|
PROCAINAMIDE 100 MG/ML INJECTION SOLUTION [6562]
|
Facility
OP
|
$10.52
|
|
|
Service Code
|
CPT J2690
|
| Hospital Charge Code |
1720209
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$2.10 |
| Max. Negotiated Rate |
$906.73 |
| Rate for Payer: Adventist Health Medi-Cal |
$146.32
|
| Rate for Payer: Adventist Health Medi-Cal |
$146.32
|
| Rate for Payer: Aetna of CA HMO/PPO |
$906.73
|
| Rate for Payer: Aetna of CA HMO/PPO |
$906.73
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$182.90
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$182.90
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$160.95
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$160.95
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$160.95
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$160.95
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$60.80
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$60.80
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$66.57
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$66.57
|
| Rate for Payer: BCBS Transplant Transplant |
$6.31
|
| Rate for Payer: BCBS Transplant Transplant |
$43.20
|
| Rate for Payer: Blue Shield of California Commercial |
$157.14
|
| Rate for Payer: Blue Shield of California Commercial |
$157.14
|
| Rate for Payer: Blue Shield of California EPN |
$142.85
|
| Rate for Payer: Blue Shield of California EPN |
$142.85
|
| Rate for Payer: Caremore Medicare Advantage |
$146.32
|
| Rate for Payer: Caremore Medicare Advantage |
$146.32
|
| Rate for Payer: Cash Price |
$32.40
|
| Rate for Payer: Cash Price |
$32.40
|
| Rate for Payer: Cash Price |
$4.73
|
| Rate for Payer: Cash Price |
$4.73
|
| Rate for Payer: Central Health Plan Commercial |
$57.60
|
| Rate for Payer: Central Health Plan Commercial |
$8.42
|
| Rate for Payer: Cigna of CA HMO |
$50.40
|
| Rate for Payer: Cigna of CA HMO |
$7.36
|
| Rate for Payer: Cigna of CA PPO |
$50.40
|
| Rate for Payer: Cigna of CA PPO |
$7.36
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$219.48
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$219.48
|
| Rate for Payer: EPIC Health Plan Commercial |
$197.53
|
| Rate for Payer: EPIC Health Plan Commercial |
$197.53
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$146.32
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$146.32
|
| Rate for Payer: EPIC Health Plan Transplant |
$146.32
|
| Rate for Payer: EPIC Health Plan Transplant |
$146.32
|
| Rate for Payer: Galaxy Health WC |
$61.20
|
| Rate for Payer: Galaxy Health WC |
$8.94
|
| Rate for Payer: Global Benefits Group Commercial |
$43.20
|
| Rate for Payer: Global Benefits Group Commercial |
$6.31
|
| Rate for Payer: Health Management Network EPO/PPO |
$9.47
|
| Rate for Payer: Health Management Network EPO/PPO |
$64.80
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$7.89
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$54.00
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$239.96
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$239.96
|
| Rate for Payer: IEHP medi-cal |
$241.42
|
| Rate for Payer: IEHP medi-cal |
$241.42
|
| Rate for Payer: IEHP Medicare Advantage |
$146.32
|
| Rate for Payer: IEHP Medicare Advantage |
$146.32
|
| Rate for Payer: Innovage PACE Commercial |
$219.48
|
| Rate for Payer: Innovage PACE Commercial |
$219.48
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$7.02
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$48.02
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$146.32
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$146.32
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$14.40
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.10
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$196.06
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$196.06
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$196.06
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$196.06
|
| Rate for Payer: Multiplan Commercial |
$7.89
|
| Rate for Payer: Multiplan Commercial |
$54.00
|
| Rate for Payer: Networks By Design Commercial |
$36.00
|
| Rate for Payer: Networks By Design Commercial |
$5.26
|
| Rate for Payer: Prime Health Services Commercial |
$61.20
|
| Rate for Payer: Prime Health Services Commercial |
$8.94
|
| Rate for Payer: Prime Health Services Medicare |
$155.10
|
| Rate for Payer: Prime Health Services Medicare |
$155.10
|
| Rate for Payer: Riverside University Health MISP |
$160.95
|
| Rate for Payer: Riverside University Health MISP |
$160.95
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$43.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$6.31
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$43.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$6.31
|
| Rate for Payer: United Healthcare All Other Commercial |
$36.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$5.26
|
| Rate for Payer: United Healthcare All Other HMO |
$36.00
|
| Rate for Payer: United Healthcare All Other HMO |
$5.26
|
| Rate for Payer: United Healthcare HMO Rider |
$36.00
|
| Rate for Payer: United Healthcare HMO Rider |
$5.26
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$36.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$5.26
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$219.48
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$219.48
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$160.95
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$160.95
|
| Rate for Payer: Vantage Medical Group Senior |
$146.32
|
| Rate for Payer: Vantage Medical Group Senior |
$146.32
|
|
|
PROCAINAMIDE 100 MG/ML INJECTION SOLUTION [6562]
|
Facility
IP
|
$72.00
|
|
|
Service Code
|
CPT J2690
|
| Hospital Charge Code |
1720209
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$14.40 |
| Max. Negotiated Rate |
$34,005.88 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$34,005.88
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$34,005.88
|
| Rate for Payer: Blue Shield of California Commercial |
$7.89
|
| Rate for Payer: Blue Shield of California Commercial |
$54.00
|
| Rate for Payer: Blue Shield of California EPN |
$5.62
|
| Rate for Payer: Blue Shield of California EPN |
$38.45
|
| Rate for Payer: Cash Price |
$4.73
|
| Rate for Payer: Cash Price |
$32.40
|
| Rate for Payer: Cash Price |
$4.73
|
| Rate for Payer: Cash Price |
$32.40
|
| Rate for Payer: Central Health Plan Commercial |
$8.42
|
| Rate for Payer: Central Health Plan Commercial |
$57.60
|
| Rate for Payer: Cigna of CA HMO |
$50.40
|
| Rate for Payer: Cigna of CA HMO |
$7.36
|
| Rate for Payer: Cigna of CA PPO |
$7.36
|
| Rate for Payer: Cigna of CA PPO |
$50.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$4.21
|
| Rate for Payer: EPIC Health Plan Commercial |
$28.80
|
| Rate for Payer: EPIC Health Plan Transplant |
$28.80
|
| Rate for Payer: EPIC Health Plan Transplant |
$4.21
|
| Rate for Payer: Galaxy Health WC |
$8.94
|
| Rate for Payer: Galaxy Health WC |
$61.20
|
| Rate for Payer: Global Benefits Group Commercial |
$6.31
|
| Rate for Payer: Global Benefits Group Commercial |
$43.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$64.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$9.47
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$48.02
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$7.02
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$14.40
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.10
|
| Rate for Payer: Multiplan Commercial |
$54.00
|
| Rate for Payer: Multiplan Commercial |
$7.89
|
| Rate for Payer: Networks By Design Commercial |
$5.26
|
| Rate for Payer: Networks By Design Commercial |
$36.00
|
| Rate for Payer: Prime Health Services Commercial |
$8.94
|
| Rate for Payer: Prime Health Services Commercial |
$61.20
|
|
|
PROCAINAMIDE 500 MG/ML INJECTION SOLUTION [6563]
|
Facility
IP
|
$43.66
|
|
|
Service Code
|
CPT J2690
|
| Hospital Charge Code |
1720217
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$8.73 |
| Max. Negotiated Rate |
$34,005.88 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$34,005.88
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$34,005.88
|
| Rate for Payer: Blue Shield of California Commercial |
$270.00
|
| Rate for Payer: Blue Shield of California Commercial |
$32.74
|
| Rate for Payer: Blue Shield of California EPN |
$23.31
|
| Rate for Payer: Blue Shield of California EPN |
$192.24
|
| Rate for Payer: Cash Price |
$162.00
|
| Rate for Payer: Cash Price |
$19.65
|
| Rate for Payer: Cash Price |
$19.65
|
| Rate for Payer: Cash Price |
$162.00
|
| Rate for Payer: Central Health Plan Commercial |
$34.93
|
| Rate for Payer: Central Health Plan Commercial |
$288.00
|
| Rate for Payer: Cigna of CA HMO |
$252.00
|
| Rate for Payer: Cigna of CA HMO |
$30.56
|
| Rate for Payer: Cigna of CA PPO |
$30.56
|
| Rate for Payer: Cigna of CA PPO |
$252.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$17.46
|
| Rate for Payer: EPIC Health Plan Commercial |
$144.00
|
| Rate for Payer: EPIC Health Plan Transplant |
$17.46
|
| Rate for Payer: EPIC Health Plan Transplant |
$144.00
|
| Rate for Payer: Galaxy Health WC |
$306.00
|
| Rate for Payer: Galaxy Health WC |
$37.11
|
| Rate for Payer: Global Benefits Group Commercial |
$26.20
|
| Rate for Payer: Global Benefits Group Commercial |
$216.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$324.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$39.29
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$29.12
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$240.12
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$8.73
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$72.00
|
| Rate for Payer: Multiplan Commercial |
$270.00
|
| Rate for Payer: Multiplan Commercial |
$32.74
|
| Rate for Payer: Networks By Design Commercial |
$180.00
|
| Rate for Payer: Networks By Design Commercial |
$21.83
|
| Rate for Payer: Prime Health Services Commercial |
$37.11
|
| Rate for Payer: Prime Health Services Commercial |
$306.00
|
|
|
PROCAINAMIDE 500 MG/ML INJECTION SOLUTION [6563]
|
Facility
OP
|
$360.00
|
|
|
Service Code
|
CPT J2690
|
| Hospital Charge Code |
1720217
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$60.80 |
| Max. Negotiated Rate |
$906.73 |
| Rate for Payer: Adventist Health Medi-Cal |
$146.32
|
| Rate for Payer: Adventist Health Medi-Cal |
$146.32
|
| Rate for Payer: Aetna of CA HMO/PPO |
$906.73
|
| Rate for Payer: Aetna of CA HMO/PPO |
$906.73
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$182.90
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$182.90
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$160.95
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$160.95
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$160.95
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$160.95
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$60.80
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$60.80
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$66.57
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$66.57
|
| Rate for Payer: BCBS Transplant Transplant |
$216.00
|
| Rate for Payer: BCBS Transplant Transplant |
$26.20
|
| Rate for Payer: Blue Shield of California Commercial |
$157.14
|
| Rate for Payer: Blue Shield of California Commercial |
$157.14
|
| Rate for Payer: Blue Shield of California EPN |
$142.85
|
| Rate for Payer: Blue Shield of California EPN |
$142.85
|
| Rate for Payer: Caremore Medicare Advantage |
$146.32
|
| Rate for Payer: Caremore Medicare Advantage |
$146.32
|
| Rate for Payer: Cash Price |
$19.65
|
| Rate for Payer: Cash Price |
$19.65
|
| Rate for Payer: Cash Price |
$162.00
|
| Rate for Payer: Cash Price |
$162.00
|
| Rate for Payer: Central Health Plan Commercial |
$34.93
|
| Rate for Payer: Central Health Plan Commercial |
$288.00
|
| Rate for Payer: Cigna of CA HMO |
$30.56
|
| Rate for Payer: Cigna of CA HMO |
$252.00
|
| Rate for Payer: Cigna of CA PPO |
$252.00
|
| Rate for Payer: Cigna of CA PPO |
$30.56
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$219.48
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$219.48
|
| Rate for Payer: EPIC Health Plan Commercial |
$197.53
|
| Rate for Payer: EPIC Health Plan Commercial |
$197.53
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$146.32
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$146.32
|
| Rate for Payer: EPIC Health Plan Transplant |
$146.32
|
| Rate for Payer: EPIC Health Plan Transplant |
$146.32
|
| Rate for Payer: Galaxy Health WC |
$306.00
|
| Rate for Payer: Galaxy Health WC |
$37.11
|
| Rate for Payer: Global Benefits Group Commercial |
$26.20
|
| Rate for Payer: Global Benefits Group Commercial |
$216.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$324.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$39.29
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$32.74
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$270.00
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$239.96
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$239.96
|
| Rate for Payer: IEHP medi-cal |
$241.42
|
| Rate for Payer: IEHP medi-cal |
$241.42
|
| Rate for Payer: IEHP Medicare Advantage |
$146.32
|
| Rate for Payer: IEHP Medicare Advantage |
$146.32
|
| Rate for Payer: Innovage PACE Commercial |
$219.48
|
| Rate for Payer: Innovage PACE Commercial |
$219.48
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$29.12
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$240.12
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$146.32
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$146.32
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$72.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$8.73
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$196.06
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$196.06
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$196.06
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$196.06
|
| Rate for Payer: Multiplan Commercial |
$270.00
|
| Rate for Payer: Multiplan Commercial |
$32.74
|
| Rate for Payer: Networks By Design Commercial |
$21.83
|
| Rate for Payer: Networks By Design Commercial |
$180.00
|
| Rate for Payer: Prime Health Services Commercial |
$37.11
|
| Rate for Payer: Prime Health Services Commercial |
$306.00
|
| Rate for Payer: Prime Health Services Medicare |
$155.10
|
| Rate for Payer: Prime Health Services Medicare |
$155.10
|
| Rate for Payer: Riverside University Health MISP |
$160.95
|
| Rate for Payer: Riverside University Health MISP |
$160.95
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$216.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$26.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$26.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$216.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$180.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$21.83
|
| Rate for Payer: United Healthcare All Other HMO |
$21.83
|
| Rate for Payer: United Healthcare All Other HMO |
$180.00
|
| Rate for Payer: United Healthcare HMO Rider |
$21.83
|
| Rate for Payer: United Healthcare HMO Rider |
$180.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$21.83
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$180.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$219.48
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$219.48
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$160.95
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$160.95
|
| Rate for Payer: Vantage Medical Group Senior |
$146.32
|
| Rate for Payer: Vantage Medical Group Senior |
$146.32
|
|
|
PROCAINAMIDE ORAL SOLUTION (IV FORM) 50 MG/ML [4080440]
|
Facility
OP
|
$1.29
|
|
|
Service Code
|
NDC 9994-0804-40
|
| Hospital Charge Code |
1715897
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.26 |
| Max. Negotiated Rate |
$1.16 |
| Rate for Payer: Aetna of CA HMO/PPO |
$0.78
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$1.10
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$0.71
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$0.71
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$0.62
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.76
|
| Rate for Payer: BCBS Transplant Transplant |
$0.77
|
| Rate for Payer: Blue Shield of California Commercial |
$0.81
|
| Rate for Payer: Blue Shield of California EPN |
$0.63
|
| Rate for Payer: Cash Price |
$0.58
|
| Rate for Payer: Central Health Plan Commercial |
$1.03
|
| Rate for Payer: Cigna of CA HMO |
$0.90
|
| Rate for Payer: Cigna of CA PPO |
$0.90
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.52
|
| Rate for Payer: EPIC Health Plan Transplant |
$0.52
|
| Rate for Payer: Galaxy Health WC |
$1.10
|
| Rate for Payer: Global Benefits Group Commercial |
$0.77
|
| Rate for Payer: Health Management Network EPO/PPO |
$1.16
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$0.97
|
| Rate for Payer: IEHP medi-cal |
$0.45
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.86
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.26
|
| Rate for Payer: Multiplan Commercial |
$0.97
|
| Rate for Payer: Networks By Design Commercial |
$0.84
|
| Rate for Payer: Prime Health Services Commercial |
$1.10
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$0.77
|
| Rate for Payer: Riverside University Health MISP |
$0.52
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.77
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.77
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.65
|
| Rate for Payer: United Healthcare All Other HMO |
$0.65
|
| Rate for Payer: United Healthcare HMO Rider |
$0.65
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.65
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1.10
|
| Rate for Payer: Vantage Medical Group Senior |
$1.10
|
|
|
PROCAINAMIDE ORAL SOLUTION (IV FORM) 50 MG/ML [4080440]
|
Facility
IP
|
$1.29
|
|
|
Service Code
|
NDC 9994-0804-40
|
| Hospital Charge Code |
1715897
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.26 |
| Max. Negotiated Rate |
$34,005.88 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$34,005.88
|
| Rate for Payer: Blue Shield of California Commercial |
$0.97
|
| Rate for Payer: Blue Shield of California EPN |
$0.69
|
| Rate for Payer: Cash Price |
$0.58
|
| Rate for Payer: Cash Price |
$0.58
|
| Rate for Payer: Central Health Plan Commercial |
$1.03
|
| Rate for Payer: Cigna of CA HMO |
$0.90
|
| Rate for Payer: Cigna of CA PPO |
$0.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.52
|
| Rate for Payer: Galaxy Health WC |
$1.10
|
| Rate for Payer: Global Benefits Group Commercial |
$0.77
|
| Rate for Payer: Health Management Network EPO/PPO |
$1.16
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.86
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.26
|
| Rate for Payer: Multiplan Commercial |
$0.97
|
| Rate for Payer: Networks By Design Commercial |
$0.84
|
| Rate for Payer: Prime Health Services Commercial |
$1.10
|
|
|
PROCARBAZINE ORAL SUSPENSION COMPOUND 10 MG/ML [4080323]
|
Facility
IP
|
$12.07
|
|
|
Service Code
|
NDC 9994-0803-23
|
| Hospital Charge Code |
1715155
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$2.41 |
| Max. Negotiated Rate |
$34,005.88 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$34,005.88
|
| Rate for Payer: Blue Shield of California Commercial |
$9.05
|
| Rate for Payer: Blue Shield of California EPN |
$6.45
|
| Rate for Payer: Cash Price |
$5.43
|
| Rate for Payer: Cash Price |
$5.43
|
| Rate for Payer: Central Health Plan Commercial |
$9.66
|
| Rate for Payer: Cigna of CA HMO |
$8.45
|
| Rate for Payer: Cigna of CA PPO |
$8.45
|
| Rate for Payer: EPIC Health Plan Commercial |
$4.83
|
| Rate for Payer: Galaxy Health WC |
$10.26
|
| Rate for Payer: Global Benefits Group Commercial |
$7.24
|
| Rate for Payer: Health Management Network EPO/PPO |
$10.86
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$8.05
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.41
|
| Rate for Payer: Multiplan Commercial |
$9.05
|
| Rate for Payer: Networks By Design Commercial |
$7.85
|
| Rate for Payer: Prime Health Services Commercial |
$10.26
|
|
|
PROCARBAZINE ORAL SUSPENSION COMPOUND 10 MG/ML [4080323]
|
Facility
OP
|
$12.07
|
|
|
Service Code
|
NDC 9994-0803-23
|
| Hospital Charge Code |
1715155
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$2.41 |
| Max. Negotiated Rate |
$10.86 |
| Rate for Payer: Aetna of CA HMO/PPO |
$7.33
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$10.26
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$6.64
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$6.64
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$5.84
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$7.13
|
| Rate for Payer: BCBS Transplant Transplant |
$7.24
|
| Rate for Payer: Blue Shield of California Commercial |
$7.59
|
| Rate for Payer: Blue Shield of California EPN |
$5.90
|
| Rate for Payer: Cash Price |
$5.43
|
| Rate for Payer: Central Health Plan Commercial |
$9.66
|
| Rate for Payer: Cigna of CA HMO |
$8.45
|
| Rate for Payer: Cigna of CA PPO |
$8.45
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$10.26
|
| Rate for Payer: EPIC Health Plan Commercial |
$4.83
|
| Rate for Payer: EPIC Health Plan Transplant |
$4.83
|
| Rate for Payer: Galaxy Health WC |
$10.26
|
| Rate for Payer: Global Benefits Group Commercial |
$7.24
|
| Rate for Payer: Health Management Network EPO/PPO |
$10.86
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$9.05
|
| Rate for Payer: IEHP medi-cal |
$4.22
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$8.05
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.41
|
| Rate for Payer: Multiplan Commercial |
$9.05
|
| Rate for Payer: Networks By Design Commercial |
$7.85
|
| Rate for Payer: Prime Health Services Commercial |
$10.26
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$7.24
|
| Rate for Payer: Riverside University Health MISP |
$4.83
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$7.24
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$7.24
|
| Rate for Payer: United Healthcare All Other Commercial |
$6.04
|
| Rate for Payer: United Healthcare All Other HMO |
$6.04
|
| Rate for Payer: United Healthcare HMO Rider |
$6.04
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$6.04
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$10.26
|
| Rate for Payer: Vantage Medical Group Senior |
$10.26
|
|
|
PROCEDURES FOR OBESITY
|
Facility
IP
|
$34,005.88
|
|
|
Service Code
|
APR-DRG 4032
|
| Min. Negotiated Rate |
$13,067.98 |
| Max. Negotiated Rate |
$34,005.88 |
| Rate for Payer: Adventist Health Medi-Cal |
$13,067.98
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$34,005.88
|
| Rate for Payer: IEHP medi-cal |
$15,572.67
|
|
|
PROCEDURES FOR OBESITY
|
Facility
IP
|
$34,005.88
|
|
|
Service Code
|
APR-DRG 4031
|
| Min. Negotiated Rate |
$11,255.69 |
| Max. Negotiated Rate |
$34,005.88 |
| Rate for Payer: Adventist Health Medi-Cal |
$11,255.69
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$34,005.88
|
| Rate for Payer: IEHP medi-cal |
$13,413.03
|
|
|
PROCEDURES FOR OBESITY
|
Facility
IP
|
$45,375.23
|
|
|
Service Code
|
APR-DRG 4034
|
| Min. Negotiated Rate |
$34,005.88 |
| Max. Negotiated Rate |
$45,375.23 |
| Rate for Payer: Adventist Health Medi-Cal |
$38,077.12
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$34,005.88
|
| Rate for Payer: IEHP medi-cal |
$45,375.23
|
|
|
PROCEDURES FOR OBESITY
|
Facility
IP
|
$34,005.88
|
|
|
Service Code
|
APR-DRG 4033
|
| Min. Negotiated Rate |
$18,642.61 |
| Max. Negotiated Rate |
$34,005.88 |
| Rate for Payer: Adventist Health Medi-Cal |
$18,642.61
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$34,005.88
|
| Rate for Payer: IEHP medi-cal |
$22,215.78
|
|
|
PROCEDURE WITH DIAGNOSIS OF REHABILITATION, AFTERCARE OR OTHER CONTACT WITH HEALTH SERVICES
|
Facility
IP
|
$70,069.67
|
|
|
Service Code
|
APR-DRG 8504
|
| Min. Negotiated Rate |
$34,005.88 |
| Max. Negotiated Rate |
$70,069.67 |
| Rate for Payer: Adventist Health Medi-Cal |
$58,799.72
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$34,005.88
|
| Rate for Payer: IEHP medi-cal |
$70,069.67
|
|
|
PROCEDURE WITH DIAGNOSIS OF REHABILITATION, AFTERCARE OR OTHER CONTACT WITH HEALTH SERVICES
|
Facility
IP
|
$34,005.88
|
|
|
Service Code
|
APR-DRG 8501
|
| Min. Negotiated Rate |
$16,646.63 |
| Max. Negotiated Rate |
$34,005.88 |
| Rate for Payer: Adventist Health Medi-Cal |
$16,646.63
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$34,005.88
|
| Rate for Payer: IEHP medi-cal |
$19,837.23
|
|
|
PROCEDURE WITH DIAGNOSIS OF REHABILITATION, AFTERCARE OR OTHER CONTACT WITH HEALTH SERVICES
|
Facility
IP
|
$34,005.88
|
|
|
Service Code
|
APR-DRG 8503
|
| Min. Negotiated Rate |
$27,676.06 |
| Max. Negotiated Rate |
$34,005.88 |
| Rate for Payer: Adventist Health Medi-Cal |
$27,676.06
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$34,005.88
|
| Rate for Payer: IEHP medi-cal |
$32,980.63
|
|
|
PROCEDURE WITH DIAGNOSIS OF REHABILITATION, AFTERCARE OR OTHER CONTACT WITH HEALTH SERVICES
|
Facility
IP
|
$34,005.88
|
|
|
Service Code
|
APR-DRG 8502
|
| Min. Negotiated Rate |
$22,576.33 |
| Max. Negotiated Rate |
$34,005.88 |
| Rate for Payer: Adventist Health Medi-Cal |
$22,576.33
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$34,005.88
|
| Rate for Payer: IEHP medi-cal |
$26,903.46
|
|
|
PROCHLORPERAZINE 25 MG RECTAL SUPPOSITORY [11138]
|
Facility
OP
|
$10.46
|
|
|
Service Code
|
NDC 0713-0135-06
|
| Hospital Charge Code |
1748022
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$2.09 |
| Max. Negotiated Rate |
$9.41 |
| Rate for Payer: Aetna of CA HMO/PPO |
$6.35
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$8.89
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$5.75
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$5.75
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$5.06
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$6.18
|
| Rate for Payer: BCBS Transplant Transplant |
$6.28
|
| Rate for Payer: Blue Shield of California Commercial |
$6.58
|
| Rate for Payer: Blue Shield of California EPN |
$5.11
|
| Rate for Payer: Cash Price |
$4.71
|
| Rate for Payer: Central Health Plan Commercial |
$8.37
|
| Rate for Payer: Cigna of CA HMO |
$7.32
|
| Rate for Payer: Cigna of CA PPO |
$7.32
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$8.89
|
| Rate for Payer: EPIC Health Plan Commercial |
$4.18
|
| Rate for Payer: EPIC Health Plan Transplant |
$4.18
|
| Rate for Payer: Galaxy Health WC |
$8.89
|
| Rate for Payer: Global Benefits Group Commercial |
$6.28
|
| Rate for Payer: Health Management Network EPO/PPO |
$9.41
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$7.84
|
| Rate for Payer: IEHP medi-cal |
$3.66
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$6.98
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.09
|
| Rate for Payer: Multiplan Commercial |
$7.84
|
| Rate for Payer: Networks By Design Commercial |
$6.80
|
| Rate for Payer: Prime Health Services Commercial |
$8.89
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$6.28
|
| Rate for Payer: Riverside University Health MISP |
$4.18
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$6.28
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$6.28
|
| Rate for Payer: United Healthcare All Other Commercial |
$5.23
|
| Rate for Payer: United Healthcare All Other HMO |
$5.23
|
| Rate for Payer: United Healthcare HMO Rider |
$5.23
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$5.23
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$8.89
|
| Rate for Payer: Vantage Medical Group Senior |
$8.89
|
|
|
PROCHLORPERAZINE 25 MG RECTAL SUPPOSITORY [11138]
|
Facility
OP
|
$10.46
|
|
|
Service Code
|
NDC 0574-7226-12
|
| Hospital Charge Code |
1748022
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$2.09 |
| Max. Negotiated Rate |
$9.41 |
| Rate for Payer: Aetna of CA HMO/PPO |
$6.35
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$8.89
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$5.75
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$5.75
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$5.06
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$6.18
|
| Rate for Payer: BCBS Transplant Transplant |
$6.28
|
| Rate for Payer: Blue Shield of California Commercial |
$6.58
|
| Rate for Payer: Blue Shield of California EPN |
$5.11
|
| Rate for Payer: Cash Price |
$4.71
|
| Rate for Payer: Central Health Plan Commercial |
$8.37
|
| Rate for Payer: Cigna of CA HMO |
$7.32
|
| Rate for Payer: Cigna of CA PPO |
$7.32
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$8.89
|
| Rate for Payer: EPIC Health Plan Commercial |
$4.18
|
| Rate for Payer: EPIC Health Plan Transplant |
$4.18
|
| Rate for Payer: Galaxy Health WC |
$8.89
|
| Rate for Payer: Global Benefits Group Commercial |
$6.28
|
| Rate for Payer: Health Management Network EPO/PPO |
$9.41
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$7.84
|
| Rate for Payer: IEHP medi-cal |
$3.66
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$6.98
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.09
|
| Rate for Payer: Multiplan Commercial |
$7.84
|
| Rate for Payer: Networks By Design Commercial |
$6.80
|
| Rate for Payer: Prime Health Services Commercial |
$8.89
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$6.28
|
| Rate for Payer: Riverside University Health MISP |
$4.18
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$6.28
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$6.28
|
| Rate for Payer: United Healthcare All Other Commercial |
$5.23
|
| Rate for Payer: United Healthcare All Other HMO |
$5.23
|
| Rate for Payer: United Healthcare HMO Rider |
$5.23
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$5.23
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$8.89
|
| Rate for Payer: Vantage Medical Group Senior |
$8.89
|
|
|
PROCHLORPERAZINE 25 MG RECTAL SUPPOSITORY [11138]
|
Facility
IP
|
$10.46
|
|
|
Service Code
|
NDC 0574-7226-12
|
| Hospital Charge Code |
1748022
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$2.09 |
| Max. Negotiated Rate |
$34,005.88 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$34,005.88
|
| Rate for Payer: Blue Shield of California Commercial |
$7.84
|
| Rate for Payer: Blue Shield of California EPN |
$5.59
|
| Rate for Payer: Cash Price |
$4.71
|
| Rate for Payer: Cash Price |
$4.71
|
| Rate for Payer: Central Health Plan Commercial |
$8.37
|
| Rate for Payer: Cigna of CA HMO |
$7.32
|
| Rate for Payer: Cigna of CA PPO |
$7.32
|
| Rate for Payer: EPIC Health Plan Commercial |
$4.18
|
| Rate for Payer: Galaxy Health WC |
$8.89
|
| Rate for Payer: Global Benefits Group Commercial |
$6.28
|
| Rate for Payer: Health Management Network EPO/PPO |
$9.41
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$6.98
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.09
|
| Rate for Payer: Multiplan Commercial |
$7.84
|
| Rate for Payer: Networks By Design Commercial |
$6.80
|
| Rate for Payer: Prime Health Services Commercial |
$8.89
|
|
|
PROCHLORPERAZINE 25 MG RECTAL SUPPOSITORY [11138]
|
Facility
IP
|
$10.46
|
|
|
Service Code
|
NDC 0713-0135-06
|
| Hospital Charge Code |
1748022
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$2.09 |
| Max. Negotiated Rate |
$34,005.88 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$34,005.88
|
| Rate for Payer: Blue Shield of California Commercial |
$7.84
|
| Rate for Payer: Blue Shield of California EPN |
$5.59
|
| Rate for Payer: Cash Price |
$4.71
|
| Rate for Payer: Cash Price |
$4.71
|
| Rate for Payer: Central Health Plan Commercial |
$8.37
|
| Rate for Payer: Cigna of CA HMO |
$7.32
|
| Rate for Payer: Cigna of CA PPO |
$7.32
|
| Rate for Payer: EPIC Health Plan Commercial |
$4.18
|
| Rate for Payer: Galaxy Health WC |
$8.89
|
| Rate for Payer: Global Benefits Group Commercial |
$6.28
|
| Rate for Payer: Health Management Network EPO/PPO |
$9.41
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$6.98
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.09
|
| Rate for Payer: Multiplan Commercial |
$7.84
|
| Rate for Payer: Networks By Design Commercial |
$6.80
|
| Rate for Payer: Prime Health Services Commercial |
$8.89
|
|
|
PROCHLORPERAZINE EDISYLATE 10 MG/2 ML (5 MG/ML) INJECTION SOLUTION [153823]
|
Facility
OP
|
$2.78
|
|
|
Service Code
|
CPT J0780
|
| Hospital Charge Code |
1720454
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.56 |
| Max. Negotiated Rate |
$22.10 |
| Rate for Payer: Aetna of CA HMO/PPO |
$21.23
|
| Rate for Payer: Aetna of CA HMO/PPO |
$21.23
|
| Rate for Payer: Aetna of CA HMO/PPO |
$21.23
|
| Rate for Payer: Aetna of CA HMO/PPO |
$21.23
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$4.68
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$4.59
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$3.24
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$2.36
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$3.03
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$1.53
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$2.10
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$2.97
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$1.53
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$2.97
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$3.03
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$2.10
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$15.14
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$15.14
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$15.14
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$15.14
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$16.57
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$16.57
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$16.57
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$16.57
|
| Rate for Payer: BCBS Transplant Transplant |
$2.29
|
| Rate for Payer: BCBS Transplant Transplant |
$1.67
|
| Rate for Payer: BCBS Transplant Transplant |
$3.24
|
| Rate for Payer: BCBS Transplant Transplant |
$3.31
|
| Rate for Payer: Blue Shield of California Commercial |
$22.10
|
| Rate for Payer: Blue Shield of California Commercial |
$22.10
|
| Rate for Payer: Blue Shield of California Commercial |
$22.10
|
| Rate for Payer: Blue Shield of California Commercial |
$22.10
|
| Rate for Payer: Blue Shield of California EPN |
$20.09
|
| Rate for Payer: Blue Shield of California EPN |
$20.09
|
| Rate for Payer: Blue Shield of California EPN |
$20.09
|
| Rate for Payer: Blue Shield of California EPN |
$20.09
|
| Rate for Payer: Cash Price |
$2.48
|
| Rate for Payer: Cash Price |
$2.43
|
| Rate for Payer: Cash Price |
$1.71
|
| Rate for Payer: Cash Price |
$1.25
|
| Rate for Payer: Cash Price |
$2.48
|
| Rate for Payer: Cash Price |
$1.71
|
| Rate for Payer: Cash Price |
$2.43
|
| Rate for Payer: Cash Price |
$1.25
|
| Rate for Payer: Central Health Plan Commercial |
$2.22
|
| Rate for Payer: Central Health Plan Commercial |
$4.41
|
| Rate for Payer: Central Health Plan Commercial |
$4.32
|
| Rate for Payer: Central Health Plan Commercial |
$3.05
|
| Rate for Payer: Cigna of CA HMO |
$3.86
|
| Rate for Payer: Cigna of CA HMO |
$3.78
|
| Rate for Payer: Cigna of CA HMO |
$2.67
|
| Rate for Payer: Cigna of CA HMO |
$1.95
|
| Rate for Payer: Cigna of CA PPO |
$3.86
|
| Rate for Payer: Cigna of CA PPO |
$2.67
|
| Rate for Payer: Cigna of CA PPO |
$1.95
|
| Rate for Payer: Cigna of CA PPO |
$3.78
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$4.59
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3.24
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2.36
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$4.68
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.52
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.16
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.11
|
| Rate for Payer: EPIC Health Plan Transplant |
$1.52
|
| Rate for Payer: EPIC Health Plan Transplant |
$1.11
|
| Rate for Payer: EPIC Health Plan Transplant |
$2.20
|
| Rate for Payer: EPIC Health Plan Transplant |
$2.16
|
| Rate for Payer: Galaxy Health WC |
$4.59
|
| Rate for Payer: Galaxy Health WC |
$3.24
|
| Rate for Payer: Galaxy Health WC |
$4.68
|
| Rate for Payer: Galaxy Health WC |
$2.36
|
| Rate for Payer: Global Benefits Group Commercial |
$3.24
|
| Rate for Payer: Global Benefits Group Commercial |
$2.29
|
| Rate for Payer: Global Benefits Group Commercial |
$1.67
|
| Rate for Payer: Global Benefits Group Commercial |
$3.31
|
| Rate for Payer: Health Management Network EPO/PPO |
$3.43
|
| Rate for Payer: Health Management Network EPO/PPO |
$4.96
|
| Rate for Payer: Health Management Network EPO/PPO |
$2.50
|
| Rate for Payer: Health Management Network EPO/PPO |
$4.86
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$2.08
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$4.13
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$4.05
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$2.86
|
| Rate for Payer: IEHP medi-cal |
$3.64
|
| Rate for Payer: IEHP medi-cal |
$3.64
|
| Rate for Payer: IEHP medi-cal |
$3.64
|
| Rate for Payer: IEHP medi-cal |
$3.64
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2.54
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1.85
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3.68
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.08
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.56
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.76
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.10
|
| Rate for Payer: Multiplan Commercial |
$2.08
|
| Rate for Payer: Multiplan Commercial |
$4.13
|
| Rate for Payer: Multiplan Commercial |
$4.05
|
| Rate for Payer: Multiplan Commercial |
$2.86
|
| Rate for Payer: Networks By Design Commercial |
$1.39
|
| Rate for Payer: Networks By Design Commercial |
$1.90
|
| Rate for Payer: Networks By Design Commercial |
$2.70
|
| Rate for Payer: Networks By Design Commercial |
$2.76
|
| Rate for Payer: Prime Health Services Commercial |
$3.24
|
| Rate for Payer: Prime Health Services Commercial |
$4.59
|
| Rate for Payer: Prime Health Services Commercial |
$2.36
|
| Rate for Payer: Prime Health Services Commercial |
$4.68
|
| Rate for Payer: Riverside University Health MISP |
$1.52
|
| Rate for Payer: Riverside University Health MISP |
$1.11
|
| Rate for Payer: Riverside University Health MISP |
$2.20
|
| Rate for Payer: Riverside University Health MISP |
$2.16
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1.67
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2.29
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3.24
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3.31
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2.29
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1.67
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$3.31
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$3.24
|
| Rate for Payer: United Healthcare All Other Commercial |
$1.39
|
| Rate for Payer: United Healthcare All Other Commercial |
$1.90
|
| Rate for Payer: United Healthcare All Other Commercial |
$2.70
|
| Rate for Payer: United Healthcare All Other Commercial |
$2.76
|
| Rate for Payer: United Healthcare All Other HMO |
$1.39
|
| Rate for Payer: United Healthcare All Other HMO |
$2.70
|
| Rate for Payer: United Healthcare All Other HMO |
$1.90
|
| Rate for Payer: United Healthcare All Other HMO |
$2.76
|
| Rate for Payer: United Healthcare HMO Rider |
$1.90
|
| Rate for Payer: United Healthcare HMO Rider |
$2.76
|
| Rate for Payer: United Healthcare HMO Rider |
$2.70
|
| Rate for Payer: United Healthcare HMO Rider |
$1.39
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1.90
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2.70
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1.39
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2.76
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2.36
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$3.24
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4.68
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4.59
|
| Rate for Payer: Vantage Medical Group Senior |
$3.24
|
| Rate for Payer: Vantage Medical Group Senior |
$4.59
|
| Rate for Payer: Vantage Medical Group Senior |
$4.68
|
| Rate for Payer: Vantage Medical Group Senior |
$2.36
|
|
|
PROCHLORPERAZINE EDISYLATE 10 MG/2 ML (5 MG/ML) INJECTION SOLUTION [153823]
|
Facility
IP
|
$5.51
|
|
|
Service Code
|
CPT J0780
|
| Hospital Charge Code |
1720454
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.10 |
| Max. Negotiated Rate |
$34,005.88 |
| Rate for Payer: EPIC Health Plan Transplant |
$1.52
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$34,005.88
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$34,005.88
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$34,005.88
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$34,005.88
|
| Rate for Payer: Blue Shield of California Commercial |
$4.05
|
| Rate for Payer: Blue Shield of California Commercial |
$4.13
|
| Rate for Payer: Blue Shield of California Commercial |
$2.86
|
| Rate for Payer: Blue Shield of California Commercial |
$2.08
|
| Rate for Payer: Blue Shield of California EPN |
$1.48
|
| Rate for Payer: Blue Shield of California EPN |
$2.88
|
| Rate for Payer: Blue Shield of California EPN |
$2.94
|
| Rate for Payer: Blue Shield of California EPN |
$2.03
|
| Rate for Payer: Cash Price |
$1.71
|
| Rate for Payer: Cash Price |
$1.25
|
| Rate for Payer: Cash Price |
$1.25
|
| Rate for Payer: Cash Price |
$2.48
|
| Rate for Payer: Cash Price |
$2.48
|
| Rate for Payer: Cash Price |
$2.43
|
| Rate for Payer: Cash Price |
$1.71
|
| Rate for Payer: Cash Price |
$2.43
|
| Rate for Payer: Central Health Plan Commercial |
$2.22
|
| Rate for Payer: Central Health Plan Commercial |
$4.41
|
| Rate for Payer: Central Health Plan Commercial |
$4.32
|
| Rate for Payer: Central Health Plan Commercial |
$3.05
|
| Rate for Payer: Cigna of CA HMO |
$3.86
|
| Rate for Payer: Cigna of CA HMO |
$1.95
|
| Rate for Payer: Cigna of CA HMO |
$2.67
|
| Rate for Payer: Cigna of CA HMO |
$3.78
|
| Rate for Payer: Cigna of CA PPO |
$1.95
|
| Rate for Payer: Cigna of CA PPO |
$3.78
|
| Rate for Payer: Cigna of CA PPO |
$2.67
|
| Rate for Payer: Cigna of CA PPO |
$3.86
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.11
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.52
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.16
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.20
|
| Rate for Payer: EPIC Health Plan Transplant |
$1.11
|
| Rate for Payer: EPIC Health Plan Transplant |
$2.20
|
| Rate for Payer: EPIC Health Plan Transplant |
$2.16
|
| Rate for Payer: Galaxy Health WC |
$2.36
|
| Rate for Payer: Galaxy Health WC |
$3.24
|
| Rate for Payer: Galaxy Health WC |
$4.59
|
| Rate for Payer: Galaxy Health WC |
$4.68
|
| Rate for Payer: Global Benefits Group Commercial |
$1.67
|
| Rate for Payer: Global Benefits Group Commercial |
$3.31
|
| Rate for Payer: Global Benefits Group Commercial |
$2.29
|
| Rate for Payer: Global Benefits Group Commercial |
$3.24
|
| Rate for Payer: Health Management Network EPO/PPO |
$4.96
|
| Rate for Payer: Health Management Network EPO/PPO |
$4.86
|
| Rate for Payer: Health Management Network EPO/PPO |
$3.43
|
| Rate for Payer: Health Management Network EPO/PPO |
$2.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3.68
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2.54
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1.85
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.10
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.76
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.08
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.56
|
| Rate for Payer: Multiplan Commercial |
$4.13
|
| Rate for Payer: Multiplan Commercial |
$4.05
|
| Rate for Payer: Multiplan Commercial |
$2.86
|
| Rate for Payer: Multiplan Commercial |
$2.08
|
| Rate for Payer: Networks By Design Commercial |
$2.76
|
| Rate for Payer: Networks By Design Commercial |
$1.39
|
| Rate for Payer: Networks By Design Commercial |
$1.90
|
| Rate for Payer: Networks By Design Commercial |
$2.70
|
| Rate for Payer: Prime Health Services Commercial |
$2.36
|
| Rate for Payer: Prime Health Services Commercial |
$3.24
|
| Rate for Payer: Prime Health Services Commercial |
$4.59
|
| Rate for Payer: Prime Health Services Commercial |
$4.68
|
|
|
PROCHLORPERAZINE EDISYLATE 5 MG/ML INJECTION SOLUTION [6580]
|
Facility
OP
|
$2.79
|
|
|
Service Code
|
CPT J0780
|
| Hospital Charge Code |
NDG6580
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.56 |
| Max. Negotiated Rate |
$22.10 |
| Rate for Payer: Aetna of CA HMO/PPO |
$21.23
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$2.37
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$1.53
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$1.53
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$15.14
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$16.57
|
| Rate for Payer: BCBS Transplant Transplant |
$1.67
|
| Rate for Payer: Blue Shield of California Commercial |
$22.10
|
| Rate for Payer: Blue Shield of California EPN |
$20.09
|
| Rate for Payer: Cash Price |
$1.26
|
| Rate for Payer: Cash Price |
$1.26
|
| Rate for Payer: Central Health Plan Commercial |
$2.23
|
| Rate for Payer: Cigna of CA HMO |
$1.95
|
| Rate for Payer: Cigna of CA PPO |
$1.95
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2.37
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.12
|
| Rate for Payer: EPIC Health Plan Transplant |
$1.12
|
| Rate for Payer: Galaxy Health WC |
$2.37
|
| Rate for Payer: Global Benefits Group Commercial |
$1.67
|
| Rate for Payer: Health Management Network EPO/PPO |
$2.51
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$2.09
|
| Rate for Payer: IEHP medi-cal |
$3.64
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1.86
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.56
|
| Rate for Payer: Multiplan Commercial |
$2.09
|
| Rate for Payer: Networks By Design Commercial |
$1.40
|
| Rate for Payer: Prime Health Services Commercial |
$2.37
|
| Rate for Payer: Riverside University Health MISP |
$1.12
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1.67
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1.67
|
| Rate for Payer: United Healthcare All Other Commercial |
$1.40
|
| Rate for Payer: United Healthcare All Other HMO |
$1.40
|
| Rate for Payer: United Healthcare HMO Rider |
$1.40
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1.40
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2.37
|
| Rate for Payer: Vantage Medical Group Senior |
$2.37
|
|
|
PROCHLORPERAZINE EDISYLATE 5 MG/ML INJECTION SOLUTION [6580]
|
Facility
IP
|
$2.79
|
|
|
Service Code
|
CPT J0780
|
| Hospital Charge Code |
NDG6580
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.56 |
| Max. Negotiated Rate |
$34,005.88 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$34,005.88
|
| Rate for Payer: Blue Shield of California Commercial |
$2.09
|
| Rate for Payer: Blue Shield of California EPN |
$1.49
|
| Rate for Payer: Cash Price |
$1.26
|
| Rate for Payer: Cash Price |
$1.26
|
| Rate for Payer: Central Health Plan Commercial |
$2.23
|
| Rate for Payer: Cigna of CA HMO |
$1.95
|
| Rate for Payer: Cigna of CA PPO |
$1.95
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.12
|
| Rate for Payer: EPIC Health Plan Transplant |
$1.12
|
| Rate for Payer: Galaxy Health WC |
$2.37
|
| Rate for Payer: Global Benefits Group Commercial |
$1.67
|
| Rate for Payer: Health Management Network EPO/PPO |
$2.51
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1.86
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.56
|
| Rate for Payer: Multiplan Commercial |
$2.09
|
| Rate for Payer: Networks By Design Commercial |
$1.40
|
| Rate for Payer: Prime Health Services Commercial |
$2.37
|
|
|
PROCHLORPERAZINE MALEATE 10 MG TABLET [6582]
|
Facility
IP
|
$0.63
|
|
|
Service Code
|
NDC 59746-115-06
|
| Hospital Charge Code |
1710783
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.13 |
| Max. Negotiated Rate |
$34,005.88 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$34,005.88
|
| Rate for Payer: Blue Shield of California Commercial |
$0.47
|
| Rate for Payer: Blue Shield of California EPN |
$0.34
|
| Rate for Payer: Cash Price |
$0.28
|
| Rate for Payer: Cash Price |
$0.28
|
| Rate for Payer: Central Health Plan Commercial |
$0.50
|
| Rate for Payer: Cigna of CA HMO |
$0.44
|
| Rate for Payer: Cigna of CA PPO |
$0.44
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.25
|
| Rate for Payer: Galaxy Health WC |
$0.54
|
| Rate for Payer: Global Benefits Group Commercial |
$0.38
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.57
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.42
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.13
|
| Rate for Payer: Multiplan Commercial |
$0.47
|
| Rate for Payer: Networks By Design Commercial |
$0.41
|
| Rate for Payer: Prime Health Services Commercial |
$0.54
|
|
