|
PILOCARPINE 5 MG TABLET [12803]
|
Facility
IP
|
$2.73
|
|
|
Service Code
|
NDC 68084-928-25
|
| Hospital Charge Code |
1711692
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.55 |
| Max. Negotiated Rate |
$2.46 |
| Rate for Payer: Blue Shield of California Commercial |
$2.05
|
| Rate for Payer: Blue Shield of California EPN |
$1.46
|
| Rate for Payer: Cash Price |
$1.23
|
| Rate for Payer: Central Health Plan Commercial |
$2.18
|
| Rate for Payer: Cigna of CA HMO |
$1.91
|
| Rate for Payer: Cigna of CA PPO |
$1.91
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.09
|
| Rate for Payer: Galaxy Health WC |
$2.32
|
| Rate for Payer: Global Benefits Group Commercial |
$1.64
|
| Rate for Payer: Health Management Network EPO/PPO |
$2.46
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1.82
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.55
|
| Rate for Payer: Multiplan Commercial |
$2.05
|
| Rate for Payer: Networks By Design Commercial |
$1.77
|
| Rate for Payer: Prime Health Services Commercial |
$2.32
|
|
|
PIMECROLIMUS 1 % TOPICAL CREAM [32052]
|
Facility
OP
|
$11.96
|
|
|
Service Code
|
NDC 0187-5100-01
|
| Hospital Charge Code |
1743701
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$2.39 |
| Max. Negotiated Rate |
$10.76 |
| Rate for Payer: Aetna of CA HMO/PPO |
$7.26
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$10.17
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$6.58
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$6.58
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$5.79
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$7.07
|
| Rate for Payer: BCBS Transplant Transplant |
$7.18
|
| Rate for Payer: Blue Shield of California Commercial |
$7.52
|
| Rate for Payer: Blue Shield of California EPN |
$5.85
|
| Rate for Payer: Cash Price |
$5.38
|
| 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: EPIC Health Plan Commercial |
$4.78
|
| Rate for Payer: EPIC Health Plan Transplant |
$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: Health Plan of Nevada - Sierra Transplant Other |
$8.97
|
| Rate for Payer: IEHP medi-cal |
$4.19
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$7.98
|
| 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
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$7.18
|
| Rate for Payer: Riverside University Health 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 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 |
1743701
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$2.39 |
| Max. Negotiated Rate |
$10.76 |
| Rate for Payer: Blue Shield of California Commercial |
$8.97
|
| Rate for Payer: Blue Shield of California EPN |
$6.39
|
| Rate for Payer: Cash Price |
$5.38
|
| 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: 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: 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
|
|
|
Pinch graft, single or multiple, to cover small ulcer, tip of digit, or other minimal open area (except on face), up to defect size 2 cm diameter
|
Facility
OP
|
$397,400.00
|
|
|
Service Code
|
CPT 15050
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$784.71 |
| Max. Negotiated Rate |
$397,400.00 |
| Rate for Payer: Adventist Health Medi-Cal |
$784.71
|
| Rate for Payer: Aetna of CA HMO/PPO |
$6,248.00
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$1,177.06
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$863.18
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$784.71
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$397,400.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,846.00
|
| Rate for Payer: Blue Shield of California Commercial |
$4,121.55
|
| Rate for Payer: Blue Shield of California EPN |
$2,960.28
|
| Rate for Payer: Caremore Medicare Advantage |
$784.71
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,177.06
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,059.36
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$784.71
|
| Rate for Payer: EPIC Health Plan Transplant |
$784.71
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$1,286.92
|
| Rate for Payer: IEHP medi-cal |
$1,294.77
|
| Rate for Payer: IEHP Medicare Advantage |
$784.71
|
| Rate for Payer: Innovage PACE Commercial |
$1,177.06
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$784.71
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,051.51
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,051.51
|
| Rate for Payer: Prime Health Services Medicare |
$831.79
|
| Rate for Payer: Riverside University Health MISP |
$863.18
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,834.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1,517.00
|
| Rate for Payer: United Healthcare HMO Rider |
$1,041.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$951.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,177.06
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$863.18
|
| Rate for Payer: Vantage Medical Group Senior |
$784.71
|
|
|
PIOGLITAZONE 15 MG TABLET [25528]
|
Facility
IP
|
$0.44
|
|
|
Service Code
|
NDC 0781-5420-92
|
| Hospital Charge Code |
1710878
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.09 |
| Max. Negotiated Rate |
$0.40 |
| Rate for Payer: Blue Shield of California Commercial |
$0.33
|
| Rate for Payer: Blue Shield of California EPN |
$0.23
|
| Rate for Payer: Cash Price |
$0.20
|
| Rate for Payer: Central Health Plan Commercial |
$0.35
|
| Rate for Payer: Cigna of CA HMO |
$0.31
|
| Rate for Payer: Cigna of CA PPO |
$0.31
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.18
|
| Rate for Payer: Galaxy Health WC |
$0.37
|
| Rate for Payer: Global Benefits Group Commercial |
$0.26
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.29
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.09
|
| Rate for Payer: Multiplan Commercial |
$0.33
|
| Rate for Payer: Networks By Design Commercial |
$0.29
|
| Rate for Payer: Prime Health Services Commercial |
$0.37
|
|
|
PIOGLITAZONE 15 MG TABLET [25528]
|
Facility
OP
|
$0.44
|
|
|
Service Code
|
NDC 0781-5420-92
|
| Hospital Charge Code |
1710878
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.09 |
| Max. Negotiated Rate |
$0.40 |
| Rate for Payer: Aetna of CA HMO/PPO |
$0.27
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$0.37
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$0.24
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$0.24
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$0.21
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.26
|
| Rate for Payer: BCBS Transplant Transplant |
$0.26
|
| Rate for Payer: Blue Shield of California Commercial |
$0.28
|
| Rate for Payer: Blue Shield of California EPN |
$0.22
|
| Rate for Payer: Cash Price |
$0.20
|
| Rate for Payer: Central Health Plan Commercial |
$0.35
|
| Rate for Payer: Cigna of CA HMO |
$0.31
|
| Rate for Payer: Cigna of CA PPO |
$0.31
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.37
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.18
|
| Rate for Payer: EPIC Health Plan Transplant |
$0.18
|
| Rate for Payer: Galaxy Health WC |
$0.37
|
| Rate for Payer: Global Benefits Group Commercial |
$0.26
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.40
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$0.33
|
| Rate for Payer: IEHP medi-cal |
$0.15
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.29
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.09
|
| Rate for Payer: Multiplan Commercial |
$0.33
|
| Rate for Payer: Networks By Design Commercial |
$0.29
|
| Rate for Payer: Prime Health Services Commercial |
$0.37
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$0.26
|
| Rate for Payer: Riverside University Health MISP |
$0.18
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.26
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.26
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.22
|
| Rate for Payer: United Healthcare All Other HMO |
$0.22
|
| Rate for Payer: United Healthcare HMO Rider |
$0.22
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.22
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.37
|
| Rate for Payer: Vantage Medical Group Senior |
$0.37
|
|
|
PIOGLITAZONE 30 MG TABLET [25529]
|
Facility
OP
|
$0.22
|
|
|
Service Code
|
NDC 33342-055-07
|
| Hospital Charge Code |
1712291
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.04 |
| Max. Negotiated Rate |
$0.20 |
| Rate for Payer: Aetna of CA HMO/PPO |
$0.13
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$0.19
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$0.12
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$0.12
|
| 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: BCBS Transplant Transplant |
$0.13
|
| Rate for Payer: Blue Shield of California Commercial |
$0.14
|
| Rate for Payer: Blue Shield of California EPN |
$0.11
|
| Rate for Payer: Cash Price |
$0.10
|
| Rate for Payer: Central Health Plan Commercial |
$0.18
|
| Rate for Payer: Cigna of CA HMO |
$0.15
|
| Rate for Payer: Cigna of CA PPO |
$0.15
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.19
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.09
|
| Rate for Payer: EPIC Health Plan Transplant |
$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: Health Plan of Nevada - Sierra Transplant Other |
$0.17
|
| Rate for Payer: IEHP medi-cal |
$0.08
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.15
|
| 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
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$0.13
|
| Rate for Payer: Riverside University Health 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 Medi-Cal |
$0.19
|
| Rate for Payer: Vantage Medical Group Senior |
$0.19
|
|
|
PIOGLITAZONE 30 MG TABLET [25529]
|
Facility
IP
|
$0.22
|
|
|
Service Code
|
NDC 33342-055-07
|
| Hospital Charge Code |
1712291
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.04 |
| Max. Negotiated Rate |
$0.20 |
| Rate for Payer: Blue Shield of California Commercial |
$0.17
|
| Rate for Payer: Blue Shield of California EPN |
$0.12
|
| Rate for Payer: Cash Price |
$0.10
|
| Rate for Payer: Central Health Plan Commercial |
$0.18
|
| Rate for Payer: Cigna of CA HMO |
$0.15
|
| Rate for Payer: Cigna of CA PPO |
$0.15
|
| Rate for Payer: EPIC Health Plan Commercial |
$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: LLUH Dept of Risk Management WC |
$0.04
|
| Rate for Payer: Multiplan Commercial |
$0.17
|
| Rate for Payer: Networks By Design Commercial |
$0.14
|
| Rate for Payer: Prime Health Services Commercial |
$0.19
|
|
|
PIPERACILLIN-TAZOBACTAM 2.25 GRAM/50 ML IN DEXTROSE(ISO) IV PIGGYBACK [34523]
|
Facility
OP
|
$0.37
|
|
|
Service Code
|
CPT J2543
|
| Hospital Charge Code |
NDG34523
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.07 |
| Max. Negotiated Rate |
$10.95 |
| Rate for Payer: Aetna of CA HMO/PPO |
$7.30
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$0.31
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$0.20
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$0.20
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$10.01
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$10.95
|
| Rate for Payer: BCBS Transplant Transplant |
$0.22
|
| Rate for Payer: Blue Shield of California Commercial |
$4.41
|
| Rate for Payer: Blue Shield of California EPN |
$4.01
|
| Rate for Payer: Cash Price |
$0.17
|
| Rate for Payer: Cash Price |
$0.17
|
| Rate for Payer: Central Health Plan Commercial |
$0.30
|
| Rate for Payer: Cigna of CA HMO |
$0.26
|
| Rate for Payer: Cigna of CA PPO |
$0.26
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.31
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.15
|
| Rate for Payer: EPIC Health Plan Transplant |
$0.15
|
| 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 |
$0.33
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$0.28
|
| Rate for Payer: IEHP medi-cal |
$1.18
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.25
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.07
|
| Rate for Payer: Multiplan Commercial |
$0.28
|
| Rate for Payer: Networks By Design Commercial |
$0.19
|
| Rate for Payer: Prime Health Services Commercial |
$0.31
|
| Rate for Payer: Riverside University Health MISP |
$0.15
|
| 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 |
$0.19
|
| Rate for Payer: United Healthcare All Other HMO |
$0.19
|
| Rate for Payer: United Healthcare HMO Rider |
$0.19
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.19
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.31
|
| Rate for Payer: Vantage Medical Group Senior |
$0.31
|
|
|
PIPERACILLIN-TAZOBACTAM 2.25 GRAM/50 ML IN DEXTROSE(ISO) IV PIGGYBACK [34523]
|
Facility
IP
|
$0.37
|
|
|
Service Code
|
CPT J2543
|
| Hospital Charge Code |
NDG34523
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.07 |
| Max. Negotiated Rate |
$0.33 |
| Rate for Payer: Blue Shield of California Commercial |
$0.28
|
| Rate for Payer: Blue Shield of California EPN |
$0.20
|
| Rate for Payer: Cash Price |
$0.17
|
| Rate for Payer: Central Health Plan Commercial |
$0.30
|
| Rate for Payer: Cigna of CA HMO |
$0.26
|
| Rate for Payer: Cigna of CA PPO |
$0.26
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.15
|
| Rate for Payer: EPIC Health Plan Transplant |
$0.15
|
| 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 |
$0.33
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.25
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.07
|
| Rate for Payer: Multiplan Commercial |
$0.28
|
| Rate for Payer: Networks By Design Commercial |
$0.19
|
| Rate for Payer: Prime Health Services Commercial |
$0.31
|
|
|
PIPERACILLIN-TAZOBACTAM 2.25 GRAM INTRAVENOUS SOLUTION [18304]
|
Facility
IP
|
$11.10
|
|
|
Service Code
|
CPT J2543
|
| Hospital Charge Code |
ERX18304
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$2.22 |
| Max. Negotiated Rate |
$9.99 |
| Rate for Payer: Blue Shield of California Commercial |
$8.32
|
| Rate for Payer: Blue Shield of California Commercial |
$6.30
|
| Rate for Payer: Blue Shield of California Commercial |
$6.92
|
| Rate for Payer: Blue Shield of California Commercial |
$3.09
|
| Rate for Payer: Blue Shield of California Commercial |
$4.95
|
| Rate for Payer: Blue Shield of California EPN |
$4.49
|
| Rate for Payer: Blue Shield of California EPN |
$2.20
|
| Rate for Payer: Blue Shield of California EPN |
$3.52
|
| Rate for Payer: Blue Shield of California EPN |
$4.92
|
| Rate for Payer: Blue Shield of California EPN |
$5.93
|
| Rate for Payer: Cash Price |
$1.85
|
| Rate for Payer: Cash Price |
$5.00
|
| Rate for Payer: Cash Price |
$2.97
|
| Rate for Payer: Cash Price |
$3.78
|
| Rate for Payer: Cash Price |
$4.15
|
| Rate for Payer: Central Health Plan Commercial |
$6.72
|
| Rate for Payer: Central Health Plan Commercial |
$8.88
|
| Rate for Payer: Central Health Plan Commercial |
$7.38
|
| Rate for Payer: Central Health Plan Commercial |
$3.30
|
| Rate for Payer: Central Health Plan Commercial |
$5.28
|
| Rate for Payer: Cigna of CA HMO |
$2.88
|
| Rate for Payer: Cigna of CA HMO |
$7.77
|
| Rate for Payer: Cigna of CA HMO |
$4.62
|
| Rate for Payer: Cigna of CA HMO |
$6.45
|
| Rate for Payer: Cigna of CA HMO |
$5.88
|
| Rate for Payer: Cigna of CA PPO |
$6.45
|
| Rate for Payer: Cigna of CA PPO |
$7.77
|
| Rate for Payer: Cigna of CA PPO |
$5.88
|
| Rate for Payer: Cigna of CA PPO |
$4.62
|
| Rate for Payer: Cigna of CA PPO |
$2.88
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.64
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.65
|
| Rate for Payer: EPIC Health Plan Commercial |
$3.69
|
| Rate for Payer: EPIC Health Plan Commercial |
$3.36
|
| Rate for Payer: EPIC Health Plan Commercial |
$4.44
|
| Rate for Payer: EPIC Health Plan Transplant |
$3.36
|
| Rate for Payer: EPIC Health Plan Transplant |
$4.44
|
| Rate for Payer: EPIC Health Plan Transplant |
$1.65
|
| Rate for Payer: EPIC Health Plan Transplant |
$2.64
|
| Rate for Payer: EPIC Health Plan Transplant |
$3.69
|
| Rate for Payer: Galaxy Health WC |
$5.61
|
| Rate for Payer: Galaxy Health WC |
$9.44
|
| Rate for Payer: Galaxy Health WC |
$7.14
|
| Rate for Payer: Galaxy Health WC |
$3.50
|
| Rate for Payer: Galaxy Health WC |
$7.84
|
| 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 |
$3.96
|
| Rate for Payer: Global Benefits Group Commercial |
$5.04
|
| Rate for Payer: Global Benefits Group Commercial |
$5.53
|
| Rate for Payer: Health Management Network EPO/PPO |
$9.99
|
| Rate for Payer: Health Management Network EPO/PPO |
$5.94
|
| Rate for Payer: Health Management Network EPO/PPO |
$3.71
|
| Rate for Payer: Health Management Network EPO/PPO |
$7.56
|
| Rate for Payer: Health Management Network EPO/PPO |
$8.30
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$5.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2.75
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$7.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$6.15
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.32
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.68
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.82
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.22
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.84
|
| Rate for Payer: Multiplan Commercial |
$6.30
|
| Rate for Payer: Multiplan Commercial |
$8.32
|
| Rate for Payer: Multiplan Commercial |
$3.09
|
| Rate for Payer: Multiplan Commercial |
$4.95
|
| Rate for Payer: Multiplan Commercial |
$6.92
|
| Rate for Payer: Networks By Design Commercial |
$4.20
|
| Rate for Payer: Networks By Design Commercial |
$3.30
|
| 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 |
$4.61
|
| Rate for Payer: Prime Health Services Commercial |
$7.84
|
| Rate for Payer: Prime Health Services Commercial |
$5.61
|
| Rate for Payer: Prime Health Services Commercial |
$3.50
|
| Rate for Payer: Prime Health Services Commercial |
$7.14
|
| Rate for Payer: Prime Health Services Commercial |
$9.44
|
|
|
PIPERACILLIN-TAZOBACTAM 2.25 GRAM INTRAVENOUS SOLUTION [18304]
|
Facility
OP
|
$9.22
|
|
|
Service Code
|
CPT J2543
|
| Hospital Charge Code |
ERX18304
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.18 |
| Max. Negotiated Rate |
$10.95 |
| Rate for Payer: Aetna of CA HMO/PPO |
$7.30
|
| Rate for Payer: Aetna of CA HMO/PPO |
$7.30
|
| Rate for Payer: Aetna of CA HMO/PPO |
$7.30
|
| Rate for Payer: Aetna of CA HMO/PPO |
$7.30
|
| Rate for Payer: Aetna of CA HMO/PPO |
$7.30
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$7.84
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$7.14
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$9.44
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$5.61
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$3.50
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$2.27
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$6.10
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$5.07
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$4.62
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$3.63
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$4.62
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$3.63
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$5.07
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$2.27
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$6.10
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$10.01
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$10.01
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$10.01
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$10.01
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$10.01
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$10.95
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$10.95
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$10.95
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$10.95
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$10.95
|
| Rate for Payer: BCBS Transplant Transplant |
$3.96
|
| Rate for Payer: BCBS Transplant Transplant |
$6.66
|
| Rate for Payer: BCBS Transplant Transplant |
$5.04
|
| Rate for Payer: BCBS Transplant Transplant |
$2.47
|
| Rate for Payer: BCBS Transplant Transplant |
$5.53
|
| Rate for Payer: Blue Shield of California Commercial |
$4.41
|
| Rate for Payer: Blue Shield of California Commercial |
$4.41
|
| Rate for Payer: Blue Shield of California Commercial |
$4.41
|
| Rate for Payer: Blue Shield of California Commercial |
$4.41
|
| Rate for Payer: Blue Shield of California Commercial |
$4.41
|
| Rate for Payer: Blue Shield of California EPN |
$4.01
|
| Rate for Payer: Blue Shield of California EPN |
$4.01
|
| Rate for Payer: Blue Shield of California EPN |
$4.01
|
| Rate for Payer: Blue Shield of California EPN |
$4.01
|
| Rate for Payer: Blue Shield of California EPN |
$4.01
|
| Rate for Payer: Cash Price |
$2.97
|
| Rate for Payer: Cash Price |
$5.00
|
| Rate for Payer: Cash Price |
$1.85
|
| Rate for Payer: Cash Price |
$3.78
|
| Rate for Payer: Cash Price |
$3.78
|
| Rate for Payer: Cash Price |
$5.00
|
| Rate for Payer: Cash Price |
$1.85
|
| Rate for Payer: Cash Price |
$2.97
|
| Rate for Payer: Cash Price |
$4.15
|
| Rate for Payer: Cash Price |
$4.15
|
| Rate for Payer: Central Health Plan Commercial |
$8.88
|
| Rate for Payer: Central Health Plan Commercial |
$3.30
|
| Rate for Payer: Central Health Plan Commercial |
$5.28
|
| Rate for Payer: Central Health Plan Commercial |
$6.72
|
| Rate for Payer: Central Health Plan Commercial |
$7.38
|
| Rate for Payer: Cigna of CA HMO |
$2.88
|
| Rate for Payer: Cigna of CA HMO |
$4.62
|
| Rate for Payer: Cigna of CA HMO |
$6.45
|
| Rate for Payer: Cigna of CA HMO |
$7.77
|
| Rate for Payer: Cigna of CA HMO |
$5.88
|
| 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 |
$4.62
|
| Rate for Payer: Cigna of CA PPO |
$5.88
|
| Rate for Payer: Cigna of CA PPO |
$6.45
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$7.14
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$7.84
|
| 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 |
$5.61
|
| Rate for Payer: EPIC Health Plan Commercial |
$4.44
|
| Rate for Payer: EPIC Health Plan Commercial |
$3.36
|
| Rate for Payer: EPIC Health Plan Commercial |
$3.69
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.65
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.64
|
| Rate for Payer: EPIC Health Plan Transplant |
$1.65
|
| Rate for Payer: EPIC Health Plan Transplant |
$3.36
|
| Rate for Payer: EPIC Health Plan Transplant |
$4.44
|
| Rate for Payer: EPIC Health Plan Transplant |
$3.69
|
| Rate for Payer: EPIC Health Plan Transplant |
$2.64
|
| Rate for Payer: Galaxy Health WC |
$7.14
|
| Rate for Payer: Galaxy Health WC |
$9.44
|
| Rate for Payer: Galaxy Health WC |
$3.50
|
| Rate for Payer: Galaxy Health WC |
$5.61
|
| Rate for Payer: Galaxy Health WC |
$7.84
|
| Rate for Payer: Global Benefits Group Commercial |
$5.04
|
| Rate for Payer: Global Benefits Group Commercial |
$2.47
|
| Rate for Payer: Global Benefits Group Commercial |
$3.96
|
| Rate for Payer: Global Benefits Group Commercial |
$5.53
|
| Rate for Payer: Global Benefits Group Commercial |
$6.66
|
| Rate for Payer: Health Management Network EPO/PPO |
$8.30
|
| Rate for Payer: Health Management Network EPO/PPO |
$3.71
|
| Rate for Payer: Health Management Network EPO/PPO |
$5.94
|
| Rate for Payer: Health Management Network EPO/PPO |
$7.56
|
| Rate for Payer: Health Management Network EPO/PPO |
$9.99
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$3.09
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$8.32
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$4.95
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$6.30
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$6.92
|
| Rate for Payer: IEHP medi-cal |
$1.18
|
| Rate for Payer: IEHP medi-cal |
$1.18
|
| Rate for Payer: IEHP medi-cal |
$1.18
|
| Rate for Payer: IEHP medi-cal |
$1.18
|
| Rate for Payer: IEHP medi-cal |
$1.18
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$6.15
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2.75
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$7.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$5.60
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.82
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.84
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.68
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.32
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.22
|
| Rate for Payer: Multiplan Commercial |
$3.09
|
| Rate for Payer: Multiplan Commercial |
$8.32
|
| Rate for Payer: Multiplan Commercial |
$6.92
|
| Rate for Payer: Multiplan Commercial |
$4.95
|
| Rate for Payer: Multiplan Commercial |
$6.30
|
| Rate for Payer: Networks By Design Commercial |
$4.61
|
| Rate for Payer: Networks By Design Commercial |
$5.55
|
| Rate for Payer: Networks By Design Commercial |
$3.30
|
| Rate for Payer: Networks By Design Commercial |
$4.20
|
| Rate for Payer: Networks By Design Commercial |
$2.06
|
| Rate for Payer: Prime Health Services Commercial |
$3.50
|
| Rate for Payer: Prime Health Services Commercial |
$9.44
|
| Rate for Payer: Prime Health Services Commercial |
$7.14
|
| Rate for Payer: Prime Health Services Commercial |
$7.84
|
| Rate for Payer: Prime Health Services Commercial |
$5.61
|
| Rate for Payer: Riverside University Health MISP |
$3.69
|
| Rate for Payer: Riverside University Health MISP |
$3.36
|
| Rate for Payer: Riverside University Health MISP |
$4.44
|
| Rate for Payer: Riverside University Health MISP |
$1.65
|
| Rate for Payer: Riverside University Health MISP |
$2.64
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$5.53
|
| 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 |
$3.96
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$5.04
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$3.96
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$5.04
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2.47
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$5.53
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$6.66
|
| Rate for Payer: United Healthcare All Other Commercial |
$4.61
|
| Rate for Payer: United Healthcare All Other Commercial |
$3.30
|
| Rate for Payer: United Healthcare All Other Commercial |
$5.55
|
| Rate for Payer: United Healthcare All Other Commercial |
$4.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$2.06
|
| Rate for Payer: United Healthcare All Other HMO |
$4.61
|
| Rate for Payer: United Healthcare All Other HMO |
$4.20
|
| Rate for Payer: United Healthcare All Other HMO |
$5.55
|
| Rate for Payer: United Healthcare All Other HMO |
$3.30
|
| Rate for Payer: United Healthcare All Other HMO |
$2.06
|
| Rate for Payer: United Healthcare HMO Rider |
$2.06
|
| Rate for Payer: United Healthcare HMO Rider |
$3.30
|
| Rate for Payer: United Healthcare HMO Rider |
$5.55
|
| Rate for Payer: United Healthcare HMO Rider |
$4.61
|
| Rate for Payer: United Healthcare HMO Rider |
$4.20
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$4.20
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2.06
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3.30
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$5.55
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$4.61
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$7.14
|
| 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 Medi-Cal |
$7.84
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$5.61
|
| Rate for Payer: Vantage Medical Group Senior |
$7.14
|
| Rate for Payer: Vantage Medical Group Senior |
$3.50
|
| Rate for Payer: Vantage Medical Group Senior |
$5.61
|
| Rate for Payer: Vantage Medical Group Senior |
$9.44
|
| Rate for Payer: Vantage Medical Group Senior |
$7.84
|
|
|
PIPERACILLIN-TAZOBACTAM 3.375 GRAM/50 ML DEXTROSE(ISO-OS) IV PIGGYBACK [34524]
|
Facility
IP
|
$0.49
|
|
|
Service Code
|
CPT J2543
|
| Hospital Charge Code |
1753480
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.10 |
| Max. Negotiated Rate |
$0.44 |
| Rate for Payer: Blue Shield of California Commercial |
$0.37
|
| Rate for Payer: Blue Shield of California EPN |
$0.26
|
| Rate for Payer: Cash Price |
$0.22
|
| Rate for Payer: Central Health Plan Commercial |
$0.39
|
| Rate for Payer: Cigna of CA HMO |
$0.34
|
| Rate for Payer: Cigna of CA PPO |
$0.34
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.20
|
| Rate for Payer: EPIC Health Plan Transplant |
$0.20
|
| Rate for Payer: Galaxy Health WC |
$0.42
|
| Rate for Payer: Global Benefits Group Commercial |
$0.29
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.44
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.33
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.10
|
| Rate for Payer: Multiplan Commercial |
$0.37
|
| Rate for Payer: Networks By Design Commercial |
$0.25
|
| Rate for Payer: Prime Health Services Commercial |
$0.42
|
|
|
PIPERACILLIN-TAZOBACTAM 3.375 GRAM/50 ML DEXTROSE(ISO-OS) IV PIGGYBACK [34524]
|
Facility
OP
|
$0.49
|
|
|
Service Code
|
CPT J2543
|
| Hospital Charge Code |
1753480
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.10 |
| Max. Negotiated Rate |
$10.95 |
| Rate for Payer: Aetna of CA HMO/PPO |
$7.30
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$0.42
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$0.27
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$0.27
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$10.01
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$10.95
|
| Rate for Payer: BCBS Transplant Transplant |
$0.29
|
| Rate for Payer: Blue Shield of California Commercial |
$4.41
|
| Rate for Payer: Blue Shield of California EPN |
$4.01
|
| Rate for Payer: Cash Price |
$0.22
|
| Rate for Payer: Cash Price |
$0.22
|
| Rate for Payer: Central Health Plan Commercial |
$0.39
|
| Rate for Payer: Cigna of CA HMO |
$0.34
|
| Rate for Payer: Cigna of CA PPO |
$0.34
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.42
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.20
|
| Rate for Payer: EPIC Health Plan Transplant |
$0.20
|
| Rate for Payer: Galaxy Health WC |
$0.42
|
| Rate for Payer: Global Benefits Group Commercial |
$0.29
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.44
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$0.37
|
| Rate for Payer: IEHP medi-cal |
$1.18
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.33
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.10
|
| Rate for Payer: Multiplan Commercial |
$0.37
|
| Rate for Payer: Networks By Design Commercial |
$0.25
|
| Rate for Payer: Prime Health Services Commercial |
$0.42
|
| Rate for Payer: Riverside University Health MISP |
$0.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.29
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.29
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.25
|
| Rate for Payer: United Healthcare All Other HMO |
$0.25
|
| Rate for Payer: United Healthcare HMO Rider |
$0.25
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.25
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.42
|
| Rate for Payer: Vantage Medical Group Senior |
$0.42
|
|
|
PIPERACILLIN-TAZOBACTAM 3.375 GRAM/50 ML DEXTROSE(ISO-OS) IV PIGGYBACK [34524]
|
Facility
IP
|
$0.48
|
|
|
Service Code
|
CPT J2543
|
| Hospital Charge Code |
NDG34524
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.10 |
| Max. Negotiated Rate |
$0.43 |
| Rate for Payer: Blue Shield of California Commercial |
$0.36
|
| Rate for Payer: Blue Shield of California EPN |
$0.26
|
| Rate for Payer: Cash Price |
$0.22
|
| Rate for Payer: Central Health Plan Commercial |
$0.38
|
| Rate for Payer: Cigna of CA HMO |
$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 Transplant |
$0.19
|
| Rate for Payer: Galaxy Health WC |
$0.41
|
| Rate for Payer: Global Benefits Group Commercial |
$0.29
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.43
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.32
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.10
|
| Rate for Payer: Multiplan Commercial |
$0.36
|
| Rate for Payer: Networks By Design Commercial |
$0.24
|
| Rate for Payer: Prime Health Services Commercial |
$0.41
|
|
|
PIPERACILLIN-TAZOBACTAM 3.375 GRAM/50 ML DEXTROSE(ISO-OS) IV PIGGYBACK [34524]
|
Facility
OP
|
$0.48
|
|
|
Service Code
|
CPT J2543
|
| Hospital Charge Code |
NDG34524
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.10 |
| Max. Negotiated Rate |
$10.95 |
| Rate for Payer: Aetna of CA HMO/PPO |
$7.30
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$0.41
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$0.26
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$0.26
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$10.01
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$10.95
|
| Rate for Payer: BCBS Transplant Transplant |
$0.29
|
| Rate for Payer: Blue Shield of California Commercial |
$4.41
|
| Rate for Payer: Blue Shield of California EPN |
$4.01
|
| Rate for Payer: Cash Price |
$0.22
|
| Rate for Payer: Cash Price |
$0.22
|
| Rate for Payer: Central Health Plan Commercial |
$0.38
|
| Rate for Payer: Cigna of CA HMO |
$0.34
|
| Rate for Payer: Cigna of CA PPO |
$0.34
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.41
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.19
|
| Rate for Payer: EPIC Health Plan Transplant |
$0.19
|
| Rate for Payer: Galaxy Health WC |
$0.41
|
| Rate for Payer: Global Benefits Group Commercial |
$0.29
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.43
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$0.36
|
| Rate for Payer: IEHP medi-cal |
$1.18
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.32
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.10
|
| Rate for Payer: Multiplan Commercial |
$0.36
|
| Rate for Payer: Networks By Design Commercial |
$0.24
|
| Rate for Payer: Prime Health Services Commercial |
$0.41
|
| Rate for Payer: Riverside University Health MISP |
$0.19
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.29
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.29
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.24
|
| Rate for Payer: United Healthcare All Other HMO |
$0.24
|
| Rate for Payer: United Healthcare HMO Rider |
$0.24
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.24
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.41
|
| Rate for Payer: Vantage Medical Group Senior |
$0.41
|
|
|
PIPERACILLIN-TAZOBACTAM 3.375 GRAM INTRAVENOUS SOLUTION [18303]
|
Facility
OP
|
$10.56
|
|
|
Service Code
|
CPT J2543
|
| Hospital Charge Code |
1721150
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.18 |
| Max. Negotiated Rate |
$10.95 |
| Rate for Payer: Aetna of CA HMO/PPO |
$7.30
|
| Rate for Payer: Aetna of CA HMO/PPO |
$7.30
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$8.98
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$9.98
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$6.46
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$5.81
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$6.46
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$5.81
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$10.01
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$10.01
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$10.95
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$10.95
|
| Rate for Payer: BCBS Transplant Transplant |
$7.04
|
| Rate for Payer: BCBS Transplant Transplant |
$6.34
|
| Rate for Payer: Blue Shield of California Commercial |
$4.41
|
| Rate for Payer: Blue Shield of California Commercial |
$4.41
|
| Rate for Payer: Blue Shield of California EPN |
$4.01
|
| Rate for Payer: Blue Shield of California EPN |
$4.01
|
| Rate for Payer: Cash Price |
$4.75
|
| Rate for Payer: Cash Price |
$4.75
|
| Rate for Payer: Cash Price |
$5.28
|
| Rate for Payer: Cash Price |
$5.28
|
| Rate for Payer: Central Health Plan Commercial |
$8.45
|
| Rate for Payer: Central Health Plan Commercial |
$9.39
|
| Rate for Payer: Cigna of CA HMO |
$7.39
|
| Rate for Payer: Cigna of CA HMO |
$8.22
|
| Rate for Payer: Cigna of CA PPO |
$8.22
|
| Rate for Payer: Cigna of CA PPO |
$7.39
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$9.98
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$8.98
|
| Rate for Payer: EPIC Health Plan Commercial |
$4.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$4.22
|
| Rate for Payer: EPIC Health Plan Transplant |
$4.70
|
| Rate for Payer: EPIC Health Plan Transplant |
$4.22
|
| Rate for Payer: Galaxy Health WC |
$8.98
|
| Rate for Payer: Galaxy Health WC |
$9.98
|
| Rate for Payer: Global Benefits Group Commercial |
$7.04
|
| Rate for Payer: Global Benefits Group Commercial |
$6.34
|
| Rate for Payer: Health Management Network EPO/PPO |
$9.50
|
| Rate for Payer: Health Management Network EPO/PPO |
$10.57
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$7.92
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$8.80
|
| Rate for Payer: IEHP medi-cal |
$1.18
|
| Rate for Payer: IEHP medi-cal |
$1.18
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$7.83
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$7.04
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.11
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.35
|
| Rate for Payer: Multiplan Commercial |
$8.80
|
| Rate for Payer: Multiplan Commercial |
$7.92
|
| Rate for Payer: Networks By Design Commercial |
$5.28
|
| Rate for Payer: Networks By Design Commercial |
$5.87
|
| Rate for Payer: Prime Health Services Commercial |
$8.98
|
| Rate for Payer: Prime Health Services Commercial |
$9.98
|
| Rate for Payer: Riverside University Health MISP |
$4.70
|
| Rate for Payer: Riverside University Health MISP |
$4.22
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$6.34
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$7.04
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$6.34
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$7.04
|
| Rate for Payer: United Healthcare All Other Commercial |
$5.87
|
| Rate for Payer: United Healthcare All Other Commercial |
$5.28
|
| Rate for Payer: United Healthcare All Other HMO |
$5.28
|
| Rate for Payer: United Healthcare All Other HMO |
$5.87
|
| Rate for Payer: United Healthcare HMO Rider |
$5.87
|
| Rate for Payer: United Healthcare HMO Rider |
$5.28
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$5.87
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$5.28
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$8.98
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$9.98
|
| Rate for Payer: Vantage Medical Group Senior |
$8.98
|
| Rate for Payer: Vantage Medical Group Senior |
$9.98
|
|
|
PIPERACILLIN-TAZOBACTAM 3.375 GRAM INTRAVENOUS SOLUTION [18303]
|
Facility
IP
|
$11.74
|
|
|
Service Code
|
CPT J2543
|
| Hospital Charge Code |
1721150
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$2.35 |
| Max. Negotiated Rate |
$10.57 |
| Rate for Payer: Blue Shield of California Commercial |
$8.80
|
| Rate for Payer: Blue Shield of California Commercial |
$7.92
|
| Rate for Payer: Blue Shield of California EPN |
$5.64
|
| Rate for Payer: Blue Shield of California EPN |
$6.27
|
| Rate for Payer: Cash Price |
$4.75
|
| Rate for Payer: Cash Price |
$5.28
|
| Rate for Payer: Central Health Plan Commercial |
$8.45
|
| Rate for Payer: Central Health Plan Commercial |
$9.39
|
| Rate for Payer: Cigna of CA HMO |
$7.39
|
| Rate for Payer: Cigna of CA HMO |
$8.22
|
| Rate for Payer: Cigna of CA PPO |
$8.22
|
| Rate for Payer: Cigna of CA PPO |
$7.39
|
| Rate for Payer: EPIC Health Plan Commercial |
$4.22
|
| Rate for Payer: EPIC Health Plan Commercial |
$4.70
|
| Rate for Payer: EPIC Health Plan Transplant |
$4.70
|
| Rate for Payer: EPIC Health Plan Transplant |
$4.22
|
| Rate for Payer: Galaxy Health WC |
$8.98
|
| Rate for Payer: Galaxy Health WC |
$9.98
|
| Rate for Payer: Global Benefits Group Commercial |
$6.34
|
| Rate for Payer: Global Benefits Group Commercial |
$7.04
|
| Rate for Payer: Health Management Network EPO/PPO |
$10.57
|
| Rate for Payer: Health Management Network EPO/PPO |
$9.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$7.04
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$7.83
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.35
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.11
|
| Rate for Payer: Multiplan Commercial |
$8.80
|
| Rate for Payer: Multiplan Commercial |
$7.92
|
| Rate for Payer: Networks By Design Commercial |
$5.28
|
| Rate for Payer: Networks By Design Commercial |
$5.87
|
| Rate for Payer: Prime Health Services Commercial |
$9.98
|
| Rate for Payer: Prime Health Services Commercial |
$8.98
|
|
|
PIPERACILLIN-TAZOBACTAM 4.5 GRAM/100 ML DEXTROSE(ISO-OSM) IV PIGGYBACK [108121]
|
Facility
OP
|
$0.31
|
|
|
Service Code
|
CPT J2543
|
| Hospital Charge Code |
NDG108121
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.06 |
| Max. Negotiated Rate |
$10.95 |
| Rate for Payer: Aetna of CA HMO/PPO |
$7.30
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$0.26
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$0.17
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$0.17
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$10.01
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$10.95
|
| Rate for Payer: BCBS Transplant Transplant |
$0.19
|
| Rate for Payer: Blue Shield of California Commercial |
$4.41
|
| Rate for Payer: Blue Shield of California EPN |
$4.01
|
| Rate for Payer: Cash Price |
$0.14
|
| Rate for Payer: Cash Price |
$0.14
|
| Rate for Payer: Central Health Plan Commercial |
$0.25
|
| Rate for Payer: Cigna of CA HMO |
$0.22
|
| Rate for Payer: Cigna of CA PPO |
$0.22
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.26
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.12
|
| Rate for Payer: EPIC Health Plan Transplant |
$0.12
|
| Rate for Payer: Galaxy Health WC |
$0.26
|
| Rate for Payer: Global Benefits Group Commercial |
$0.19
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.28
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$0.23
|
| Rate for Payer: IEHP medi-cal |
$1.18
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.21
|
| 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 |
$0.16
|
| Rate for Payer: Prime Health Services Commercial |
$0.26
|
| Rate for Payer: Riverside University Health MISP |
$0.12
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.19
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.19
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.16
|
| Rate for Payer: United Healthcare All Other HMO |
$0.16
|
| Rate for Payer: United Healthcare HMO Rider |
$0.16
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.16
|
| 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
|
$0.31
|
|
|
Service Code
|
CPT J2543
|
| Hospital Charge Code |
NDG108121
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.06 |
| Max. Negotiated Rate |
$0.28 |
| Rate for Payer: Blue Shield of California Commercial |
$0.23
|
| Rate for Payer: Blue Shield of California EPN |
$0.17
|
| Rate for Payer: Cash Price |
$0.14
|
| Rate for Payer: Central Health Plan Commercial |
$0.25
|
| Rate for Payer: Cigna of CA HMO |
$0.22
|
| Rate for Payer: Cigna of CA PPO |
$0.22
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.12
|
| Rate for Payer: EPIC Health Plan Transplant |
$0.12
|
| Rate for Payer: Galaxy Health WC |
$0.26
|
| Rate for Payer: Global Benefits Group Commercial |
$0.19
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.28
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.21
|
| 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 |
$0.16
|
| Rate for Payer: Prime Health Services Commercial |
$0.26
|
|
|
PIPERACILLIN-TAZOBACTAM 4.5 GRAM INTRAVENOUS SOLUTION [18302]
|
Facility
OP
|
$13.32
|
|
|
Service Code
|
CPT J2543
|
| Hospital Charge Code |
1721132
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.18 |
| Max. Negotiated Rate |
$11.99 |
| Rate for Payer: Aetna of CA HMO/PPO |
$7.30
|
| Rate for Payer: Aetna of CA HMO/PPO |
$7.30
|
| Rate for Payer: Aetna of CA HMO/PPO |
$7.30
|
| Rate for Payer: Aetna of CA HMO/PPO |
$7.30
|
| Rate for Payer: Aetna of CA HMO/PPO |
$7.30
|
| Rate for Payer: Aetna of CA HMO/PPO |
$7.30
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$14.22
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$7.00
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$11.32
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$6.94
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$14.28
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$14.89
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$7.33
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$9.20
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$9.24
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$9.64
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$4.49
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$4.53
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$4.53
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$4.49
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$7.33
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$9.24
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$9.64
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$9.20
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$10.01
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$10.01
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$10.01
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$10.01
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$10.01
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$10.01
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$10.95
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$10.95
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$10.95
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$10.95
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$10.95
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$10.95
|
| Rate for Payer: BCBS Transplant Transplant |
$7.99
|
| Rate for Payer: BCBS Transplant Transplant |
$4.94
|
| Rate for Payer: BCBS Transplant Transplant |
$10.51
|
| Rate for Payer: BCBS Transplant Transplant |
$10.04
|
| Rate for Payer: BCBS Transplant Transplant |
$10.08
|
| Rate for Payer: BCBS Transplant Transplant |
$4.90
|
| Rate for Payer: Blue Shield of California Commercial |
$4.41
|
| Rate for Payer: Blue Shield of California Commercial |
$4.41
|
| Rate for Payer: Blue Shield of California Commercial |
$4.41
|
| Rate for Payer: Blue Shield of California Commercial |
$4.41
|
| Rate for Payer: Blue Shield of California Commercial |
$4.41
|
| Rate for Payer: Blue Shield of California Commercial |
$4.41
|
| Rate for Payer: Blue Shield of California EPN |
$4.01
|
| Rate for Payer: Blue Shield of California EPN |
$4.01
|
| Rate for Payer: Blue Shield of California EPN |
$4.01
|
| Rate for Payer: Blue Shield of California EPN |
$4.01
|
| Rate for Payer: Blue Shield of California EPN |
$4.01
|
| Rate for Payer: Blue Shield of California EPN |
$4.01
|
| Rate for Payer: Cash Price |
$7.53
|
| Rate for Payer: Cash Price |
$5.99
|
| Rate for Payer: Cash Price |
$3.71
|
| Rate for Payer: Cash Price |
$7.53
|
| Rate for Payer: Cash Price |
$5.99
|
| Rate for Payer: Cash Price |
$7.56
|
| Rate for Payer: Cash Price |
$7.88
|
| Rate for Payer: Cash Price |
$3.67
|
| Rate for Payer: Cash Price |
$3.67
|
| Rate for Payer: Cash Price |
$7.56
|
| Rate for Payer: Cash Price |
$7.88
|
| Rate for Payer: Cash Price |
$3.71
|
| Rate for Payer: Central Health Plan Commercial |
$6.53
|
| Rate for Payer: Central Health Plan Commercial |
$6.59
|
| Rate for Payer: Central Health Plan Commercial |
$10.66
|
| Rate for Payer: Central Health Plan Commercial |
$13.38
|
| Rate for Payer: Central Health Plan Commercial |
$13.44
|
| Rate for Payer: Central Health Plan Commercial |
$14.02
|
| Rate for Payer: Cigna of CA HMO |
$11.76
|
| Rate for Payer: Cigna of CA HMO |
$5.71
|
| Rate for Payer: Cigna of CA HMO |
$5.77
|
| Rate for Payer: Cigna of CA HMO |
$9.32
|
| Rate for Payer: Cigna of CA HMO |
$12.26
|
| Rate for Payer: Cigna of CA HMO |
$11.71
|
| Rate for Payer: Cigna of CA PPO |
$5.71
|
| Rate for Payer: Cigna of CA PPO |
$11.71
|
| Rate for Payer: Cigna of CA PPO |
$11.76
|
| Rate for Payer: Cigna of CA PPO |
$12.26
|
| Rate for Payer: Cigna of CA PPO |
$5.77
|
| Rate for Payer: Cigna of CA PPO |
$9.32
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$7.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$14.89
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$11.32
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$14.28
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$6.94
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$14.22
|
| Rate for Payer: EPIC Health Plan Commercial |
$7.01
|
| Rate for Payer: EPIC Health Plan Commercial |
$6.72
|
| Rate for Payer: EPIC Health Plan Commercial |
$3.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$3.26
|
| Rate for Payer: EPIC Health Plan Commercial |
$5.33
|
| Rate for Payer: EPIC Health Plan Commercial |
$6.69
|
| Rate for Payer: EPIC Health Plan Transplant |
$6.72
|
| Rate for Payer: EPIC Health Plan Transplant |
$3.30
|
| Rate for Payer: EPIC Health Plan Transplant |
$3.26
|
| Rate for Payer: EPIC Health Plan Transplant |
$6.69
|
| Rate for Payer: EPIC Health Plan Transplant |
$5.33
|
| Rate for Payer: EPIC Health Plan Transplant |
$7.01
|
| Rate for Payer: Galaxy Health WC |
$14.22
|
| Rate for Payer: Galaxy Health WC |
$7.00
|
| Rate for Payer: Galaxy Health WC |
$14.28
|
| Rate for Payer: Galaxy Health WC |
$6.94
|
| Rate for Payer: Galaxy Health WC |
$14.89
|
| Rate for Payer: Galaxy Health WC |
$11.32
|
| Rate for Payer: Global Benefits Group Commercial |
$7.99
|
| Rate for Payer: Global Benefits Group Commercial |
$10.04
|
| Rate for Payer: Global Benefits Group Commercial |
$10.08
|
| Rate for Payer: Global Benefits Group Commercial |
$10.51
|
| Rate for Payer: Global Benefits Group Commercial |
$4.90
|
| Rate for Payer: Global Benefits Group Commercial |
$4.94
|
| Rate for Payer: Health Management Network EPO/PPO |
$11.99
|
| Rate for Payer: Health Management Network EPO/PPO |
$7.34
|
| Rate for Payer: Health Management Network EPO/PPO |
$15.06
|
| Rate for Payer: Health Management Network EPO/PPO |
$7.42
|
| Rate for Payer: Health Management Network EPO/PPO |
$15.12
|
| Rate for Payer: Health Management Network EPO/PPO |
$15.77
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$12.60
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$9.99
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$6.12
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$6.18
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$13.14
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$12.55
|
| Rate for Payer: IEHP medi-cal |
$1.18
|
| Rate for Payer: IEHP medi-cal |
$1.18
|
| Rate for Payer: IEHP medi-cal |
$1.18
|
| Rate for Payer: IEHP medi-cal |
$1.18
|
| Rate for Payer: IEHP medi-cal |
$1.18
|
| Rate for Payer: IEHP medi-cal |
$1.18
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$11.16
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$5.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$11.21
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$11.69
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$8.88
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$5.44
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.35
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.36
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.63
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.66
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.65
|
| Rate for Payer: Multiplan Commercial |
$6.18
|
| Rate for Payer: Multiplan Commercial |
$9.99
|
| Rate for Payer: Multiplan Commercial |
$6.12
|
| Rate for Payer: Multiplan Commercial |
$12.55
|
| Rate for Payer: Multiplan Commercial |
$13.14
|
| Rate for Payer: Multiplan Commercial |
$12.60
|
| Rate for Payer: Networks By Design Commercial |
$8.76
|
| Rate for Payer: Networks By Design Commercial |
$6.66
|
| Rate for Payer: Networks By Design Commercial |
$8.40
|
| Rate for Payer: Networks By Design Commercial |
$4.08
|
| Rate for Payer: Networks By Design Commercial |
$4.12
|
| Rate for Payer: Networks By Design Commercial |
$8.36
|
| Rate for Payer: Prime Health Services Commercial |
$14.28
|
| Rate for Payer: Prime Health Services Commercial |
$14.22
|
| Rate for Payer: Prime Health Services Commercial |
$14.89
|
| Rate for Payer: Prime Health Services Commercial |
$11.32
|
| Rate for Payer: Prime Health Services Commercial |
$6.94
|
| Rate for Payer: Prime Health Services Commercial |
$7.00
|
| Rate for Payer: Riverside University Health MISP |
$6.69
|
| Rate for Payer: Riverside University Health MISP |
$6.72
|
| Rate for Payer: Riverside University Health MISP |
$7.01
|
| Rate for Payer: Riverside University Health MISP |
$3.26
|
| Rate for Payer: Riverside University Health MISP |
$5.33
|
| Rate for Payer: Riverside University Health MISP |
$3.30
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$10.51
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$10.08
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$4.94
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$10.04
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$4.90
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$7.99
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$4.94
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$10.04
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$4.90
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$7.99
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$10.08
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$10.51
|
| Rate for Payer: United Healthcare All Other Commercial |
$8.76
|
| Rate for Payer: United Healthcare All Other Commercial |
$8.36
|
| Rate for Payer: United Healthcare All Other Commercial |
$4.08
|
| Rate for Payer: United Healthcare All Other Commercial |
$6.66
|
| Rate for Payer: United Healthcare All Other Commercial |
$4.12
|
| Rate for Payer: United Healthcare All Other Commercial |
$8.40
|
| Rate for Payer: United Healthcare All Other HMO |
$4.08
|
| Rate for Payer: United Healthcare All Other HMO |
$8.36
|
| Rate for Payer: United Healthcare All Other HMO |
$6.66
|
| Rate for Payer: United Healthcare All Other HMO |
$8.76
|
| Rate for Payer: United Healthcare All Other HMO |
$8.40
|
| Rate for Payer: United Healthcare All Other HMO |
$4.12
|
| Rate for Payer: United Healthcare HMO Rider |
$4.08
|
| Rate for Payer: United Healthcare HMO Rider |
$8.40
|
| Rate for Payer: United Healthcare HMO Rider |
$4.12
|
| Rate for Payer: United Healthcare HMO Rider |
$8.76
|
| Rate for Payer: United Healthcare HMO Rider |
$6.66
|
| Rate for Payer: United Healthcare HMO Rider |
$8.36
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$4.08
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$6.66
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$4.12
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$8.36
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$8.76
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$8.40
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$6.94
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$11.32
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$14.89
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$7.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$14.22
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$14.28
|
| Rate for Payer: Vantage Medical Group Senior |
$14.28
|
| Rate for Payer: Vantage Medical Group Senior |
$11.32
|
| Rate for Payer: Vantage Medical Group Senior |
$6.94
|
| Rate for Payer: Vantage Medical Group Senior |
$7.00
|
| Rate for Payer: Vantage Medical Group Senior |
$14.22
|
| Rate for Payer: Vantage Medical Group Senior |
$14.89
|
|
|
PIPERACILLIN-TAZOBACTAM 4.5 GRAM INTRAVENOUS SOLUTION [18302]
|
Facility
IP
|
$16.80
|
|
|
Service Code
|
CPT J2543
|
| Hospital Charge Code |
1721132
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$3.36 |
| Max. Negotiated Rate |
$15.12 |
| Rate for Payer: Blue Shield of California Commercial |
$12.60
|
| Rate for Payer: Blue Shield of California Commercial |
$12.55
|
| Rate for Payer: Blue Shield of California Commercial |
$13.14
|
| Rate for Payer: Blue Shield of California Commercial |
$6.12
|
| Rate for Payer: Blue Shield of California Commercial |
$9.99
|
| Rate for Payer: Blue Shield of California Commercial |
$6.18
|
| Rate for Payer: Blue Shield of California EPN |
$4.40
|
| Rate for Payer: Blue Shield of California EPN |
$7.11
|
| Rate for Payer: Blue Shield of California EPN |
$9.36
|
| Rate for Payer: Blue Shield of California EPN |
$8.97
|
| Rate for Payer: Blue Shield of California EPN |
$8.93
|
| Rate for Payer: Blue Shield of California EPN |
$4.36
|
| Rate for Payer: Cash Price |
$3.67
|
| Rate for Payer: Cash Price |
$7.56
|
| Rate for Payer: Cash Price |
$5.99
|
| Rate for Payer: Cash Price |
$7.53
|
| Rate for Payer: Cash Price |
$7.88
|
| Rate for Payer: Cash Price |
$3.71
|
| Rate for Payer: Central Health Plan Commercial |
$6.53
|
| Rate for Payer: Central Health Plan Commercial |
$13.44
|
| Rate for Payer: Central Health Plan Commercial |
$13.38
|
| Rate for Payer: Central Health Plan Commercial |
$14.02
|
| Rate for Payer: Central Health Plan Commercial |
$10.66
|
| Rate for Payer: Central Health Plan Commercial |
$6.59
|
| Rate for Payer: Cigna of CA HMO |
$5.71
|
| Rate for Payer: Cigna of CA HMO |
$9.32
|
| Rate for Payer: Cigna of CA HMO |
$11.71
|
| Rate for Payer: Cigna of CA HMO |
$5.77
|
| Rate for Payer: Cigna of CA HMO |
$11.76
|
| Rate for Payer: Cigna of CA HMO |
$12.26
|
| Rate for Payer: Cigna of CA PPO |
$9.32
|
| Rate for Payer: Cigna of CA PPO |
$5.71
|
| Rate for Payer: Cigna of CA PPO |
$5.77
|
| Rate for Payer: Cigna of CA PPO |
$11.76
|
| Rate for Payer: Cigna of CA PPO |
$11.71
|
| Rate for Payer: Cigna of CA PPO |
$12.26
|
| Rate for Payer: EPIC Health Plan Commercial |
$5.33
|
| Rate for Payer: EPIC Health Plan Commercial |
$7.01
|
| Rate for Payer: EPIC Health Plan Commercial |
$3.26
|
| Rate for Payer: EPIC Health Plan Commercial |
$6.72
|
| Rate for Payer: EPIC Health Plan Commercial |
$3.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$6.69
|
| Rate for Payer: EPIC Health Plan Transplant |
$6.69
|
| Rate for Payer: EPIC Health Plan Transplant |
$3.30
|
| Rate for Payer: EPIC Health Plan Transplant |
$6.72
|
| Rate for Payer: EPIC Health Plan Transplant |
$3.26
|
| Rate for Payer: EPIC Health Plan Transplant |
$5.33
|
| Rate for Payer: EPIC Health Plan Transplant |
$7.01
|
| Rate for Payer: Galaxy Health WC |
$14.28
|
| Rate for Payer: Galaxy Health WC |
$14.22
|
| Rate for Payer: Galaxy Health WC |
$14.89
|
| Rate for Payer: Galaxy Health WC |
$7.00
|
| Rate for Payer: Galaxy Health WC |
$6.94
|
| Rate for Payer: Galaxy Health WC |
$11.32
|
| Rate for Payer: Global Benefits Group Commercial |
$4.90
|
| Rate for Payer: Global Benefits Group Commercial |
$7.99
|
| Rate for Payer: Global Benefits Group Commercial |
$10.04
|
| Rate for Payer: Global Benefits Group Commercial |
$10.08
|
| Rate for Payer: Global Benefits Group Commercial |
$10.51
|
| Rate for Payer: Global Benefits Group Commercial |
$4.94
|
| Rate for Payer: Health Management Network EPO/PPO |
$11.99
|
| Rate for Payer: Health Management Network EPO/PPO |
$15.06
|
| Rate for Payer: Health Management Network EPO/PPO |
$15.12
|
| Rate for Payer: Health Management Network EPO/PPO |
$15.77
|
| Rate for Payer: Health Management Network EPO/PPO |
$7.34
|
| Rate for Payer: Health Management Network EPO/PPO |
$7.42
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$5.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$11.21
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$8.88
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$5.44
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$11.16
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$11.69
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.36
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.35
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.65
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.66
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.63
|
| Rate for Payer: Multiplan Commercial |
$12.60
|
| Rate for Payer: Multiplan Commercial |
$13.14
|
| Rate for Payer: Multiplan Commercial |
$6.12
|
| Rate for Payer: Multiplan Commercial |
$12.55
|
| Rate for Payer: Multiplan Commercial |
$9.99
|
| Rate for Payer: Multiplan Commercial |
$6.18
|
| Rate for Payer: Networks By Design Commercial |
$4.12
|
| Rate for Payer: Networks By Design Commercial |
$8.40
|
| Rate for Payer: Networks By Design Commercial |
$6.66
|
| Rate for Payer: Networks By Design Commercial |
$8.76
|
| Rate for Payer: Networks By Design Commercial |
$4.08
|
| Rate for Payer: Networks By Design Commercial |
$8.36
|
| Rate for Payer: Prime Health Services Commercial |
$6.94
|
| Rate for Payer: Prime Health Services Commercial |
$11.32
|
| Rate for Payer: Prime Health Services Commercial |
$14.89
|
| Rate for Payer: Prime Health Services Commercial |
$14.28
|
| Rate for Payer: Prime Health Services Commercial |
$7.00
|
| Rate for Payer: Prime Health Services Commercial |
$14.22
|
|
|
Placement of amniotic membrane on the ocular surface; without sutures
|
Facility
OP
|
$397,400.00
|
|
|
Service Code
|
CPT 65778
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$683.14 |
| Max. Negotiated Rate |
$397,400.00 |
| Rate for Payer: Adventist Health Medi-Cal |
$1,264.97
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,901.00
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$1,897.46
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$1,391.47
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$1,264.97
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$397,400.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,846.00
|
| Rate for Payer: Blue Shield of California Commercial |
$951.13
|
| Rate for Payer: Blue Shield of California EPN |
$683.14
|
| Rate for Payer: Caremore Medicare Advantage |
$1,264.97
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,897.46
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,707.71
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$1,264.97
|
| Rate for Payer: EPIC Health Plan Transplant |
$1,264.97
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$2,074.55
|
| Rate for Payer: IEHP medi-cal |
$2,087.20
|
| Rate for Payer: IEHP Medicare Advantage |
$1,264.97
|
| Rate for Payer: Innovage PACE Commercial |
$1,897.46
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,264.97
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,695.06
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,695.06
|
| Rate for Payer: Prime Health Services Medicare |
$1,340.87
|
| Rate for Payer: Riverside University Health MISP |
$1,391.47
|
| Rate for Payer: United Healthcare All Other Commercial |
$5,893.00
|
| Rate for Payer: United Healthcare All Other HMO |
$7,027.00
|
| Rate for Payer: United Healthcare HMO Rider |
$4,217.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3,918.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,897.46
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,391.47
|
| Rate for Payer: Vantage Medical Group Senior |
$1,264.97
|
|
|
Placement of nephrostomy catheter, percutaneous, including diagnostic nephrostogram and/or ureterogram when performed, imaging guidance (eg, ultrasound and/or fluoroscopy) and all associated radiological supervision and interpretation
|
Facility
OP
|
$397,400.00
|
|
|
Service Code
|
CPT 50432
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$2,212.08 |
| Max. Negotiated Rate |
$397,400.00 |
| Rate for Payer: Adventist Health Medi-Cal |
$2,544.87
|
| Rate for Payer: Aetna of CA HMO/PPO |
$6,248.00
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$3,817.30
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$2,799.36
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$2,544.87
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$397,400.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,846.00
|
| Rate for Payer: Blue Shield of California Commercial |
$3,079.84
|
| Rate for Payer: Blue Shield of California EPN |
$2,212.08
|
| Rate for Payer: Caremore Medicare Advantage |
$2,544.87
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,817.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,435.57
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$2,544.87
|
| Rate for Payer: EPIC Health Plan Transplant |
$2,544.87
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$4,173.59
|
| Rate for Payer: IEHP medi-cal |
$4,199.04
|
| Rate for Payer: IEHP Medicare Advantage |
$2,544.87
|
| Rate for Payer: Innovage PACE Commercial |
$3,817.30
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,544.87
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$3,410.13
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$3,410.13
|
| Rate for Payer: Prime Health Services Medicare |
$2,697.56
|
| Rate for Payer: Riverside University Health MISP |
$2,799.36
|
| Rate for Payer: United Healthcare All Other Commercial |
$11,375.00
|
| Rate for Payer: United Healthcare All Other HMO |
$15,354.00
|
| Rate for Payer: United Healthcare HMO Rider |
$9,681.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$8,852.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,817.30
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,799.36
|
| Rate for Payer: Vantage Medical Group Senior |
$2,544.87
|
|
|
Placement of seton
|
Facility
OP
|
$397,400.00
|
|
|
Service Code
|
CPT 46020
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$3,383.18 |
| Max. Negotiated Rate |
$397,400.00 |
| Rate for Payer: Adventist Health Medi-Cal |
$3,508.15
|
| Rate for Payer: Aetna of CA HMO/PPO |
$8,114.00
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$5,262.22
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$3,858.96
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$3,508.15
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$397,400.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,846.00
|
| Rate for Payer: Blue Shield of California Commercial |
$4,710.35
|
| Rate for Payer: Blue Shield of California EPN |
$3,383.18
|
| Rate for Payer: Caremore Medicare Advantage |
$3,508.15
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$5,262.22
|
| Rate for Payer: EPIC Health Plan Commercial |
$4,736.00
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$3,508.15
|
| Rate for Payer: EPIC Health Plan Transplant |
$3,508.15
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$5,753.37
|
| Rate for Payer: IEHP medi-cal |
$5,788.45
|
| Rate for Payer: IEHP Medicare Advantage |
$3,508.15
|
| Rate for Payer: Innovage PACE Commercial |
$5,262.22
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3,508.15
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$4,700.92
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$4,700.92
|
| Rate for Payer: Prime Health Services Medicare |
$3,718.64
|
| Rate for Payer: Riverside University Health MISP |
$3,858.96
|
| Rate for Payer: United Healthcare All Other Commercial |
$11,375.00
|
| Rate for Payer: United Healthcare All Other HMO |
$15,354.00
|
| Rate for Payer: United Healthcare HMO Rider |
$9,681.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$8,852.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$5,262.22
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$3,858.96
|
| Rate for Payer: Vantage Medical Group Senior |
$3,508.15
|
|
