
$204.55
|
| Rate for Payer: Cigna of CA HMO |
$178.98
|
| Rate for Payer: Cigna of CA PPO |
$178.98
|
| Rate for Payer: EPIC Health Plan Commercial |
$102.28
|
| Rate for Payer: EPIC Health Plan Senior |
$102.28
|
| Rate for Payer: Galaxy Health WC |
$217.34
|
| Rate for Payer: Global Benefits Group Commercial |
$153.41
|
| Rate for Payer: Health Management Network EPO/PPO |
$230.12
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$170.55
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$97.42
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$158.27
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$51.14
|
| Rate for Payer: Multiplan Commercial |
$191.77
|
| Rate for Payer: Networks By Design Commercial |
$127.84
|
| Rate for Payer: Prime Health Services Commercial |
$217.34
|
| Rate for Payer: United Healthcare All Other Commercial |
$95.96
|
| Rate for Payer: United Healthcare All Other HMO |
$93.40
|
| Rate for Payer: United Healthcare HMO Rider |
$91.38
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$83.74
|
|
|
PENICILLIN G BENZATHINE AND PROCAINE 1,200,000 UNIT/2 ML IM SYRINGE [108051]
|
Facility
|
OP
|
$145.87
|
|
|
Service Code
|
HCPCS J0558
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$13.67 |
| Max. Negotiated Rate |
$131.28 |
| Rate for Payer: Adventist Health Commercial |
$29.17
|
| Rate for Payer: Adventist Health Medi-Cal |
$17.37
|
| Rate for Payer: Aetna of CA HMO/PPO |
$88.59
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$21.71
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$19.10
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$19.10
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$44.55
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13.67
|
| Rate for Payer: Blue Shield of California Commercial |
$26.74
|
| Rate for Payer: Blue Shield of California EPN |
$24.31
|
| Rate for Payer: Cash Price |
$80.23
|
| Rate for Payer: Cash Price |
$80.23
|
| Rate for Payer: Central Health Plan Commercial |
$116.70
|
| Rate for Payer: Cigna of CA HMO |
$102.11
|
| Rate for Payer: Cigna of CA PPO |
$102.11
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$21.71
|
| Rate for Payer: Dignity Health Medi-Cal |
$19.10
|
| Rate for Payer: Dignity Health Medicare Advantage |
$19.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$23.45
|
| Rate for Payer: EPIC Health Plan Senior |
$17.37
|
| Rate for Payer: Galaxy Health WC |
$123.99
|
| Rate for Payer: Global Benefits Group Commercial |
$87.52
|
| Rate for Payer: Health Management Network EPO/PPO |
$131.28
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$28.48
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$17.37
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$17.37
|
| Rate for Payer: InnovAge PACE Commercial |
$26.05
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$97.30
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$41.48
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$17.37
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$29.17
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$23.27
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$23.27
|
| Rate for Payer: Multiplan Commercial |
$109.40
|
| Rate for Payer: Networks By Design Commercial |
$72.94
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$17.37
|
| Rate for Payer: Prime Health Services Commercial |
$123.99
|
| Rate for Payer: Prime Health Services Medicare |
$18.41
|
| Rate for Payer: Riverside University Health System MISP |
$19.10
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$87.52
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$87.52
|
| Rate for Payer: United Healthcare All Other Commercial |
$54.75
|
| Rate for Payer: United Healthcare All Other HMO |
$53.29
|
| Rate for Payer: United Healthcare HMO Rider |
$52.13
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$47.77
|
| Rate for Payer: Upland Medical Group Pediatric |
$17.37
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$21.71
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$19.10
|
| Rate for Payer: Vantage Medical Group Senior |
$19.10
|
|
|
PENICILLIN G BENZATHINE AND PROCAINE 1,200,000 UNIT/2 ML IM SYRINGE [108051]
|
Facility
|
IP
|
$145.87
|
|
|
Service Code
|
HCPCS J0558
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$29.17 |
| Max. Negotiated Rate |
$131.28 |
| Rate for Payer: Adventist Health Commercial |
$29.17
|
| Rate for Payer: Blue Shield of California Commercial |
$112.76
|
| Rate for Payer: Blue Shield of California EPN |
$73.52
|
| Rate for Payer: Cash Price |
$80.23
|
| Rate for Payer: Central Health Plan Commercial |
$116.70
|
| Rate for Payer: Cigna of CA HMO |
$102.11
|
| Rate for Payer: Cigna of CA PPO |
$102.11
|
| Rate for Payer: EPIC Health Plan Commercial |
$58.35
|
| Rate for Payer: EPIC Health Plan Senior |
$58.35
|
| Rate for Payer: Galaxy Health WC |
$123.99
|
| Rate for Payer: Global Benefits Group Commercial |
$87.52
|
| Rate for Payer: Health Management Network EPO/PPO |
$131.28
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$97.30
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$55.58
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$90.29
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$29.17
|
| Rate for Payer: Multiplan Commercial |
$109.40
|
| Rate for Payer: Networks By Design Commercial |
$72.94
|
| Rate for Payer: Prime Health Services Commercial |
$123.99
|
| Rate for Payer: United Healthcare All Other Commercial |
$54.75
|
| Rate for Payer: United Healthcare All Other HMO |
$53.29
|
| Rate for Payer: United Healthcare HMO Rider |
$52.13
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$47.77
|
|
|
PENICILLIN G POTASSIUM 20 MILLION UNIT SOLUTION FOR INJECTION [6085]
|
Facility
|
OP
|
$59.99
|
|
|
Service Code
|
HCPCS J2540
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.34 |
| Max. Negotiated Rate |
$53.99 |
| Rate for Payer: Adventist Health Commercial |
$12.00
|
| Rate for Payer: Adventist Health Commercial |
$12.21
|
| Rate for Payer: Adventist Health Commercial |
$11.94
|
| Rate for Payer: Aetna of CA HMO/PPO |
$37.08
|
| Rate for Payer: Aetna of CA HMO/PPO |
$36.26
|
| Rate for Payer: Aetna of CA HMO/PPO |
$36.43
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$50.99
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$51.90
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$50.74
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$32.99
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$32.84
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$33.58
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$44.77
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$44.99
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$45.80
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1.12
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1.12
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1.12
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.34
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.34
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.34
|
| Rate for Payer: Blue Shield of California Commercial |
$1.96
|
| Rate for Payer: Blue Shield of California Commercial |
$1.96
|
| Rate for Payer: Blue Shield of California Commercial |
$1.96
|
| Rate for Payer: Blue Shield of California EPN |
$1.78
|
| Rate for Payer: Blue Shield of California EPN |
$1.78
|
| Rate for Payer: Blue Shield of California EPN |
$1.78
|
| Rate for Payer: Cash Price |
$33.58
|
| Rate for Payer: Cash Price |
$32.84
|
| Rate for Payer: Cash Price |
$32.84
|
| Rate for Payer: Cash Price |
$32.99
|
| Rate for Payer: Cash Price |
$32.99
|
| Rate for Payer: Cash Price |
$33.58
|
| Rate for Payer: Central Health Plan Commercial |
$48.85
|
| Rate for Payer: Central Health Plan Commercial |
$47.99
|
| Rate for Payer: Central Health Plan Commercial |
$47.76
|
| Rate for Payer: Cigna of CA HMO |
$42.74
|
| Rate for Payer: Cigna of CA HMO |
$41.99
|
| Rate for Payer: Cigna of CA HMO |
$41.79
|
| Rate for Payer: Cigna of CA PPO |
$41.79
|
| Rate for Payer: Cigna of CA PPO |
$42.74
|
| Rate for Payer: Cigna of CA PPO |
$41.99
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$51.90
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$50.74
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$50.99
|
| Rate for Payer: Dignity Health Medi-Cal |
$50.74
|
| Rate for Payer: Dignity Health Medi-Cal |
$50.99
|
| Rate for Payer: Dignity Health Medi-Cal |
$51.90
|
| Rate for Payer: Dignity Health Medicare Advantage |
$50.99
|
| Rate for Payer: Dignity Health Medicare Advantage |
$50.74
|
| Rate for Payer: Dignity Health Medicare Advantage |
$51.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$23.88
|
| Rate for Payer: EPIC Health Plan Commercial |
$24.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$24.42
|
| Rate for Payer: EPIC Health Plan Senior |
$23.88
|
| Rate for Payer: EPIC Health Plan Senior |
$24.00
|
| Rate for Payer: EPIC Health Plan Senior |
$24.42
|
| Rate for Payer: Galaxy Health WC |
$51.90
|
| Rate for Payer: Galaxy Health WC |
$50.74
|
| Rate for Payer: Galaxy Health WC |
$50.99
|
| Rate for Payer: Global Benefits Group Commercial |
$35.82
|
| Rate for Payer: Global Benefits Group Commercial |
$36.64
|
| Rate for Payer: Global Benefits Group Commercial |
$35.99
|
| Rate for Payer: Health Management Network EPO/PPO |
$54.95
|
| Rate for Payer: Health Management Network EPO/PPO |
$53.73
|
| Rate for Payer: Health Management Network EPO/PPO |
$53.99
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$0.78
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$0.78
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$0.78
|
| Rate for Payer: InnovAge PACE Commercial |
$30.53
|
| Rate for Payer: InnovAge PACE Commercial |
$30.00
|
| Rate for Payer: InnovAge PACE Commercial |
$29.85
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$40.01
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$39.82
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$40.73
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$9.90
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$9.90
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$9.90
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$37.80
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$36.95
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$37.13
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$12.21
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$11.94
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$12.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$42.74
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$41.99
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$41.79
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$41.79
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$41.99
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$42.74
|
| Rate for Payer: Multiplan Commercial |
$45.80
|
| Rate for Payer: Multiplan Commercial |
$44.77
|
| Rate for Payer: Multiplan Commercial |
$44.99
|
| Rate for Payer: Networks By Design Commercial |
$29.85
|
| Rate for Payer: Networks By Design Commercial |
$30.53
|
| Rate for Payer: Networks By Design Commercial |
$30.00
|
| Rate for Payer: Prime Health Services Commercial |
$50.99
|
| Rate for Payer: Prime Health Services Commercial |
$51.90
|
| Rate for Payer: Prime Health Services Commercial |
$50.74
|
| Rate for Payer: Riverside University Health System MISP |
$24.42
|
| Rate for Payer: Riverside University Health System MISP |
$24.00
|
| Rate for Payer: Riverside University Health System MISP |
$23.88
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$35.99
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$36.64
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$35.82
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$35.99
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$36.64
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$35.82
|
| Rate for Payer: United Healthcare All Other Commercial |
$22.92
|
| Rate for Payer: United Healthcare All Other Commercial |
$22.51
|
| Rate for Payer: United Healthcare All Other Commercial |
$22.41
|
| Rate for Payer: United Healthcare All Other HMO |
$21.81
|
| Rate for Payer: United Healthcare All Other HMO |
$21.91
|
| Rate for Payer: United Healthcare All Other HMO |
$22.31
|
| Rate for Payer: United Healthcare HMO Rider |
$21.44
|
| Rate for Payer: United Healthcare HMO Rider |
$21.34
|
| Rate for Payer: United Healthcare HMO Rider |
$21.82
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$20.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$19.55
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$19.65
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$50.99
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$50.74
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$51.90
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$50.74
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$51.90
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$50.99
|
| Rate for Payer: Vantage Medical Group Senior |
$50.99
|
| Rate for Payer: Vantage Medical Group Senior |
$50.74
|
| Rate for Payer: Vantage Medical Group Senior |
$51.90
|
|
|
PENICILLIN G POTASSIUM 20 MILLION UNIT SOLUTION FOR INJECTION [6085]
|
Facility
|
IP
|
$61.06
|
|
|
Service Code
|
HCPCS J2540
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$12.21 |
| Max. Negotiated Rate |
$54.95 |
| Rate for Payer: Adventist Health Commercial |
$12.21
|
| Rate for Payer: Adventist Health Commercial |
$12.00
|
| Rate for Payer: Adventist Health Commercial |
$11.94
|
| Rate for Payer: Blue Shield of California Commercial |
$47.20
|
| Rate for Payer: Blue Shield of California Commercial |
$46.37
|
| Rate for Payer: Blue Shield of California Commercial |
$46.15
|
| Rate for Payer: Blue Shield of California EPN |
$30.09
|
| Rate for Payer: Blue Shield of California EPN |
$30.77
|
| Rate for Payer: Blue Shield of California EPN |
$30.23
|
| Rate for Payer: Cash Price |
$33.58
|
| Rate for Payer: Cash Price |
$32.84
|
| Rate for Payer: Cash Price |
$32.99
|
| Rate for Payer: Central Health Plan Commercial |
$47.99
|
| Rate for Payer: Central Health Plan Commercial |
$47.76
|
| Rate for Payer: Central Health Plan Commercial |
$48.85
|
| Rate for Payer: Cigna of CA HMO |
$42.74
|
| Rate for Payer: Cigna of CA HMO |
$41.79
|
| Rate for Payer: Cigna of CA HMO |
$41.99
|
| Rate for Payer: Cigna of CA PPO |
$42.74
|
| Rate for Payer: Cigna of CA PPO |
$41.99
|
| Rate for Payer: Cigna of CA PPO |
$41.79
|
| Rate for Payer: EPIC Health Plan Commercial |
$24.42
|
| Rate for Payer: EPIC Health Plan Commercial |
$24.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$23.88
|
| Rate for Payer: EPIC Health Plan Senior |
$24.00
|
| Rate for Payer: EPIC Health Plan Senior |
$23.88
|
| Rate for Payer: EPIC Health Plan Senior |
$24.42
|
| Rate for Payer: Galaxy Health WC |
$50.99
|
| Rate for Payer: Galaxy Health WC |
$50.74
|
| Rate for Payer: Galaxy Health WC |
$51.90
|
| Rate for Payer: Global Benefits Group Commercial |
$35.99
|
| Rate for Payer: Global Benefits Group Commercial |
$35.82
|
| Rate for Payer: Global Benefits Group Commercial |
$36.64
|
| Rate for Payer: Health Management Network EPO/PPO |
$54.95
|
| Rate for Payer: Health Management Network EPO/PPO |
$53.99
|
| Rate for Payer: Health Management Network EPO/PPO |
$53.73
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$40.73
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$39.82
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$40.01
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$22.75
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$23.26
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$22.86
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$37.80
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$37.13
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$36.95
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$12.21
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$12.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$11.94
|
| Rate for Payer: Multiplan Commercial |
$45.80
|
| Rate for Payer: Multiplan Commercial |
$44.99
|
| Rate for Payer: Multiplan Commercial |
$44.77
|
| Rate for Payer: Networks By Design Commercial |
$30.53
|
| Rate for Payer: Networks By Design Commercial |
$29.85
|
| Rate for Payer: Networks By Design Commercial |
$30.00
|
| Rate for Payer: Prime Health Services Commercial |
$50.99
|
| Rate for Payer: Prime Health Services Commercial |
$51.90
|
| Rate for Payer: Prime Health Services Commercial |
$50.74
|
| Rate for Payer: United Healthcare All Other Commercial |
$22.41
|
| Rate for Payer: United Healthcare All Other Commercial |
$22.92
|
| Rate for Payer: United Healthcare All Other Commercial |
$22.51
|
| Rate for Payer: United Healthcare All Other HMO |
$21.91
|
| Rate for Payer: United Healthcare All Other HMO |
$21.81
|
| Rate for Payer: United Healthcare All Other HMO |
$22.31
|
| Rate for Payer: United Healthcare HMO Rider |
$21.34
|
| Rate for Payer: United Healthcare HMO Rider |
$21.44
|
| Rate for Payer: United Healthcare HMO Rider |
$21.82
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$19.65
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$20.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$19.55
|
|
|
PENICILLIN G POTASSIUM 5 MILLION UNIT SOLUTION FOR INJECTION [6086]
|
Facility
|
IP
|
$5.23
|
|
|
Service Code
|
HCPCS J2540
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.05 |
| Max. Negotiated Rate |
$4.71 |
| Rate for Payer: Adventist Health Commercial |
$1.05
|
| Rate for Payer: Adventist Health Commercial |
$1.01
|
| Rate for Payer: Adventist Health Commercial |
$3.05
|
| Rate for Payer: Blue Shield of California Commercial |
$4.04
|
| Rate for Payer: Blue Shield of California Commercial |
$3.90
|
| Rate for Payer: Blue Shield of California Commercial |
$11.80
|
| Rate for Payer: Blue Shield of California EPN |
$7.70
|
| Rate for Payer: Blue Shield of California EPN |
$2.64
|
| Rate for Payer: Blue Shield of California EPN |
$2.55
|
| Rate for Payer: Cash Price |
$2.88
|
| Rate for Payer: Cash Price |
$8.40
|
| Rate for Payer: Cash Price |
$2.78
|
| Rate for Payer: Central Health Plan Commercial |
$4.04
|
| Rate for Payer: Central Health Plan Commercial |
$12.22
|
| Rate for Payer: Central Health Plan Commercial |
$4.18
|
| Rate for Payer: Cigna of CA HMO |
$3.66
|
| Rate for Payer: Cigna of CA HMO |
$10.69
|
| Rate for Payer: Cigna of CA HMO |
$3.54
|
| Rate for Payer: Cigna of CA PPO |
$3.66
|
| Rate for Payer: Cigna of CA PPO |
$3.54
|
| Rate for Payer: Cigna of CA PPO |
$10.69
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.09
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.02
|
| Rate for Payer: EPIC Health Plan Commercial |
$6.11
|
| Rate for Payer: EPIC Health Plan Senior |
$2.02
|
| Rate for Payer: EPIC Health Plan Senior |
$6.11
|
| Rate for Payer: EPIC Health Plan Senior |
$2.09
|
| Rate for Payer: Galaxy Health WC |
$4.29
|
| Rate for Payer: Galaxy Health WC |
$12.98
|
| Rate for Payer: Galaxy Health WC |
$4.45
|
| Rate for Payer: Global Benefits Group Commercial |
$3.03
|
| Rate for Payer: Global Benefits Group Commercial |
$9.16
|
| Rate for Payer: Global Benefits Group Commercial |
$3.14
|
| Rate for Payer: Health Management Network EPO/PPO |
$4.71
|
| Rate for Payer: Health Management Network EPO/PPO |
$4.54
|
| Rate for Payer: Health Management Network EPO/PPO |
$13.74
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3.49
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$10.19
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3.37
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$5.82
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1.99
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1.92
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3.24
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3.13
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$9.45
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.05
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.01
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.05
|
| Rate for Payer: Multiplan Commercial |
$3.92
|
| Rate for Payer: Multiplan Commercial |
$3.79
|
| Rate for Payer: Multiplan Commercial |
$11.45
|
| Rate for Payer: Networks By Design Commercial |
$2.62
|
| Rate for Payer: Networks By Design Commercial |
$7.63
|
| Rate for Payer: Networks By Design Commercial |
$2.52
|
| Rate for Payer: Prime Health Services Commercial |
$4.29
|
| Rate for Payer: Prime Health Services Commercial |
$4.45
|
| Rate for Payer: Prime Health Services Commercial |
$12.98
|
| Rate for Payer: United Healthcare All Other Commercial |
$5.73
|
| Rate for Payer: United Healthcare All Other Commercial |
$1.96
|
| Rate for Payer: United Healthcare All Other Commercial |
$1.90
|
| Rate for Payer: United Healthcare All Other HMO |
$1.84
|
| Rate for Payer: United Healthcare All Other HMO |
$5.58
|
| Rate for Payer: United Healthcare All Other HMO |
$1.91
|
| Rate for Payer: United Healthcare HMO Rider |
$5.46
|
| Rate for Payer: United Healthcare HMO Rider |
$1.80
|
| Rate for Payer: United Healthcare HMO Rider |
$1.87
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1.65
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1.71
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$5.00
|
|
|
PENICILLIN G POTASSIUM 5 MILLION UNIT SOLUTION FOR INJECTION [6086]
|
Facility
|
OP
|
$5.05
|
|
|
Service Code
|
HCPCS J2540
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.34 |
| Max. Negotiated Rate |
$9.90 |
| Rate for Payer: Adventist Health Commercial |
$1.01
|
| Rate for Payer: Adventist Health Commercial |
$1.05
|
| Rate for Payer: Adventist Health Commercial |
$3.05
|
| Rate for Payer: Aetna of CA HMO/PPO |
$3.18
|
| Rate for Payer: Aetna of CA HMO/PPO |
$9.27
|
| Rate for Payer: Aetna of CA HMO/PPO |
$3.07
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$4.29
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$4.45
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$12.98
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2.78
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$8.40
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2.88
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$11.45
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$3.79
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$3.92
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1.12
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1.12
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1.12
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.34
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.34
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.34
|
| Rate for Payer: Blue Shield of California Commercial |
$1.96
|
| Rate for Payer: Blue Shield of California Commercial |
$1.96
|
| Rate for Payer: Blue Shield of California Commercial |
$1.96
|
| Rate for Payer: Blue Shield of California EPN |
$1.78
|
| Rate for Payer: Blue Shield of California EPN |
$1.78
|
| Rate for Payer: Blue Shield of California EPN |
$1.78
|
| Rate for Payer: Cash Price |
$2.88
|
| Rate for Payer: Cash Price |
$8.40
|
| Rate for Payer: Cash Price |
$8.40
|
| Rate for Payer: Cash Price |
$2.78
|
| Rate for Payer: Cash Price |
$2.78
|
| Rate for Payer: Cash Price |
$2.88
|
| Rate for Payer: Central Health Plan Commercial |
$4.18
|
| Rate for Payer: Central Health Plan Commercial |
$4.04
|
| Rate for Payer: Central Health Plan Commercial |
$12.22
|
| Rate for Payer: Cigna of CA HMO |
$3.66
|
| Rate for Payer: Cigna of CA HMO |
$3.54
|
| Rate for Payer: Cigna of CA HMO |
$10.69
|
| Rate for Payer: Cigna of CA PPO |
$10.69
|
| Rate for Payer: Cigna of CA PPO |
$3.66
|
| Rate for Payer: Cigna of CA PPO |
$3.54
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$4.45
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$12.98
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$4.29
|
| Rate for Payer: Dignity Health Medi-Cal |
$12.98
|
| Rate for Payer: Dignity Health Medi-Cal |
$4.29
|
| Rate for Payer: Dignity Health Medi-Cal |
$4.45
|
| Rate for Payer: Dignity Health Medicare Advantage |
$4.29
|
| Rate for Payer: Dignity Health Medicare Advantage |
$12.98
|
| Rate for Payer: Dignity Health Medicare Advantage |
$4.45
|
| Rate for Payer: EPIC Health Plan Commercial |
$6.11
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.02
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.09
|
| Rate for Payer: EPIC Health Plan Senior |
$6.11
|
| Rate for Payer: EPIC Health Plan Senior |
$2.02
|
| Rate for Payer: EPIC Health Plan Senior |
$2.09
|
| Rate for Payer: Galaxy Health WC |
$4.45
|
| Rate for Payer: Galaxy Health WC |
$12.98
|
| Rate for Payer: Galaxy Health WC |
$4.29
|
| Rate for Payer: Global Benefits Group Commercial |
$9.16
|
| Rate for Payer: Global Benefits Group Commercial |
$3.14
|
| Rate for Payer: Global Benefits Group Commercial |
$3.03
|
| Rate for Payer: Health Management Network EPO/PPO |
$4.71
|
| Rate for Payer: Health Management Network EPO/PPO |
$13.74
|
| Rate for Payer: Health Management Network EPO/PPO |
$4.54
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$0.78
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$0.78
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$0.78
|
| Rate for Payer: InnovAge PACE Commercial |
$2.62
|
| Rate for Payer: InnovAge PACE Commercial |
$2.52
|
| Rate for Payer: InnovAge PACE Commercial |
$7.63
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3.37
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$10.19
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3.49
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$9.90
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$9.90
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$9.90
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3.24
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$9.45
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3.13
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.05
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.05
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.01
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$3.66
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$3.54
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$10.69
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$10.69
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$3.54
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$3.66
|
| Rate for Payer: Multiplan Commercial |
$3.92
|
| Rate for Payer: Multiplan Commercial |
$11.45
|
| Rate for Payer: Multiplan Commercial |
$3.79
|
| Rate for Payer: Networks By Design Commercial |
$7.63
|
| Rate for Payer: Networks By Design Commercial |
$2.62
|
| Rate for Payer: Networks By Design Commercial |
$2.52
|
| Rate for Payer: Prime Health Services Commercial |
$4.29
|
| Rate for Payer: Prime Health Services Commercial |
$4.45
|
| Rate for Payer: Prime Health Services Commercial |
$12.98
|
| Rate for Payer: Riverside University Health System MISP |
$2.09
|
| Rate for Payer: Riverside University Health System MISP |
$2.02
|
| Rate for Payer: Riverside University Health System MISP |
$6.11
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3.03
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3.14
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$9.16
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$3.03
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$3.14
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$9.16
|
| Rate for Payer: United Healthcare All Other Commercial |
$1.96
|
| Rate for Payer: United Healthcare All Other Commercial |
$1.90
|
| Rate for Payer: United Healthcare All Other Commercial |
$5.73
|
| Rate for Payer: United Healthcare All Other HMO |
$5.58
|
| Rate for Payer: United Healthcare All Other HMO |
$1.84
|
| Rate for Payer: United Healthcare All Other HMO |
$1.91
|
| Rate for Payer: United Healthcare HMO Rider |
$1.80
|
| Rate for Payer: United Healthcare HMO Rider |
$5.46
|
| Rate for Payer: United Healthcare HMO Rider |
$1.87
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1.71
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$5.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1.65
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$4.29
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$12.98
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$4.45
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$12.98
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4.45
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4.29
|
| Rate for Payer: Vantage Medical Group Senior |
$4.29
|
| Rate for Payer: Vantage Medical Group Senior |
$12.98
|
| Rate for Payer: Vantage Medical Group Senior |
$4.45
|
|
|
PENICILLIN G SODIUM 5 MILLION UNIT SOLUTION FOR INJECTION [6087]
|
Facility
|
IP
|
$55.29
|
|
|
Service Code
|
HCPCS J2540
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$11.06 |
| Max. Negotiated Rate |
$49.76 |
| Rate for Payer: Adventist Health Commercial |
$11.06
|
| Rate for Payer: Blue Shield of California Commercial |
$42.74
|
| Rate for Payer: Blue Shield of California EPN |
$27.87
|
| Rate for Payer: Cash Price |
$30.41
|
| Rate for Payer: Central Health Plan Commercial |
$44.23
|
| Rate for Payer: Cigna of CA HMO |
$38.70
|
| Rate for Payer: Cigna of CA PPO |
$38.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$22.12
|
| Rate for Payer: EPIC Health Plan Senior |
$22.12
|
| Rate for Payer: Galaxy Health WC |
$47.00
|
| Rate for Payer: Global Benefits Group Commercial |
$33.17
|
| Rate for Payer: Health Management Network EPO/PPO |
$49.76
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$36.88
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$21.07
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$34.22
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$11.06
|
| Rate for Payer: Multiplan Commercial |
$41.47
|
| Rate for Payer: Networks By Design Commercial |
$27.64
|
| Rate for Payer: Prime Health Services Commercial |
$47.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$20.75
|
| Rate for Payer: United Healthcare All Other HMO |
$20.20
|
| Rate for Payer: United Healthcare HMO Rider |
$19.76
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$18.11
|
|
|
PENICILLIN G SODIUM 5 MILLION UNIT SOLUTION FOR INJECTION [6087]
|
Facility
|
OP
|
$55.29
|
|
|
Service Code
|
HCPCS J2540
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.34 |
| Max. Negotiated Rate |
$49.76 |
| Rate for Payer: Adventist Health Commercial |
$11.06
|
| Rate for Payer: Aetna of CA HMO/PPO |
$33.58
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$47.00
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$30.41
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$41.47
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1.12
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.34
|
| Rate for Payer: Blue Shield of California Commercial |
$1.96
|
| Rate for Payer: Blue Shield of California EPN |
$1.78
|
| Rate for Payer: Cash Price |
$30.41
|
| Rate for Payer: Cash Price |
$30.41
|
| Rate for Payer: Central Health Plan Commercial |
$44.23
|
| Rate for Payer: Cigna of CA HMO |
$38.70
|
| Rate for Payer: Cigna of CA PPO |
$38.70
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$47.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$47.00
|
| Rate for Payer: Dignity Health Medicare Advantage |
$47.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$22.12
|
| Rate for Payer: EPIC Health Plan Senior |
$22.12
|
| Rate for Payer: Galaxy Health WC |
$47.00
|
| Rate for Payer: Global Benefits Group Commercial |
$33.17
|
| Rate for Payer: Health Management Network EPO/PPO |
$49.76
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$0.78
|
| Rate for Payer: InnovAge PACE Commercial |
$27.64
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$36.88
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$9.90
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$34.22
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$11.06
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$38.70
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$38.70
|
| Rate for Payer: Multiplan Commercial |
$41.47
|
| Rate for Payer: Networks By Design Commercial |
$27.64
|
| Rate for Payer: Prime Health Services Commercial |
$47.00
|
| Rate for Payer: Riverside University Health System MISP |
$22.12
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$33.17
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$33.17
|
| Rate for Payer: United Healthcare All Other Commercial |
$20.75
|
| Rate for Payer: United Healthcare All Other HMO |
$20.20
|
| Rate for Payer: United Healthcare HMO Rider |
$19.76
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$18.11
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$47.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$47.00
|
| Rate for Payer: Vantage Medical Group Senior |
$47.00
|
|
|
PENICILLIN V POTASSIUM 0.625 MG/ML (1,000 UNITS/ML) ORAL SOLN [4081501]
|
Facility
|
IP
|
$0.08
|
|
|
Service Code
|
NDC 9994-0815-01
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.02 |
| Max. Negotiated Rate |
$0.07 |
| Rate for Payer: Adventist Health Commercial |
$0.02
|
| Rate for Payer: Blue Shield of California Commercial |
$0.06
|
| Rate for Payer: Blue Shield of California EPN |
$0.04
|
| Rate for Payer: Cash Price |
$0.04
|
| Rate for Payer: Central Health Plan Commercial |
$0.06
|
| Rate for Payer: Cigna of CA HMO |
$0.06
|
| Rate for Payer: Cigna of CA PPO |
$0.06
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.03
|
| Rate for Payer: EPIC Health Plan Senior |
$0.03
|
| Rate for Payer: Galaxy Health WC |
$0.07
|
| Rate for Payer: Global Benefits Group Commercial |
$0.05
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.07
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.05
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.03
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$0.05
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.02
|
| Rate for Payer: Multiplan Commercial |
$0.06
|
| Rate for Payer: Networks By Design Commercial |
$0.05
|
| Rate for Payer: Prime Health Services Commercial |
$0.07
|
|
|
PENICILLIN V POTASSIUM 0.625 MG/ML (1,000 UNITS/ML) ORAL SOLN [4081501]
|
Facility
|
OP
|
$0.08
|
|
|
Service Code
|
NDC 9994-0815-01
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.02 |
| Max. Negotiated Rate |
$0.07 |
| Rate for Payer: Adventist Health Commercial |
$0.02
|
| Rate for Payer: Aetna of CA HMO/PPO |
$0.05
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.07
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.04
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.06
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$0.04
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.05
|
| Rate for Payer: Blue Shield of California Commercial |
$0.05
|
| Rate for Payer: Blue Shield of California EPN |
$0.03
|
| Rate for Payer: Cash Price |
$0.04
|
| Rate for Payer: Central Health Plan Commercial |
$0.06
|
| Rate for Payer: Cigna of CA HMO |
$0.06
|
| Rate for Payer: Cigna of CA PPO |
$0.06
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.07
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.07
|
| Rate for Payer: Dignity Health Medicare Advantage |
$0.07
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.03
|
| Rate for Payer: EPIC Health Plan Senior |
$0.03
|
| Rate for Payer: Galaxy Health WC |
$0.07
|
| Rate for Payer: Global Benefits Group Commercial |
$0.05
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.07
|
| Rate for Payer: InnovAge PACE Commercial |
$0.04
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.05
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.03
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$0.05
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.02
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$0.06
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$0.06
|
| Rate for Payer: Multiplan Commercial |
$0.06
|
| Rate for Payer: Networks By Design Commercial |
$0.05
|
| Rate for Payer: Prime Health Services Commercial |
$0.07
|
| Rate for Payer: Riverside University Health System MISP |
$0.03
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.05
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.05
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.04
|
| Rate for Payer: United Healthcare All Other HMO |
$0.04
|
| Rate for Payer: United Healthcare HMO Rider |
$0.04
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.04
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.07
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.07
|
| Rate for Payer: Vantage Medical Group Senior |
$0.07
|
|
|
PENICILLIN V POTASSIUM 250 MG/5 ML ORAL SOLUTION [6091]
|
Facility
|
IP
|
$0.08
|
|
|
Service Code
|
NDC 0093-4127-74
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.02 |
| Max. Negotiated Rate |
$0.07 |
| Rate for Payer: Adventist Health Commercial |
$0.02
|
| Rate for Payer: Blue Shield of California Commercial |
$0.06
|
| Rate for Payer: Blue Shield of California EPN |
$0.04
|
| Rate for Payer: Cash Price |
$0.04
|
| Rate for Payer: Central Health Plan Commercial |
$0.06
|
| Rate for Payer: Cigna of CA HMO |
$0.06
|
| Rate for Payer: Cigna of CA PPO |
$0.06
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.03
|
| Rate for Payer: EPIC Health Plan Senior |
$0.03
|
| Rate for Payer: Galaxy Health WC |
$0.07
|
| Rate for Payer: Global Benefits Group Commercial |
$0.05
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.07
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.05
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.03
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$0.05
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.02
|
| Rate for Payer: Multiplan Commercial |
$0.06
|
| Rate for Payer: Networks By Design Commercial |
$0.05
|
| Rate for Payer: Prime Health Services Commercial |
$0.07
|
|
|
PENICILLIN V POTASSIUM 250 MG/5 ML ORAL SOLUTION [6091]
|
Facility
|
OP
|
$0.08
|
|
|
Service Code
|
NDC 0093-4127-74
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.02 |
| Max. Negotiated Rate |
$0.07 |
| Rate for Payer: Adventist Health Commercial |
$0.02
|
| Rate for Payer: Aetna of CA HMO/PPO |
$0.05
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.07
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.04
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.06
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$0.04
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.05
|
| Rate for Payer: Blue Shield of California Commercial |
$0.05
|
| Rate for Payer: Blue Shield of California EPN |
$0.03
|
| Rate for Payer: Cash Price |
$0.04
|
| Rate for Payer: Central Health Plan Commercial |
$0.06
|
| Rate for Payer: Cigna of CA HMO |
$0.06
|
| Rate for Payer: Cigna of CA PPO |
$0.06
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.07
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.07
|
| Rate for Payer: Dignity Health Medicare Advantage |
$0.07
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.03
|
| Rate for Payer: EPIC Health Plan Senior |
$0.03
|
| Rate for Payer: Galaxy Health WC |
$0.07
|
| Rate for Payer: Global Benefits Group Commercial |
$0.05
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.07
|
| Rate for Payer: InnovAge PACE Commercial |
$0.04
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.05
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.03
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$0.05
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.02
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$0.06
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$0.06
|
| Rate for Payer: Multiplan Commercial |
$0.06
|
| Rate for Payer: Networks By Design Commercial |
$0.05
|
| Rate for Payer: Prime Health Services Commercial |
$0.07
|
| Rate for Payer: Riverside University Health System MISP |
$0.03
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.05
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.05
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.04
|
| Rate for Payer: United Healthcare All Other HMO |
$0.04
|
| Rate for Payer: United Healthcare HMO Rider |
$0.04
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.04
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.07
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.07
|
| Rate for Payer: Vantage Medical Group Senior |
$0.07
|
|
|
PENICILLIN V POTASSIUM 250 MG TABLET [6092]
|
Facility
|
IP
|
$0.10
|
|
|
Service Code
|
NDC 57237-040-01
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.02 |
| Max. Negotiated Rate |
$0.09 |
| Rate for Payer: Adventist Health Commercial |
$0.02
|
| Rate for Payer: Blue Shield of California Commercial |
$0.08
|
| Rate for Payer: Blue Shield of California EPN |
$0.05
|
| Rate for Payer: Cash Price |
$0.05
|
| Rate for Payer: Central Health Plan Commercial |
$0.08
|
| Rate for Payer: Cigna of CA HMO |
$0.07
|
| Rate for Payer: Cigna of CA PPO |
$0.07
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.04
|
| Rate for Payer: EPIC Health Plan Senior |
$0.04
|
| Rate for Payer: Galaxy Health WC |
$0.09
|
| Rate for Payer: Global Benefits Group Commercial |
$0.06
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.09
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.07
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.04
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$0.06
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.02
|
| Rate for Payer: Multiplan Commercial |
$0.08
|
| Rate for Payer: Networks By Design Commercial |
$0.07
|
| Rate for Payer: Prime Health Services Commercial |
$0.09
|
|
|
PENICILLIN V POTASSIUM 250 MG TABLET [6092]
|
Facility
|
OP
|
$0.22
|
|
|
Service Code
|
NDC 0093-1172-10
|
| 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: Aetna of CA HMO/PPO |
$0.13
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.19
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.12
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.17
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$0.11
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.13
|
| Rate for Payer: Blue Shield of California Commercial |
$0.13
|
| Rate for Payer: Blue Shield of California EPN |
$0.09
|
| Rate for Payer: Cash Price |
$0.12
|
| 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: Dignity Health Commercial/Exchange |
$0.19
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.19
|
| Rate for Payer: Dignity Health Medicare Advantage |
$0.19
|
| 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: InnovAge PACE Commercial |
$0.11
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.15
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.08
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$0.14
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.04
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$0.15
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$0.15
|
| 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
|
| Rate for Payer: Riverside University Health System MISP |
$0.09
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.13
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.13
|
| 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 |
$0.11
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.19
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.19
|
| Rate for Payer: Vantage Medical Group Senior |
$0.19
|
|
|
PENICILLIN V POTASSIUM 250 MG TABLET [6092]
|
Facility
|
IP
|
$0.10
|
|
|
Service Code
|
NDC 0143-9837-01
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.02 |
| Max. Negotiated Rate |
$0.09 |
| Rate for Payer: Adventist Health Commercial |
$0.02
|
| Rate for Payer: Blue Shield of California Commercial |
$0.08
|
| Rate for Payer: Blue Shield of California EPN |
$0.05
|
| Rate for Payer: Cash Price |
$0.05
|
| Rate for Payer: Central Health Plan Commercial |
$0.08
|
| Rate for Payer: Cigna of CA HMO |
$0.07
|
| Rate for Payer: Cigna of CA PPO |
$0.07
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.04
|
| Rate for Payer: EPIC Health Plan Senior |
$0.04
|
| Rate for Payer: Galaxy Health WC |
$0.09
|
| Rate for Payer: Global Benefits Group Commercial |
$0.06
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.09
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.07
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.04
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$0.06
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.02
|
| Rate for Payer: Multiplan Commercial |
$0.08
|
| Rate for Payer: Networks By Design Commercial |
$0.07
|
| Rate for Payer: Prime Health Services Commercial |
$0.09
|
|
|
PENICILLIN V POTASSIUM 250 MG TABLET [6092]
|
Facility
|
IP
|
$0.22
|
|
|
Service Code
|
NDC 0093-1172-10
|
| 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 |
$0.17
|
| Rate for Payer: Blue Shield of California EPN |
$0.11
|
| Rate for Payer: Cash Price |
$0.12
|
| 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: 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 Permanente of CA Commercial/Self Funded |
$0.15
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.08
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$0.14
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.04
|
| Rate for Payer: Multiplan Commercial |
$0.17
|
| Rate for Payer: Networks By Design Commercial |
$0.14
|
| Rate for Payer: Prime Health Services Commercial |
$0.19
|
|
|
PENICILLIN V POTASSIUM 250 MG TABLET [6092]
|
Facility
|
OP
|
$0.10
|
|
|
Service Code
|
NDC 57237-040-01
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.02 |
| Max. Negotiated Rate |
$0.09 |
| Rate for Payer: Adventist Health Commercial |
$0.02
|
| Rate for Payer: Aetna of CA HMO/PPO |
$0.06
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.09
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.06
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.08
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$0.05
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.06
|
| Rate for Payer: Blue Shield of California Commercial |
$0.06
|
| Rate for Payer: Blue Shield of California EPN |
$0.04
|
| Rate for Payer: Cash Price |
$0.05
|
| Rate for Payer: Central Health Plan Commercial |
$0.08
|
| Rate for Payer: Cigna of CA HMO |
$0.07
|
| Rate for Payer: Cigna of CA PPO |
$0.07
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.09
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.09
|
| Rate for Payer: Dignity Health Medicare Advantage |
$0.09
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.04
|
| Rate for Payer: EPIC Health Plan Senior |
$0.04
|
| Rate for Payer: Galaxy Health WC |
$0.09
|
| Rate for Payer: Global Benefits Group Commercial |
$0.06
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.09
|
| Rate for Payer: InnovAge PACE Commercial |
$0.05
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.07
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.04
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$0.06
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.02
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$0.07
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$0.07
|
| Rate for Payer: Multiplan Commercial |
$0.08
|
| Rate for Payer: Networks By Design Commercial |
$0.07
|
| Rate for Payer: Prime Health Services Commercial |
$0.09
|
| Rate for Payer: Riverside University Health System MISP |
$0.04
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.06
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.06
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.05
|
| Rate for Payer: United Healthcare All Other HMO |
$0.05
|
| Rate for Payer: United Healthcare HMO Rider |
$0.05
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.05
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.09
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.09
|
| Rate for Payer: Vantage Medical Group Senior |
$0.09
|
|
|
PENICILLIN V POTASSIUM 250 MG TABLET [6092]
|
Facility
|
OP
|
$0.10
|
|
|
Service Code
|
NDC 0143-9837-01
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.02 |
| Max. Negotiated Rate |
$0.09 |
| Rate for Payer: Adventist Health Commercial |
$0.02
|
| Rate for Payer: Aetna of CA HMO/PPO |
$0.06
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.09
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.06
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.08
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$0.05
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.06
|
| Rate for Payer: Blue Shield of California Commercial |
$0.06
|
| Rate for Payer: Blue Shield of California EPN |
$0.04
|
| Rate for Payer: Cash Price |
$0.05
|
| Rate for Payer: Central Health Plan Commercial |
$0.08
|
| Rate for Payer: Cigna of CA HMO |
$0.07
|
| Rate for Payer: Cigna of CA PPO |
$0.07
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.09
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.09
|
| Rate for Payer: Dignity Health Medicare Advantage |
$0.09
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.04
|
| Rate for Payer: EPIC Health Plan Senior |
$0.04
|
| Rate for Payer: Galaxy Health WC |
$0.09
|
| Rate for Payer: Global Benefits Group Commercial |
$0.06
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.09
|
| Rate for Payer: InnovAge PACE Commercial |
$0.05
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.07
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.04
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$0.06
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.02
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$0.07
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$0.07
|
| Rate for Payer: Multiplan Commercial |
$0.08
|
| Rate for Payer: Networks By Design Commercial |
$0.07
|
| Rate for Payer: Prime Health Services Commercial |
$0.09
|
| Rate for Payer: Riverside University Health System MISP |
$0.04
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.06
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.06
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.05
|
| Rate for Payer: United Healthcare All Other HMO |
$0.05
|
| Rate for Payer: United Healthcare HMO Rider |
$0.05
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.05
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.09
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.09
|
| Rate for Payer: Vantage Medical Group Senior |
$0.09
|
|
|
PENICILLIN V POTASSIUM 50 MG/ML ORAL SOLUTION FOR DESENSITIZATION [40803012]
|
Facility
|
IP
|
$0.08
|
|
|
Service Code
|
NDC 0093-4127-74
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.02 |
| Max. Negotiated Rate |
$0.07 |
| Rate for Payer: Adventist Health Commercial |
$0.02
|
| Rate for Payer: Blue Shield of California Commercial |
$0.06
|
| Rate for Payer: Blue Shield of California EPN |
$0.04
|
| Rate for Payer: Cash Price |
$0.04
|
| Rate for Payer: Central Health Plan Commercial |
$0.06
|
| Rate for Payer: Cigna of CA HMO |
$0.06
|
| Rate for Payer: Cigna of CA PPO |
$0.06
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.03
|
| Rate for Payer: EPIC Health Plan Senior |
$0.03
|
| Rate for Payer: Galaxy Health WC |
$0.07
|
| Rate for Payer: Global Benefits Group Commercial |
$0.05
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.07
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.05
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.03
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$0.05
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.02
|
| Rate for Payer: Multiplan Commercial |
$0.06
|
| Rate for Payer: Networks By Design Commercial |
$0.05
|
| Rate for Payer: Prime Health Services Commercial |
$0.07
|
|
|
PENICILLIN V POTASSIUM 50 MG/ML ORAL SOLUTION FOR DESENSITIZATION [40803012]
|
Facility
|
OP
|
$0.08
|
|
|
Service Code
|
NDC 0093-4127-74
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.02 |
| Max. Negotiated Rate |
$0.07 |
| Rate for Payer: Adventist Health Commercial |
$0.02
|
| Rate for Payer: Aetna of CA HMO/PPO |
$0.05
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.07
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.04
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.06
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$0.04
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.05
|
| Rate for Payer: Blue Shield of California Commercial |
$0.05
|
| Rate for Payer: Blue Shield of California EPN |
$0.03
|
| Rate for Payer: Cash Price |
$0.04
|
| Rate for Payer: Central Health Plan Commercial |
$0.06
|
| Rate for Payer: Cigna of CA HMO |
$0.06
|
| Rate for Payer: Cigna of CA PPO |
$0.06
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.07
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.07
|
| Rate for Payer: Dignity Health Medicare Advantage |
$0.07
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.03
|
| Rate for Payer: EPIC Health Plan Senior |
$0.03
|
| Rate for Payer: Galaxy Health WC |
$0.07
|
| Rate for Payer: Global Benefits Group Commercial |
$0.05
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.07
|
| Rate for Payer: InnovAge PACE Commercial |
$0.04
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.05
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.03
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$0.05
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.02
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$0.06
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$0.06
|
| Rate for Payer: Multiplan Commercial |
$0.06
|
| Rate for Payer: Networks By Design Commercial |
$0.05
|
| Rate for Payer: Prime Health Services Commercial |
$0.07
|
| Rate for Payer: Riverside University Health System MISP |
$0.03
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.05
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.05
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.04
|
| Rate for Payer: United Healthcare All Other HMO |
$0.04
|
| Rate for Payer: United Healthcare HMO Rider |
$0.04
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.04
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.07
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.07
|
| Rate for Payer: Vantage Medical Group Senior |
$0.07
|
|
|
PENICILLIN V POTASSIUM 5 MG/ML ORAL SOLUTION FOR DESENSITIZATION [40803010]
|
Facility
|
IP
|
$0.01
|
|
|
Service Code
|
NDC 9994-3000-09
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Max. Negotiated Rate |
$0.01 |
| Rate for Payer: Adventist Health Commercial |
$0.00
|
| Rate for Payer: Blue Shield of California Commercial |
$0.01
|
| Rate for Payer: Blue Shield of California EPN |
$0.01
|
| Rate for Payer: Central Health Plan Commercial |
$0.01
|
| Rate for Payer: Cigna of CA HMO |
$0.01
|
| Rate for Payer: Cigna of CA PPO |
$0.01
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.00
|
| Rate for Payer: EPIC Health Plan Senior |
$0.00
|
| Rate for Payer: Galaxy Health WC |
$0.01
|
| Rate for Payer: Global Benefits Group Commercial |
$0.01
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.01
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.01
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.00
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$0.01
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.00
|
| Rate for Payer: Multiplan Commercial |
$0.01
|
| Rate for Payer: Networks By Design Commercial |
$0.01
|
| Rate for Payer: Prime Health Services Commercial |
$0.01
|
|
|
PENICILLIN V POTASSIUM 5 MG/ML ORAL SOLUTION FOR DESENSITIZATION [40803010]
|
Facility
|
OP
|
$0.01
|
|
|
Service Code
|
NDC 9994-3000-09
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Max. Negotiated Rate |
$0.01 |
| Rate for Payer: Adventist Health Commercial |
$0.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$0.01
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.01
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.01
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.01
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$0.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.01
|
| Rate for Payer: Blue Shield of California Commercial |
$0.01
|
| Rate for Payer: Blue Shield of California EPN |
$0.00
|
| Rate for Payer: Central Health Plan Commercial |
$0.01
|
| Rate for Payer: Cigna of CA HMO |
$0.01
|
| Rate for Payer: Cigna of CA PPO |
$0.01
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.01
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.01
|
| Rate for Payer: Dignity Health Medicare Advantage |
$0.01
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.00
|
| Rate for Payer: EPIC Health Plan Senior |
$0.00
|
| Rate for Payer: Galaxy Health WC |
$0.01
|
| Rate for Payer: Global Benefits Group Commercial |
$0.01
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.01
|
| Rate for Payer: InnovAge PACE Commercial |
$0.01
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.01
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.00
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$0.01
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$0.01
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$0.01
|
| Rate for Payer: Multiplan Commercial |
$0.01
|
| Rate for Payer: Networks By Design Commercial |
$0.01
|
| Rate for Payer: Prime Health Services Commercial |
$0.01
|
| Rate for Payer: Riverside University Health System MISP |
$0.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.01
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.01
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.01
|
| Rate for Payer: United Healthcare All Other HMO |
$0.01
|
| Rate for Payer: United Healthcare HMO Rider |
$0.01
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.01
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.01
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.01
|
| Rate for Payer: Vantage Medical Group Senior |
$0.01
|
|
|
PENICILLIN V POTASSIUM 6.25 MG/ML (10,000 UNITS/ML) ORAL SOLN [4081500]
|
Facility
|
IP
|
$0.08
|
|
|
Service Code
|
NDC 9994-0815-00
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.02 |
| Max. Negotiated Rate |
$0.07 |
| Rate for Payer: Adventist Health Commercial |
$0.02
|
| Rate for Payer: Blue Shield of California Commercial |
$0.06
|
| Rate for Payer: Blue Shield of California EPN |
$0.04
|
| Rate for Payer: Cash Price |
$0.04
|
| Rate for Payer: Central Health Plan Commercial |
$0.06
|
| Rate for Payer: Cigna of CA HMO |
$0.06
|
| Rate for Payer: Cigna of CA PPO |
$0.06
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.03
|
| Rate for Payer: EPIC Health Plan Senior |
$0.03
|
| Rate for Payer: Galaxy Health WC |
$0.07
|
| Rate for Payer: Global Benefits Group Commercial |
$0.05
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.07
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.05
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.03
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$0.05
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.02
|
| Rate for Payer: Multiplan Commercial |
$0.06
|
| Rate for Payer: Networks By Design Commercial |
$0.05
|
| Rate for Payer: Prime Health Services Commercial |
$0.07
|
|
|
PENICILLIN V POTASSIUM 6.25 MG/ML (10,000 UNITS/ML) ORAL SOLN [4081500]
|
Facility
|
OP
|
$0.08
|
|
|
Service Code
|
NDC 9994-0815-00
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.02 |
| Max. Negotiated Rate |
$0.07 |
| Rate for Payer: Adventist Health Commercial |
$0.02
|
| Rate for Payer: Aetna of CA HMO/PPO |
$0.05
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.07
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.04
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.06
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$0.04
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.05
|
| Rate for Payer: Blue Shield of California Commercial |
$0.05
|
| Rate for Payer: Blue Shield of California EPN |
$0.03
|
| Rate for Payer: Cash Price |
$0.04
|
| Rate for Payer: Central Health Plan Commercial |
$0.06
|
| Rate for Payer: Cigna of CA HMO |
$0.06
|
| Rate for Payer: Cigna of CA PPO |
$0.06
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.07
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.07
|
| Rate for Payer: Dignity Health Medicare Advantage |
$0.07
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.03
|
| Rate for Payer: EPIC Health Plan Senior |
$0.03
|
| Rate for Payer: Galaxy Health WC |
$0.07
|
| Rate for Payer: Global Benefits Group Commercial |
$0.05
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.07
|
| Rate for Payer: InnovAge PACE Commercial |
$0.04
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.05
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.03
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$0.05
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.02
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$0.06
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$0.06
|
| Rate for Payer: Multiplan Commercial |
$0.06
|
| Rate for Payer: Networks By Design Commercial |
$0.05
|
| Rate for Payer: Prime Health Services Commercial |
$0.07
|
| Rate for Payer: Riverside University Health System MISP |
$0.03
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.05
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.05
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.04
|
| Rate for Payer: United Healthcare All Other HMO |
$0.04
|
| Rate for Payer: United Healthcare HMO Rider |
$0.04
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.04
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.07
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.07
|
| Rate for Payer: Vantage Medical Group Senior |
$0.07
|
|
