|
OXYTOCIN CONTINUOUS INFUSION (MILLI-UNITS/MIN) 30 UNITS/500 ML LR PREMIX [4081758]
|
Facility
OP
|
$0.03
|
|
|
Service Code
|
CPT J2590
|
| Hospital Charge Code |
ERX4081758
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.01 |
| Max. Negotiated Rate |
$8.53 |
| Rate for Payer: Aetna of CA HMO/PPO |
$8.53
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$0.03
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$0.02
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$0.02
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1.80
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1.97
|
| Rate for Payer: BCBS Transplant Transplant |
$0.02
|
| Rate for Payer: Blue Shield of California Commercial |
$1.14
|
| Rate for Payer: Blue Shield of California EPN |
$1.04
|
| Rate for Payer: Cash Price |
$0.01
|
| Rate for Payer: Cash Price |
$0.01
|
| Rate for Payer: Central Health Plan Commercial |
$0.02
|
| Rate for Payer: Cigna of CA HMO |
$0.02
|
| Rate for Payer: Cigna of CA PPO |
$0.02
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.03
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.01
|
| Rate for Payer: EPIC Health Plan Transplant |
$0.01
|
| Rate for Payer: Galaxy Health WC |
$0.03
|
| Rate for Payer: Global Benefits Group Commercial |
$0.02
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.03
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$0.02
|
| Rate for Payer: IEHP medi-cal |
$0.01
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.02
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.01
|
| Rate for Payer: Multiplan Commercial |
$0.02
|
| Rate for Payer: Networks By Design Commercial |
$0.02
|
| Rate for Payer: Prime Health Services Commercial |
$0.03
|
| Rate for Payer: Riverside University Health MISP |
$0.01
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.02
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.02
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.02
|
| Rate for Payer: United Healthcare All Other HMO |
$0.02
|
| Rate for Payer: United Healthcare HMO Rider |
$0.02
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.02
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.03
|
| Rate for Payer: Vantage Medical Group Senior |
$0.03
|
|
|
OXYTOCIN CONTINUOUS INFUSION (MILLI-UNITS/MIN) 30 UNITS/500 ML LR PREMIX [4081758]
|
Facility
IP
|
$0.03
|
|
|
Service Code
|
CPT J2590
|
| Hospital Charge Code |
ERX4081758
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.01 |
| Max. Negotiated Rate |
$34,005.88 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$34,005.88
|
| Rate for Payer: Blue Shield of California Commercial |
$0.02
|
| Rate for Payer: Blue Shield of California EPN |
$0.02
|
| Rate for Payer: Cash Price |
$0.01
|
| Rate for Payer: Cash Price |
$0.01
|
| Rate for Payer: Central Health Plan Commercial |
$0.02
|
| Rate for Payer: Cigna of CA HMO |
$0.02
|
| Rate for Payer: Cigna of CA PPO |
$0.02
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.01
|
| Rate for Payer: EPIC Health Plan Transplant |
$0.01
|
| Rate for Payer: Galaxy Health WC |
$0.03
|
| Rate for Payer: Global Benefits Group Commercial |
$0.02
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.03
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.02
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.01
|
| Rate for Payer: Multiplan Commercial |
$0.02
|
| Rate for Payer: Networks By Design Commercial |
$0.02
|
| Rate for Payer: Prime Health Services Commercial |
$0.03
|
|
|
OXYTOCIN IN LACTATED RINGERS 30 UNIT/500 ML INTRAVENOUS SOLUTION [117913]
|
Facility
OP
|
$0.05
|
|
|
Service Code
|
CPT J2590
|
| Hospital Charge Code |
NDG117913
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.01 |
| Max. Negotiated Rate |
$8.53 |
| Rate for Payer: Aetna of CA HMO/PPO |
$8.53
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$0.04
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$0.03
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$0.03
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1.80
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1.97
|
| Rate for Payer: BCBS Transplant Transplant |
$0.03
|
| Rate for Payer: Blue Shield of California Commercial |
$1.14
|
| Rate for Payer: Blue Shield of California EPN |
$1.04
|
| Rate for Payer: Cash Price |
$0.02
|
| Rate for Payer: Cash Price |
$0.02
|
| Rate for Payer: Central Health Plan Commercial |
$0.04
|
| Rate for Payer: Cigna of CA HMO |
$0.04
|
| Rate for Payer: Cigna of CA PPO |
$0.04
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.04
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.02
|
| Rate for Payer: EPIC Health Plan Transplant |
$0.02
|
| Rate for Payer: Galaxy Health WC |
$0.04
|
| Rate for Payer: Global Benefits Group Commercial |
$0.03
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.05
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$0.04
|
| Rate for Payer: IEHP medi-cal |
$0.02
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.03
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.01
|
| Rate for Payer: Multiplan Commercial |
$0.04
|
| Rate for Payer: Networks By Design Commercial |
$0.03
|
| Rate for Payer: Prime Health Services Commercial |
$0.04
|
| Rate for Payer: Riverside University Health MISP |
$0.02
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.03
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.03
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.03
|
| Rate for Payer: United Healthcare All Other HMO |
$0.03
|
| Rate for Payer: United Healthcare HMO Rider |
$0.03
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.03
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.04
|
| Rate for Payer: Vantage Medical Group Senior |
$0.04
|
|
|
OXYTOCIN IN LACTATED RINGERS 30 UNIT/500 ML INTRAVENOUS SOLUTION [117913]
|
Facility
IP
|
$0.05
|
|
|
Service Code
|
CPT J2590
|
| Hospital Charge Code |
NDG117913
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.01 |
| Max. Negotiated Rate |
$34,005.88 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$34,005.88
|
| Rate for Payer: Blue Shield of California Commercial |
$0.04
|
| Rate for Payer: Blue Shield of California EPN |
$0.03
|
| Rate for Payer: Cash Price |
$0.02
|
| Rate for Payer: Cash Price |
$0.02
|
| Rate for Payer: Central Health Plan Commercial |
$0.04
|
| Rate for Payer: Cigna of CA HMO |
$0.04
|
| Rate for Payer: Cigna of CA PPO |
$0.04
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.02
|
| Rate for Payer: EPIC Health Plan Transplant |
$0.02
|
| Rate for Payer: Galaxy Health WC |
$0.04
|
| Rate for Payer: Global Benefits Group Commercial |
$0.03
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.05
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.03
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.01
|
| Rate for Payer: Multiplan Commercial |
$0.04
|
| Rate for Payer: Networks By Design Commercial |
$0.03
|
| Rate for Payer: Prime Health Services Commercial |
$0.04
|
|
|
OXYTOCIN (ML/HR) CONTINUOUS INFUSION 30 UNITS/500 ML LR PREMIX [4081759]
|
Facility
IP
|
$0.40
|
|
|
Service Code
|
CPT J2590
|
| Hospital Charge Code |
ERX4081759
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.08 |
| Max. Negotiated Rate |
$34,005.88 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$34,005.88
|
| Rate for Payer: Blue Shield of California Commercial |
$0.30
|
| Rate for Payer: Blue Shield of California EPN |
$0.21
|
| Rate for Payer: Cash Price |
$0.18
|
| Rate for Payer: Cash Price |
$0.18
|
| Rate for Payer: Central Health Plan Commercial |
$0.32
|
| Rate for Payer: Cigna of CA HMO |
$0.28
|
| Rate for Payer: Cigna of CA PPO |
$0.28
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.16
|
| Rate for Payer: EPIC Health Plan Transplant |
$0.16
|
| Rate for Payer: Galaxy Health WC |
$0.34
|
| Rate for Payer: Global Benefits Group Commercial |
$0.24
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.36
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.27
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.08
|
| Rate for Payer: Multiplan Commercial |
$0.30
|
| Rate for Payer: Networks By Design Commercial |
$0.20
|
| Rate for Payer: Prime Health Services Commercial |
$0.34
|
|
|
OXYTOCIN (ML/HR) CONTINUOUS INFUSION 30 UNITS/500 ML LR PREMIX [4081759]
|
Facility
OP
|
$0.40
|
|
|
Service Code
|
CPT J2590
|
| Hospital Charge Code |
ERX4081759
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.08 |
| Max. Negotiated Rate |
$8.53 |
| Rate for Payer: Aetna of CA HMO/PPO |
$8.53
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$0.34
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$0.22
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$0.22
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1.80
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1.97
|
| Rate for Payer: BCBS Transplant Transplant |
$0.24
|
| Rate for Payer: Blue Shield of California Commercial |
$1.14
|
| Rate for Payer: Blue Shield of California EPN |
$1.04
|
| Rate for Payer: Cash Price |
$0.18
|
| Rate for Payer: Cash Price |
$0.18
|
| Rate for Payer: Central Health Plan Commercial |
$0.32
|
| Rate for Payer: Cigna of CA HMO |
$0.28
|
| Rate for Payer: Cigna of CA PPO |
$0.28
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.34
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.16
|
| Rate for Payer: EPIC Health Plan Transplant |
$0.16
|
| Rate for Payer: Galaxy Health WC |
$0.34
|
| Rate for Payer: Global Benefits Group Commercial |
$0.24
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.36
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$0.30
|
| Rate for Payer: IEHP medi-cal |
$0.14
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.27
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.08
|
| Rate for Payer: Multiplan Commercial |
$0.30
|
| Rate for Payer: Networks By Design Commercial |
$0.20
|
| Rate for Payer: Prime Health Services Commercial |
$0.34
|
| Rate for Payer: Riverside University Health MISP |
$0.16
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.24
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.24
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.20
|
| Rate for Payer: United Healthcare All Other HMO |
$0.20
|
| Rate for Payer: United Healthcare HMO Rider |
$0.20
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.20
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.34
|
| Rate for Payer: Vantage Medical Group Senior |
$0.34
|
|
|
PACLITAXEL 6 MG/ML CONCENTRATE,INTRAVENOUS [10843]
|
Facility
OP
|
$2.40
|
|
|
Service Code
|
CPT J9267
|
| Hospital Charge Code |
1759501
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.09 |
| Max. Negotiated Rate |
$2.16 |
| Rate for Payer: IEHP medi-cal |
$0.09
|
| Rate for Payer: Aetna of CA HMO/PPO |
$0.21
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$2.04
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$1.32
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$1.32
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$0.90
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.98
|
| Rate for Payer: BCBS Transplant Transplant |
$1.44
|
| Rate for Payer: Blue Shield of California Commercial |
$0.43
|
| Rate for Payer: Blue Shield of California EPN |
$0.39
|
| Rate for Payer: Cash Price |
$1.08
|
| Rate for Payer: Cash Price |
$1.08
|
| Rate for Payer: Central Health Plan Commercial |
$1.92
|
| Rate for Payer: Cigna of CA HMO |
$1.68
|
| Rate for Payer: Cigna of CA PPO |
$1.68
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2.04
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.96
|
| Rate for Payer: EPIC Health Plan Transplant |
$0.96
|
| Rate for Payer: Galaxy Health WC |
$2.04
|
| Rate for Payer: Global Benefits Group Commercial |
$1.44
|
| Rate for Payer: Health Management Network EPO/PPO |
$2.16
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$1.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1.60
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.48
|
| Rate for Payer: Multiplan Commercial |
$1.80
|
| Rate for Payer: Networks By Design Commercial |
$1.20
|
| Rate for Payer: Prime Health Services Commercial |
$2.04
|
| Rate for Payer: Riverside University Health MISP |
$0.96
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1.44
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1.44
|
| Rate for Payer: United Healthcare All Other Commercial |
$1.20
|
| Rate for Payer: United Healthcare All Other HMO |
$1.20
|
| Rate for Payer: United Healthcare HMO Rider |
$1.20
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1.20
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2.04
|
| Rate for Payer: Vantage Medical Group Senior |
$2.04
|
|
|
PACLITAXEL 6 MG/ML CONCENTRATE,INTRAVENOUS [10843]
|
Facility
IP
|
$1.71
|
|
|
Service Code
|
CPT J9267
|
| Hospital Charge Code |
1755743
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.34 |
| Max. Negotiated Rate |
$34,005.88 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$34,005.88
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$34,005.88
|
| Rate for Payer: Blue Shield of California Commercial |
$1.28
|
| Rate for Payer: Blue Shield of California Commercial |
$1.80
|
| Rate for Payer: Blue Shield of California EPN |
$0.91
|
| Rate for Payer: Blue Shield of California EPN |
$1.28
|
| Rate for Payer: Cash Price |
$0.77
|
| Rate for Payer: Cash Price |
$1.08
|
| Rate for Payer: Cash Price |
$0.77
|
| Rate for Payer: Cash Price |
$1.08
|
| Rate for Payer: Central Health Plan Commercial |
$1.37
|
| Rate for Payer: Central Health Plan Commercial |
$1.92
|
| Rate for Payer: Cigna of CA HMO |
$1.68
|
| Rate for Payer: Cigna of CA HMO |
$1.20
|
| Rate for Payer: Cigna of CA PPO |
$1.20
|
| Rate for Payer: Cigna of CA PPO |
$1.68
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.68
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.96
|
| Rate for Payer: EPIC Health Plan Transplant |
$0.96
|
| Rate for Payer: EPIC Health Plan Transplant |
$0.68
|
| Rate for Payer: Galaxy Health WC |
$2.04
|
| Rate for Payer: Galaxy Health WC |
$1.45
|
| Rate for Payer: Global Benefits Group Commercial |
$1.03
|
| Rate for Payer: Global Benefits Group Commercial |
$1.44
|
| Rate for Payer: Health Management Network EPO/PPO |
$2.16
|
| Rate for Payer: Health Management Network EPO/PPO |
$1.54
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1.14
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.48
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.34
|
| Rate for Payer: Multiplan Commercial |
$1.80
|
| Rate for Payer: Multiplan Commercial |
$1.28
|
| Rate for Payer: Networks By Design Commercial |
$0.86
|
| Rate for Payer: Networks By Design Commercial |
$1.20
|
| Rate for Payer: Prime Health Services Commercial |
$1.45
|
| Rate for Payer: Prime Health Services Commercial |
$2.04
|
|
|
PACLITAXEL 6 MG/ML CONCENTRATE,INTRAVENOUS [10843]
|
Facility
IP
|
$2.84
|
|
|
Service Code
|
CPT J9267
|
| Hospital Charge Code |
1755742
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.57 |
| Max. Negotiated Rate |
$34,005.88 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$34,005.88
|
| Rate for Payer: Blue Shield of California Commercial |
$2.13
|
| Rate for Payer: Blue Shield of California EPN |
$1.52
|
| Rate for Payer: Cash Price |
$1.28
|
| Rate for Payer: Cash Price |
$1.28
|
| Rate for Payer: Central Health Plan Commercial |
$2.27
|
| Rate for Payer: Cigna of CA HMO |
$1.99
|
| Rate for Payer: Cigna of CA PPO |
$1.99
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.14
|
| Rate for Payer: EPIC Health Plan Transplant |
$1.14
|
| Rate for Payer: Galaxy Health WC |
$2.41
|
| Rate for Payer: Global Benefits Group Commercial |
$1.70
|
| Rate for Payer: Health Management Network EPO/PPO |
$2.56
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1.89
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.57
|
| Rate for Payer: Multiplan Commercial |
$2.13
|
| Rate for Payer: Networks By Design Commercial |
$1.42
|
| Rate for Payer: Prime Health Services Commercial |
$2.41
|
|
|
PACLITAXEL 6 MG/ML CONCENTRATE,INTRAVENOUS [10843]
|
Facility
OP
|
$2.84
|
|
|
Service Code
|
CPT J9267
|
| Hospital Charge Code |
1755742
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.09 |
| Max. Negotiated Rate |
$2.56 |
| Rate for Payer: Aetna of CA HMO/PPO |
$0.21
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$2.41
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$1.56
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$1.56
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$0.90
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.98
|
| Rate for Payer: BCBS Transplant Transplant |
$1.70
|
| Rate for Payer: Blue Shield of California Commercial |
$0.43
|
| Rate for Payer: Blue Shield of California EPN |
$0.39
|
| Rate for Payer: Cash Price |
$1.28
|
| Rate for Payer: Cash Price |
$1.28
|
| Rate for Payer: Central Health Plan Commercial |
$2.27
|
| Rate for Payer: Cigna of CA HMO |
$1.99
|
| Rate for Payer: Cigna of CA PPO |
$1.99
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2.41
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.14
|
| Rate for Payer: EPIC Health Plan Transplant |
$1.14
|
| Rate for Payer: Galaxy Health WC |
$2.41
|
| Rate for Payer: Global Benefits Group Commercial |
$1.70
|
| Rate for Payer: Health Management Network EPO/PPO |
$2.56
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$2.13
|
| Rate for Payer: IEHP medi-cal |
$0.09
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1.89
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.57
|
| Rate for Payer: Multiplan Commercial |
$2.13
|
| Rate for Payer: Networks By Design Commercial |
$1.42
|
| Rate for Payer: Prime Health Services Commercial |
$2.41
|
| Rate for Payer: Riverside University Health MISP |
$1.14
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1.70
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1.70
|
| Rate for Payer: United Healthcare All Other Commercial |
$1.42
|
| Rate for Payer: United Healthcare All Other HMO |
$1.42
|
| Rate for Payer: United Healthcare HMO Rider |
$1.42
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1.42
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2.41
|
| Rate for Payer: Vantage Medical Group Senior |
$2.41
|
|
|
PACLITAXEL 6 MG/ML CONCENTRATE,INTRAVENOUS [10843]
|
Facility
IP
|
$2.40
|
|
|
Service Code
|
CPT J9267
|
| Hospital Charge Code |
1759501
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.48 |
| Max. Negotiated Rate |
$34,005.88 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$34,005.88
|
| Rate for Payer: Blue Shield of California Commercial |
$1.80
|
| Rate for Payer: Blue Shield of California EPN |
$1.28
|
| Rate for Payer: Cash Price |
$1.08
|
| Rate for Payer: Cash Price |
$1.08
|
| Rate for Payer: Central Health Plan Commercial |
$1.92
|
| Rate for Payer: Cigna of CA HMO |
$1.68
|
| Rate for Payer: Cigna of CA PPO |
$1.68
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.96
|
| Rate for Payer: EPIC Health Plan Transplant |
$0.96
|
| Rate for Payer: Galaxy Health WC |
$2.04
|
| Rate for Payer: Global Benefits Group Commercial |
$1.44
|
| Rate for Payer: Health Management Network EPO/PPO |
$2.16
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1.60
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.48
|
| Rate for Payer: Multiplan Commercial |
$1.80
|
| Rate for Payer: Networks By Design Commercial |
$1.20
|
| Rate for Payer: Prime Health Services Commercial |
$2.04
|
|
|
PACLITAXEL 6 MG/ML CONCENTRATE,INTRAVENOUS [10843]
|
Facility
OP
|
$1.71
|
|
|
Service Code
|
CPT J9267
|
| Hospital Charge Code |
1755743
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.09 |
| Max. Negotiated Rate |
$1.54 |
| Rate for Payer: Aetna of CA HMO/PPO |
$0.21
|
| Rate for Payer: Aetna of CA HMO/PPO |
$0.21
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$1.45
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$2.04
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$0.94
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$1.32
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$0.94
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$1.32
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$0.90
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$0.90
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.98
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.98
|
| Rate for Payer: BCBS Transplant Transplant |
$1.44
|
| Rate for Payer: BCBS Transplant Transplant |
$1.03
|
| Rate for Payer: Blue Shield of California Commercial |
$0.43
|
| Rate for Payer: Blue Shield of California Commercial |
$0.43
|
| Rate for Payer: Blue Shield of California EPN |
$0.39
|
| Rate for Payer: Blue Shield of California EPN |
$0.39
|
| Rate for Payer: Cash Price |
$1.08
|
| Rate for Payer: Cash Price |
$1.08
|
| Rate for Payer: Cash Price |
$0.77
|
| Rate for Payer: Cash Price |
$0.77
|
| Rate for Payer: Central Health Plan Commercial |
$1.92
|
| Rate for Payer: Central Health Plan Commercial |
$1.37
|
| Rate for Payer: Cigna of CA HMO |
$1.68
|
| Rate for Payer: Cigna of CA HMO |
$1.20
|
| Rate for Payer: Cigna of CA PPO |
$1.20
|
| Rate for Payer: Cigna of CA PPO |
$1.68
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2.04
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1.45
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.68
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.96
|
| Rate for Payer: EPIC Health Plan Transplant |
$0.68
|
| Rate for Payer: EPIC Health Plan Transplant |
$0.96
|
| Rate for Payer: Galaxy Health WC |
$2.04
|
| Rate for Payer: Galaxy Health WC |
$1.45
|
| Rate for Payer: Global Benefits Group Commercial |
$1.44
|
| Rate for Payer: Global Benefits Group Commercial |
$1.03
|
| Rate for Payer: Health Management Network EPO/PPO |
$1.54
|
| Rate for Payer: Health Management Network EPO/PPO |
$2.16
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$1.28
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$1.80
|
| Rate for Payer: IEHP medi-cal |
$0.09
|
| Rate for Payer: IEHP medi-cal |
$0.09
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1.14
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1.60
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.48
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.34
|
| Rate for Payer: Multiplan Commercial |
$1.28
|
| Rate for Payer: Multiplan Commercial |
$1.80
|
| Rate for Payer: Networks By Design Commercial |
$1.20
|
| Rate for Payer: Networks By Design Commercial |
$0.86
|
| Rate for Payer: Prime Health Services Commercial |
$1.45
|
| Rate for Payer: Prime Health Services Commercial |
$2.04
|
| Rate for Payer: Riverside University Health MISP |
$0.96
|
| Rate for Payer: Riverside University Health MISP |
$0.68
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1.03
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1.44
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1.03
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1.44
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.86
|
| Rate for Payer: United Healthcare All Other Commercial |
$1.20
|
| Rate for Payer: United Healthcare All Other HMO |
$1.20
|
| Rate for Payer: United Healthcare All Other HMO |
$0.86
|
| Rate for Payer: United Healthcare HMO Rider |
$0.86
|
| Rate for Payer: United Healthcare HMO Rider |
$1.20
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1.20
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.86
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1.45
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2.04
|
| Rate for Payer: Vantage Medical Group Senior |
$2.04
|
| Rate for Payer: Vantage Medical Group Senior |
$1.45
|
|
|
PACLITAXEL PROTEIN-BOUND 100 MG INTRAVENOUS SUSPENSION [40475]
|
Facility
OP
|
$1,896.07
|
|
|
Service Code
|
NDC 68817-134-50
|
| Hospital Charge Code |
1755722
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$379.21 |
| Max. Negotiated Rate |
$1,706.46 |
| Rate for Payer: Aetna of CA HMO/PPO |
$1,151.48
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$1,611.66
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$1,042.84
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$1,042.84
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$918.08
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,120.20
|
| Rate for Payer: BCBS Transplant Transplant |
$1,137.64
|
| Rate for Payer: Blue Shield of California Commercial |
$1,192.63
|
| Rate for Payer: Blue Shield of California EPN |
$927.18
|
| Rate for Payer: Cash Price |
$853.23
|
| Rate for Payer: Cash Price |
$853.23
|
| Rate for Payer: Central Health Plan Commercial |
$1,516.86
|
| Rate for Payer: Cigna of CA HMO |
$1,327.25
|
| Rate for Payer: Cigna of CA PPO |
$1,327.25
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,611.66
|
| Rate for Payer: EPIC Health Plan Commercial |
$758.43
|
| Rate for Payer: EPIC Health Plan Transplant |
$758.43
|
| Rate for Payer: Galaxy Health WC |
$1,611.66
|
| Rate for Payer: Global Benefits Group Commercial |
$1,137.64
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,706.46
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$1,422.05
|
| Rate for Payer: IEHP medi-cal |
$663.62
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,264.68
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$379.21
|
| Rate for Payer: Multiplan Commercial |
$1,422.05
|
| Rate for Payer: Networks By Design Commercial |
$948.04
|
| Rate for Payer: Prime Health Services Commercial |
$1,611.66
|
| Rate for Payer: Riverside University Health MISP |
$758.43
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,137.64
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,137.64
|
| Rate for Payer: United Healthcare All Other Commercial |
$948.04
|
| Rate for Payer: United Healthcare All Other HMO |
$948.04
|
| Rate for Payer: United Healthcare HMO Rider |
$948.04
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$948.04
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,611.66
|
| Rate for Payer: Vantage Medical Group Senior |
$1,611.66
|
|
|
PACLITAXEL PROTEIN-BOUND 100 MG INTRAVENOUS SUSPENSION [40475]
|
Facility
IP
|
$1,896.07
|
|
|
Service Code
|
NDC 68817-134-50
|
| Hospital Charge Code |
1755722
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$379.21 |
| Max. Negotiated Rate |
$34,005.88 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$34,005.88
|
| Rate for Payer: Blue Shield of California Commercial |
$1,422.05
|
| Rate for Payer: Blue Shield of California EPN |
$1,012.50
|
| Rate for Payer: Cash Price |
$853.23
|
| Rate for Payer: Cash Price |
$853.23
|
| Rate for Payer: Central Health Plan Commercial |
$1,516.86
|
| Rate for Payer: Cigna of CA HMO |
$1,327.25
|
| Rate for Payer: Cigna of CA PPO |
$1,327.25
|
| Rate for Payer: EPIC Health Plan Commercial |
$758.43
|
| Rate for Payer: EPIC Health Plan Transplant |
$758.43
|
| Rate for Payer: Galaxy Health WC |
$1,611.66
|
| Rate for Payer: Global Benefits Group Commercial |
$1,137.64
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,706.46
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,264.68
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$379.21
|
| Rate for Payer: Multiplan Commercial |
$1,422.05
|
| Rate for Payer: Networks By Design Commercial |
$948.04
|
| Rate for Payer: Prime Health Services Commercial |
$1,611.66
|
|
|
Palatopharyngoplasty (eg, uvulopalatopharyngoplasty, uvulopharyngoplasty)
|
Facility
OP
|
$15,354.00
|
|
|
Service Code
|
CPT 42145
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$4,755.97 |
| Max. Negotiated Rate |
$15,354.00 |
| Rate for Payer: Adventist Health Medi-Cal |
$7,316.90
|
| Rate for Payer: Aetna of CA HMO/PPO |
$11,071.00
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$10,975.35
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$8,048.59
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$7,316.90
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$6,419.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$7,830.00
|
| Rate for Payer: Anthem Blue Cross of CA Workers' Comp |
$10,003.24
|
| Rate for Payer: Blue Shield of California Commercial |
$6,621.66
|
| Rate for Payer: Blue Shield of California EPN |
$4,755.97
|
| Rate for Payer: Caremore Medicare Advantage |
$7,316.90
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$10,975.35
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,877.82
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$7,316.90
|
| Rate for Payer: EPIC Health Plan Transplant |
$7,316.90
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$11,999.72
|
| Rate for Payer: IEHP medi-cal |
$12,072.88
|
| Rate for Payer: IEHP Medicare Advantage |
$7,316.90
|
| Rate for Payer: Innovage PACE Commercial |
$10,975.35
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$7,316.90
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$9,804.65
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$9,804.65
|
| Rate for Payer: Multiplan WC |
$10,003.24
|
| Rate for Payer: Preferred Health Network WC |
$10,207.39
|
| Rate for Payer: Prime Health Services Medicare |
$7,755.91
|
| Rate for Payer: Prime Health Services WC |
$9,901.17
|
| Rate for Payer: Riverside University Health MISP |
$8,048.59
|
| Rate for Payer: United Healthcare All Other Commercial |
$11,375.00
|
| Rate for Payer: United Healthcare All Other HMO |
$15,354.00
|
| Rate for Payer: United Healthcare HMO Rider |
$9,681.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$8,852.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$10,975.35
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$8,048.59
|
| Rate for Payer: Vantage Medical Group Senior |
$7,316.90
|
|
|
PALIFERMIN 6.25 MG INTRAVENOUS SOLUTION [40400]
|
Facility
IP
|
$3,751.26
|
|
|
Service Code
|
CPT J2425
|
| Hospital Charge Code |
1753463
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$750.25 |
| Max. Negotiated Rate |
$34,005.88 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$34,005.88
|
| Rate for Payer: Blue Shield of California Commercial |
$2,813.44
|
| Rate for Payer: Blue Shield of California EPN |
$2,003.17
|
| Rate for Payer: Cash Price |
$1,688.07
|
| Rate for Payer: Cash Price |
$1,688.07
|
| Rate for Payer: Central Health Plan Commercial |
$3,001.01
|
| Rate for Payer: Cigna of CA HMO |
$2,625.88
|
| Rate for Payer: Cigna of CA PPO |
$2,625.88
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,500.50
|
| Rate for Payer: EPIC Health Plan Transplant |
$1,500.50
|
| Rate for Payer: Galaxy Health WC |
$3,188.57
|
| Rate for Payer: Global Benefits Group Commercial |
$2,250.76
|
| Rate for Payer: Health Management Network EPO/PPO |
$3,376.13
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,502.09
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$750.25
|
| Rate for Payer: Multiplan Commercial |
$2,813.44
|
| Rate for Payer: Networks By Design Commercial |
$1,875.63
|
| Rate for Payer: Prime Health Services Commercial |
$3,188.57
|
|
|
PALIFERMIN 6.25 MG INTRAVENOUS SOLUTION [40400]
|
Facility
OP
|
$3,751.26
|
|
|
Service Code
|
CPT J2425
|
| Hospital Charge Code |
1753463
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$22.70 |
| Max. Negotiated Rate |
$3,376.13 |
| Rate for Payer: Adventist Health Medi-Cal |
$26.51
|
| Rate for Payer: Aetna of CA HMO/PPO |
$196.22
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$33.14
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$29.16
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$29.16
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$22.70
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$24.86
|
| Rate for Payer: BCBS Transplant Transplant |
$2,250.76
|
| Rate for Payer: Blue Shield of California Commercial |
$28.49
|
| Rate for Payer: Blue Shield of California EPN |
$25.90
|
| Rate for Payer: Caremore Medicare Advantage |
$26.51
|
| Rate for Payer: Cash Price |
$1,688.07
|
| Rate for Payer: Cash Price |
$1,688.07
|
| Rate for Payer: Central Health Plan Commercial |
$3,001.01
|
| Rate for Payer: Cigna of CA HMO |
$2,625.88
|
| Rate for Payer: Cigna of CA PPO |
$2,625.88
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$39.76
|
| Rate for Payer: EPIC Health Plan Commercial |
$35.79
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$26.51
|
| Rate for Payer: EPIC Health Plan Transplant |
$26.51
|
| Rate for Payer: Galaxy Health WC |
$3,188.57
|
| Rate for Payer: Global Benefits Group Commercial |
$2,250.76
|
| Rate for Payer: Health Management Network EPO/PPO |
$3,376.13
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$2,813.44
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$43.47
|
| Rate for Payer: IEHP medi-cal |
$43.74
|
| Rate for Payer: IEHP Medicare Advantage |
$26.51
|
| Rate for Payer: Innovage PACE Commercial |
$39.76
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,502.09
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$26.51
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$750.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$35.52
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$35.52
|
| Rate for Payer: Multiplan Commercial |
$2,813.44
|
| Rate for Payer: Networks By Design Commercial |
$1,875.63
|
| Rate for Payer: Prime Health Services Commercial |
$3,188.57
|
| Rate for Payer: Prime Health Services Medicare |
$28.10
|
| Rate for Payer: Riverside University Health MISP |
$29.16
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,250.76
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2,250.76
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,875.63
|
| Rate for Payer: United Healthcare All Other HMO |
$1,875.63
|
| Rate for Payer: United Healthcare HMO Rider |
$1,875.63
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,875.63
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$39.76
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$29.16
|
| Rate for Payer: Vantage Medical Group Senior |
$26.51
|
|
|
PALIPERIDONE PALMITATE 156 MG/ML INTRAMUSCULAR SYRINGE [99702]
|
Facility
OP
|
$2,678.57
|
|
|
Service Code
|
CPT J2426
|
| Hospital Charge Code |
NDG99702
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$12.57 |
| Max. Negotiated Rate |
$2,410.71 |
| Rate for Payer: Adventist Health Medi-Cal |
$14.32
|
| Rate for Payer: Aetna of CA HMO/PPO |
$88.72
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$17.90
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$15.75
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$15.75
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$12.57
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13.76
|
| Rate for Payer: BCBS Transplant Transplant |
$1,607.14
|
| Rate for Payer: Blue Shield of California Commercial |
$15.83
|
| Rate for Payer: Blue Shield of California EPN |
$14.39
|
| Rate for Payer: Caremore Medicare Advantage |
$14.32
|
| Rate for Payer: Cash Price |
$1,205.36
|
| Rate for Payer: Cash Price |
$1,205.36
|
| Rate for Payer: Central Health Plan Commercial |
$2,142.86
|
| Rate for Payer: Cigna of CA HMO |
$1,875.00
|
| Rate for Payer: Cigna of CA PPO |
$1,875.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$21.48
|
| Rate for Payer: EPIC Health Plan Commercial |
$19.33
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$14.32
|
| Rate for Payer: EPIC Health Plan Transplant |
$14.32
|
| Rate for Payer: Galaxy Health WC |
$2,276.78
|
| Rate for Payer: Global Benefits Group Commercial |
$1,607.14
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,410.71
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$2,008.93
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$23.48
|
| Rate for Payer: IEHP medi-cal |
$23.62
|
| Rate for Payer: IEHP Medicare Advantage |
$14.32
|
| Rate for Payer: Innovage PACE Commercial |
$21.48
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,786.61
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$14.32
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$535.71
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$19.19
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$19.19
|
| Rate for Payer: Multiplan Commercial |
$2,008.93
|
| Rate for Payer: Networks By Design Commercial |
$1,339.28
|
| Rate for Payer: Prime Health Services Commercial |
$2,276.78
|
| Rate for Payer: Prime Health Services Medicare |
$15.18
|
| Rate for Payer: Riverside University Health MISP |
$15.75
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,607.14
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,607.14
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,339.28
|
| Rate for Payer: United Healthcare All Other HMO |
$1,339.28
|
| Rate for Payer: United Healthcare HMO Rider |
$1,339.28
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,339.28
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$21.48
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$15.75
|
| Rate for Payer: Vantage Medical Group Senior |
$14.32
|
|
|
PALIPERIDONE PALMITATE 156 MG/ML INTRAMUSCULAR SYRINGE [99702]
|
Facility
IP
|
$2,678.57
|
|
|
Service Code
|
CPT J2426
|
| Hospital Charge Code |
NDG99702
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$535.71 |
| Max. Negotiated Rate |
$34,005.88 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$34,005.88
|
| Rate for Payer: Blue Shield of California Commercial |
$2,008.93
|
| Rate for Payer: Blue Shield of California EPN |
$1,430.36
|
| Rate for Payer: Cash Price |
$1,205.36
|
| Rate for Payer: Cash Price |
$1,205.36
|
| Rate for Payer: Central Health Plan Commercial |
$2,142.86
|
| Rate for Payer: Cigna of CA HMO |
$1,875.00
|
| Rate for Payer: Cigna of CA PPO |
$1,875.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,071.43
|
| Rate for Payer: EPIC Health Plan Transplant |
$1,071.43
|
| Rate for Payer: Galaxy Health WC |
$2,276.78
|
| Rate for Payer: Global Benefits Group Commercial |
$1,607.14
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,410.71
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,786.61
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$535.71
|
| Rate for Payer: Multiplan Commercial |
$2,008.93
|
| Rate for Payer: Networks By Design Commercial |
$1,339.28
|
| Rate for Payer: Prime Health Services Commercial |
$2,276.78
|
|
|
PALIPERIDONE PALMITATE 234 MG/1.5 ML INTRAMUSCULAR SYRINGE [108109]
|
Facility
OP
|
$2,678.50
|
|
|
Service Code
|
CPT J2426
|
| Hospital Charge Code |
1712607
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$12.57 |
| Max. Negotiated Rate |
$2,410.65 |
| Rate for Payer: Adventist Health Medi-Cal |
$14.32
|
| Rate for Payer: Aetna of CA HMO/PPO |
$88.72
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$17.90
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$15.75
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$15.75
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$12.57
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13.76
|
| Rate for Payer: BCBS Transplant Transplant |
$1,607.10
|
| Rate for Payer: Blue Shield of California Commercial |
$15.83
|
| Rate for Payer: Blue Shield of California EPN |
$14.39
|
| Rate for Payer: Caremore Medicare Advantage |
$14.32
|
| Rate for Payer: Cash Price |
$1,205.33
|
| Rate for Payer: Cash Price |
$1,205.33
|
| Rate for Payer: Central Health Plan Commercial |
$2,142.80
|
| Rate for Payer: Cigna of CA HMO |
$1,874.95
|
| Rate for Payer: Cigna of CA PPO |
$1,874.95
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$21.48
|
| Rate for Payer: EPIC Health Plan Commercial |
$19.33
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$14.32
|
| Rate for Payer: EPIC Health Plan Transplant |
$14.32
|
| Rate for Payer: Galaxy Health WC |
$2,276.72
|
| Rate for Payer: Global Benefits Group Commercial |
$1,607.10
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,410.65
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$2,008.88
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$23.48
|
| Rate for Payer: IEHP medi-cal |
$23.62
|
| Rate for Payer: IEHP Medicare Advantage |
$14.32
|
| Rate for Payer: Innovage PACE Commercial |
$21.48
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,786.56
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$14.32
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$535.70
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$19.19
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$19.19
|
| Rate for Payer: Multiplan Commercial |
$2,008.88
|
| Rate for Payer: Networks By Design Commercial |
$1,339.25
|
| Rate for Payer: Prime Health Services Commercial |
$2,276.72
|
| Rate for Payer: Prime Health Services Medicare |
$15.18
|
| Rate for Payer: Riverside University Health MISP |
$15.75
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,607.10
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,607.10
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,339.25
|
| Rate for Payer: United Healthcare All Other HMO |
$1,339.25
|
| Rate for Payer: United Healthcare HMO Rider |
$1,339.25
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,339.25
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$21.48
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$15.75
|
| Rate for Payer: Vantage Medical Group Senior |
$14.32
|
|
|
PALIPERIDONE PALMITATE 234 MG/1.5 ML INTRAMUSCULAR SYRINGE [108109]
|
Facility
IP
|
$2,678.50
|
|
|
Service Code
|
CPT J2426
|
| Hospital Charge Code |
1712607
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$535.70 |
| Max. Negotiated Rate |
$34,005.88 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$34,005.88
|
| Rate for Payer: Blue Shield of California Commercial |
$2,008.88
|
| Rate for Payer: Blue Shield of California EPN |
$1,430.32
|
| Rate for Payer: Cash Price |
$1,205.33
|
| Rate for Payer: Cash Price |
$1,205.33
|
| Rate for Payer: Central Health Plan Commercial |
$2,142.80
|
| Rate for Payer: Cigna of CA HMO |
$1,874.95
|
| Rate for Payer: Cigna of CA PPO |
$1,874.95
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,071.40
|
| Rate for Payer: EPIC Health Plan Transplant |
$1,071.40
|
| Rate for Payer: Galaxy Health WC |
$2,276.72
|
| Rate for Payer: Global Benefits Group Commercial |
$1,607.10
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,410.65
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,786.56
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$535.70
|
| Rate for Payer: Multiplan Commercial |
$2,008.88
|
| Rate for Payer: Networks By Design Commercial |
$1,339.25
|
| Rate for Payer: Prime Health Services Commercial |
$2,276.72
|
|
|
PALIVIZUMAB 100 MG/ML INTRAMUSCULAR SOLUTION [41675]
|
Facility
IP
|
$4,125.50
|
|
|
Service Code
|
CPT 90378
|
| Hospital Charge Code |
NDG41675
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$825.10 |
| Max. Negotiated Rate |
$34,005.88 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$34,005.88
|
| Rate for Payer: Blue Shield of California Commercial |
$3,094.12
|
| Rate for Payer: Blue Shield of California EPN |
$2,203.02
|
| Rate for Payer: Cash Price |
$1,856.48
|
| Rate for Payer: Cash Price |
$1,856.48
|
| Rate for Payer: Central Health Plan Commercial |
$3,300.40
|
| Rate for Payer: Cigna of CA HMO |
$2,887.85
|
| Rate for Payer: Cigna of CA PPO |
$2,887.85
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,650.20
|
| Rate for Payer: EPIC Health Plan Transplant |
$1,650.20
|
| Rate for Payer: Galaxy Health WC |
$3,506.68
|
| Rate for Payer: Global Benefits Group Commercial |
$2,475.30
|
| Rate for Payer: Health Management Network EPO/PPO |
$3,712.95
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,751.71
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$825.10
|
| Rate for Payer: Multiplan Commercial |
$3,094.12
|
| Rate for Payer: Networks By Design Commercial |
$2,062.75
|
| Rate for Payer: Prime Health Services Commercial |
$3,506.68
|
|
|
PALIVIZUMAB 100 MG/ML INTRAMUSCULAR SOLUTION [41675]
|
Facility
OP
|
$4,125.50
|
|
|
Service Code
|
CPT 90378
|
| Hospital Charge Code |
NDG41675
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$339.68 |
| Max. Negotiated Rate |
$11,394.42 |
| Rate for Payer: Adventist Health Medi-Cal |
$339.68
|
| Rate for Payer: Aetna of CA HMO/PPO |
$11,394.42
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$424.60
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$373.65
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$373.65
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1,168.53
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,279.42
|
| Rate for Payer: BCBS Transplant Transplant |
$2,475.30
|
| Rate for Payer: Blue Shield of California Commercial |
$2,018.65
|
| Rate for Payer: Blue Shield of California EPN |
$1,835.14
|
| Rate for Payer: Caremore Medicare Advantage |
$339.68
|
| Rate for Payer: Cash Price |
$1,856.48
|
| Rate for Payer: Cash Price |
$1,856.48
|
| Rate for Payer: Central Health Plan Commercial |
$3,300.40
|
| Rate for Payer: Cigna of CA HMO |
$2,887.85
|
| Rate for Payer: Cigna of CA PPO |
$2,887.85
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$509.52
|
| Rate for Payer: EPIC Health Plan Commercial |
$458.57
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$339.68
|
| Rate for Payer: EPIC Health Plan Transplant |
$339.68
|
| Rate for Payer: Galaxy Health WC |
$3,506.68
|
| Rate for Payer: Global Benefits Group Commercial |
$2,475.30
|
| Rate for Payer: Health Management Network EPO/PPO |
$3,712.95
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$3,094.12
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$557.08
|
| Rate for Payer: IEHP medi-cal |
$560.47
|
| Rate for Payer: IEHP Medicare Advantage |
$339.68
|
| Rate for Payer: Innovage PACE Commercial |
$509.52
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,751.71
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$339.68
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$825.10
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$455.17
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$455.17
|
| Rate for Payer: Multiplan Commercial |
$3,094.12
|
| Rate for Payer: Networks By Design Commercial |
$2,062.75
|
| Rate for Payer: Prime Health Services Commercial |
$3,506.68
|
| Rate for Payer: Prime Health Services Medicare |
$360.06
|
| Rate for Payer: Riverside University Health MISP |
$373.65
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,475.30
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2,475.30
|
| Rate for Payer: United Healthcare All Other Commercial |
$2,062.75
|
| Rate for Payer: United Healthcare All Other HMO |
$2,062.75
|
| Rate for Payer: United Healthcare HMO Rider |
$2,062.75
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,062.75
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$509.52
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$373.65
|
| Rate for Payer: Vantage Medical Group Senior |
$339.68
|
|
|
Pallidotomy ICD
|
Facility
IP
|
$34,005.88
|
|
|
Service Code
|
ICD 00583ZZ
|
| Min. Negotiated Rate |
$10,000.00 |
| Max. Negotiated Rate |
$34,005.88 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$34,005.88
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$12,866.00
|
| Rate for Payer: Networks By Design Commercial |
$10,000.00
|
|
|
Pallidotomy ICD
|
Facility
IP
|
$34,005.88
|
|
|
Service Code
|
ICD 00584ZZ
|
| Min. Negotiated Rate |
$10,000.00 |
| Max. Negotiated Rate |
$34,005.88 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$34,005.88
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$12,866.00
|
| Rate for Payer: Networks By Design Commercial |
$10,000.00
|
|
