|
PROGESTERONE 50 MG/ML INTRAMUSCULAR OIL [6597]
|
Facility
|
OP
|
$2.40
|
|
|
Service Code
|
HCPCS J2675
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.48 |
| Max. Negotiated Rate |
$10.16 |
| Rate for Payer: Adventist Health Commercial |
$0.48
|
| Rate for Payer: Aetna of CA HMO/PPO |
$1.46
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2.04
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1.32
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1.80
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$6.40
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1.96
|
| Rate for Payer: Blue Shield of California Commercial |
$3.84
|
| Rate for Payer: Blue Shield of California EPN |
$3.49
|
| Rate for Payer: Cash Price |
$1.32
|
| Rate for Payer: Cash Price |
$1.32
|
| Rate for Payer: Central Health Plan Commercial |
$1.92
|
| Rate for Payer: Cigna of CA HMO |
$1.68
|
| Rate for Payer: Cigna of CA PPO |
$1.68
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2.04
|
| Rate for Payer: Dignity Health Medi-Cal |
$2.04
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2.04
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.96
|
| Rate for Payer: EPIC Health Plan Senior |
$0.96
|
| Rate for Payer: Galaxy Health WC |
$2.04
|
| Rate for Payer: Global Benefits Group Commercial |
$1.44
|
| Rate for Payer: Health Management Network EPO/PPO |
$2.16
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$0.66
|
| Rate for Payer: InnovAge PACE Commercial |
$1.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1.60
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$10.16
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1.49
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.48
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1.68
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1.68
|
| Rate for Payer: Multiplan Commercial |
$1.80
|
| Rate for Payer: Networks By Design Commercial |
$1.20
|
| Rate for Payer: Prime Health Services Commercial |
$2.04
|
| Rate for Payer: Riverside University Health System MISP |
$0.96
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1.44
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1.44
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.90
|
| Rate for Payer: United Healthcare All Other HMO |
$0.88
|
| Rate for Payer: United Healthcare HMO Rider |
$0.86
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.79
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2.04
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2.04
|
| Rate for Payer: Vantage Medical Group Senior |
$2.04
|
|
|
PROGESTERONE 50 MG/ML INTRAMUSCULAR OIL [6597]
|
Facility
|
IP
|
$2.40
|
|
|
Service Code
|
HCPCS J2675
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.48 |
| Max. Negotiated Rate |
$2.16 |
| Rate for Payer: Adventist Health Commercial |
$0.48
|
| Rate for Payer: Blue Shield of California Commercial |
$1.86
|
| Rate for Payer: Blue Shield of California EPN |
$1.21
|
| Rate for Payer: Cash Price |
$1.32
|
| Rate for Payer: Central Health Plan Commercial |
$1.92
|
| Rate for Payer: Cigna of CA HMO |
$1.68
|
| Rate for Payer: Cigna of CA PPO |
$1.68
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.96
|
| Rate for Payer: EPIC Health Plan Senior |
$0.96
|
| Rate for Payer: Galaxy Health WC |
$2.04
|
| Rate for Payer: Global Benefits Group Commercial |
$1.44
|
| Rate for Payer: Health Management Network EPO/PPO |
$2.16
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1.60
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.91
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1.49
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.48
|
| Rate for Payer: Multiplan Commercial |
$1.80
|
| Rate for Payer: Networks By Design Commercial |
$1.20
|
| Rate for Payer: Prime Health Services Commercial |
$2.04
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.90
|
| Rate for Payer: United Healthcare All Other HMO |
$0.88
|
| Rate for Payer: United Healthcare HMO Rider |
$0.86
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.79
|
|
|
PROGESTERONE MICRONIZED 100 MG CAPSULE [23122]
|
Facility
|
OP
|
$0.48
|
|
|
Service Code
|
NDC 65162-807-10
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.10 |
| Max. Negotiated Rate |
$0.43 |
| Rate for Payer: Adventist Health Commercial |
$0.10
|
| Rate for Payer: Aetna of CA HMO/PPO |
$0.29
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.41
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.26
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.36
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$0.23
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.28
|
| Rate for Payer: Blue Shield of California Commercial |
$0.29
|
| Rate for Payer: Blue Shield of California EPN |
$0.19
|
| Rate for Payer: Cash Price |
$0.26
|
| 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: Dignity Health Medi-Cal |
$0.41
|
| Rate for Payer: Dignity Health Medicare Advantage |
$0.41
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.19
|
| Rate for Payer: EPIC Health Plan Senior |
$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: InnovAge PACE Commercial |
$0.24
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.32
|
| 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: 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 Medicare |
$0.34
|
| Rate for Payer: Multiplan Commercial |
$0.36
|
| Rate for Payer: Networks By Design Commercial |
$0.31
|
| Rate for Payer: Prime Health Services Commercial |
$0.41
|
| Rate for Payer: Riverside University Health System 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 Commercial/Exchange |
$0.41
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.41
|
| Rate for Payer: Vantage Medical Group Senior |
$0.41
|
|
|
PROGESTERONE MICRONIZED 100 MG CAPSULE [23122]
|
Facility
|
OP
|
$0.24
|
|
|
Service Code
|
NDC 59651-152-01
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.05 |
| Max. Negotiated Rate |
$0.22 |
| Rate for Payer: Adventist Health Commercial |
$0.05
|
| Rate for Payer: Aetna of CA HMO/PPO |
$0.15
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.20
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.13
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.18
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$0.12
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.14
|
| Rate for Payer: Blue Shield of California Commercial |
$0.15
|
| Rate for Payer: Blue Shield of California EPN |
$0.10
|
| Rate for Payer: Cash Price |
$0.13
|
| Rate for Payer: Central Health Plan Commercial |
$0.19
|
| Rate for Payer: Cigna of CA HMO |
$0.17
|
| Rate for Payer: Cigna of CA PPO |
$0.17
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.20
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.20
|
| Rate for Payer: Dignity Health Medicare Advantage |
$0.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.10
|
| Rate for Payer: EPIC Health Plan Senior |
$0.10
|
| Rate for Payer: Galaxy Health WC |
$0.20
|
| Rate for Payer: Global Benefits Group Commercial |
$0.14
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.22
|
| Rate for Payer: InnovAge PACE Commercial |
$0.12
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.16
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.09
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$0.15
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.05
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$0.17
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$0.17
|
| Rate for Payer: Multiplan Commercial |
$0.18
|
| Rate for Payer: Networks By Design Commercial |
$0.16
|
| Rate for Payer: Prime Health Services Commercial |
$0.20
|
| Rate for Payer: Riverside University Health System MISP |
$0.10
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.14
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.14
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.12
|
| Rate for Payer: United Healthcare All Other HMO |
$0.12
|
| Rate for Payer: United Healthcare HMO Rider |
$0.12
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.12
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.20
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.20
|
| Rate for Payer: Vantage Medical Group Senior |
$0.20
|
|
|
PROGESTERONE MICRONIZED 100 MG CAPSULE [23122]
|
Facility
|
IP
|
$0.48
|
|
|
Service Code
|
NDC 65162-807-10
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.10 |
| Max. Negotiated Rate |
$0.43 |
| Rate for Payer: Adventist Health Commercial |
$0.10
|
| Rate for Payer: Blue Shield of California Commercial |
$0.37
|
| Rate for Payer: Blue Shield of California EPN |
$0.24
|
| Rate for Payer: Cash Price |
$0.26
|
| 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 Senior |
$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: Kaiser Permanente of CA Medi-Cal |
$0.18
|
| 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: Multiplan Commercial |
$0.36
|
| Rate for Payer: Networks By Design Commercial |
$0.31
|
| Rate for Payer: Prime Health Services Commercial |
$0.41
|
|
|
PROGESTERONE MICRONIZED 100 MG CAPSULE [23122]
|
Facility
|
IP
|
$0.24
|
|
|
Service Code
|
NDC 59651-152-01
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.05 |
| Max. Negotiated Rate |
$0.22 |
| Rate for Payer: Adventist Health Commercial |
$0.05
|
| Rate for Payer: Blue Shield of California Commercial |
$0.19
|
| Rate for Payer: Blue Shield of California EPN |
$0.12
|
| Rate for Payer: Cash Price |
$0.13
|
| Rate for Payer: Central Health Plan Commercial |
$0.19
|
| Rate for Payer: Cigna of CA HMO |
$0.17
|
| Rate for Payer: Cigna of CA PPO |
$0.17
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.10
|
| Rate for Payer: EPIC Health Plan Senior |
$0.10
|
| Rate for Payer: Galaxy Health WC |
$0.20
|
| Rate for Payer: Global Benefits Group Commercial |
$0.14
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.22
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.16
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.09
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$0.15
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.05
|
| Rate for Payer: Multiplan Commercial |
$0.18
|
| Rate for Payer: Networks By Design Commercial |
$0.16
|
| Rate for Payer: Prime Health Services Commercial |
$0.20
|
|
|
PROMETHAZINE 12.5 MG RECTAL SUPPOSITORY [11143]
|
Facility
|
OP
|
$11.70
|
|
|
Service Code
|
NDC 0713-0536-12
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$2.34 |
| Max. Negotiated Rate |
$10.53 |
| Rate for Payer: Adventist Health Commercial |
$2.34
|
| Rate for Payer: Aetna of CA HMO/PPO |
$7.11
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$9.95
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$6.43
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$8.78
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$5.67
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$6.87
|
| Rate for Payer: Blue Shield of California Commercial |
$7.15
|
| Rate for Payer: Blue Shield of California EPN |
$4.67
|
| Rate for Payer: Cash Price |
$6.43
|
| Rate for Payer: Central Health Plan Commercial |
$9.36
|
| Rate for Payer: Cigna of CA HMO |
$8.19
|
| Rate for Payer: Cigna of CA PPO |
$8.19
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$9.95
|
| Rate for Payer: Dignity Health Medi-Cal |
$9.95
|
| Rate for Payer: Dignity Health Medicare Advantage |
$9.95
|
| Rate for Payer: EPIC Health Plan Commercial |
$4.68
|
| Rate for Payer: EPIC Health Plan Senior |
$4.68
|
| Rate for Payer: Galaxy Health WC |
$9.95
|
| Rate for Payer: Global Benefits Group Commercial |
$7.02
|
| Rate for Payer: Health Management Network EPO/PPO |
$10.53
|
| Rate for Payer: InnovAge PACE Commercial |
$5.85
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$7.80
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4.46
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$7.24
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.34
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$8.19
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$8.19
|
| Rate for Payer: Multiplan Commercial |
$8.78
|
| Rate for Payer: Networks By Design Commercial |
$7.61
|
| Rate for Payer: Prime Health Services Commercial |
$9.95
|
| Rate for Payer: Riverside University Health System MISP |
$4.68
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$7.02
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$7.02
|
| Rate for Payer: United Healthcare All Other Commercial |
$5.85
|
| Rate for Payer: United Healthcare All Other HMO |
$5.85
|
| Rate for Payer: United Healthcare HMO Rider |
$5.85
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$5.85
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$9.95
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$9.95
|
| Rate for Payer: Vantage Medical Group Senior |
$9.95
|
|
|
PROMETHAZINE 12.5 MG RECTAL SUPPOSITORY [11143]
|
Facility
|
OP
|
$11.70
|
|
|
Service Code
|
NDC 51672-5296-1
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$2.34 |
| Max. Negotiated Rate |
$10.53 |
| Rate for Payer: Adventist Health Commercial |
$2.34
|
| Rate for Payer: Aetna of CA HMO/PPO |
$7.11
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$9.95
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$6.43
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$8.78
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$5.67
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$6.87
|
| Rate for Payer: Blue Shield of California Commercial |
$7.15
|
| Rate for Payer: Blue Shield of California EPN |
$4.67
|
| Rate for Payer: Cash Price |
$6.43
|
| Rate for Payer: Central Health Plan Commercial |
$9.36
|
| Rate for Payer: Cigna of CA HMO |
$8.19
|
| Rate for Payer: Cigna of CA PPO |
$8.19
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$9.95
|
| Rate for Payer: Dignity Health Medi-Cal |
$9.95
|
| Rate for Payer: Dignity Health Medicare Advantage |
$9.95
|
| Rate for Payer: EPIC Health Plan Commercial |
$4.68
|
| Rate for Payer: EPIC Health Plan Senior |
$4.68
|
| Rate for Payer: Galaxy Health WC |
$9.95
|
| Rate for Payer: Global Benefits Group Commercial |
$7.02
|
| Rate for Payer: Health Management Network EPO/PPO |
$10.53
|
| Rate for Payer: InnovAge PACE Commercial |
$5.85
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$7.80
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4.46
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$7.24
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.34
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$8.19
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$8.19
|
| Rate for Payer: Multiplan Commercial |
$8.78
|
| Rate for Payer: Networks By Design Commercial |
$7.61
|
| Rate for Payer: Prime Health Services Commercial |
$9.95
|
| Rate for Payer: Riverside University Health System MISP |
$4.68
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$7.02
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$7.02
|
| Rate for Payer: United Healthcare All Other Commercial |
$5.85
|
| Rate for Payer: United Healthcare All Other HMO |
$5.85
|
| Rate for Payer: United Healthcare HMO Rider |
$5.85
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$5.85
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$9.95
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$9.95
|
| Rate for Payer: Vantage Medical Group Senior |
$9.95
|
|
|
PROMETHAZINE 12.5 MG RECTAL SUPPOSITORY [11143]
|
Facility
|
OP
|
$11.70
|
|
|
Service Code
|
NDC 0713-0536-06
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$2.34 |
| Max. Negotiated Rate |
$10.53 |
| Rate for Payer: Adventist Health Commercial |
$2.34
|
| Rate for Payer: Aetna of CA HMO/PPO |
$7.11
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$9.95
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$6.43
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$8.78
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$5.67
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$6.87
|
| Rate for Payer: Blue Shield of California Commercial |
$7.15
|
| Rate for Payer: Blue Shield of California EPN |
$4.67
|
| Rate for Payer: Cash Price |
$6.43
|
| Rate for Payer: Central Health Plan Commercial |
$9.36
|
| Rate for Payer: Cigna of CA HMO |
$8.19
|
| Rate for Payer: Cigna of CA PPO |
$8.19
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$9.95
|
| Rate for Payer: Dignity Health Medi-Cal |
$9.95
|
| Rate for Payer: Dignity Health Medicare Advantage |
$9.95
|
| Rate for Payer: EPIC Health Plan Commercial |
$4.68
|
| Rate for Payer: EPIC Health Plan Senior |
$4.68
|
| Rate for Payer: Galaxy Health WC |
$9.95
|
| Rate for Payer: Global Benefits Group Commercial |
$7.02
|
| Rate for Payer: Health Management Network EPO/PPO |
$10.53
|
| Rate for Payer: InnovAge PACE Commercial |
$5.85
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$7.80
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4.46
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$7.24
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.34
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$8.19
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$8.19
|
| Rate for Payer: Multiplan Commercial |
$8.78
|
| Rate for Payer: Networks By Design Commercial |
$7.61
|
| Rate for Payer: Prime Health Services Commercial |
$9.95
|
| Rate for Payer: Riverside University Health System MISP |
$4.68
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$7.02
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$7.02
|
| Rate for Payer: United Healthcare All Other Commercial |
$5.85
|
| Rate for Payer: United Healthcare All Other HMO |
$5.85
|
| Rate for Payer: United Healthcare HMO Rider |
$5.85
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$5.85
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$9.95
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$9.95
|
| Rate for Payer: Vantage Medical Group Senior |
$9.95
|
|
|
PROMETHAZINE 12.5 MG RECTAL SUPPOSITORY [11143]
|
Facility
|
OP
|
$11.70
|
|
|
Service Code
|
NDC 51672-5296-5
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$2.34 |
| Max. Negotiated Rate |
$10.53 |
| Rate for Payer: Adventist Health Commercial |
$2.34
|
| Rate for Payer: Aetna of CA HMO/PPO |
$7.11
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$9.95
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$6.43
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$8.78
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$5.67
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$6.87
|
| Rate for Payer: Blue Shield of California Commercial |
$7.15
|
| Rate for Payer: Blue Shield of California EPN |
$4.67
|
| Rate for Payer: Cash Price |
$6.43
|
| Rate for Payer: Central Health Plan Commercial |
$9.36
|
| Rate for Payer: Cigna of CA HMO |
$8.19
|
| Rate for Payer: Cigna of CA PPO |
$8.19
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$9.95
|
| Rate for Payer: Dignity Health Medi-Cal |
$9.95
|
| Rate for Payer: Dignity Health Medicare Advantage |
$9.95
|
| Rate for Payer: EPIC Health Plan Commercial |
$4.68
|
| Rate for Payer: EPIC Health Plan Senior |
$4.68
|
| Rate for Payer: Galaxy Health WC |
$9.95
|
| Rate for Payer: Global Benefits Group Commercial |
$7.02
|
| Rate for Payer: Health Management Network EPO/PPO |
$10.53
|
| Rate for Payer: InnovAge PACE Commercial |
$5.85
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$7.80
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4.46
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$7.24
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.34
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$8.19
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$8.19
|
| Rate for Payer: Multiplan Commercial |
$8.78
|
| Rate for Payer: Networks By Design Commercial |
$7.61
|
| Rate for Payer: Prime Health Services Commercial |
$9.95
|
| Rate for Payer: Riverside University Health System MISP |
$4.68
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$7.02
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$7.02
|
| Rate for Payer: United Healthcare All Other Commercial |
$5.85
|
| Rate for Payer: United Healthcare All Other HMO |
$5.85
|
| Rate for Payer: United Healthcare HMO Rider |
$5.85
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$5.85
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$9.95
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$9.95
|
| Rate for Payer: Vantage Medical Group Senior |
$9.95
|
|
|
PROMETHAZINE 12.5 MG RECTAL SUPPOSITORY [11143]
|
Facility
|
IP
|
$11.70
|
|
|
Service Code
|
NDC 0713-0536-12
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$2.34 |
| Max. Negotiated Rate |
$10.53 |
| Rate for Payer: Adventist Health Commercial |
$2.34
|
| Rate for Payer: Blue Shield of California Commercial |
$9.04
|
| Rate for Payer: Blue Shield of California EPN |
$5.90
|
| Rate for Payer: Cash Price |
$6.43
|
| Rate for Payer: Central Health Plan Commercial |
$9.36
|
| Rate for Payer: Cigna of CA HMO |
$8.19
|
| Rate for Payer: Cigna of CA PPO |
$8.19
|
| Rate for Payer: EPIC Health Plan Commercial |
$4.68
|
| Rate for Payer: EPIC Health Plan Senior |
$4.68
|
| Rate for Payer: Galaxy Health WC |
$9.95
|
| Rate for Payer: Global Benefits Group Commercial |
$7.02
|
| Rate for Payer: Health Management Network EPO/PPO |
$10.53
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$7.80
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4.46
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$7.24
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.34
|
| Rate for Payer: Multiplan Commercial |
$8.78
|
| Rate for Payer: Networks By Design Commercial |
$7.61
|
| Rate for Payer: Prime Health Services Commercial |
$9.95
|
|
|
PROMETHAZINE 12.5 MG RECTAL SUPPOSITORY [11143]
|
Facility
|
IP
|
$11.70
|
|
|
Service Code
|
NDC 0713-0536-06
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$2.34 |
| Max. Negotiated Rate |
$10.53 |
| Rate for Payer: Adventist Health Commercial |
$2.34
|
| Rate for Payer: Blue Shield of California Commercial |
$9.04
|
| Rate for Payer: Blue Shield of California EPN |
$5.90
|
| Rate for Payer: Cash Price |
$6.43
|
| Rate for Payer: Central Health Plan Commercial |
$9.36
|
| Rate for Payer: Cigna of CA HMO |
$8.19
|
| Rate for Payer: Cigna of CA PPO |
$8.19
|
| Rate for Payer: EPIC Health Plan Commercial |
$4.68
|
| Rate for Payer: EPIC Health Plan Senior |
$4.68
|
| Rate for Payer: Galaxy Health WC |
$9.95
|
| Rate for Payer: Global Benefits Group Commercial |
$7.02
|
| Rate for Payer: Health Management Network EPO/PPO |
$10.53
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$7.80
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4.46
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$7.24
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.34
|
| Rate for Payer: Multiplan Commercial |
$8.78
|
| Rate for Payer: Networks By Design Commercial |
$7.61
|
| Rate for Payer: Prime Health Services Commercial |
$9.95
|
|
|
PROMETHAZINE 12.5 MG RECTAL SUPPOSITORY [11143]
|
Facility
|
IP
|
$11.70
|
|
|
Service Code
|
NDC 51672-5296-5
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$2.34 |
| Max. Negotiated Rate |
$10.53 |
| Rate for Payer: Adventist Health Commercial |
$2.34
|
| Rate for Payer: Blue Shield of California Commercial |
$9.04
|
| Rate for Payer: Blue Shield of California EPN |
$5.90
|
| Rate for Payer: Cash Price |
$6.43
|
| Rate for Payer: Central Health Plan Commercial |
$9.36
|
| Rate for Payer: Cigna of CA HMO |
$8.19
|
| Rate for Payer: Cigna of CA PPO |
$8.19
|
| Rate for Payer: EPIC Health Plan Commercial |
$4.68
|
| Rate for Payer: EPIC Health Plan Senior |
$4.68
|
| Rate for Payer: Galaxy Health WC |
$9.95
|
| Rate for Payer: Global Benefits Group Commercial |
$7.02
|
| Rate for Payer: Health Management Network EPO/PPO |
$10.53
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$7.80
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4.46
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$7.24
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.34
|
| Rate for Payer: Multiplan Commercial |
$8.78
|
| Rate for Payer: Networks By Design Commercial |
$7.61
|
| Rate for Payer: Prime Health Services Commercial |
$9.95
|
|
|
PROMETHAZINE 12.5 MG RECTAL SUPPOSITORY [11143]
|
Facility
|
IP
|
$11.70
|
|
|
Service Code
|
NDC 51672-5296-1
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$2.34 |
| Max. Negotiated Rate |
$10.53 |
| Rate for Payer: Adventist Health Commercial |
$2.34
|
| Rate for Payer: Blue Shield of California Commercial |
$9.04
|
| Rate for Payer: Blue Shield of California EPN |
$5.90
|
| Rate for Payer: Cash Price |
$6.43
|
| Rate for Payer: Central Health Plan Commercial |
$9.36
|
| Rate for Payer: Cigna of CA HMO |
$8.19
|
| Rate for Payer: Cigna of CA PPO |
$8.19
|
| Rate for Payer: EPIC Health Plan Commercial |
$4.68
|
| Rate for Payer: EPIC Health Plan Senior |
$4.68
|
| Rate for Payer: Galaxy Health WC |
$9.95
|
| Rate for Payer: Global Benefits Group Commercial |
$7.02
|
| Rate for Payer: Health Management Network EPO/PPO |
$10.53
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$7.80
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4.46
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$7.24
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.34
|
| Rate for Payer: Multiplan Commercial |
$8.78
|
| Rate for Payer: Networks By Design Commercial |
$7.61
|
| Rate for Payer: Prime Health Services Commercial |
$9.95
|
|
|
PROMETHAZINE 12.5 MG TABLET [6621]
|
Facility
|
OP
|
$0.07
|
|
|
Service Code
|
NDC 10702-002-01
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.01 |
| Max. Negotiated Rate |
$0.06 |
| Rate for Payer: Adventist Health Commercial |
$0.01
|
| Rate for Payer: Aetna of CA HMO/PPO |
$0.04
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.06
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.04
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.05
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$0.03
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.04
|
| Rate for Payer: Blue Shield of California Commercial |
$0.04
|
| Rate for Payer: Blue Shield of California EPN |
$0.03
|
| Rate for Payer: Cash Price |
$0.04
|
| Rate for Payer: Central Health Plan Commercial |
$0.06
|
| Rate for Payer: Cigna of CA HMO |
$0.05
|
| Rate for Payer: Cigna of CA PPO |
$0.05
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.06
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.06
|
| Rate for Payer: Dignity Health Medicare Advantage |
$0.06
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.03
|
| Rate for Payer: EPIC Health Plan Senior |
$0.03
|
| Rate for Payer: Galaxy Health WC |
$0.06
|
| Rate for Payer: Global Benefits Group Commercial |
$0.04
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.06
|
| Rate for Payer: InnovAge PACE Commercial |
$0.04
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.05
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.03
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$0.04
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.01
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$0.05
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$0.05
|
| Rate for Payer: Multiplan Commercial |
$0.05
|
| Rate for Payer: Networks By Design Commercial |
$0.05
|
| Rate for Payer: Prime Health Services Commercial |
$0.06
|
| Rate for Payer: Riverside University Health System MISP |
$0.03
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.04
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.04
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.04
|
| Rate for Payer: United Healthcare All Other HMO |
$0.04
|
| Rate for Payer: United Healthcare HMO Rider |
$0.04
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.04
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.06
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.06
|
| Rate for Payer: Vantage Medical Group Senior |
$0.06
|
|
|
PROMETHAZINE 12.5 MG TABLET [6621]
|
Facility
|
IP
|
$0.14
|
|
|
Service Code
|
NDC 68001-161-00
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.03 |
| Max. Negotiated Rate |
$0.13 |
| Rate for Payer: Adventist Health Commercial |
$0.03
|
| Rate for Payer: Blue Shield of California Commercial |
$0.11
|
| Rate for Payer: Blue Shield of California EPN |
$0.07
|
| Rate for Payer: Cash Price |
$0.08
|
| Rate for Payer: Central Health Plan Commercial |
$0.11
|
| Rate for Payer: Cigna of CA HMO |
$0.10
|
| Rate for Payer: Cigna of CA PPO |
$0.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.06
|
| Rate for Payer: EPIC Health Plan Senior |
$0.06
|
| Rate for Payer: Galaxy Health WC |
$0.12
|
| Rate for Payer: Global Benefits Group Commercial |
$0.08
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.13
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.09
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.05
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$0.09
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.03
|
| Rate for Payer: Multiplan Commercial |
$0.11
|
| Rate for Payer: Networks By Design Commercial |
$0.09
|
| Rate for Payer: Prime Health Services Commercial |
$0.12
|
|
|
PROMETHAZINE 12.5 MG TABLET [6621]
|
Facility
|
OP
|
$0.14
|
|
|
Service Code
|
NDC 68001-161-00
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.03 |
| Max. Negotiated Rate |
$0.13 |
| Rate for Payer: Adventist Health Commercial |
$0.03
|
| Rate for Payer: Aetna of CA HMO/PPO |
$0.09
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.12
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.08
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.11
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$0.07
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.08
|
| Rate for Payer: Blue Shield of California Commercial |
$0.09
|
| Rate for Payer: Blue Shield of California EPN |
$0.06
|
| Rate for Payer: Cash Price |
$0.08
|
| Rate for Payer: Central Health Plan Commercial |
$0.11
|
| Rate for Payer: Cigna of CA HMO |
$0.10
|
| Rate for Payer: Cigna of CA PPO |
$0.10
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.12
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.12
|
| Rate for Payer: Dignity Health Medicare Advantage |
$0.12
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.06
|
| Rate for Payer: EPIC Health Plan Senior |
$0.06
|
| Rate for Payer: Galaxy Health WC |
$0.12
|
| Rate for Payer: Global Benefits Group Commercial |
$0.08
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.13
|
| Rate for Payer: InnovAge PACE Commercial |
$0.07
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.09
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.05
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$0.09
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.03
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$0.10
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$0.10
|
| Rate for Payer: Multiplan Commercial |
$0.11
|
| Rate for Payer: Networks By Design Commercial |
$0.09
|
| Rate for Payer: Prime Health Services Commercial |
$0.12
|
| Rate for Payer: Riverside University Health System MISP |
$0.06
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.08
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.08
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.07
|
| Rate for Payer: United Healthcare All Other HMO |
$0.07
|
| Rate for Payer: United Healthcare HMO Rider |
$0.07
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.07
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.12
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.12
|
| Rate for Payer: Vantage Medical Group Senior |
$0.12
|
|
|
PROMETHAZINE 12.5 MG TABLET [6621]
|
Facility
|
IP
|
$0.07
|
|
|
Service Code
|
NDC 10702-002-01
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.01 |
| Max. Negotiated Rate |
$0.06 |
| Rate for Payer: Adventist Health Commercial |
$0.01
|
| Rate for Payer: Blue Shield of California Commercial |
$0.05
|
| Rate for Payer: Blue Shield of California EPN |
$0.04
|
| Rate for Payer: Cash Price |
$0.04
|
| Rate for Payer: Central Health Plan Commercial |
$0.06
|
| Rate for Payer: Cigna of CA HMO |
$0.05
|
| Rate for Payer: Cigna of CA PPO |
$0.05
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.03
|
| Rate for Payer: EPIC Health Plan Senior |
$0.03
|
| Rate for Payer: Galaxy Health WC |
$0.06
|
| Rate for Payer: Global Benefits Group Commercial |
$0.04
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.06
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.05
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.03
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$0.04
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.01
|
| Rate for Payer: Multiplan Commercial |
$0.05
|
| Rate for Payer: Networks By Design Commercial |
$0.05
|
| Rate for Payer: Prime Health Services Commercial |
$0.06
|
|
|
PROMETHAZINE 25 MG/ML INJECTION SOLUTION [6618]
|
Facility
|
IP
|
$2.40
|
|
|
Service Code
|
HCPCS J2550
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.48 |
| Max. Negotiated Rate |
$2.16 |
| Rate for Payer: Adventist Health Commercial |
$0.48
|
| Rate for Payer: Adventist Health Commercial |
$0.44
|
| Rate for Payer: Blue Shield of California Commercial |
$1.86
|
| Rate for Payer: Blue Shield of California Commercial |
$1.72
|
| Rate for Payer: Blue Shield of California EPN |
$1.12
|
| Rate for Payer: Blue Shield of California EPN |
$1.21
|
| Rate for Payer: Cash Price |
$1.32
|
| Rate for Payer: Cash Price |
$1.22
|
| Rate for Payer: Central Health Plan Commercial |
$1.92
|
| Rate for Payer: Central Health Plan Commercial |
$1.78
|
| Rate for Payer: Cigna of CA HMO |
$1.55
|
| Rate for Payer: Cigna of CA HMO |
$1.68
|
| Rate for Payer: Cigna of CA PPO |
$1.55
|
| Rate for Payer: Cigna of CA PPO |
$1.68
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.89
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.96
|
| Rate for Payer: EPIC Health Plan Senior |
$0.89
|
| Rate for Payer: EPIC Health Plan Senior |
$0.96
|
| Rate for Payer: Galaxy Health WC |
$1.89
|
| Rate for Payer: Galaxy Health WC |
$2.04
|
| Rate for Payer: Global Benefits Group Commercial |
$1.44
|
| Rate for Payer: Global Benefits Group Commercial |
$1.33
|
| Rate for Payer: Health Management Network EPO/PPO |
$2.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$2.16
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1.48
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1.60
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.91
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.85
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1.37
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1.49
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.48
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.44
|
| Rate for Payer: Multiplan Commercial |
$1.67
|
| Rate for Payer: Multiplan Commercial |
$1.80
|
| Rate for Payer: Networks By Design Commercial |
$1.11
|
| Rate for Payer: Networks By Design Commercial |
$1.20
|
| Rate for Payer: Prime Health Services Commercial |
$2.04
|
| Rate for Payer: Prime Health Services Commercial |
$1.89
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.83
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.90
|
| Rate for Payer: United Healthcare All Other HMO |
$0.88
|
| Rate for Payer: United Healthcare All Other HMO |
$0.81
|
| Rate for Payer: United Healthcare HMO Rider |
$0.79
|
| Rate for Payer: United Healthcare HMO Rider |
$0.86
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.73
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.79
|
|
|
PROMETHAZINE 25 MG/ML INJECTION SOLUTION [6618]
|
Facility
|
OP
|
$2.22
|
|
|
Service Code
|
HCPCS J2550
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.44 |
| Max. Negotiated Rate |
$15.26 |
| Rate for Payer: Adventist Health Commercial |
$0.44
|
| Rate for Payer: Adventist Health Commercial |
$0.48
|
| Rate for Payer: Aetna of CA HMO/PPO |
$1.46
|
| Rate for Payer: Aetna of CA HMO/PPO |
$1.35
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2.04
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1.89
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1.32
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1.22
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1.80
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1.67
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$7.68
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$7.68
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2.36
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2.36
|
| Rate for Payer: Blue Shield of California Commercial |
$4.61
|
| Rate for Payer: Blue Shield of California Commercial |
$4.61
|
| Rate for Payer: Blue Shield of California EPN |
$4.19
|
| Rate for Payer: Blue Shield of California EPN |
$4.19
|
| Rate for Payer: Cash Price |
$1.22
|
| Rate for Payer: Cash Price |
$1.22
|
| Rate for Payer: Cash Price |
$1.32
|
| Rate for Payer: Cash Price |
$1.32
|
| Rate for Payer: Central Health Plan Commercial |
$1.78
|
| Rate for Payer: Central Health Plan Commercial |
$1.92
|
| Rate for Payer: Cigna of CA HMO |
$1.68
|
| Rate for Payer: Cigna of CA HMO |
$1.55
|
| Rate for Payer: Cigna of CA PPO |
$1.68
|
| Rate for Payer: Cigna of CA PPO |
$1.55
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1.89
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2.04
|
| Rate for Payer: Dignity Health Medi-Cal |
$2.04
|
| Rate for Payer: Dignity Health Medi-Cal |
$1.89
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1.89
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2.04
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.96
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.89
|
| Rate for Payer: EPIC Health Plan Senior |
$0.89
|
| Rate for Payer: EPIC Health Plan Senior |
$0.96
|
| Rate for Payer: Galaxy Health WC |
$2.04
|
| Rate for Payer: Galaxy Health WC |
$1.89
|
| Rate for Payer: Global Benefits Group Commercial |
$1.44
|
| Rate for Payer: Global Benefits Group Commercial |
$1.33
|
| Rate for Payer: Health Management Network EPO/PPO |
$2.16
|
| Rate for Payer: Health Management Network EPO/PPO |
$2.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$3.31
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$3.31
|
| Rate for Payer: InnovAge PACE Commercial |
$1.11
|
| Rate for Payer: InnovAge PACE Commercial |
$1.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1.48
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1.60
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$15.26
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$15.26
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1.49
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1.37
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.44
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.48
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1.55
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1.68
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1.68
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1.55
|
| Rate for Payer: Multiplan Commercial |
$1.67
|
| Rate for Payer: Multiplan Commercial |
$1.80
|
| Rate for Payer: Networks By Design Commercial |
$1.20
|
| Rate for Payer: Networks By Design Commercial |
$1.11
|
| Rate for Payer: Prime Health Services Commercial |
$2.04
|
| Rate for Payer: Prime Health Services Commercial |
$1.89
|
| Rate for Payer: Riverside University Health System MISP |
$0.89
|
| Rate for Payer: Riverside University Health System MISP |
$0.96
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1.44
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1.33
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1.33
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1.44
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.90
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.83
|
| Rate for Payer: United Healthcare All Other HMO |
$0.81
|
| Rate for Payer: United Healthcare All Other HMO |
$0.88
|
| Rate for Payer: United Healthcare HMO Rider |
$0.79
|
| Rate for Payer: United Healthcare HMO Rider |
$0.86
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.73
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.79
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1.89
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2.04
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1.89
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2.04
|
| Rate for Payer: Vantage Medical Group Senior |
$1.89
|
| Rate for Payer: Vantage Medical Group Senior |
$2.04
|
|
|
PROMETHAZINE 25 MG RECTAL SUPPOSITORY [11144]
|
Facility
|
IP
|
$11.70
|
|
|
Service Code
|
NDC 45802-759-30
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$2.34 |
| Max. Negotiated Rate |
$10.53 |
| Rate for Payer: Adventist Health Commercial |
$2.34
|
| Rate for Payer: Blue Shield of California Commercial |
$9.04
|
| Rate for Payer: Blue Shield of California EPN |
$5.90
|
| Rate for Payer: Cash Price |
$6.43
|
| Rate for Payer: Central Health Plan Commercial |
$9.36
|
| Rate for Payer: Cigna of CA HMO |
$8.19
|
| Rate for Payer: Cigna of CA PPO |
$8.19
|
| Rate for Payer: EPIC Health Plan Commercial |
$4.68
|
| Rate for Payer: EPIC Health Plan Senior |
$4.68
|
| Rate for Payer: Galaxy Health WC |
$9.95
|
| Rate for Payer: Global Benefits Group Commercial |
$7.02
|
| Rate for Payer: Health Management Network EPO/PPO |
$10.53
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$7.80
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4.46
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$7.24
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.34
|
| Rate for Payer: Multiplan Commercial |
$8.78
|
| Rate for Payer: Networks By Design Commercial |
$7.61
|
| Rate for Payer: Prime Health Services Commercial |
$9.95
|
|
|
PROMETHAZINE 25 MG RECTAL SUPPOSITORY [11144]
|
Facility
|
IP
|
$11.70
|
|
|
Service Code
|
NDC 0713-0526-12
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$2.34 |
| Max. Negotiated Rate |
$10.53 |
| Rate for Payer: Adventist Health Commercial |
$2.34
|
| Rate for Payer: Blue Shield of California Commercial |
$9.04
|
| Rate for Payer: Blue Shield of California EPN |
$5.90
|
| Rate for Payer: Cash Price |
$6.43
|
| Rate for Payer: Central Health Plan Commercial |
$9.36
|
| Rate for Payer: Cigna of CA HMO |
$8.19
|
| Rate for Payer: Cigna of CA PPO |
$8.19
|
| Rate for Payer: EPIC Health Plan Commercial |
$4.68
|
| Rate for Payer: EPIC Health Plan Senior |
$4.68
|
| Rate for Payer: Galaxy Health WC |
$9.95
|
| Rate for Payer: Global Benefits Group Commercial |
$7.02
|
| Rate for Payer: Health Management Network EPO/PPO |
$10.53
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$7.80
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4.46
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$7.24
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.34
|
| Rate for Payer: Multiplan Commercial |
$8.78
|
| Rate for Payer: Networks By Design Commercial |
$7.61
|
| Rate for Payer: Prime Health Services Commercial |
$9.95
|
|
|
PROMETHAZINE 25 MG RECTAL SUPPOSITORY [11144]
|
Facility
|
OP
|
$11.70
|
|
|
Service Code
|
NDC 0713-0526-12
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$2.34 |
| Max. Negotiated Rate |
$10.53 |
| Rate for Payer: Adventist Health Commercial |
$2.34
|
| Rate for Payer: Aetna of CA HMO/PPO |
$7.11
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$9.95
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$6.43
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$8.78
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$5.67
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$6.87
|
| Rate for Payer: Blue Shield of California Commercial |
$7.15
|
| Rate for Payer: Blue Shield of California EPN |
$4.67
|
| Rate for Payer: Cash Price |
$6.43
|
| Rate for Payer: Central Health Plan Commercial |
$9.36
|
| Rate for Payer: Cigna of CA HMO |
$8.19
|
| Rate for Payer: Cigna of CA PPO |
$8.19
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$9.95
|
| Rate for Payer: Dignity Health Medi-Cal |
$9.95
|
| Rate for Payer: Dignity Health Medicare Advantage |
$9.95
|
| Rate for Payer: EPIC Health Plan Commercial |
$4.68
|
| Rate for Payer: EPIC Health Plan Senior |
$4.68
|
| Rate for Payer: Galaxy Health WC |
$9.95
|
| Rate for Payer: Global Benefits Group Commercial |
$7.02
|
| Rate for Payer: Health Management Network EPO/PPO |
$10.53
|
| Rate for Payer: InnovAge PACE Commercial |
$5.85
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$7.80
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4.46
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$7.24
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.34
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$8.19
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$8.19
|
| Rate for Payer: Multiplan Commercial |
$8.78
|
| Rate for Payer: Networks By Design Commercial |
$7.61
|
| Rate for Payer: Prime Health Services Commercial |
$9.95
|
| Rate for Payer: Riverside University Health System MISP |
$4.68
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$7.02
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$7.02
|
| Rate for Payer: United Healthcare All Other Commercial |
$5.85
|
| Rate for Payer: United Healthcare All Other HMO |
$5.85
|
| Rate for Payer: United Healthcare HMO Rider |
$5.85
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$5.85
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$9.95
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$9.95
|
| Rate for Payer: Vantage Medical Group Senior |
$9.95
|
|
|
PROMETHAZINE 25 MG RECTAL SUPPOSITORY [11144]
|
Facility
|
OP
|
$11.70
|
|
|
Service Code
|
NDC 51672-5297-1
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$2.34 |
| Max. Negotiated Rate |
$10.53 |
| Rate for Payer: Adventist Health Commercial |
$2.34
|
| Rate for Payer: Aetna of CA HMO/PPO |
$7.11
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$9.95
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$6.43
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$8.78
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$5.67
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$6.87
|
| Rate for Payer: Blue Shield of California Commercial |
$7.15
|
| Rate for Payer: Blue Shield of California EPN |
$4.67
|
| Rate for Payer: Cash Price |
$6.43
|
| Rate for Payer: Central Health Plan Commercial |
$9.36
|
| Rate for Payer: Cigna of CA HMO |
$8.19
|
| Rate for Payer: Cigna of CA PPO |
$8.19
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$9.95
|
| Rate for Payer: Dignity Health Medi-Cal |
$9.95
|
| Rate for Payer: Dignity Health Medicare Advantage |
$9.95
|
| Rate for Payer: EPIC Health Plan Commercial |
$4.68
|
| Rate for Payer: EPIC Health Plan Senior |
$4.68
|
| Rate for Payer: Galaxy Health WC |
$9.95
|
| Rate for Payer: Global Benefits Group Commercial |
$7.02
|
| Rate for Payer: Health Management Network EPO/PPO |
$10.53
|
| Rate for Payer: InnovAge PACE Commercial |
$5.85
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$7.80
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4.46
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$7.24
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.34
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$8.19
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$8.19
|
| Rate for Payer: Multiplan Commercial |
$8.78
|
| Rate for Payer: Networks By Design Commercial |
$7.61
|
| Rate for Payer: Prime Health Services Commercial |
$9.95
|
| Rate for Payer: Riverside University Health System MISP |
$4.68
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$7.02
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$7.02
|
| Rate for Payer: United Healthcare All Other Commercial |
$5.85
|
| Rate for Payer: United Healthcare All Other HMO |
$5.85
|
| Rate for Payer: United Healthcare HMO Rider |
$5.85
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$5.85
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$9.95
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$9.95
|
| Rate for Payer: Vantage Medical Group Senior |
$9.95
|
|
|
PROMETHAZINE 25 MG RECTAL SUPPOSITORY [11144]
|
Facility
|
OP
|
$11.70
|
|
|
Service Code
|
NDC 45802-759-30
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$2.34 |
| Max. Negotiated Rate |
$10.53 |
| Rate for Payer: Adventist Health Commercial |
$2.34
|
| Rate for Payer: Aetna of CA HMO/PPO |
$7.11
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$9.95
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$6.43
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$8.78
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$5.67
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$6.87
|
| Rate for Payer: Blue Shield of California Commercial |
$7.15
|
| Rate for Payer: Blue Shield of California EPN |
$4.67
|
| Rate for Payer: Cash Price |
$6.43
|
| Rate for Payer: Central Health Plan Commercial |
$9.36
|
| Rate for Payer: Cigna of CA HMO |
$8.19
|
| Rate for Payer: Cigna of CA PPO |
$8.19
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$9.95
|
| Rate for Payer: Dignity Health Medi-Cal |
$9.95
|
| Rate for Payer: Dignity Health Medicare Advantage |
$9.95
|
| Rate for Payer: EPIC Health Plan Commercial |
$4.68
|
| Rate for Payer: EPIC Health Plan Senior |
$4.68
|
| Rate for Payer: Galaxy Health WC |
$9.95
|
| Rate for Payer: Global Benefits Group Commercial |
$7.02
|
| Rate for Payer: Health Management Network EPO/PPO |
$10.53
|
| Rate for Payer: InnovAge PACE Commercial |
$5.85
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$7.80
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4.46
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$7.24
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.34
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$8.19
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$8.19
|
| Rate for Payer: Multiplan Commercial |
$8.78
|
| Rate for Payer: Networks By Design Commercial |
$7.61
|
| Rate for Payer: Prime Health Services Commercial |
$9.95
|
| Rate for Payer: Riverside University Health System MISP |
$4.68
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$7.02
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$7.02
|
| Rate for Payer: United Healthcare All Other Commercial |
$5.85
|
| Rate for Payer: United Healthcare All Other HMO |
$5.85
|
| Rate for Payer: United Healthcare HMO Rider |
$5.85
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$5.85
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$9.95
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$9.95
|
| Rate for Payer: Vantage Medical Group Senior |
$9.95
|
|
