|
PIMECROLIMUS 1 % TOPICAL CREAM [32052]
|
Facility
|
OP
|
$11.96
|
|
|
Service Code
|
NDC 0187-5100-01
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$2.39 |
| Max. Negotiated Rate |
$10.76 |
| Rate for Payer: Adventist Health Commercial |
$2.39
|
| Rate for Payer: Aetna of CA HMO/PPO |
$7.26
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$10.17
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$6.58
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$8.97
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$5.79
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$7.02
|
| Rate for Payer: Blue Shield of California Commercial |
$7.31
|
| Rate for Payer: Blue Shield of California EPN |
$4.77
|
| Rate for Payer: Cash Price |
$6.58
|
| Rate for Payer: Central Health Plan Commercial |
$9.57
|
| Rate for Payer: Cigna of CA HMO |
$8.37
|
| Rate for Payer: Cigna of CA PPO |
$8.37
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$10.17
|
| Rate for Payer: Dignity Health Medi-Cal |
$10.17
|
| Rate for Payer: Dignity Health Medicare Advantage |
$10.17
|
| Rate for Payer: EPIC Health Plan Commercial |
$4.78
|
| Rate for Payer: EPIC Health Plan Senior |
$4.78
|
| Rate for Payer: Galaxy Health WC |
$10.17
|
| Rate for Payer: Global Benefits Group Commercial |
$7.18
|
| Rate for Payer: Health Management Network EPO/PPO |
$10.76
|
| Rate for Payer: InnovAge PACE Commercial |
$5.98
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$7.98
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4.56
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$7.40
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.39
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$8.37
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$8.37
|
| Rate for Payer: Multiplan Commercial |
$8.97
|
| Rate for Payer: Networks By Design Commercial |
$7.77
|
| Rate for Payer: Prime Health Services Commercial |
$10.17
|
| Rate for Payer: Riverside University Health System MISP |
$4.78
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$7.18
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$7.18
|
| Rate for Payer: United Healthcare All Other Commercial |
$5.98
|
| Rate for Payer: United Healthcare All Other HMO |
$5.98
|
| Rate for Payer: United Healthcare HMO Rider |
$5.98
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$5.98
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$10.17
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$10.17
|
| Rate for Payer: Vantage Medical Group Senior |
$10.17
|
|
|
PIMECROLIMUS 1 % TOPICAL CREAM [32052]
|
Facility
|
IP
|
$11.96
|
|
|
Service Code
|
NDC 0187-5100-01
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$2.39 |
| Max. Negotiated Rate |
$10.76 |
| Rate for Payer: Adventist Health Commercial |
$2.39
|
| Rate for Payer: Blue Shield of California Commercial |
$9.25
|
| Rate for Payer: Blue Shield of California EPN |
$6.03
|
| Rate for Payer: Cash Price |
$6.58
|
| Rate for Payer: Central Health Plan Commercial |
$9.57
|
| Rate for Payer: Cigna of CA HMO |
$8.37
|
| Rate for Payer: Cigna of CA PPO |
$8.37
|
| Rate for Payer: EPIC Health Plan Commercial |
$4.78
|
| Rate for Payer: EPIC Health Plan Senior |
$4.78
|
| Rate for Payer: Galaxy Health WC |
$10.17
|
| Rate for Payer: Global Benefits Group Commercial |
$7.18
|
| Rate for Payer: Health Management Network EPO/PPO |
$10.76
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$7.98
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4.56
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$7.40
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.39
|
| Rate for Payer: Multiplan Commercial |
$8.97
|
| Rate for Payer: Networks By Design Commercial |
$7.77
|
| Rate for Payer: Prime Health Services Commercial |
$10.17
|
|
|
PIOGLITAZONE 30 MG TABLET [25529]
|
Facility
|
IP
|
$0.22
|
|
|
Service Code
|
NDC 33342-055-07
|
| 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
|
|
|
PIOGLITAZONE 30 MG TABLET [25529]
|
Facility
|
OP
|
$0.22
|
|
|
Service Code
|
NDC 33342-055-07
|
| 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
|
|
|
PIPERACILLIN-TAZOBACTAM 2.25 GRAM/50 ML IN DEXTROSE(ISO) IV PIGGYBACK [34523]
|
Facility
|
IP
|
$0.36
|
|
|
Service Code
|
HCPCS J2543
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.07 |
| Max. Negotiated Rate |
$0.32 |
| Rate for Payer: Adventist Health Commercial |
$0.07
|
| Rate for Payer: Blue Shield of California Commercial |
$0.28
|
| Rate for Payer: Blue Shield of California EPN |
$0.18
|
| Rate for Payer: Cash Price |
$0.20
|
| Rate for Payer: Central Health Plan Commercial |
$0.29
|
| Rate for Payer: Cigna of CA HMO |
$0.25
|
| Rate for Payer: Cigna of CA PPO |
$0.25
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.14
|
| Rate for Payer: EPIC Health Plan Senior |
$0.14
|
| Rate for Payer: Galaxy Health WC |
$0.31
|
| Rate for Payer: Global Benefits Group Commercial |
$0.22
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.32
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.24
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.14
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$0.22
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.07
|
| Rate for Payer: Multiplan Commercial |
$0.27
|
| Rate for Payer: Networks By Design Commercial |
$0.18
|
| Rate for Payer: Prime Health Services Commercial |
$0.31
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.14
|
| Rate for Payer: United Healthcare All Other HMO |
$0.13
|
| Rate for Payer: United Healthcare HMO Rider |
$0.13
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.12
|
|
|
PIPERACILLIN-TAZOBACTAM 2.25 GRAM/50 ML IN DEXTROSE(ISO) IV PIGGYBACK [34523]
|
Facility
|
OP
|
$0.36
|
|
|
Service Code
|
HCPCS J2543
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.07 |
| Max. Negotiated Rate |
$3.79 |
| Rate for Payer: Adventist Health Commercial |
$0.07
|
| Rate for Payer: Aetna of CA HMO/PPO |
$0.22
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.31
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.20
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.27
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$3.79
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1.16
|
| Rate for Payer: Blue Shield of California Commercial |
$2.31
|
| Rate for Payer: Blue Shield of California EPN |
$2.10
|
| Rate for Payer: Cash Price |
$0.20
|
| Rate for Payer: Cash Price |
$0.20
|
| Rate for Payer: Central Health Plan Commercial |
$0.29
|
| Rate for Payer: Cigna of CA HMO |
$0.25
|
| Rate for Payer: Cigna of CA PPO |
$0.25
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.31
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.31
|
| Rate for Payer: Dignity Health Medicare Advantage |
$0.31
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.14
|
| Rate for Payer: EPIC Health Plan Senior |
$0.14
|
| Rate for Payer: Galaxy Health WC |
$0.31
|
| Rate for Payer: Global Benefits Group Commercial |
$0.22
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.32
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$1.12
|
| Rate for Payer: InnovAge PACE Commercial |
$0.18
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.24
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.14
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$0.22
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.07
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$0.25
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$0.25
|
| Rate for Payer: Multiplan Commercial |
$0.27
|
| Rate for Payer: Networks By Design Commercial |
$0.18
|
| Rate for Payer: Prime Health Services Commercial |
$0.31
|
| Rate for Payer: Riverside University Health System MISP |
$0.14
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.22
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.22
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.14
|
| Rate for Payer: United Healthcare All Other HMO |
$0.13
|
| Rate for Payer: United Healthcare HMO Rider |
$0.13
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.12
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.31
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.31
|
| Rate for Payer: Vantage Medical Group Senior |
$0.31
|
|
|
PIPERACILLIN-TAZOBACTAM 2.25 GRAM INTRAVENOUS SOLUTION [18304]
|
Facility
|
OP
|
$3.96
|
|
|
Service Code
|
HCPCS J2543
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.79 |
| Max. Negotiated Rate |
$3.79 |
| Rate for Payer: Adventist Health Commercial |
$0.79
|
| Rate for Payer: Adventist Health Commercial |
$0.82
|
| Rate for Payer: Adventist Health Commercial |
$2.22
|
| Rate for Payer: Adventist Health Commercial |
$0.72
|
| Rate for Payer: Adventist Health Commercial |
$0.72
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2.18
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2.50
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2.19
|
| Rate for Payer: Aetna of CA HMO/PPO |
$6.74
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2.40
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3.50
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3.05
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$9.44
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3.37
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3.06
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$6.11
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1.98
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2.18
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1.97
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2.27
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2.69
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2.70
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$3.09
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2.97
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$8.32
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$3.79
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$3.79
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$3.79
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$3.79
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$3.79
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1.16
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1.16
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1.16
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1.16
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1.16
|
| Rate for Payer: Blue Shield of California Commercial |
$2.31
|
| Rate for Payer: Blue Shield of California Commercial |
$2.31
|
| Rate for Payer: Blue Shield of California Commercial |
$2.31
|
| Rate for Payer: Blue Shield of California Commercial |
$2.31
|
| Rate for Payer: Blue Shield of California Commercial |
$2.31
|
| Rate for Payer: Blue Shield of California EPN |
$2.10
|
| Rate for Payer: Blue Shield of California EPN |
$2.10
|
| Rate for Payer: Blue Shield of California EPN |
$2.10
|
| Rate for Payer: Blue Shield of California EPN |
$2.10
|
| Rate for Payer: Blue Shield of California EPN |
$2.10
|
| Rate for Payer: Cash Price |
$6.11
|
| Rate for Payer: Cash Price |
$1.97
|
| Rate for Payer: Cash Price |
$1.97
|
| Rate for Payer: Cash Price |
$2.18
|
| Rate for Payer: Cash Price |
$1.98
|
| Rate for Payer: Cash Price |
$2.27
|
| Rate for Payer: Cash Price |
$2.27
|
| Rate for Payer: Cash Price |
$1.98
|
| Rate for Payer: Cash Price |
$2.18
|
| Rate for Payer: Cash Price |
$6.11
|
| Rate for Payer: Central Health Plan Commercial |
$3.30
|
| Rate for Payer: Central Health Plan Commercial |
$2.88
|
| Rate for Payer: Central Health Plan Commercial |
$3.17
|
| Rate for Payer: Central Health Plan Commercial |
$2.87
|
| Rate for Payer: Central Health Plan Commercial |
$8.88
|
| Rate for Payer: Cigna of CA HMO |
$7.77
|
| Rate for Payer: Cigna of CA HMO |
$2.51
|
| Rate for Payer: Cigna of CA HMO |
$2.88
|
| Rate for Payer: Cigna of CA HMO |
$2.77
|
| Rate for Payer: Cigna of CA HMO |
$2.52
|
| Rate for Payer: Cigna of CA PPO |
$2.52
|
| Rate for Payer: Cigna of CA PPO |
$2.88
|
| Rate for Payer: Cigna of CA PPO |
$2.51
|
| Rate for Payer: Cigna of CA PPO |
$2.77
|
| Rate for Payer: Cigna of CA PPO |
$7.77
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3.05
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3.06
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$9.44
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3.37
|
| Rate for Payer: Dignity Health Medi-Cal |
$9.44
|
| Rate for Payer: Dignity Health Medi-Cal |
$3.05
|
| Rate for Payer: Dignity Health Medi-Cal |
$3.50
|
| Rate for Payer: Dignity Health Medi-Cal |
$3.37
|
| Rate for Payer: Dignity Health Medi-Cal |
$3.06
|
| Rate for Payer: Dignity Health Medicare Advantage |
$3.50
|
| Rate for Payer: Dignity Health Medicare Advantage |
$3.37
|
| Rate for Payer: Dignity Health Medicare Advantage |
$9.44
|
| Rate for Payer: Dignity Health Medicare Advantage |
$3.06
|
| Rate for Payer: Dignity Health Medicare Advantage |
$3.05
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.58
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.65
|
| Rate for Payer: EPIC Health Plan Commercial |
$4.44
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.44
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.44
|
| Rate for Payer: EPIC Health Plan Senior |
$1.44
|
| Rate for Payer: EPIC Health Plan Senior |
$4.44
|
| Rate for Payer: EPIC Health Plan Senior |
$1.65
|
| Rate for Payer: EPIC Health Plan Senior |
$1.58
|
| Rate for Payer: EPIC Health Plan Senior |
$1.44
|
| Rate for Payer: Galaxy Health WC |
$3.37
|
| Rate for Payer: Galaxy Health WC |
$3.06
|
| Rate for Payer: Galaxy Health WC |
$3.05
|
| Rate for Payer: Galaxy Health WC |
$9.44
|
| Rate for Payer: Galaxy Health WC |
$3.50
|
| Rate for Payer: Global Benefits Group Commercial |
$2.16
|
| Rate for Payer: Global Benefits Group Commercial |
$2.15
|
| Rate for Payer: Global Benefits Group Commercial |
$6.66
|
| Rate for Payer: Global Benefits Group Commercial |
$2.38
|
| Rate for Payer: Global Benefits Group Commercial |
$2.47
|
| Rate for Payer: Health Management Network EPO/PPO |
$3.24
|
| Rate for Payer: Health Management Network EPO/PPO |
$3.56
|
| Rate for Payer: Health Management Network EPO/PPO |
$9.99
|
| Rate for Payer: Health Management Network EPO/PPO |
$3.23
|
| Rate for Payer: Health Management Network EPO/PPO |
$3.71
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$1.12
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$1.12
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$1.12
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$1.12
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$1.12
|
| Rate for Payer: InnovAge PACE Commercial |
$5.55
|
| Rate for Payer: InnovAge PACE Commercial |
$2.06
|
| Rate for Payer: InnovAge PACE Commercial |
$1.79
|
| Rate for Payer: InnovAge PACE Commercial |
$1.98
|
| Rate for Payer: InnovAge PACE Commercial |
$1.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2.39
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2.64
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$7.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2.75
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4.23
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1.57
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1.37
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1.51
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1.37
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$6.87
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2.55
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2.45
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2.22
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2.23
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.82
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.72
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.22
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.79
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.72
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2.52
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$7.77
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2.88
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2.51
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2.77
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2.77
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$7.77
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2.88
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2.51
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2.52
|
| Rate for Payer: Multiplan Commercial |
$2.69
|
| Rate for Payer: Multiplan Commercial |
$2.70
|
| Rate for Payer: Multiplan Commercial |
$8.32
|
| Rate for Payer: Multiplan Commercial |
$3.09
|
| Rate for Payer: Multiplan Commercial |
$2.97
|
| Rate for Payer: Networks By Design Commercial |
$1.79
|
| Rate for Payer: Networks By Design Commercial |
$2.06
|
| Rate for Payer: Networks By Design Commercial |
$5.55
|
| Rate for Payer: Networks By Design Commercial |
$1.80
|
| Rate for Payer: Networks By Design Commercial |
$1.98
|
| Rate for Payer: Prime Health Services Commercial |
$3.37
|
| Rate for Payer: Prime Health Services Commercial |
$3.06
|
| Rate for Payer: Prime Health Services Commercial |
$3.50
|
| Rate for Payer: Prime Health Services Commercial |
$3.05
|
| Rate for Payer: Prime Health Services Commercial |
$9.44
|
| Rate for Payer: Riverside University Health System MISP |
$4.44
|
| Rate for Payer: Riverside University Health System MISP |
$1.58
|
| Rate for Payer: Riverside University Health System MISP |
$1.44
|
| Rate for Payer: Riverside University Health System MISP |
$1.65
|
| Rate for Payer: Riverside University Health System MISP |
$1.44
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2.15
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$6.66
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2.47
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2.16
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2.38
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$6.66
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2.15
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2.38
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2.47
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2.16
|
| Rate for Payer: United Healthcare All Other Commercial |
$1.35
|
| Rate for Payer: United Healthcare All Other Commercial |
$1.35
|
| Rate for Payer: United Healthcare All Other Commercial |
$1.49
|
| Rate for Payer: United Healthcare All Other Commercial |
$4.17
|
| Rate for Payer: United Healthcare All Other Commercial |
$1.55
|
| Rate for Payer: United Healthcare All Other HMO |
$1.45
|
| Rate for Payer: United Healthcare All Other HMO |
$4.05
|
| Rate for Payer: United Healthcare All Other HMO |
$1.51
|
| Rate for Payer: United Healthcare All Other HMO |
$1.32
|
| Rate for Payer: United Healthcare All Other HMO |
$1.31
|
| Rate for Payer: United Healthcare HMO Rider |
$1.28
|
| Rate for Payer: United Healthcare HMO Rider |
$1.42
|
| Rate for Payer: United Healthcare HMO Rider |
$3.97
|
| Rate for Payer: United Healthcare HMO Rider |
$1.29
|
| Rate for Payer: United Healthcare HMO Rider |
$1.47
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1.35
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1.18
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1.18
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3.64
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1.30
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$9.44
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3.37
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3.06
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3.05
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$3.06
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$3.37
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$3.05
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$9.44
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$3.50
|
| Rate for Payer: Vantage Medical Group Senior |
$3.50
|
| Rate for Payer: Vantage Medical Group Senior |
$9.44
|
| Rate for Payer: Vantage Medical Group Senior |
$3.06
|
| Rate for Payer: Vantage Medical Group Senior |
$3.05
|
| Rate for Payer: Vantage Medical Group Senior |
$3.37
|
|
|
PIPERACILLIN-TAZOBACTAM 2.25 GRAM INTRAVENOUS SOLUTION [18304]
|
Facility
|
IP
|
$3.96
|
|
|
Service Code
|
HCPCS J2543
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.79 |
| Max. Negotiated Rate |
$3.56 |
| Rate for Payer: Adventist Health Commercial |
$0.79
|
| Rate for Payer: Adventist Health Commercial |
$0.72
|
| Rate for Payer: Adventist Health Commercial |
$0.72
|
| Rate for Payer: Adventist Health Commercial |
$2.22
|
| Rate for Payer: Adventist Health Commercial |
$0.82
|
| Rate for Payer: Blue Shield of California Commercial |
$2.78
|
| Rate for Payer: Blue Shield of California Commercial |
$3.18
|
| Rate for Payer: Blue Shield of California Commercial |
$3.06
|
| Rate for Payer: Blue Shield of California Commercial |
$8.58
|
| Rate for Payer: Blue Shield of California Commercial |
$2.78
|
| Rate for Payer: Blue Shield of California EPN |
$2.00
|
| Rate for Payer: Blue Shield of California EPN |
$1.81
|
| Rate for Payer: Blue Shield of California EPN |
$2.08
|
| Rate for Payer: Blue Shield of California EPN |
$1.81
|
| Rate for Payer: Blue Shield of California EPN |
$5.59
|
| Rate for Payer: Cash Price |
$1.98
|
| Rate for Payer: Cash Price |
$1.97
|
| Rate for Payer: Cash Price |
$2.18
|
| Rate for Payer: Cash Price |
$2.27
|
| Rate for Payer: Cash Price |
$6.11
|
| Rate for Payer: Central Health Plan Commercial |
$3.30
|
| Rate for Payer: Central Health Plan Commercial |
$2.87
|
| Rate for Payer: Central Health Plan Commercial |
$8.88
|
| Rate for Payer: Central Health Plan Commercial |
$2.88
|
| Rate for Payer: Central Health Plan Commercial |
$3.17
|
| Rate for Payer: Cigna of CA HMO |
$2.88
|
| Rate for Payer: Cigna of CA HMO |
$2.52
|
| Rate for Payer: Cigna of CA HMO |
$7.77
|
| Rate for Payer: Cigna of CA HMO |
$2.51
|
| Rate for Payer: Cigna of CA HMO |
$2.77
|
| Rate for Payer: Cigna of CA PPO |
$2.51
|
| Rate for Payer: Cigna of CA PPO |
$7.77
|
| Rate for Payer: Cigna of CA PPO |
$2.88
|
| Rate for Payer: Cigna of CA PPO |
$2.77
|
| Rate for Payer: Cigna of CA PPO |
$2.52
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.44
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.65
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.58
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.44
|
| Rate for Payer: EPIC Health Plan Commercial |
$4.44
|
| Rate for Payer: EPIC Health Plan Senior |
$1.44
|
| Rate for Payer: EPIC Health Plan Senior |
$4.44
|
| Rate for Payer: EPIC Health Plan Senior |
$1.58
|
| Rate for Payer: EPIC Health Plan Senior |
$1.65
|
| Rate for Payer: EPIC Health Plan Senior |
$1.44
|
| Rate for Payer: Galaxy Health WC |
$3.06
|
| Rate for Payer: Galaxy Health WC |
$9.44
|
| Rate for Payer: Galaxy Health WC |
$3.05
|
| Rate for Payer: Galaxy Health WC |
$3.50
|
| Rate for Payer: Galaxy Health WC |
$3.37
|
| Rate for Payer: Global Benefits Group Commercial |
$2.38
|
| Rate for Payer: Global Benefits Group Commercial |
$6.66
|
| Rate for Payer: Global Benefits Group Commercial |
$2.47
|
| Rate for Payer: Global Benefits Group Commercial |
$2.16
|
| Rate for Payer: Global Benefits Group Commercial |
$2.15
|
| Rate for Payer: Health Management Network EPO/PPO |
$3.71
|
| Rate for Payer: Health Management Network EPO/PPO |
$3.56
|
| Rate for Payer: Health Management Network EPO/PPO |
$9.99
|
| Rate for Payer: Health Management Network EPO/PPO |
$3.24
|
| Rate for Payer: Health Management Network EPO/PPO |
$3.23
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2.75
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2.39
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$7.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2.64
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1.51
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4.23
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1.37
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1.37
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1.57
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2.22
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2.23
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$6.87
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2.45
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2.55
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.22
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.72
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.72
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.82
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.79
|
| Rate for Payer: Multiplan Commercial |
$3.09
|
| Rate for Payer: Multiplan Commercial |
$2.70
|
| Rate for Payer: Multiplan Commercial |
$2.69
|
| Rate for Payer: Multiplan Commercial |
$2.97
|
| Rate for Payer: Multiplan Commercial |
$8.32
|
| Rate for Payer: Networks By Design Commercial |
$5.55
|
| Rate for Payer: Networks By Design Commercial |
$2.06
|
| Rate for Payer: Networks By Design Commercial |
$1.98
|
| Rate for Payer: Networks By Design Commercial |
$1.79
|
| Rate for Payer: Networks By Design Commercial |
$1.80
|
| Rate for Payer: Prime Health Services Commercial |
$3.50
|
| Rate for Payer: Prime Health Services Commercial |
$3.05
|
| Rate for Payer: Prime Health Services Commercial |
$3.06
|
| Rate for Payer: Prime Health Services Commercial |
$9.44
|
| Rate for Payer: Prime Health Services Commercial |
$3.37
|
| Rate for Payer: United Healthcare All Other Commercial |
$1.35
|
| Rate for Payer: United Healthcare All Other Commercial |
$1.55
|
| Rate for Payer: United Healthcare All Other Commercial |
$4.17
|
| Rate for Payer: United Healthcare All Other Commercial |
$1.35
|
| Rate for Payer: United Healthcare All Other Commercial |
$1.49
|
| Rate for Payer: United Healthcare All Other HMO |
$1.32
|
| Rate for Payer: United Healthcare All Other HMO |
$1.31
|
| Rate for Payer: United Healthcare All Other HMO |
$4.05
|
| Rate for Payer: United Healthcare All Other HMO |
$1.45
|
| Rate for Payer: United Healthcare All Other HMO |
$1.51
|
| Rate for Payer: United Healthcare HMO Rider |
$1.47
|
| Rate for Payer: United Healthcare HMO Rider |
$3.97
|
| Rate for Payer: United Healthcare HMO Rider |
$1.29
|
| Rate for Payer: United Healthcare HMO Rider |
$1.28
|
| Rate for Payer: United Healthcare HMO Rider |
$1.42
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1.30
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1.35
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1.18
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3.64
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1.18
|
|
|
PIPERACILLIN-TAZOBACTAM 3.375 GRAM/50 ML DEXTROSE(ISO-OS) IV PIGGYBACK [34524]
|
Facility
|
OP
|
$0.49
|
|
|
Service Code
|
HCPCS J2543
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.10 |
| Max. Negotiated Rate |
$3.79 |
| Rate for Payer: Adventist Health Commercial |
$0.10
|
| Rate for Payer: Adventist Health Commercial |
$0.10
|
| Rate for Payer: Aetna of CA HMO/PPO |
$0.30
|
| Rate for Payer: Aetna of CA HMO/PPO |
$0.29
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.42
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.41
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.27
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.26
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.37
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.36
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$3.79
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$3.79
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1.16
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1.16
|
| Rate for Payer: Blue Shield of California Commercial |
$2.31
|
| Rate for Payer: Blue Shield of California Commercial |
$2.31
|
| Rate for Payer: Blue Shield of California EPN |
$2.10
|
| Rate for Payer: Blue Shield of California EPN |
$2.10
|
| Rate for Payer: Cash Price |
$0.27
|
| Rate for Payer: Cash Price |
$0.27
|
| Rate for Payer: Cash Price |
$0.27
|
| Rate for Payer: Cash Price |
$0.27
|
| Rate for Payer: Central Health Plan Commercial |
$0.39
|
| Rate for Payer: Central Health Plan Commercial |
$0.38
|
| Rate for Payer: Cigna of CA HMO |
$0.34
|
| Rate for Payer: Cigna of CA HMO |
$0.34
|
| Rate for Payer: Cigna of CA PPO |
$0.34
|
| Rate for Payer: Cigna of CA PPO |
$0.34
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.42
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.41
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.41
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.42
|
| Rate for Payer: Dignity Health Medicare Advantage |
$0.41
|
| Rate for Payer: Dignity Health Medicare Advantage |
$0.42
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.19
|
| Rate for Payer: EPIC Health Plan Senior |
$0.19
|
| Rate for Payer: EPIC Health Plan Senior |
$0.20
|
| Rate for Payer: Galaxy Health WC |
$0.42
|
| Rate for Payer: Galaxy Health WC |
$0.41
|
| Rate for Payer: Global Benefits Group Commercial |
$0.29
|
| Rate for Payer: Global Benefits Group Commercial |
$0.29
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.43
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.44
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$1.12
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$1.12
|
| Rate for Payer: InnovAge PACE Commercial |
$0.24
|
| Rate for Payer: InnovAge PACE Commercial |
$0.25
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.32
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.33
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.19
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.18
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$0.30
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$0.30
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.10
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.10
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$0.34
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$0.34
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$0.34
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$0.34
|
| Rate for Payer: Multiplan Commercial |
$0.36
|
| Rate for Payer: Multiplan Commercial |
$0.37
|
| Rate for Payer: Networks By Design Commercial |
$0.24
|
| Rate for Payer: Networks By Design Commercial |
$0.25
|
| Rate for Payer: Prime Health Services Commercial |
$0.42
|
| Rate for Payer: Prime Health Services Commercial |
$0.41
|
| Rate for Payer: Riverside University Health System MISP |
$0.19
|
| Rate for Payer: Riverside University Health System MISP |
$0.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.29
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.29
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.29
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.29
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.18
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.18
|
| Rate for Payer: United Healthcare All Other HMO |
$0.18
|
| Rate for Payer: United Healthcare All Other HMO |
$0.18
|
| Rate for Payer: United Healthcare HMO Rider |
$0.17
|
| Rate for Payer: United Healthcare HMO Rider |
$0.18
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.16
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.16
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.42
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.41
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.41
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.42
|
| Rate for Payer: Vantage Medical Group Senior |
$0.42
|
| Rate for Payer: Vantage Medical Group Senior |
$0.41
|
|
|
PIPERACILLIN-TAZOBACTAM 3.375 GRAM/50 ML DEXTROSE(ISO-OS) IV PIGGYBACK [34524]
|
Facility
|
IP
|
$0.49
|
|
|
Service Code
|
HCPCS J2543
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.10 |
| Max. Negotiated Rate |
$0.44 |
| Rate for Payer: Adventist Health Commercial |
$0.10
|
| Rate for Payer: Adventist Health Commercial |
$0.10
|
| Rate for Payer: Blue Shield of California Commercial |
$0.38
|
| Rate for Payer: Blue Shield of California Commercial |
$0.37
|
| Rate for Payer: Blue Shield of California EPN |
$0.24
|
| Rate for Payer: Blue Shield of California EPN |
$0.25
|
| Rate for Payer: Cash Price |
$0.27
|
| Rate for Payer: Cash Price |
$0.27
|
| Rate for Payer: Central Health Plan Commercial |
$0.39
|
| Rate for Payer: Central Health Plan Commercial |
$0.38
|
| Rate for Payer: Cigna of CA HMO |
$0.34
|
| Rate for Payer: Cigna of CA HMO |
$0.34
|
| Rate for Payer: Cigna of CA PPO |
$0.34
|
| Rate for Payer: Cigna of CA PPO |
$0.34
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.19
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.20
|
| Rate for Payer: EPIC Health Plan Senior |
$0.19
|
| Rate for Payer: EPIC Health Plan Senior |
$0.20
|
| Rate for Payer: Galaxy Health WC |
$0.41
|
| Rate for Payer: Galaxy Health WC |
$0.42
|
| Rate for Payer: Global Benefits Group Commercial |
$0.29
|
| Rate for Payer: Global Benefits Group Commercial |
$0.29
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.43
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.44
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.32
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.33
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.19
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.18
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$0.30
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$0.30
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.10
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.10
|
| Rate for Payer: Multiplan Commercial |
$0.36
|
| Rate for Payer: Multiplan Commercial |
$0.37
|
| Rate for Payer: Networks By Design Commercial |
$0.24
|
| Rate for Payer: Networks By Design Commercial |
$0.25
|
| Rate for Payer: Prime Health Services Commercial |
$0.42
|
| Rate for Payer: Prime Health Services Commercial |
$0.41
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.18
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.18
|
| Rate for Payer: United Healthcare All Other HMO |
$0.18
|
| Rate for Payer: United Healthcare All Other HMO |
$0.18
|
| Rate for Payer: United Healthcare HMO Rider |
$0.17
|
| Rate for Payer: United Healthcare HMO Rider |
$0.18
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.16
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.16
|
|
|
PIPERACILLIN-TAZOBACTAM 3.375 GRAM/50 ML IN D5W INFUSION ADMIXTURE KIT (ADSOK) [504084141]
|
Facility
|
IP
|
$2.69
|
|
|
Service Code
|
NDC 9994-8147-10
|
| Min. Negotiated Rate |
$0.54 |
| Max. Negotiated Rate |
$2.42 |
| Rate for Payer: Adventist Health Commercial |
$0.54
|
| Rate for Payer: Cash Price |
$1.48
|
| Rate for Payer: Central Health Plan Commercial |
$2.15
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.08
|
| Rate for Payer: EPIC Health Plan Senior |
$1.08
|
| Rate for Payer: Galaxy Health WC |
$2.29
|
| Rate for Payer: Global Benefits Group Commercial |
$1.61
|
| Rate for Payer: Health Management Network EPO/PPO |
$2.42
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1.79
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1.02
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1.67
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.54
|
| Rate for Payer: Multiplan Commercial |
$2.02
|
| Rate for Payer: Networks By Design Commercial |
$1.75
|
| Rate for Payer: Prime Health Services Commercial |
$2.29
|
|
|
PIPERACILLIN-TAZOBACTAM 3.375 GRAM/50 ML IN D5W INFUSION ADMIXTURE KIT (ADSOK) [504084141]
|
Facility
|
OP
|
$2.69
|
|
|
Service Code
|
NDC 9994-8147-10
|
| Min. Negotiated Rate |
$0.54 |
| Max. Negotiated Rate |
$2.42 |
| Rate for Payer: Adventist Health Commercial |
$0.54
|
| Rate for Payer: Aetna of CA HMO/PPO |
$1.63
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2.29
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1.48
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2.02
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1.30
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1.58
|
| Rate for Payer: Blue Shield of California Commercial |
$1.64
|
| Rate for Payer: Blue Shield of California EPN |
$1.07
|
| Rate for Payer: Cash Price |
$1.48
|
| Rate for Payer: Central Health Plan Commercial |
$2.15
|
| Rate for Payer: Cigna of CA HMO |
$1.72
|
| Rate for Payer: Cigna of CA PPO |
$1.99
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2.29
|
| Rate for Payer: Dignity Health Medi-Cal |
$2.29
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2.29
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.08
|
| Rate for Payer: EPIC Health Plan Senior |
$1.08
|
| Rate for Payer: Galaxy Health WC |
$2.29
|
| Rate for Payer: Global Benefits Group Commercial |
$1.61
|
| Rate for Payer: Health Management Network EPO/PPO |
$2.42
|
| Rate for Payer: InnovAge PACE Commercial |
$1.34
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1.79
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1.02
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1.67
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.54
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1.88
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1.88
|
| Rate for Payer: Multiplan Commercial |
$2.02
|
| Rate for Payer: Networks By Design Commercial |
$1.75
|
| Rate for Payer: Prime Health Services Commercial |
$2.29
|
| Rate for Payer: Riverside University Health System MISP |
$1.08
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1.61
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1.61
|
| Rate for Payer: United Healthcare All Other Commercial |
$1.34
|
| Rate for Payer: United Healthcare All Other HMO |
$1.34
|
| Rate for Payer: United Healthcare HMO Rider |
$1.34
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1.34
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2.29
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2.29
|
| Rate for Payer: Vantage Medical Group Senior |
$2.29
|
|
|
PIPERACILLIN-TAZOBACTAM 3.375 GRAM INTRAVENOUS SOLUTION [18303]
|
Facility
|
IP
|
$6.60
|
|
|
Service Code
|
HCPCS J2543
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.32 |
| Max. Negotiated Rate |
$5.94 |
| Rate for Payer: Adventist Health Commercial |
$1.32
|
| Rate for Payer: Adventist Health Commercial |
$0.84
|
| Rate for Payer: Blue Shield of California Commercial |
$5.10
|
| Rate for Payer: Blue Shield of California Commercial |
$3.25
|
| Rate for Payer: Blue Shield of California EPN |
$2.12
|
| Rate for Payer: Blue Shield of California EPN |
$3.33
|
| Rate for Payer: Cash Price |
$3.63
|
| Rate for Payer: Cash Price |
$2.31
|
| Rate for Payer: Central Health Plan Commercial |
$5.28
|
| Rate for Payer: Central Health Plan Commercial |
$3.36
|
| Rate for Payer: Cigna of CA HMO |
$2.94
|
| Rate for Payer: Cigna of CA HMO |
$4.62
|
| Rate for Payer: Cigna of CA PPO |
$2.94
|
| Rate for Payer: Cigna of CA PPO |
$4.62
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.68
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.64
|
| Rate for Payer: EPIC Health Plan Senior |
$1.68
|
| Rate for Payer: EPIC Health Plan Senior |
$2.64
|
| Rate for Payer: Galaxy Health WC |
$3.57
|
| Rate for Payer: Galaxy Health WC |
$5.61
|
| Rate for Payer: Global Benefits Group Commercial |
$3.96
|
| Rate for Payer: Global Benefits Group Commercial |
$2.52
|
| Rate for Payer: Health Management Network EPO/PPO |
$3.78
|
| Rate for Payer: Health Management Network EPO/PPO |
$5.94
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4.40
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2.51
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1.60
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2.60
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4.09
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.32
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.84
|
| Rate for Payer: Multiplan Commercial |
$3.15
|
| Rate for Payer: Multiplan Commercial |
$4.95
|
| Rate for Payer: Networks By Design Commercial |
$2.10
|
| Rate for Payer: Networks By Design Commercial |
$3.30
|
| Rate for Payer: Prime Health Services Commercial |
$5.61
|
| Rate for Payer: Prime Health Services Commercial |
$3.57
|
| Rate for Payer: United Healthcare All Other Commercial |
$1.58
|
| Rate for Payer: United Healthcare All Other Commercial |
$2.48
|
| Rate for Payer: United Healthcare All Other HMO |
$2.41
|
| Rate for Payer: United Healthcare All Other HMO |
$1.53
|
| Rate for Payer: United Healthcare HMO Rider |
$1.50
|
| Rate for Payer: United Healthcare HMO Rider |
$2.36
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1.38
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2.16
|
|
|
PIPERACILLIN-TAZOBACTAM 3.375 GRAM INTRAVENOUS SOLUTION [18303]
|
Facility
|
OP
|
$6.60
|
|
|
Service Code
|
HCPCS J2543
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.12 |
| Max. Negotiated Rate |
$5.94 |
| Rate for Payer: Adventist Health Commercial |
$1.32
|
| Rate for Payer: Adventist Health Commercial |
$0.84
|
| Rate for Payer: Aetna of CA HMO/PPO |
$4.01
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2.55
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$5.61
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3.57
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$3.63
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2.31
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4.95
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$3.15
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$3.79
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$3.79
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1.16
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1.16
|
| Rate for Payer: Blue Shield of California Commercial |
$2.31
|
| Rate for Payer: Blue Shield of California Commercial |
$2.31
|
| Rate for Payer: Blue Shield of California EPN |
$2.10
|
| Rate for Payer: Blue Shield of California EPN |
$2.10
|
| Rate for Payer: Cash Price |
$3.63
|
| Rate for Payer: Cash Price |
$3.63
|
| Rate for Payer: Cash Price |
$2.31
|
| Rate for Payer: Cash Price |
$2.31
|
| Rate for Payer: Central Health Plan Commercial |
$5.28
|
| Rate for Payer: Central Health Plan Commercial |
$3.36
|
| Rate for Payer: Cigna of CA HMO |
$2.94
|
| Rate for Payer: Cigna of CA HMO |
$4.62
|
| Rate for Payer: Cigna of CA PPO |
$4.62
|
| Rate for Payer: Cigna of CA PPO |
$2.94
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$5.61
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3.57
|
| Rate for Payer: Dignity Health Medi-Cal |
$3.57
|
| Rate for Payer: Dignity Health Medi-Cal |
$5.61
|
| Rate for Payer: Dignity Health Medicare Advantage |
$3.57
|
| Rate for Payer: Dignity Health Medicare Advantage |
$5.61
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.64
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.68
|
| Rate for Payer: EPIC Health Plan Senior |
$1.68
|
| Rate for Payer: EPIC Health Plan Senior |
$2.64
|
| Rate for Payer: Galaxy Health WC |
$5.61
|
| Rate for Payer: Galaxy Health WC |
$3.57
|
| Rate for Payer: Global Benefits Group Commercial |
$3.96
|
| Rate for Payer: Global Benefits Group Commercial |
$2.52
|
| Rate for Payer: Health Management Network EPO/PPO |
$3.78
|
| Rate for Payer: Health Management Network EPO/PPO |
$5.94
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$1.12
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$1.12
|
| Rate for Payer: InnovAge PACE Commercial |
$2.10
|
| Rate for Payer: InnovAge PACE Commercial |
$3.30
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4.40
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2.51
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1.60
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2.60
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4.09
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.84
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.32
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2.94
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$4.62
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2.94
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$4.62
|
| Rate for Payer: Multiplan Commercial |
$3.15
|
| Rate for Payer: Multiplan Commercial |
$4.95
|
| Rate for Payer: Networks By Design Commercial |
$2.10
|
| Rate for Payer: Networks By Design Commercial |
$3.30
|
| Rate for Payer: Prime Health Services Commercial |
$5.61
|
| Rate for Payer: Prime Health Services Commercial |
$3.57
|
| Rate for Payer: Riverside University Health System MISP |
$1.68
|
| Rate for Payer: Riverside University Health System MISP |
$2.64
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3.96
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2.52
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2.52
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$3.96
|
| Rate for Payer: United Healthcare All Other Commercial |
$2.48
|
| Rate for Payer: United Healthcare All Other Commercial |
$1.58
|
| Rate for Payer: United Healthcare All Other HMO |
$2.41
|
| Rate for Payer: United Healthcare All Other HMO |
$1.53
|
| Rate for Payer: United Healthcare HMO Rider |
$1.50
|
| Rate for Payer: United Healthcare HMO Rider |
$2.36
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1.38
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2.16
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$5.61
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3.57
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$3.57
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$5.61
|
| Rate for Payer: Vantage Medical Group Senior |
$5.61
|
| Rate for Payer: Vantage Medical Group Senior |
$3.57
|
|
|
PIPERACILLIN-TAZOBACTAM 40.5 GRAM INTRAVENOUS SOLUTION [12587]
|
Facility
|
OP
|
$176.12
|
|
|
Service Code
|
HCPCS J2543
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.12 |
| Max. Negotiated Rate |
$158.51 |
| Rate for Payer: Adventist Health Commercial |
$35.22
|
| Rate for Payer: Adventist Health Commercial |
$17.50
|
| Rate for Payer: Adventist Health Commercial |
$16.56
|
| Rate for Payer: Aetna of CA HMO/PPO |
$53.13
|
| Rate for Payer: Aetna of CA HMO/PPO |
$50.28
|
| Rate for Payer: Aetna of CA HMO/PPO |
$106.96
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$74.36
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$70.38
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$149.70
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$96.87
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$48.11
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$45.54
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$132.09
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$62.10
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$65.61
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$3.79
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$3.79
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$3.79
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1.16
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1.16
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1.16
|
| Rate for Payer: Blue Shield of California Commercial |
$2.31
|
| Rate for Payer: Blue Shield of California Commercial |
$2.31
|
| Rate for Payer: Blue Shield of California Commercial |
$2.31
|
| Rate for Payer: Blue Shield of California EPN |
$2.10
|
| Rate for Payer: Blue Shield of California EPN |
$2.10
|
| Rate for Payer: Blue Shield of California EPN |
$2.10
|
| Rate for Payer: Cash Price |
$45.54
|
| Rate for Payer: Cash Price |
$45.54
|
| Rate for Payer: Cash Price |
$96.87
|
| Rate for Payer: Cash Price |
$96.87
|
| Rate for Payer: Cash Price |
$48.11
|
| Rate for Payer: Cash Price |
$48.11
|
| Rate for Payer: Central Health Plan Commercial |
$140.90
|
| Rate for Payer: Central Health Plan Commercial |
$66.24
|
| Rate for Payer: Central Health Plan Commercial |
$69.98
|
| Rate for Payer: Cigna of CA HMO |
$61.24
|
| Rate for Payer: Cigna of CA HMO |
$57.96
|
| Rate for Payer: Cigna of CA HMO |
$123.28
|
| Rate for Payer: Cigna of CA PPO |
$61.24
|
| Rate for Payer: Cigna of CA PPO |
$123.28
|
| Rate for Payer: Cigna of CA PPO |
$57.96
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$70.38
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$74.36
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$149.70
|
| Rate for Payer: Dignity Health Medi-Cal |
$74.36
|
| Rate for Payer: Dignity Health Medi-Cal |
$149.70
|
| Rate for Payer: Dignity Health Medi-Cal |
$70.38
|
| Rate for Payer: Dignity Health Medicare Advantage |
$149.70
|
| Rate for Payer: Dignity Health Medicare Advantage |
$70.38
|
| Rate for Payer: Dignity Health Medicare Advantage |
$74.36
|
| Rate for Payer: EPIC Health Plan Commercial |
$34.99
|
| Rate for Payer: EPIC Health Plan Commercial |
$33.12
|
| Rate for Payer: EPIC Health Plan Commercial |
$70.45
|
| Rate for Payer: EPIC Health Plan Senior |
$33.12
|
| Rate for Payer: EPIC Health Plan Senior |
$70.45
|
| Rate for Payer: EPIC Health Plan Senior |
$34.99
|
| Rate for Payer: Galaxy Health WC |
$74.36
|
| Rate for Payer: Galaxy Health WC |
$149.70
|
| Rate for Payer: Galaxy Health WC |
$70.38
|
| Rate for Payer: Global Benefits Group Commercial |
$105.67
|
| Rate for Payer: Global Benefits Group Commercial |
$52.49
|
| Rate for Payer: Global Benefits Group Commercial |
$49.68
|
| Rate for Payer: Health Management Network EPO/PPO |
$78.73
|
| Rate for Payer: Health Management Network EPO/PPO |
$158.51
|
| Rate for Payer: Health Management Network EPO/PPO |
$74.52
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$1.12
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$1.12
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$1.12
|
| Rate for Payer: InnovAge PACE Commercial |
$88.06
|
| Rate for Payer: InnovAge PACE Commercial |
$41.40
|
| Rate for Payer: InnovAge PACE Commercial |
$43.74
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$117.47
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$55.23
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$58.35
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$31.55
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$67.10
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$33.33
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$54.15
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$109.02
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$51.25
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$17.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$35.22
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$16.56
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$61.24
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$57.96
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$123.28
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$123.28
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$57.96
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$61.24
|
| Rate for Payer: Multiplan Commercial |
$65.61
|
| Rate for Payer: Multiplan Commercial |
$132.09
|
| Rate for Payer: Multiplan Commercial |
$62.10
|
| Rate for Payer: Networks By Design Commercial |
$88.06
|
| Rate for Payer: Networks By Design Commercial |
$43.74
|
| Rate for Payer: Networks By Design Commercial |
$41.40
|
| Rate for Payer: Prime Health Services Commercial |
$70.38
|
| Rate for Payer: Prime Health Services Commercial |
$74.36
|
| Rate for Payer: Prime Health Services Commercial |
$149.70
|
| Rate for Payer: Riverside University Health System MISP |
$34.99
|
| Rate for Payer: Riverside University Health System MISP |
$33.12
|
| Rate for Payer: Riverside University Health System MISP |
$70.45
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$49.68
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$52.49
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$105.67
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$49.68
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$52.49
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$105.67
|
| Rate for Payer: United Healthcare All Other Commercial |
$32.83
|
| Rate for Payer: United Healthcare All Other Commercial |
$31.07
|
| Rate for Payer: United Healthcare All Other Commercial |
$66.10
|
| Rate for Payer: United Healthcare All Other HMO |
$64.34
|
| Rate for Payer: United Healthcare All Other HMO |
$30.25
|
| Rate for Payer: United Healthcare All Other HMO |
$31.96
|
| Rate for Payer: United Healthcare HMO Rider |
$29.59
|
| Rate for Payer: United Healthcare HMO Rider |
$62.95
|
| Rate for Payer: United Healthcare HMO Rider |
$31.27
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$28.65
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$57.68
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$27.12
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$70.38
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$149.70
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$74.36
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$149.70
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$74.36
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$70.38
|
| Rate for Payer: Vantage Medical Group Senior |
$70.38
|
| Rate for Payer: Vantage Medical Group Senior |
$149.70
|
| Rate for Payer: Vantage Medical Group Senior |
$74.36
|
|
|
PIPERACILLIN-TAZOBACTAM 40.5 GRAM INTRAVENOUS SOLUTION [12587]
|
Facility
|
IP
|
$87.48
|
|
|
Service Code
|
HCPCS J2543
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$17.50 |
| Max. Negotiated Rate |
$78.73 |
| Rate for Payer: Adventist Health Commercial |
$17.50
|
| Rate for Payer: Adventist Health Commercial |
$16.56
|
| Rate for Payer: Adventist Health Commercial |
$35.22
|
| Rate for Payer: Blue Shield of California Commercial |
$67.62
|
| Rate for Payer: Blue Shield of California Commercial |
$64.00
|
| Rate for Payer: Blue Shield of California Commercial |
$136.14
|
| Rate for Payer: Blue Shield of California EPN |
$88.76
|
| Rate for Payer: Blue Shield of California EPN |
$44.09
|
| Rate for Payer: Blue Shield of California EPN |
$41.73
|
| Rate for Payer: Cash Price |
$48.11
|
| Rate for Payer: Cash Price |
$96.87
|
| Rate for Payer: Cash Price |
$45.54
|
| Rate for Payer: Central Health Plan Commercial |
$66.24
|
| Rate for Payer: Central Health Plan Commercial |
$140.90
|
| Rate for Payer: Central Health Plan Commercial |
$69.98
|
| Rate for Payer: Cigna of CA HMO |
$61.24
|
| Rate for Payer: Cigna of CA HMO |
$123.28
|
| Rate for Payer: Cigna of CA HMO |
$57.96
|
| Rate for Payer: Cigna of CA PPO |
$61.24
|
| Rate for Payer: Cigna of CA PPO |
$57.96
|
| Rate for Payer: Cigna of CA PPO |
$123.28
|
| Rate for Payer: EPIC Health Plan Commercial |
$34.99
|
| Rate for Payer: EPIC Health Plan Commercial |
$33.12
|
| Rate for Payer: EPIC Health Plan Commercial |
$70.45
|
| Rate for Payer: EPIC Health Plan Senior |
$33.12
|
| Rate for Payer: EPIC Health Plan Senior |
$70.45
|
| Rate for Payer: EPIC Health Plan Senior |
$34.99
|
| Rate for Payer: Galaxy Health WC |
$70.38
|
| Rate for Payer: Galaxy Health WC |
$149.70
|
| Rate for Payer: Galaxy Health WC |
$74.36
|
| Rate for Payer: Global Benefits Group Commercial |
$49.68
|
| Rate for Payer: Global Benefits Group Commercial |
$105.67
|
| Rate for Payer: Global Benefits Group Commercial |
$52.49
|
| Rate for Payer: Health Management Network EPO/PPO |
$78.73
|
| Rate for Payer: Health Management Network EPO/PPO |
$74.52
|
| Rate for Payer: Health Management Network EPO/PPO |
$158.51
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$58.35
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$117.47
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$55.23
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$67.10
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$33.33
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$31.55
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$54.15
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$51.25
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$109.02
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$17.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$16.56
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$35.22
|
| Rate for Payer: Multiplan Commercial |
$65.61
|
| Rate for Payer: Multiplan Commercial |
$62.10
|
| Rate for Payer: Multiplan Commercial |
$132.09
|
| Rate for Payer: Networks By Design Commercial |
$43.74
|
| Rate for Payer: Networks By Design Commercial |
$88.06
|
| Rate for Payer: Networks By Design Commercial |
$41.40
|
| Rate for Payer: Prime Health Services Commercial |
$70.38
|
| Rate for Payer: Prime Health Services Commercial |
$74.36
|
| Rate for Payer: Prime Health Services Commercial |
$149.70
|
| Rate for Payer: United Healthcare All Other Commercial |
$66.10
|
| Rate for Payer: United Healthcare All Other Commercial |
$32.83
|
| Rate for Payer: United Healthcare All Other Commercial |
$31.07
|
| Rate for Payer: United Healthcare All Other HMO |
$30.25
|
| Rate for Payer: United Healthcare All Other HMO |
$64.34
|
| Rate for Payer: United Healthcare All Other HMO |
$31.96
|
| Rate for Payer: United Healthcare HMO Rider |
$62.95
|
| Rate for Payer: United Healthcare HMO Rider |
$29.59
|
| Rate for Payer: United Healthcare HMO Rider |
$31.27
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$27.12
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$28.65
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$57.68
|
|
|
PIPERACILLIN-TAZOBACTAM 4.5 GRAM/100 ML DEXTROSE(ISO-OSM) IV PIGGYBACK [108121]
|
Facility
|
OP
|
$0.30
|
|
|
Service Code
|
HCPCS J2543
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.06 |
| Max. Negotiated Rate |
$3.79 |
| Rate for Payer: Adventist Health Commercial |
$0.06
|
| Rate for Payer: Aetna of CA HMO/PPO |
$0.18
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.26
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.17
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.23
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$3.79
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1.16
|
| Rate for Payer: Blue Shield of California Commercial |
$2.31
|
| Rate for Payer: Blue Shield of California EPN |
$2.10
|
| Rate for Payer: Cash Price |
$0.17
|
| Rate for Payer: Cash Price |
$0.17
|
| Rate for Payer: Central Health Plan Commercial |
$0.24
|
| Rate for Payer: Cigna of CA HMO |
$0.21
|
| Rate for Payer: Cigna of CA PPO |
$0.21
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.26
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.26
|
| Rate for Payer: Dignity Health Medicare Advantage |
$0.26
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.12
|
| Rate for Payer: EPIC Health Plan Senior |
$0.12
|
| Rate for Payer: Galaxy Health WC |
$0.26
|
| Rate for Payer: Global Benefits Group Commercial |
$0.18
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.27
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$1.12
|
| Rate for Payer: InnovAge PACE Commercial |
$0.15
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.20
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.11
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$0.19
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.06
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$0.21
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$0.21
|
| Rate for Payer: Multiplan Commercial |
$0.23
|
| Rate for Payer: Networks By Design Commercial |
$0.15
|
| Rate for Payer: Prime Health Services Commercial |
$0.26
|
| Rate for Payer: Riverside University Health System MISP |
$0.12
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.18
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.18
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.11
|
| Rate for Payer: United Healthcare All Other HMO |
$0.11
|
| Rate for Payer: United Healthcare HMO Rider |
$0.11
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.10
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.26
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.26
|
| Rate for Payer: Vantage Medical Group Senior |
$0.26
|
|
|
PIPERACILLIN-TAZOBACTAM 4.5 GRAM/100 ML DEXTROSE(ISO-OSM) IV PIGGYBACK [108121]
|
Facility
|
IP
|
$0.30
|
|
|
Service Code
|
HCPCS J2543
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.06 |
| Max. Negotiated Rate |
$0.27 |
| Rate for Payer: Adventist Health Commercial |
$0.06
|
| Rate for Payer: Blue Shield of California Commercial |
$0.23
|
| Rate for Payer: Blue Shield of California EPN |
$0.15
|
| Rate for Payer: Cash Price |
$0.17
|
| Rate for Payer: Central Health Plan Commercial |
$0.24
|
| Rate for Payer: Cigna of CA HMO |
$0.21
|
| Rate for Payer: Cigna of CA PPO |
$0.21
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.12
|
| Rate for Payer: EPIC Health Plan Senior |
$0.12
|
| Rate for Payer: Galaxy Health WC |
$0.26
|
| Rate for Payer: Global Benefits Group Commercial |
$0.18
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.27
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.20
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.11
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$0.19
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.06
|
| Rate for Payer: Multiplan Commercial |
$0.23
|
| Rate for Payer: Networks By Design Commercial |
$0.15
|
| Rate for Payer: Prime Health Services Commercial |
$0.26
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.11
|
| Rate for Payer: United Healthcare All Other HMO |
$0.11
|
| Rate for Payer: United Healthcare HMO Rider |
$0.11
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.10
|
|
|
PIPERACILLIN-TAZOBACTAM 4.5 GRAM INTRAVENOUS SOLUTION [18302]
|
Facility
|
OP
|
$12.70
|
|
|
Service Code
|
HCPCS J2543
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.12 |
| Max. Negotiated Rate |
$11.43 |
| Rate for Payer: Adventist Health Commercial |
$2.54
|
| Rate for Payer: Adventist Health Commercial |
$1.56
|
| Rate for Payer: Adventist Health Commercial |
$1.63
|
| Rate for Payer: Adventist Health Commercial |
$1.35
|
| Rate for Payer: Aetna of CA HMO/PPO |
$4.96
|
| Rate for Payer: Aetna of CA HMO/PPO |
$7.71
|
| Rate for Payer: Aetna of CA HMO/PPO |
$4.74
|
| Rate for Payer: Aetna of CA HMO/PPO |
$4.09
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$6.63
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$5.72
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$10.79
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$6.94
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4.29
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$6.99
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$3.70
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4.49
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$6.12
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$5.05
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$9.53
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$5.85
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$3.79
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$3.79
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$3.79
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$3.79
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1.16
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1.16
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1.16
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1.16
|
| Rate for Payer: Blue Shield of California Commercial |
$2.31
|
| Rate for Payer: Blue Shield of California Commercial |
$2.31
|
| Rate for Payer: Blue Shield of California Commercial |
$2.31
|
| Rate for Payer: Blue Shield of California Commercial |
$2.31
|
| Rate for Payer: Blue Shield of California EPN |
$2.10
|
| Rate for Payer: Blue Shield of California EPN |
$2.10
|
| Rate for Payer: Blue Shield of California EPN |
$2.10
|
| Rate for Payer: Blue Shield of California EPN |
$2.10
|
| Rate for Payer: Cash Price |
$3.70
|
| Rate for Payer: Cash Price |
$4.49
|
| Rate for Payer: Cash Price |
$4.29
|
| Rate for Payer: Cash Price |
$3.70
|
| Rate for Payer: Cash Price |
$6.98
|
| Rate for Payer: Cash Price |
$6.98
|
| Rate for Payer: Cash Price |
$4.49
|
| Rate for Payer: Cash Price |
$4.29
|
| Rate for Payer: Central Health Plan Commercial |
$6.53
|
| Rate for Payer: Central Health Plan Commercial |
$5.38
|
| Rate for Payer: Central Health Plan Commercial |
$6.24
|
| Rate for Payer: Central Health Plan Commercial |
$10.16
|
| Rate for Payer: Cigna of CA HMO |
$4.71
|
| Rate for Payer: Cigna of CA HMO |
$5.46
|
| Rate for Payer: Cigna of CA HMO |
$5.71
|
| Rate for Payer: Cigna of CA HMO |
$8.89
|
| Rate for Payer: Cigna of CA PPO |
$4.71
|
| Rate for Payer: Cigna of CA PPO |
$5.46
|
| Rate for Payer: Cigna of CA PPO |
$5.71
|
| Rate for Payer: Cigna of CA PPO |
$8.89
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$5.72
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$6.94
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$6.63
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$10.79
|
| Rate for Payer: Dignity Health Medi-Cal |
$5.72
|
| Rate for Payer: Dignity Health Medi-Cal |
$6.94
|
| Rate for Payer: Dignity Health Medi-Cal |
$10.79
|
| Rate for Payer: Dignity Health Medi-Cal |
$6.63
|
| Rate for Payer: Dignity Health Medicare Advantage |
$10.79
|
| Rate for Payer: Dignity Health Medicare Advantage |
$6.94
|
| Rate for Payer: Dignity Health Medicare Advantage |
$6.63
|
| Rate for Payer: Dignity Health Medicare Advantage |
$5.72
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.69
|
| Rate for Payer: EPIC Health Plan Commercial |
$5.08
|
| Rate for Payer: EPIC Health Plan Commercial |
$3.26
|
| Rate for Payer: EPIC Health Plan Commercial |
$3.12
|
| Rate for Payer: EPIC Health Plan Senior |
$2.69
|
| Rate for Payer: EPIC Health Plan Senior |
$5.08
|
| Rate for Payer: EPIC Health Plan Senior |
$3.12
|
| Rate for Payer: EPIC Health Plan Senior |
$3.26
|
| Rate for Payer: Galaxy Health WC |
$6.63
|
| Rate for Payer: Galaxy Health WC |
$6.94
|
| Rate for Payer: Galaxy Health WC |
$10.79
|
| Rate for Payer: Galaxy Health WC |
$5.72
|
| Rate for Payer: Global Benefits Group Commercial |
$4.90
|
| Rate for Payer: Global Benefits Group Commercial |
$4.04
|
| Rate for Payer: Global Benefits Group Commercial |
$7.62
|
| Rate for Payer: Global Benefits Group Commercial |
$4.68
|
| Rate for Payer: Health Management Network EPO/PPO |
$6.06
|
| Rate for Payer: Health Management Network EPO/PPO |
$7.02
|
| Rate for Payer: Health Management Network EPO/PPO |
$7.34
|
| Rate for Payer: Health Management Network EPO/PPO |
$11.43
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$1.12
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$1.12
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$1.12
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$1.12
|
| Rate for Payer: InnovAge PACE Commercial |
$3.37
|
| Rate for Payer: InnovAge PACE Commercial |
$4.08
|
| Rate for Payer: InnovAge PACE Commercial |
$3.90
|
| Rate for Payer: InnovAge PACE Commercial |
$6.35
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4.49
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$8.47
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$5.44
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$5.20
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2.97
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3.11
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4.84
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2.56
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4.17
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$7.86
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$5.05
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4.83
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.63
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.35
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.54
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.56
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$8.89
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$5.71
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$4.71
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$5.46
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$5.71
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$5.46
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$4.71
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$8.89
|
| Rate for Payer: Multiplan Commercial |
$5.05
|
| Rate for Payer: Multiplan Commercial |
$5.85
|
| Rate for Payer: Multiplan Commercial |
$6.12
|
| Rate for Payer: Multiplan Commercial |
$9.53
|
| Rate for Payer: Networks By Design Commercial |
$4.08
|
| Rate for Payer: Networks By Design Commercial |
$3.37
|
| Rate for Payer: Networks By Design Commercial |
$3.90
|
| Rate for Payer: Networks By Design Commercial |
$6.35
|
| Rate for Payer: Prime Health Services Commercial |
$6.94
|
| Rate for Payer: Prime Health Services Commercial |
$5.72
|
| Rate for Payer: Prime Health Services Commercial |
$10.79
|
| Rate for Payer: Prime Health Services Commercial |
$6.63
|
| Rate for Payer: Riverside University Health System MISP |
$2.69
|
| Rate for Payer: Riverside University Health System MISP |
$3.12
|
| Rate for Payer: Riverside University Health System MISP |
$3.26
|
| Rate for Payer: Riverside University Health System MISP |
$5.08
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$7.62
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$4.68
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$4.04
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$4.90
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$4.90
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$4.04
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$7.62
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$4.68
|
| Rate for Payer: United Healthcare All Other Commercial |
$4.77
|
| Rate for Payer: United Healthcare All Other Commercial |
$2.93
|
| Rate for Payer: United Healthcare All Other Commercial |
$2.53
|
| Rate for Payer: United Healthcare All Other Commercial |
$3.06
|
| Rate for Payer: United Healthcare All Other HMO |
$2.98
|
| Rate for Payer: United Healthcare All Other HMO |
$4.64
|
| Rate for Payer: United Healthcare All Other HMO |
$2.85
|
| Rate for Payer: United Healthcare All Other HMO |
$2.46
|
| Rate for Payer: United Healthcare HMO Rider |
$2.79
|
| Rate for Payer: United Healthcare HMO Rider |
$2.41
|
| Rate for Payer: United Healthcare HMO Rider |
$2.92
|
| Rate for Payer: United Healthcare HMO Rider |
$4.54
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$4.16
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2.55
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2.20
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2.67
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$10.79
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$6.63
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$5.72
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$6.94
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$5.72
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$10.79
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$6.94
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$6.63
|
| Rate for Payer: Vantage Medical Group Senior |
$6.94
|
| Rate for Payer: Vantage Medical Group Senior |
$5.72
|
| Rate for Payer: Vantage Medical Group Senior |
$6.63
|
| Rate for Payer: Vantage Medical Group Senior |
$10.79
|
|
|
PIPERACILLIN-TAZOBACTAM 4.5 GRAM INTRAVENOUS SOLUTION [18302]
|
Facility
|
IP
|
$6.73
|
|
|
Service Code
|
HCPCS J2543
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.35 |
| Max. Negotiated Rate |
$6.06 |
| Rate for Payer: Adventist Health Commercial |
$1.35
|
| Rate for Payer: Adventist Health Commercial |
$1.63
|
| Rate for Payer: Adventist Health Commercial |
$1.56
|
| Rate for Payer: Adventist Health Commercial |
$2.54
|
| Rate for Payer: Blue Shield of California Commercial |
$5.20
|
| Rate for Payer: Blue Shield of California Commercial |
$9.82
|
| Rate for Payer: Blue Shield of California Commercial |
$6.31
|
| Rate for Payer: Blue Shield of California Commercial |
$6.03
|
| Rate for Payer: Blue Shield of California EPN |
$3.39
|
| Rate for Payer: Blue Shield of California EPN |
$6.40
|
| Rate for Payer: Blue Shield of California EPN |
$3.93
|
| Rate for Payer: Blue Shield of California EPN |
$4.11
|
| Rate for Payer: Cash Price |
$4.49
|
| Rate for Payer: Cash Price |
$6.98
|
| Rate for Payer: Cash Price |
$4.29
|
| Rate for Payer: Cash Price |
$3.70
|
| Rate for Payer: Central Health Plan Commercial |
$6.53
|
| Rate for Payer: Central Health Plan Commercial |
$5.38
|
| Rate for Payer: Central Health Plan Commercial |
$10.16
|
| Rate for Payer: Central Health Plan Commercial |
$6.24
|
| Rate for Payer: Cigna of CA HMO |
$4.71
|
| Rate for Payer: Cigna of CA HMO |
$5.46
|
| Rate for Payer: Cigna of CA HMO |
$5.71
|
| Rate for Payer: Cigna of CA HMO |
$8.89
|
| Rate for Payer: Cigna of CA PPO |
$8.89
|
| Rate for Payer: Cigna of CA PPO |
$4.71
|
| Rate for Payer: Cigna of CA PPO |
$5.46
|
| Rate for Payer: Cigna of CA PPO |
$5.71
|
| Rate for Payer: EPIC Health Plan Commercial |
$5.08
|
| Rate for Payer: EPIC Health Plan Commercial |
$3.26
|
| Rate for Payer: EPIC Health Plan Commercial |
$3.12
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.69
|
| Rate for Payer: EPIC Health Plan Senior |
$2.69
|
| Rate for Payer: EPIC Health Plan Senior |
$3.26
|
| Rate for Payer: EPIC Health Plan Senior |
$3.12
|
| Rate for Payer: EPIC Health Plan Senior |
$5.08
|
| Rate for Payer: Galaxy Health WC |
$5.72
|
| Rate for Payer: Galaxy Health WC |
$6.63
|
| Rate for Payer: Galaxy Health WC |
$6.94
|
| Rate for Payer: Galaxy Health WC |
$10.79
|
| Rate for Payer: Global Benefits Group Commercial |
$4.68
|
| Rate for Payer: Global Benefits Group Commercial |
$7.62
|
| Rate for Payer: Global Benefits Group Commercial |
$4.04
|
| Rate for Payer: Global Benefits Group Commercial |
$4.90
|
| Rate for Payer: Health Management Network EPO/PPO |
$7.34
|
| Rate for Payer: Health Management Network EPO/PPO |
$6.06
|
| Rate for Payer: Health Management Network EPO/PPO |
$7.02
|
| Rate for Payer: Health Management Network EPO/PPO |
$11.43
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$5.44
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4.49
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$5.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$8.47
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3.11
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2.56
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2.97
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4.84
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4.17
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$5.05
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4.83
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$7.86
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.35
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.54
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.63
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.56
|
| Rate for Payer: Multiplan Commercial |
$6.12
|
| Rate for Payer: Multiplan Commercial |
$5.05
|
| Rate for Payer: Multiplan Commercial |
$9.53
|
| Rate for Payer: Multiplan Commercial |
$5.85
|
| Rate for Payer: Networks By Design Commercial |
$4.08
|
| Rate for Payer: Networks By Design Commercial |
$6.35
|
| Rate for Payer: Networks By Design Commercial |
$3.90
|
| Rate for Payer: Networks By Design Commercial |
$3.37
|
| Rate for Payer: Prime Health Services Commercial |
$6.63
|
| Rate for Payer: Prime Health Services Commercial |
$5.72
|
| Rate for Payer: Prime Health Services Commercial |
$10.79
|
| Rate for Payer: Prime Health Services Commercial |
$6.94
|
| Rate for Payer: United Healthcare All Other Commercial |
$3.06
|
| Rate for Payer: United Healthcare All Other Commercial |
$2.93
|
| Rate for Payer: United Healthcare All Other Commercial |
$4.77
|
| Rate for Payer: United Healthcare All Other Commercial |
$2.53
|
| Rate for Payer: United Healthcare All Other HMO |
$2.46
|
| Rate for Payer: United Healthcare All Other HMO |
$4.64
|
| Rate for Payer: United Healthcare All Other HMO |
$2.98
|
| Rate for Payer: United Healthcare All Other HMO |
$2.85
|
| Rate for Payer: United Healthcare HMO Rider |
$4.54
|
| Rate for Payer: United Healthcare HMO Rider |
$2.79
|
| Rate for Payer: United Healthcare HMO Rider |
$2.92
|
| Rate for Payer: United Healthcare HMO Rider |
$2.41
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2.67
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$4.16
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2.20
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2.55
|
|
|
PLERIXAFOR 24 MG/1.2 ML (20 MG/ML) SUBCUTANEOUS SOLUTION [95849]
|
Facility
|
IP
|
$500.00
|
|
|
Service Code
|
HCPCS J2562
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$100.00 |
| Max. Negotiated Rate |
$450.00 |
| Rate for Payer: Adventist Health Commercial |
$100.00
|
| Rate for Payer: Blue Shield of California Commercial |
$386.50
|
| Rate for Payer: Blue Shield of California EPN |
$252.00
|
| Rate for Payer: Cash Price |
$275.00
|
| Rate for Payer: Central Health Plan Commercial |
$400.00
|
| Rate for Payer: Cigna of CA HMO |
$350.00
|
| Rate for Payer: Cigna of CA PPO |
$350.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$200.00
|
| Rate for Payer: EPIC Health Plan Senior |
$200.00
|
| Rate for Payer: Galaxy Health WC |
$425.00
|
| Rate for Payer: Global Benefits Group Commercial |
$300.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$450.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$333.50
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$190.50
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$309.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$100.00
|
| Rate for Payer: Multiplan Commercial |
$375.00
|
| Rate for Payer: Networks By Design Commercial |
$250.00
|
| Rate for Payer: Prime Health Services Commercial |
$425.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$187.65
|
| Rate for Payer: United Healthcare All Other HMO |
$182.65
|
| Rate for Payer: United Healthcare HMO Rider |
$178.70
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$163.75
|
|
|
PLERIXAFOR 24 MG/1.2 ML (20 MG/ML) SUBCUTANEOUS SOLUTION [95849]
|
Facility
|
OP
|
$500.00
|
|
|
Service Code
|
HCPCS J2562
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$21.89 |
| Max. Negotiated Rate |
$450.00 |
| Rate for Payer: Adventist Health Commercial |
$100.00
|
| Rate for Payer: Adventist Health Medi-Cal |
$119.47
|
| Rate for Payer: Aetna of CA HMO/PPO |
$303.65
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$149.34
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$131.42
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$131.42
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$71.34
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$21.89
|
| Rate for Payer: Blue Shield of California Commercial |
$47.38
|
| Rate for Payer: Blue Shield of California EPN |
$43.07
|
| Rate for Payer: Cash Price |
$275.00
|
| Rate for Payer: Cash Price |
$275.00
|
| Rate for Payer: Central Health Plan Commercial |
$400.00
|
| Rate for Payer: Cigna of CA HMO |
$350.00
|
| Rate for Payer: Cigna of CA PPO |
$350.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$149.34
|
| Rate for Payer: Dignity Health Medi-Cal |
$131.42
|
| Rate for Payer: Dignity Health Medicare Advantage |
$131.42
|
| Rate for Payer: EPIC Health Plan Commercial |
$161.28
|
| Rate for Payer: EPIC Health Plan Senior |
$119.47
|
| Rate for Payer: Galaxy Health WC |
$425.00
|
| Rate for Payer: Global Benefits Group Commercial |
$300.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$450.00
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$195.93
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$24.98
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$119.47
|
| Rate for Payer: InnovAge PACE Commercial |
$179.21
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$333.50
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$78.93
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$119.47
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$100.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$160.09
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$160.09
|
| Rate for Payer: Multiplan Commercial |
$375.00
|
| Rate for Payer: Networks By Design Commercial |
$250.00
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$119.47
|
| Rate for Payer: Prime Health Services Commercial |
$425.00
|
| Rate for Payer: Prime Health Services Medicare |
$126.64
|
| Rate for Payer: Riverside University Health System MISP |
$131.42
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$300.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$300.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$187.65
|
| Rate for Payer: United Healthcare All Other HMO |
$182.65
|
| Rate for Payer: United Healthcare HMO Rider |
$178.70
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$163.75
|
| Rate for Payer: Upland Medical Group Pediatric |
$119.47
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$149.34
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$131.42
|
| Rate for Payer: Vantage Medical Group Senior |
$131.42
|
|
|
PNEUMOCOCCAL 20-VALENT CONJ VACCINE-DIP CRM (PF) 0.5 ML IM SYRINGE [231988]
|
Facility
|
IP
|
$677.90
|
|
|
Service Code
|
HCPCS 90677
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$135.58 |
| Max. Negotiated Rate |
$610.11 |
| Rate for Payer: Adventist Health Commercial |
$135.58
|
| Rate for Payer: Adventist Health Commercial |
$131.45
|
| Rate for Payer: Blue Shield of California Commercial |
$524.02
|
| Rate for Payer: Blue Shield of California Commercial |
$508.05
|
| Rate for Payer: Blue Shield of California EPN |
$331.25
|
| Rate for Payer: Blue Shield of California EPN |
$341.66
|
| Rate for Payer: Cash Price |
$372.85
|
| Rate for Payer: Cash Price |
$361.48
|
| Rate for Payer: Central Health Plan Commercial |
$542.32
|
| Rate for Payer: Central Health Plan Commercial |
$525.79
|
| Rate for Payer: Cigna of CA HMO |
$460.07
|
| Rate for Payer: Cigna of CA HMO |
$474.53
|
| Rate for Payer: Cigna of CA PPO |
$460.07
|
| Rate for Payer: Cigna of CA PPO |
$474.53
|
| Rate for Payer: EPIC Health Plan Commercial |
$262.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$271.16
|
| Rate for Payer: EPIC Health Plan Senior |
$262.90
|
| Rate for Payer: EPIC Health Plan Senior |
$271.16
|
| Rate for Payer: Galaxy Health WC |
$558.65
|
| Rate for Payer: Galaxy Health WC |
$576.22
|
| Rate for Payer: Global Benefits Group Commercial |
$406.74
|
| Rate for Payer: Global Benefits Group Commercial |
$394.34
|
| Rate for Payer: Health Management Network EPO/PPO |
$591.52
|
| Rate for Payer: Health Management Network EPO/PPO |
$610.11
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$438.38
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$452.16
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$258.28
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$250.41
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$406.83
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$419.62
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$135.58
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$131.45
|
| Rate for Payer: Multiplan Commercial |
$492.93
|
| Rate for Payer: Multiplan Commercial |
$508.43
|
| Rate for Payer: Networks By Design Commercial |
$328.62
|
| Rate for Payer: Networks By Design Commercial |
$338.95
|
| Rate for Payer: Prime Health Services Commercial |
$576.22
|
| Rate for Payer: Prime Health Services Commercial |
$558.65
|
| Rate for Payer: United Healthcare All Other Commercial |
$246.66
|
| Rate for Payer: United Healthcare All Other Commercial |
$254.42
|
| Rate for Payer: United Healthcare All Other HMO |
$247.64
|
| Rate for Payer: United Healthcare All Other HMO |
$240.09
|
| Rate for Payer: United Healthcare HMO Rider |
$234.90
|
| Rate for Payer: United Healthcare HMO Rider |
$242.28
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$215.25
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$222.01
|
|
|
PNEUMOCOCCAL 20-VALENT CONJ VACCINE-DIP CRM (PF) 0.5 ML IM SYRINGE [231988]
|
Facility
|
OP
|
$657.24
|
|
|
Service Code
|
HCPCS 90677
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$131.45 |
| Max. Negotiated Rate |
$603.57 |
| Rate for Payer: Adventist Health Commercial |
$131.45
|
| Rate for Payer: Adventist Health Commercial |
$135.58
|
| Rate for Payer: Aetna of CA HMO/PPO |
$411.69
|
| Rate for Payer: Aetna of CA HMO/PPO |
$399.14
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$576.22
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$558.65
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$372.85
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$361.48
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$508.43
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$492.93
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$603.57
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$603.57
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$185.24
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$185.24
|
| Rate for Payer: Blue Shield of California Commercial |
$345.15
|
| Rate for Payer: Blue Shield of California Commercial |
$345.15
|
| Rate for Payer: Blue Shield of California EPN |
$313.77
|
| Rate for Payer: Blue Shield of California EPN |
$313.77
|
| Rate for Payer: Cash Price |
$361.48
|
| Rate for Payer: Cash Price |
$361.48
|
| Rate for Payer: Cash Price |
$372.85
|
| Rate for Payer: Cash Price |
$372.85
|
| Rate for Payer: Central Health Plan Commercial |
$525.79
|
| Rate for Payer: Central Health Plan Commercial |
$542.32
|
| Rate for Payer: Cigna of CA HMO |
$474.53
|
| Rate for Payer: Cigna of CA HMO |
$460.07
|
| Rate for Payer: Cigna of CA PPO |
$474.53
|
| Rate for Payer: Cigna of CA PPO |
$460.07
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$558.65
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$576.22
|
| Rate for Payer: Dignity Health Medi-Cal |
$576.22
|
| Rate for Payer: Dignity Health Medi-Cal |
$558.65
|
| Rate for Payer: Dignity Health Medicare Advantage |
$558.65
|
| Rate for Payer: Dignity Health Medicare Advantage |
$576.22
|
| Rate for Payer: EPIC Health Plan Commercial |
$271.16
|
| Rate for Payer: EPIC Health Plan Commercial |
$262.90
|
| Rate for Payer: EPIC Health Plan Senior |
$262.90
|
| Rate for Payer: EPIC Health Plan Senior |
$271.16
|
| Rate for Payer: Galaxy Health WC |
$576.22
|
| Rate for Payer: Galaxy Health WC |
$558.65
|
| Rate for Payer: Global Benefits Group Commercial |
$406.74
|
| Rate for Payer: Global Benefits Group Commercial |
$394.34
|
| Rate for Payer: Health Management Network EPO/PPO |
$610.11
|
| Rate for Payer: Health Management Network EPO/PPO |
$591.52
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$312.90
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$312.90
|
| Rate for Payer: InnovAge PACE Commercial |
$328.62
|
| Rate for Payer: InnovAge PACE Commercial |
$338.95
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$438.38
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$452.16
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$574.75
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$574.75
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$419.62
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$406.83
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$131.45
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$135.58
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$460.07
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$474.53
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$474.53
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$460.07
|
| Rate for Payer: Multiplan Commercial |
$492.93
|
| Rate for Payer: Multiplan Commercial |
$508.43
|
| Rate for Payer: Networks By Design Commercial |
$338.95
|
| Rate for Payer: Networks By Design Commercial |
$328.62
|
| Rate for Payer: Prime Health Services Commercial |
$576.22
|
| Rate for Payer: Prime Health Services Commercial |
$558.65
|
| Rate for Payer: Riverside University Health System MISP |
$262.90
|
| Rate for Payer: Riverside University Health System MISP |
$271.16
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$406.74
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$394.34
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$394.34
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$406.74
|
| Rate for Payer: United Healthcare All Other Commercial |
$254.42
|
| Rate for Payer: United Healthcare All Other Commercial |
$246.66
|
| Rate for Payer: United Healthcare All Other HMO |
$240.09
|
| Rate for Payer: United Healthcare All Other HMO |
$247.64
|
| Rate for Payer: United Healthcare HMO Rider |
$234.90
|
| Rate for Payer: United Healthcare HMO Rider |
$242.28
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$215.25
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$222.01
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$558.65
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$576.22
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$558.65
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$576.22
|
| Rate for Payer: Vantage Medical Group Senior |
$558.65
|
| Rate for Payer: Vantage Medical Group Senior |
$576.22
|
|
|
PNEUMOCOCCAL 23 POLYVALENT VACCINE 25 MCG/0.5 ML INJECTION SYRINGE [113995]
|
Facility
|
OP
|
$280.99
|
|
|
Service Code
|
HCPCS 90732
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$56.20 |
| Max. Negotiated Rate |
$262.07 |
| Rate for Payer: Adventist Health Commercial |
$56.20
|
| Rate for Payer: Aetna of CA HMO/PPO |
$170.65
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$238.84
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$154.54
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$210.74
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$257.47
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$79.02
|
| Rate for Payer: Blue Shield of California Commercial |
$154.55
|
| Rate for Payer: Blue Shield of California EPN |
$140.50
|
| Rate for Payer: Cash Price |
$154.55
|
| Rate for Payer: Cash Price |
$154.55
|
| Rate for Payer: Central Health Plan Commercial |
$224.79
|
| Rate for Payer: Cigna of CA HMO |
$196.69
|
| Rate for Payer: Cigna of CA PPO |
$196.69
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$238.84
|
| Rate for Payer: Dignity Health Medi-Cal |
$238.84
|
| Rate for Payer: Dignity Health Medicare Advantage |
$238.84
|
| Rate for Payer: EPIC Health Plan Commercial |
$112.40
|
| Rate for Payer: EPIC Health Plan Senior |
$112.40
|
| Rate for Payer: Galaxy Health WC |
$238.84
|
| Rate for Payer: Global Benefits Group Commercial |
$168.59
|
| Rate for Payer: Health Management Network EPO/PPO |
$252.89
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$133.47
|
| Rate for Payer: InnovAge PACE Commercial |
$140.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$187.42
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$262.07
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$173.93
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$56.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$196.69
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$196.69
|
| Rate for Payer: Multiplan Commercial |
$210.74
|
| Rate for Payer: Networks By Design Commercial |
$140.50
|
| Rate for Payer: Prime Health Services Commercial |
$238.84
|
| Rate for Payer: Riverside University Health System MISP |
$112.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$168.59
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$168.59
|
| Rate for Payer: United Healthcare All Other Commercial |
$105.46
|
| Rate for Payer: United Healthcare All Other HMO |
$102.65
|
| Rate for Payer: United Healthcare HMO Rider |
$100.43
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$92.02
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$238.84
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$238.84
|
| Rate for Payer: Vantage Medical Group Senior |
$238.84
|
|
